Every Doctor Needs To Preserve Their Professional Autonomy

This post was originally published on Dr. Incorporated March 25, 2023

Lessons Learned About the Best Life

I am living my best life. Unplugged from my job, chilling out with my family along a spectacular beach in Kauai, and working on writing a book during a business trip covered by my company.

Ten years ago, this would have never happened because it was a world I never knew existed for doctors. It’s a life that centrally includes using my own professional micro-corporation.

So I wrote a book that tells you exactly how you can do the same.

My book, "Dr. Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy" is written from the perspective of what I would tell my younger self about how to experience my best life as a physician.

It is filled with personal and professional tips that would have saved me time, energy, and money had I been equipped with it thirty years ago when I earned my medical degree.

The information found in its pages would have spared me years of blindly following the same career path as my peers—a path that unknowingly eroded my personal and professional well-being each year that I was traditionally employed.

The Tensions of Employment

I accepted the tensions created by employment as common for a young doctor and reacted to combat those pressures with personal resiliency measures and working harder. I naively thought this was my only option, as I was not aware of any other alternatives that would provide me relief. After all, that is how I was conditioned during medical school and residency training—when things were hard and stressful, I just had to dig deeper and adapt to the tension as the new normal. Adjust and just suck it up as the normal life of a doctor—a pretty common mindset for most of us in medicine.

I reasoned the system I was employed within was unchangeable. Therefore, the changes had to occur from within me.

I Was Both Right and Wrong

I Was Right

I was right that a change had to occur within me. The truth is that none of us should blindly allow our employer to fully guide and control our medical career. You will be far better off controlling it yourself. This required a change in mindset from one that passively depended on my employer to one that proactively and unashamedly prioritized my personal and professional well-being.

Your employer does not have the same goals for your career as you do, and thus you will find your interdependence on them will eventually result in tension from the divergent endpoints. Your hard-earned professional career should translate into a great life that holistically supports your well-being. This is not in their interest. Their interest is solely to use you to make money for them.

Many doctors are unaware that employment by definition is about corporate control over your professional life. It’s a slow fade professionally as you choose a job and begin earning money as an attending physician. The incremental loss of professional control of your life can even be imperceptible as your peers walk down the same path. Your expectations for professional autonomy as a doctor will ultimately collide with your employer’s control over your decisions. The erosion of your autonomy will eventually give rise to burnout.

I Feel Your Pain

I share my full story with you in my book because I want you to know I am one of you—a little fish in a big pond. I especially understand the various good and bad aspects of the employed doctor’s life. I know how important it is to feel valued by your employer, receive fair compensation, and be empowered with professional autonomy.

Despite its challenges, I still believe employment is an excellent option for most. However, the status quo system of traditional employment is not healthy for doctors and needs to be reformed.

I Was Wrong

I was wrong about my assumption that the system could not change; rather, all the changes had to be orchestrated within me as I learned to adapt to the hazards of employment.

The system does need to change, but we can’t depend on those who control it to be incentivized to bring about needed changes.

The reality is that they can’t operate without us collectively. Thus, we have the power to force systemic change by unifying under a simple action that will preserve our autonomy and empower us to be contractors of our professional services (businesses) rather than employees under their control.

Getting out from under their total control professionally is foundational.

The key step to force this market correction is for all doctors to form a professional micro-corporation.

Avoid My Mistake

I hope that I can help you avoid replicating one of the bigger mistakes that I made in my career: when I passively trusted my employer to guide my professional life.

This professional passivity is the default mode for most employed doctors who blindly place all their eggs in their employer’s basket and then trust in the beneficence of their employer to support their professional development and well-being.

You will eventually discover that they love you for what you do for them, not for who you are. As the saying goes, “It’s not personal, it’s just business.”

Passive Co-Dependence

Choosing the path of passive professional co-dependence within traditional employment leads to a gradual loss of control over your life. This loss of control is one of the underlying factors causing burnout for many in our profession. In addition, the corporate takeover of the healthcare economy has resulted in doctors losing their small business powers and thus feeling trapped and morally injured by the soulless system of big business.

My journey included a near-burnout experience within traditional employment. A little more than ten years ago, major corporate changes filtered down to systemic changes that affected my little rural medicine world. I was forced to stop doing hospital admissions in order to support the new hospitalist program. My compensation was cut because caps were placed on my productivity income (I was a high producer). New EHR adoption led to a few hours of work being pushed into my home each night—after I was done in the clinic. And the last straw was the migration from a local board of directors to a regional board of directors that essentially gutted any local power and influence we had over our physician network and hospital system decisions. We were now part of a regional health system that was owned by a national health system. Within that structure, our local influence, decision-making, and community-mindedness were flipped to us simply becoming a transactional asset on a corporate financial spreadsheet.

Money superseded the mission, essentially eliminating it. “No margin, no mission” became the guiding light in every decision.

This corporate playbook connected to expansion with diminishing local influence/leadership is common, and most health systems follow the four well-known stages of corporate growth:

1. Stage 1: Amassing market share and focusing on revenue rather than profits is the priority. Acquisitions are a fundamental element of gaining market share, in addition to innovation and establishing new business income streams.

2. Stage 2: Building scale for business services or products is the next plateau. Consolidation of market control and scalability involves buying up competitors and growing market share. Acquisition, merger-integration-assimilation cycles ensue. Brand and corporate culture become clarified, and the best employees are retained, while poor performers are shed. Assets are aggregated and profit losers are abandoned.

3. Stage 3: The focus becomes aggressive growth and expanding the core business through mega-takeovers and elimination of competitors. Mega-deals with large-scale consolidation occur, and profitability becomes more important than revenue. Competitors are either crushed, acquired, or emulated.

4. Stage 4: Alliance with other industry leaders becomes more important as maintaining market leadership and control is critical. The corporation is forced to find new ways to grow its core business and create a new wave of growth by spinning off new businesses into industries in the early stages of consolidation. They must be alert to the potential for industry regulation and the danger of being lulled into complacency by their own dominance.

In my over 25 years at one rural clinic, I have traversed through all four of these stages with my employer. Every change brought transitional pain and opportunities personally, and eventually, my individuality was swallowed up by the sheer size and scope of the enterprise.

What I did not understand early in my career was that I was simply a business asset that was being managed by a corporation working its way through the above stages. Ultimately, my personal and professional life was disregarded as I was forced to comply with corporate citizenship duties that were increasingly burdensome and detrimental to me, but beneficial to my corporate employer.

The consequence of this tension over time was and is burnout.

Change My Mindset

Fortunately, I avoided burnout and revived my career by taking control of my professional life by proactively making decisions that were in my best interest.

That’s right; my mindset changed from one of sacrificial alliance with my corporate employer to a healthier individualized alliance for my personal and professional well-being. I had been raised to believe that it was noble to be willing to do whatever was personally necessary for the sake of my team to be successful. While there is some truth to this principle, I came to realize that in the big business world of healthcare, I am a disposable or replaceable piece of equipment in their corporate operations.

Although it seems a little selfish to think of my own interests first, this was a necessary change and a reasonable ethos to embrace in the ruthless system of physician employment. In the end I needed to make a change that would restore my agency as a professional.

Making A Change

Central to that rebuild was the formation of my professional micro-corporation and its associated “employment lite” contractual structure. I encourage you to download a free primer on employment lite here and begin to explore how it can help you. I also talk extensively about it in my new course “Creating A Practice Without Walls” , which I am making available for half off this month by using the coupon code EARLYBIRD at check out.

Or if you want to take a deeper dive, grab a copy of my book and read the full story about how you can follow my lead.

My positive experience with using a professional micro-corporation within the safe harbor of employment has served as the inspiration for me to share my discoveries with you. My faith informs me that sharing my “good news” with others is morally right as it supports my sense of purpose and meaning.

In the end, this is my motivation for this SimpliMD—to share with you what I have learned so that you can thrive in your life as a physician.

Ultimately, I believe the concepts in my book will illuminate a hidden path that many of you can benefit from.

Avoid The 50%

The hard cold truth is this: Half of you will end up teetering on the same burnout cliff that I found myself peering over the edge of ten years ago. It’s a painful abyss, and the fact is that one out of two of you will experience it.

The status quo of resigning ourselves to accept this appalling statistic among the brightest and most altruistic humans on the earth is just not acceptable to me.

It’s not OK.

It has to stop.

I Have Walked In Your Shoes

With a nearly 30-year career, I can say that I have walked in your shoes from the spectrum of training to your life as an attending. This experience informs the validity of my words but also allows me to point you to a better path than traditional employment.

If you're ready to take control of your professional life and experience the same transformation I did, I invite you to purchase my book, "Dr. Incorporated: Stop the Insanity of Traditional Employment And Preserve Your Professional Autonomy." It's packed with insights and strategies that will empower you to build a rewarding and autonomous career.

Additionally, for those seeking a comprehensive guide to preserving your professional autonomy, my course "Creating a Practice Without Walls" is half off this month using coupon code EARLYBIRD. It is designed to help you navigate the complexities of modern medical practice and thrive as an independent professional. Take the first step towards a more fulfilling career today.

Buy my book here and Enroll in my course here to start your journey toward professional freedom and well-being.