The Quest For Professional Independence & Autonomy

I read a recent blog post on KevinMD with great interest. It was written by a primary care physician who shared their decision to leave hospital employment in order to regain professional autonomy and independence. This physician is now embarking on a new journey by starting a direct primary care practice.

Over 10 years ago, I made the same decision myself in order to restore my professional autonomy as a traditionally employed primary care doctor. Instead of opting for direct primary care, I chose to transition to a long-term independent contracting position through what is known as an employment lite contract. This decision proved to be the right choice for me, and it could be the right choice for you too. If you're interested, I highly recommend reading my best-selling book, "Doctor Incorporated: Stop The Insanity of Traditional Employment and Preserve Your Professional Autonomy." In this book, I document my complete journey and provide valuable insights that can help you navigate similar challenges and make informed decisions.

Empowering Options

In the end, it is my strong belief that you have worked hard to earn all the assets and powers associated with your professional status as a doctor. Fundamentally, professionals should have the freedom to choose from various job options to utilize their professional services. However, the current marketplace control of the physician labor market by large corporations can lead to a herd mentality among doctors, making them feel compelled to conform to a traditional employment labor space where they are controlled.

My message to you is that you don't have to choose traditional employment, nor do you have to stay in a traditional job. You have the power to chart your own path and pursue an independent professional life.

The real problem lies in the competency deficit of your small business knowledge, which is reinforced during your medical training experience. This indirectly leads you to feel incapable of entering the marketplace independently.

This is precisely why our SimpliMD physician community is desperately needed. By becoming business competent, doctors are being liberated from the limitations of traditional employment. Our mission at SimpliMD is to empower you in the marketplace!

The current herd mentality has led to a troubling outcome: the forced dependence on traditional employment. Initially, it may seem like a safe haven for professional growth, but eventually, it transforms into a prison that leads to burnout. This paradigm is the main driver behind the burnout crisis we are experiencing in the field of medicine.

Now, I want you to hear about a physician's story about their journey to freedom.

A Social Story For Doctors

After nearly a year of planning my exit strategy, my final day as a hospital-employed physician was June 30th, 2023. How surreal to finally be independent! In a recent phone call, a dear friend and fellow physician asked what drove me to my decision.

“Because I felt like a failure every day,” I disclosed to my normally sympathetic colleague. To my dismay, he responded with a chuckle. I asked why he was laughing at me. “It’s just that I recognize that sentiment,” he replied. “I am exactly the same way, beating myself up and catastrophizing when I’m not perfect. You know it’s not true, right?”

I protested, “But I wasn’t expecting perfection. Just … improvement. No matter what I did, I was always behind.” He reminded me that what matters most is the actual work of caring for patients, not the billing, coding, and sundry box-checking, dictating, and typing that in any other field would largely be relegated to a trained paraprofessional. I retorted that for better or worse,

American medicine is a business, and the business of mainstream primary care depends on physicians spending the bulk of their day chained to a screen operating their employer’s cash register.

In fact, unless we are performing a billable procedure, we are punished for taking the time to have a meaningful (but wholly non-billable) conversation with a patient. A day full of such conversations means a lunch hour, dinner time, and late night of catching up on administrative tasks. Heaven forbid that we actually eat and sleep—that means double work for the next day. Only the most efficient physicians with well-trained, experienced staff; generally straightforward patients; and intuitive electronic medical record systems consistently stay afloat.

Such was not the case for me. So I suffered from this repeated ethical conundrum: Do I choose to actually listen to my patients and work collaboratively to help them feel their best, knowing I would not have sufficient time for my family or myself? Or do I fly through the day, doing the bare minimum for my patients, but actually complete all my documentation at a reasonable hour? I almost always opted for the former. Eventually, I got so busy that all my obligations piled up to an unsustainable level. My efforts to catch up were too little, too late, with any progress inevitably followed by an onslaught of even more tasks that threatened to drown me.

No more. I have taken a hiatus from outpatient family medicine, with the intention to jump back in as soon as I am able. Next time I won’t have insurance companies or administrators to answer to because I will be practicing direct primary care (DPC). DPC keeps medical decisions where they belong: between the doctor and the patient.

My friend was right; I am not a failure. The traditional American health care system sets up multiple players to lose. Often it’s the patients themselves. Sometimes it’s the office or hospital. At my former practice, it was me. Now that I am an independent entity, I am excited about the prospect of a future in which my patients and I can win together.

Jacqui O’Kane is a family physician.

Preserving Your Professional Autonomy

The most important step you can take as a professional who has spent well over a decade investing in your career is to make a thoughtful choice at the beginning of your career launch is to preserve your professional autonomy.

Your first step for doing this is to create a professional micro-corporation as the fortress and structure that acts a barrier and shield to others stealing your professional autonomy. This ideally be done during residency so that it can be used as you enter the marketplace. It will ultimately frame and inform your professional agreements that will increasingly become hard-wired as time goes on. Engaging in business to business contracts right from the start will solidify your marketplace status as self-employed contractor rather than a traditional employee.

To further emphasize why this is important before you finish your training, it is crucial to understand that aggressive recruiting and signing contracts for various specialties begin well in advance, typically 1-2 years before completing your specialty training. Therefore, it is advisable not to wait until your last year of training to engage in this process. Consider a professional micro-corporation as a capstone to your training process. It only requires around a $5000 investment in yourself. This amount pales in comparison to the significant investment of $300,000-$500,000 you have already made to become a doctor. Do not underestimate the importance of creating this capstone for your professional life. If you want more reasons to start a micro-corporation during your training, check out my free e-book 20 Reasons Every Doctor Should Form A PC During Residency.

You Have The Power

If you are like me or Dr. O'Kane in our social story, and you may start off as a traditional employee, and later realize that it is harmful to you. This pain will force you to find ways to restore your professional autonomy, and please know that it's never too late to make a change!

• You have the power to completely change your primary job structure and do something different—including any of the following:

  • Become a long term independent contractor through an employment lite agreement and continue to work for a large corporate employer.

  • Become a short-term independent contractor and start doing locums work, or a host of location independent jobs like tele-health jobs, APC supervision, etc. With the national physician shortage and the growth of post-covid job options for doctors—the opportunities are enormous.

  • You can choose to go off the grid altogether and start practicing direct primary care or specialty care that operates on a cash-pay basis only. These models are gaining popularity as both patients and doctors become increasingly frustrated with third-party involvement in healthcare.

• Alternatively, a trend I am observing more and more in the physician labor market is to reduce your full-time equivalent (FTE) % in your traditional employment job and supplement the extra marginal time with various side work-contracting jobs that align with preserving your professional autonomy. This work architecture of so-called Job Stacking is becoming increasingly common due to the way is supports your preferred quality of life. Read more about this Job Stacking term here if it is new to you.

Regardless of the direction you choose, the path to emancipation starts with establishing your micro-corporation.

I am currently working on an online course called “Doctor, You Are A Business” specifically designed to guide you through the process of setting up a micro-corporation. I expect the evergreen video course to be ready for you by the first quarter of 2024. As a special offer, I am making this course available to a select group of waiting list members at a 50% discount. The first 20 physicians to sign up at this page will get the course for half price, and I’ll even throw in a free SimpliMD annual membership! Wow, check it our now!

I am also happy to provide a provide a free discovery call with you to discuss using our SimpliMD legal network to help you create a highly personalized professional micro-corporation that is structured optimally to benefit your household. Go here to learn about how SimpliMD Starting Your Micro-Corporation & Business Consultation.

Tod