For the past few years, the media has been highlighting what many of us have been seeing-medical students and residents are dropping out of clinical medicine to pursue non-clinical careers. To many, particularly the medical education establishment, this is disturbing. To others, it is exciting. To most with craniorectal inversion syndrome, it is a passing fad that is but a small blip on the screen that can be ignored.

The drivers of the phenomenon are many:

1. Student debt burden and the long education and training requirements
2. A toxic education culture
3. Decreasing attractiveness of practicing clinical medicine
4. Decreasing compensation given the long work hour requirements
5. High burnout rates
6. More and more alternative non-clinical career opportunities that enable doctors to leverage their talents
7. Lack of faculty support and flexibility in medical school education programs for students interested in physician entrepreneurship and non-clinical careers
8. The rise of digital health and sick care startups
9. The demand for physician input early in the all phases of new product development
10. Constantly evolving new jobs in industry
11. The rise of the clinical medical management establishment creating physician administrators

12. Care delivery substitutes, such as nurse practitioners and physician assistants and new business models that are increasingly disintermediating doctors

13. Generational attitudes about work, work-life balance and meaning.

The solutions, I believe, are basically two-fold- 1)re-engineer clinical medicine to make it more attractive to practice, and 2) offer non-clinical career tracks to those who want to add value through the deployment of innovation in ways other than seeing patients face to face for their entire professional career.

Here are the principles that should guide medical education reform. We need MD/MBEs not more MD/MBAs and more entrepreneurial medical schools.

The shift is already happening. Medical schools, unfortunately, have been slow to respond. Technology, the 4th industrial revolution and demographics are driving change. In the end, money, technology and talent go where they are treated best.