Location Independence for Working Doctors

This post first appeared on KevinMD on May 19, 2023

One Doctor, One Job, One Location

There was a time when one doctor worked one job in one geographic location where he/she was altruistically dedicated to serving a population publicly or privately in the practice of medicine.

In this space a doctor’s life was dominated by their “call” to use their special healing skills in a specific community. The presence of a doctor improved the well-being of the community through their professional service, the presence of their small business, and their interconnections with the socioeconomic fabric of the town/city.

Employment Preserved the Good Life

For years this idea of working one job in one location was anchored within the private practice model which then gave way to the traditional employment model. The latter offered a parallel promise of a stable and long-term medical practice in one location—with the added twist of a very predictable high income without the stress of managing employees & a medical business. Generally, it preserved the good life of the physician in the evolving marketplace.

Employment became the simplest way to transfer the mindset of one doctor with one job in one location. It has become the secure, predictable, and financially enticing job option for most of you—and now the gold standard for as much as 90% of new residency and fellowship graduates.

A Paradigm Shift To Location Independence

But underlying basis for both private practice and employment—which is a long term commitment to one full time position in one location—is now being replaced a modern model of physician work that is location independent. Now physicians are using combinations of %FTE jobs that are stacked with side jobs to add up to meet a preferred income that leads to a quality of life in a location that is often separated from the location of a doctor’s job.

6 Take Away Messages

I offer up 6 take-away for physicians when it comes to this shifting landscape. As I work with doctors all over the country through my online community at SimpliMD, I see this following consistent themes that inform what the future physician labor force will look like.

1. Employment Is Just A Job Without Meaning

The age old medical school interview question of “why do you want to be a doctor” is typically framed by a story that inspires you to want to help others medically. Your answer likely was not “so my employer can make a gazillion dollars for it’s shareholders and CEO” . However if you have been employed by a large corporation for any period of time you realize that you and the patients are just commodities. Both are ingredients in their money making machinery as medical care is now reduced to a transactional economic event between two corporately controlled commodities-doctors and patients

In this depersonalized state, your work has become stripped of its purpose and meaning. Now it’s just a job, not a calling. Ultimately this loss of purpose and meaning at work coupled with the corporation’s view of you as business asset is one of the underlying causes of burnout for doctors.

The predictable fair market value compensation, lack of business management responsibilities, and job security all form the flip-side of soul-less employment position. Some have mastered the ability to mindfully work within these safe harbors, while others recognize that something had to change in order to survive. The latter is what I ultimately did as I discovered the long sequestered power that I had earned —which was to to use my micro-business powers in the marketplace.

2. Disruptive Changes In The Marketplace

The times are changing for physician jobs, and the status quo of traditional employment is being questioned by both experienced mid-career doctors and young physicians.

This old model is gradually being replaced by an acceptance that a career in medicine is just a job whose high income allows for a mixture of both active and passive income sources that additively lead to a preferred lifestyle.

The choice of where to live is no longer informed by the location of the patients you are called to serve, rather it is informed by the quality of life factors that support your preferred lifestyle.

There are four broad tends that have converged to disrupt the old idea of location dependent work at one meaningful job:

• Disillusionment with Traditional Employment—The loss of professional autonomy, growing burnout rates, elevated taxes as W-2 workers, and the loss of control over your personal/professional life has forced many doctors to look for non-employment job options—including many who are abandoning the system all together and doing direct care models with no 3rd parties

• Gen Z and Millennials’ Evolving View of Work-Younger workers tend to work multiple jobs, work independently, and are skeptical about the security of employment. Gen Z tends to question whether they can find contentment in traditional American lifestyle—which is employment focused. They tend to see themselves as entrepreneurs who wear multiple hats with flexible work schedules, working vacations and more consideration for personal time. Almost two-thirds of Gen Z Americans have started, or intend to start, their own business and nearly half of Gen Z have side hustles. In the end for Gen Z doctor a preferred lifestyle is their goal and medical work with its high income is the means to get them there. This is in contrast to baby boomers whose mission/goals were based an all an consuming job/personal identity that produced what they called the “good life”.

• The accelerated adoption of virtual medicine due to COVID-19. Medicine is now more mobile and more virtual than ever. Virtual work requires virtual workers.

• The growing physician shortage that is accentuated by a proliferation of job opportunities brought on by virtual medicine that accommodates part-time/side job/contracting work. This has all created recruitment and retention challenges for corporate employers of doctors, and thus they have had to adapt by offering less than 1.0 FTE jobs, part-time jobs, and independent contracting jobs in order to attract doctors.

3. The New Normal of Multiple Jobs

This mindset directs young doctors in particular to abandon old paradigms for medical practice and adopt a new, modern version of a medical career that is based on working several jobs in several locations.

This is the new normal. The mixture of income sources is typically a combination of employment and self-employment jobs (W-2 and 1099 income). The decision of where to live is not based on a singular job location as much as it is based on their preferred lifestyle in a preferred location. Virtual mobility and diverse work options allow for stacking jobs to support a location based quality of life. Suburban or urban areas are often preferred. This shift is one of the reason’s rural medicine is being abandoned by the new wave of doctors.

The unique combination of jobs will likely change and evolve as the labor market and physician needs change and grow. Work for a doctor is no longer considered a permanent job in a single location.

Thus in this modern mode and thus long term alignment with a single employer is highly unusual.

The result of this new mindset is that many modern doctors are receiving income via a combination of sources that can range from active (professionally generated) to passive (your money working for you) income channels. This new work paradigm is called Job Stacking and I explain it all in my free e-book here.

4. Doctors Are Contractors

Doctors are starting to view their jobs as non-permanent, and less employment based. Young doctors are particularly beginning to see the value and importance of embracing their power to identify themself as a micro business and thus receive non-employee 1099 income. This means they are independent contractors who are finding their footing in the gig economy. A good example of this is the space of asynchronous or chat based medicine like Hims & Hers, Calibrate, and Lemonaid just to name a few.

Virtual workers need virtual business structures. The easy button is to choose to receive the 1099 income as small business sole proprietor, especially due to the associated deductible business expenses and access it provides to a tax advantaged solo 401(k).

Doctors tend to shy away from opening a professional micro-corporation for their 1099 work due to their business illiteracy and their fear that it means they will be opening a private practice.

5. A Doctor Is A Professional Micro-Business

But what they don’t realize that a single member professional micro-corporation is NOT private practice. Instead it is a virtual business that can be used within any job structure, is portable, and goes everywhere they go. It covers a the doctor like a suit—just like white coats used to cover us. These micro-corporations a simple to start and operate.

Every doctor has the power to form a professional micro-corporation and it’s surprisingly inexpensive. Download my free e-book explaining it all here.

Professional micro-corporations provide multiple benefits over a sole proprietor business model including asset protection, additional business deductions, tax advantages, retained income, and larger retirement plans.

6. Every Doctor Should Start A Micro-Corporation

If you are an attending physician who works multiple jobs, receives any 1099 income, or is tired of traditional employment and seeking a change, starting a professional micro-corporation is highly recommended. It will enable you to thrive in the ever-changing landscape of physician labor, which is becoming more diverse, non-permanent, and independent of location. A virtual micro-corporation is the perfect solution for embracing this new reality.

One thing that fuels Gen Z's passion for starting a small business is the autonomy it provides to do good. This is particularly appealing to Gen Z doctors who want to tap into their altruistic motives that led them to a career in medicine. While traditional medicine tends to strip them of purpose and meaning in their work, a professional micro-corporation allows them to preserve it. As one Gen Z said about their inspiration to start a business “The best part about being an entrepreneur is that we’re very mission-driven and believe that what we’re going to do is going to change lives for the better and help cities become better places to live.”

For this reason, I believe every resident in the country should consider starting a professional micro-corporation before graduating from residency and taking their first job. This will position them to thrive in the new world of physician work, while also supporting a desired lifestyle and quality of life. The autonomy and purposeful nature of this type of work can bring great meaning to their careers.

Ultimately a professional micro-corporation can be used by a doctor for any job they encounter.

If you need some support on how you can start your own professional micro-corporation, reach out to me for a $99 business consultation at SimpliMD. I will help assess and determine if you would benefit from taking the next step to form your professional micro-corporation.

Professional Micro-Corporations For Any Job

Professional micro-corporations can be used as an alternative to traditional employment (W-2) via what is a called and employment lite contract (long term 1099 work). This is what I do.

Tired of the system and would rather go off the grid with Direct Primary Care or Direct Specialty Care? A professional micro-corporation is perfect for this.

Prefer locums so you can travel and pick and choose when and where you work? A professional micro-corporation is the ideal structure for this independent contracting work

Love your full-time or part-time employment job as a W-2 worker, but are among the 40% of doctors who take on side work. A professional micro-corporation will allow you to keep more of those side income dollars in comparison to to sole proprietors and W-2 workers. You can check out my case study on the comparison here.

If you're a resident moonlighting and wondering how to effectively manage your extra income, consider leveraging your medical degree and independent medical license. In most states, you can apply for a license after just one year of training. With this, you have the opportunity to establish a professional micro-corporation, allowing you to run your virtual small business. This is an ideal time to learn about the intricacies of managing a small business and take advantage of the tax benefits available to such entities in the tax code. Check out my free e-book 20 Reasons Every Doctor Should Form A PC During Residency that breaks it all down.

Tod