A Tale of Lost Agency: How Being a Doctor in the U.S. Compares to Other Countries

The profession of medicine in the United States has, for generations, been regarded with a deep sense of reverence and admiration. This esteemed standing is rooted not only in the critical role that you play in preserving and enhancing human life but also in your enduring commitment to advancing healthcare knowledge and practices.

From the archetype of the "town doctor," who once managed their own small practice and was a pillar of the community, intimately familiar with every family member's history and health, to today's high-achieving specialists operating within sprawling modern hospitals, physicians have consistently been seen as figures deserving respect. Historically, becoming a physician has not only guaranteed financial security but also offered a degree of professional independence that few other careers could match.

This combination of respectability and autonomy has made medicine an aspirational field for many. The ability to make life-altering decisions, often based on years of rigorous training and study, imbues you with a unique authority that commands trust from patients and peers alike. As healthcare evolves with new technologies and methodologies, this longstanding veneration continues to motivate individuals drawn to this noble calling.

However, over the years, these core elements of being a doctor have eroded, and many physicians now find themselves disillusioned. A key phrase from a Vox article encapsulates this shift:

"As society and medicine changed, the doctor’s individual primacy was lost. More and more are now employees, not business owners, and the doctor-patient relationship is fraying."

Read the full Vox article here

The growing corporatization of medicine in the United States has diminished the role of the individual physician, turning many into employees rather than the independent professionals they once were. Let’s dive into how this compares to other countries and why the U.S. medical landscape needs a new paradigm for doctors to reclaim agency and autonomy.

The Rise of the Employed Physician in the U.S.

In the United States, the percentage of doctors who own their own practices has plummeted. According to the American Medical Association, only 26.1% of physicians operated as independent business owners in 2022. Compare this to 1983, when over 75% of physicians were self-employed. This dramatic shift is largely due to the growing dominance of hospital systems, corporate ownership of practices, and third-party payers that dictate how physicians work and get reimbursed.

The consequences of this trend are profound. As the Vox article highlights, being an employed physician often comes with significant constraints on how you can practice medicine. Decisions about patient care may be dictated by administrators or corporate policies rather than your professional judgment. The erosion of the doctor-patient relationship—once the cornerstone of medicine—has led to increasing dissatisfaction and burnout among physicians.

How Other Countries Empower Doctors

While the U. S. model has traditionally emphasized the importance of corporate medicine and the allure of high salaries for healthcare professionals, other countries have taken a markedly different approach. In many places around the world, healthcare systems are designed to empower doctors with a greater sense of agency and autonomy in their practice. These alternative models often focus on patient-centered care and collaborative decision-making, allowing physicians to engage more deeply with their patients without the constraints imposed by profit-driven motives.

For instance, in Scandinavian countries, healthcare structures are often publicly funded and emphasize comprehensive care that prioritizes long-term wellness over immediate financial gain. This framework can liberate doctors from certain administrative burdens and financial pressures, enabling them to focus more intently on their core mission: providing quality care tailored to each individual's needs. Such environments foster a professional culture where medical practitioners can explore innovative treatment methods or spend additional time understanding complex cases without external pressures skewing their priorities or moral compass.

Here are a few more examples to consider:

Canada

In Canada, physicians often operate as private contractors, even when working within the publicly funded healthcare system. They bill provincial health plans directly for their services, giving them more control over how they run their practices. This system combines financial security with professional autonomy, a balance many U.S. physicians find elusive.

Germany

German doctors also benefit from a hybrid model. Many work in small, private practices, even within a universal healthcare framework. Physicians in Germany are not only well-compensated but are also less encumbered by administrative burdens compared to their U.S. counterparts. They spend more time on patient care and less on insurance paperwork.

Australia

In Australia, doctors can choose between working in the public system, private practice, or both. The public system provides a safety net for patients while allowing physicians the freedom to operate private businesses. This flexibility gives Australian doctors more control over their work-life balance and professional decisions.

What’s Driving the Difference?

The U.S. healthcare system’s focus on profits and third-party interference has fundamentally altered the role of the physician. Unlike their counterparts in other countries, American doctors face:

• Administrative Overload: Physicians in the U.S. spend an average of 16 hours per week on paperwork.

• Loss of Autonomy: Corporate employers and insurance companies often dictate treatment plans and protocols.

• Burnout Epidemic: The American Medical Association reports that 63% of physicians experience burnout, much higher than in many other countries.

These challenges are exacerbated by the sheer cost of becoming a doctor in the U.S. Medical school tuition often exceeds $200,000, leaving new physicians burdened with crushing debt that forces them into high-paying jobs rather than entrepreneurial ventures.

Reclaiming Agency: A Path Forward

If you’re a U.S. physician feeling trapped by the system, there is hope. The key lies in reclaiming your autonomy through self-employment and micro-corporations. Imagine running your own practice, free from corporate interference, where you set the terms for how you care for patients. This isn’t just wishful thinking; it’s a viable path that SimpliMD can help you achieve.

Take the First Step: Membership

Consider becoming a member of SimpliMD for the remarkably affordable price of just $99. This investment grants you a full year's access to resources and services valued at an impressive $2,500. By joining, you unlock a wealth of essential business tools and resources designed to support and enhance your professional endeavors. Whether you're looking to streamline operations as an independent doctor or gain insightful industry knowledge, SimpliMD memberships offer unparalleled value that can significantly contribute to your success, making this opportunity as compelling as it is cost-effective.

Learn to Build a Practice Without Walls

Our course, “Creating a Practice Without Walls,” teaches you how to establish a micro-corporation that offers freedom and flexibility. You’ll learn:

• How to navigate the legal and financial aspects of self-employment.

• Strategies for telehealth and other location-independent practice models.

• How to diversify income streams with multiple 1099 and part-time W-2 jobs.

Streamline Your Business Planning

SimpliMD’s Business Plan Bundle includes:

• A customized Business Plan Template tailored for self-employed doctors.

• A Micro-Corporation Budget Template to save you hours of time.

• A SWOT Analysis Template to help optimize your business planning.

A Final Thought

The Vox article’s observation about the loss of the doctor’s individual primacy is a sobering reminder of how far the U.S. medical profession has drifted from its roots. But it’s also a call to action. Physicians don’t have to accept the status quo. By embracing self-employment and micro-corporations, you can regain control over your professional life and rekindle the joy of practicing medicine on your terms.

Take the first step today. Book your personalized SimpliMD micro-business consult for just $99, enroll in our “Creating a Practice Without Walls” course, or start planning your business with our comprehensive Business Plan Suite. Let’s build a future where physicians thrive as both healers and entrepreneurs.