Dismantling the mythical dichotomy of physician career options

by Tod Stillson MD posted on KevinMD 4-28-24

In our journey as physicians, the traditional narrative often presents a seemingly binary decision: you must choose between seeking employment within a hospital or health care institution or venturing into the challenges of establishing a private practice. However, this oversimplified dichotomy fails to capture the evolving landscape of health care entrepreneurship, particularly the emergence of a third, less conventional path – that of the single-member professional micro-corporation.

The myth of the binary choice suggests that you must decide between the stability and structure of institutional employment or the autonomy and risks inherent in private practice ownership. Yet, this oversimplification overlooks a growing trend among health care professionals who are redefining their roles as both healers and entrepreneurs.

The rise of the single-member professional micro-corporation offers a compelling alternative if you seek greater autonomy and flexibility without the burdensome overhead costs and administrative complexities typically associated with traditional private practices. This innovative model allows you to establish your own virtual business, providing location-independent professional services tailored to your expertise and the needs of your patients.

Key characteristics of the professional micro-corporation model

1. Minimal overhead. By operating as a single-member virtual entity, you can minimize overhead costs traditionally associated with brick-and-mortar practices. With no need for physical office space or staff, overhead expenses are significantly reduced, enabling you to retain a greater share of your earnings. The only employee you have to manage is yourself.

2. Virtual business model. The micro-corporation leverages technology to deliver health care services transcending geographical barriers and expanding access to care. Through telemedicine platforms, secure messaging systems, and electronic health records, you can provide consultations, diagnosis, and treatment remotely or in person, offering convenience and flexibility to patients and yourself.

3. Location independence. Perhaps most liberating is your ability to practice from anywhere with an internet connection. Whether it’s from the comfort of your home, while traveling, or even during sabbaticals, the micro-corporation model empowers you to maintain your professional endeavors without being tethered to a specific physical location. Your business structure can be as visible or invisible as you want it to be because your tangible professional expertise and services are all that are needed for you to do your job.

4. Income potential. Contrary to the notion that autonomy comes at the expense of financial stability, the professional micro-corporation model can offer competitive earning potential through multiple income channels, tax optimization, personalized benefits, and enhanced retirement plans. By streamlining operations and focusing on high-value services, you can optimize your financial well-being while maintaining control over your professional and personal life.

Marketplace options for micro-business owners

The next question that arises is how and where you can use your professional micro-corporation in the marketplace, let’s take a look.

Traditional private practice

• Solo practice. Operating as a solo practitioner allows you to maintain full autonomy over your practice, decision-making, and patient. With no partners or shareholders, you have complete control over the direction and management of your practice.

• Group practice. Joining or forming a group practice enables you to collaborate with colleagues, share resources, and expand the scope of services offered. Whether it’s a multi-specialty group or a focused practice, group practices provide opportunities for networking, support, and shared responsibilities. By the way, depending on how a group practice is organized, your shares in the group can be owned by your micro-corporation (providing you some tax optimization.

• Part-time practice. For those of you seeking a work-life balance or pursuing other interests, part-time practice allows for flexible scheduling and reduced clinical hours while still maintaining a professional presence in health care.

Independent contracting

• Employment lite. This is the best alternative to traditional employment and is a form of long-term independent contracting.

• Locum tenens. This is a well-known form of short-term independent contracting that allows you to work anywhere in the world for weeks to months.

• Per diem work. This involves providing medical services on an as-needed day-to-day basis, often in hospital settings or urgent care centers. It typically involves shift work or call coverage.

Job stacking

Job stacking involves stacking any combination of employed and self-employment jobs together to create your preferred lifestyle. This is typically a combination of W-2 and 1099 income sources.

Direct care models

• Concierge medicine. In the concierge medicine model, you provide personalized, high-quality care to a smaller panel of patients who pay a membership or retainer fee.

• Direct primary care (DPC). Direct primary care involves a membership-based model where patients pay a monthly subscription fee for unlimited access to primary care services.

• Cash-based practice. Cash-based practices operate outside the insurance system, allowing patients to pay directly for services rendered. This model offers flexibility in pricing and services, enabling you to customize your practice to meet the needs of your patient population and your personal life.

Telemedicine

Telemedicine involves providing medical services remotely through video conferencing, phone calls, or secure messaging platforms. This model allows you to reach patients beyond geographical boundaries.

Specialized services

• Consulting. Leverage your expertise to advise health care organizations, startups, or other professionals on various aspects of health care delivery, policy, or business development, but it can also include medical-legal work, insurance work, and health care technology consulting.

• Others. Medical writing, medical education, medical directorships, research, coaching, and working for pharma.

As a single-member micro-corporation, you have a multitude of job opportunities that cater to your expertise, preferences, and entrepreneurial spirit. Your career choices are no longer binary but rather are trifurcated.

This micro-business option provides a diverse range of job opportunities spanning traditional clinical practice, innovative health care delivery models, and non-clinical roles. Whether you prioritize autonomy, flexibility, or a specific patient care model, there’s a path suited to your interests and entrepreneurial aspirations in this dynamic sector of health care.

Why is all this important? Because it’s time for you to empower yourself in the marketplace! The current system of traditional employment places you in shackles and ultimately can harm you. The herd, representing 90 percent of doctors entering the marketplace as traditional employees, is short-sighted and wrong.

Professional service jobs are pervasive. Don’t follow this herd, believing there are just two options; you deserve better!

If you are interested in learning more about this option, then I invite you to check out my lecture “Why You Should Start A Practice Without Walls” at the SoMeDoc virtual Private Practice 101 Conference May 31st-June 2nd.

If you can’t make it this conference, then I invite you to sign up for the waitlist for my brand new course that will drop this summer “Doctor, You Are A Business”. When you join the waitlist you’ll get the course for 50% off here.