Autonomy for Physicians: Reclaiming Control in the Age of Hospital Gatekeeping

In response to my recent blog post, The Gatekeeping of Hospital Legal Teams: Resistance to Physician Independence Through Micro-Corporations, a member for SimpliMD community reached out to me with the following feedback:

Personally, I do not believe in the merit of most of these arguments from the hospital attorneys. 

I my experience, hospitals almost never want to contact with a physician, especially a primary care physician, on 1099 terms directly, unless the physician has their own viable independent practice.  On the other hand, they are usually perfectly comfortable contacting with a locums tenens company, which in turn hires a locums doc on cheap terms.  Under a typical locums contract, the doc typically has no rights whatsoever, and is completely expendable.  The hospitals and locums companies are fine with 1099 status for the doc, as long as the doc is paid poorly and can be tossed out at any time, for any reason.  It is all about underpaying the doc, and keeping the docs expendable and under the control of the hospital.  

For a generalist physician, my belief is that a hospital is never your friend.  Ultimately, the best chance of regaining autonomy is to go "back to the future", with physicians owning and controlling their own practices, in their own private offices, under a direct primary care (or retainer/concierge) model.  The party who owns or leases the office building and who owns the accounts receivable revenue stream is the party that is in control.  Having a micro-corporation sounds great, but no type of corporate entity itself will change that basic reality.  To avoid being controlled by a hospital, physicians have to work in a physical space that is not owned or controlled by the hospital, and their revenues most flow from the patient (or the patient's insurers) to them without any hospital intermediary. 

This reader highlighted a critical issue facing physicians today: hospitals’ resistance to engaging physicians as independent contractors unless it benefits their own bottom line. This reader’s experience mirrors a sentiment I hear repeatedly from physicians across the country: hospitals are not interested in physician autonomy unless it fits within their narrow scope of control.

The question many doctors face is this: How can I maintain my independence while still engaging in meaningful, financially sustainable work with hospitals or other institutions? The answer isn’t one-size-fits-all, but the starting point for nearly every physician begins with reclaiming autonomy by forming a micro-corporation.

Locum Tenens: The Illusion of Independence

It’s true that hospitals often engage with locum tenens agencies instead of directly contracting with physicians. This is a safe space for hospitals that reduces their scrutiny by the federal government who monitors employers to make sure they are not trying to avoid paying FICA taxes by calling an employee a contractor. For more on this, check out my post: Employee or Contractor: Doctors are Long-Term Independent Contractors. By using a locum agency, albeit more expensive physician labor for them, allows the hospital to benefit from 1099 status for the doctor without offering any real autonomy or fair compensation. In essence, both the hospital and the locum agency both profit off the physician’s work, with the doctor left as a disposable resource in the system.

The locum tenens model underscores an ugly reality in today’s healthcare marketplace: hospitals want the benefits of 1099 contracting but without giving physicians the corresponding rights, agency, or fair pay. Under these arrangements, you’re still under the hospital’s thumb—despite the illusion of independence.

Micro-Corporations: The Bridge to True Autonomy

Many physicians I coach at SimpliMD start where my reader is today: frustrated, disillusioned, and searching for an alternative. The idea of a micro-corporation—an entity you own that contracts out your professional services—is an essential bridge toward reclaiming control of your career. Hospitals love this employment lite model (Every Physician Needs To Know About Employment Lite) when it works in their favor, often using it to align private practice doctors with their system without needing to hire them directly. But hospital want to make this a one way street, ushering in private practice doctors into their safe harbor, but not allowing anyone from their safe harbor to come and go across the same bridge. It’s perplexing and infuriating to be honest, and it’s evidence that hospitals conveniently hide these options from doctor and conveniently limit their use when it’s to their advantage.

But the real power of a micro-corporation comes when you take the reins. This business structure allows you to contract independently, not just with one hospital but across multiple settings—telehealth, consulting, legal work, or even opening a Direct Primary Care (DPC) or concierge practice. It's not just about leaving hospital employment; it’s about creating a sustainable, flexible professional business model that can thrive in today’s changing medical landscape. For more read my post: It’s time for every doctor to start a professional micro-corporation.

Getting Past the Gatekeepers: The Legal Hurdles

Many physicians run into a brick wall when attempting to negotiate independent contracts with hospitals. Hospital legal teams are, in essence, gatekeepers who protect the institution's interests. These lawyers are paid to maintain the status quo, and that often means keeping physicians locked into W-2 employment or unfavorable locum contracts.

One of the most effective ways to overcome this barrier is to hire your own legal representation. A lawyer who understands physician micro-corporations and independent contracting can challenge the hospital’s legal team, helping you move past their objections. In my personal experience, hiring a lawyer was the key to negotiating a favorable “employment lite” contract—an arrangement that allowed me to step back into the marketplace as a self-employed independent contractor with both freedom and security. If you are looking for someone to represent you during your conversations with the hospital, in invite you to engage with me for SimpliMD guide services and I will get you connected to a legal professional who can help you. This will be one of the best decisions you can make as I get to know your situation and then refer you to our trusted concierge legal network that represents doctors at a very reasonable rate.

Owning Your Practice Space: The Power of Direct Primary Care

As my reader astutely pointed out, owning or leasing your office space and controlling your accounts receivable revenue stream is vital. Whether you go the route of Direct Primary Care (DPC), concierge medicine, or another model, the key to true autonomy is having direct control over your practice’s physical and financial infrastructure. That was the playbook that led to making nearly a million dollars a year as a primary care contractor. You can check it out in my post: Rewriting the Rules: Achieving a Million-Dollar Income in Family Medicine.

There is a growing movement of physicians who are choosing to "go back to the future"—returning to independent practice ownership, albeit with modern twists like telemedicine, fractional work, and hybrid models that allow them to retain control over their professional lives. Read more at my post: Why I Recommend Self-Employment for Doctors. Physicians who adopt this approach are creating practices without walls, redefining what it means to be independent in medicine today. Read more at my post: Say Yes To Self-Employment: Taking Control of Your Medical Career

If you are looking for the profile of hospitals and employers that are more likely to creatively engage with you as an independent contractor, such as in employment lite, check out my post: Employment Lite: Profiling Employers Who Will Hire You As A Contractor

Take Action: The Time is Now

Are you tired of being underpaid, expendable, and trapped in a system that doesn’t value your expertise or autonomy? Now is the time to explore how a micro-corporation can liberate you from hospital control and open up new opportunities for job stacking, telehealth, and independent contracting.

At SimpliMD, we specialize in helping you create micro-businesses that gives you agency in the marketplace. Schedule a personalized consult for only $99 today, and you’ll receive a one-year membership worth $2500 in business products on SimpliMD, including legal resources, business setup tools, and personalized coaching to help you regain your independence.

Additionally, if you’re ready to take your career to the next level, check out my course “Creating A Practice Without Walls.” In this course, for less than $200, you’ll learn how to create a micro-corporation that provides you with the flexibility, autonomy, and security you need to thrive in today’s medical landscape.