You Were Meant For More Than Healthcare Factory Work

The Good Life?

It's important to note that those on the outside often have a romanticized view of your "doctor's life," seeing it as a perfect blend of altruism, professional autonomy, and high income. It appears to have all the ingredients for a fulfilling and prosperous life—what many call the good life. Thus, our close friends and family may be initially surprised to hear about our professional frustrations and disappointments. After all, it was assumed that these challenges would disappear once you became an attending physician. Both you and your confidants are beginning to realize that the "good life" of being a doctor may not be as fulfilling when you are working at your employer's medical factory.

You are likely to persevere believing that much like your training, things will often get better with more time. So you will utilize your best personal resilience techniques, all while simultaneously hoping for systemic changes that will improve the situation.

Spoiler alert: In the employment world, the never-ending series of "it's gonna get better" will always include some combination of needed changes that address your tension over:

• Inadequate staffing

• New management

• New ownership

• A new practice location

• The next contract

• New corporate HR policies

• Trying to land the newest piece of medical equipment

• Needing more doctors, NPs, PAs, or other extenders to share your load

• The need for scribes to help you with documentation

• An EHR transition

• A new compensation formula

• Side jobs to help boost your income

• Too much or too little call

• Too many or too few shifts

This merry-go-round of changes, tension, and the mindset that things will get better will continue for years. I can confidently say this based on my personal experience, as it was the reality of my life for the first 15 years of my career. My wife would witness my misery and stress at home, growing increasingly bitter over the moral injury inflicted on me by my employer. Despite this, she would resign herself to believing in my defense of our employer-employee relationship. She accepted my reassurances that things would improve when "x" happened. In a strange way, I became accustomed to defending my employer, believing that they would change and stop hurting me.

Harmful Co-Dependence

To be completely honest, this is an incredibly unsettling similarity to the dynamics of co-dependence that are often present in cases of domestic abuse.

Co-dependent domestic abuse relationships occur when two parties rely on each other and engage in a mutually destructive dynamic. This often manifests as physical, emotional, or psychological abuse, where one partner exhibits controlling and manipulative behavior while the other partner passively accepts this dynamic. The victim may feel compelled to remain with their abuser due to fear or a misguided sense of loyalty. The abuser relies on their partner's ongoing presence to exert control and maintain power. The abuser depends on their partner's continued presence to exert control and retain power. Recognizing co-dependent relationships can be challenging, as both parties are trapped in a cycle of fear and dependency that often perpetuates further abuse. This type of relationship creates a vicious cycle that can be difficult for victims to break free from without external assistance.

The interdependence between you and your employer can be a challenging bond to break for both parties. Ultimately, this dependency can become suffocating for you.

The business culture has labeled this as burnout, unfairly placing the blame on you and suggesting that you have failed to resiliently handle your workload.

More appropriately, our profession now recognizes this as a moral injury, acknowledging that systemic forces are to blame for the harm inflicted on individuals who find themselves trapped in medical factory work.

Modern doctors, who were once revered for their power and prestige, have now become lifelong workers in the medical factories of our country.

We, along with nurses, housekeeping, dietary, security, and maintenance workers, are now referred to as "associates," just mere cogs in their wheels. The only distinction is that we are paid more. However, we are all equally controlled workers, identified by our badges, and trained like Pavlov's dogs to eagerly await our paychecks on payday.

Employed Doctors Are Non-Permanent Workers

In a previous post, I discussed the need to redefine physician labor and brought attention to the fact that many employed doctors are classified as non-permanent workers under their contracts. Thus, every doctor should be given the choice to classify themselves as either long-term independent contractors or employees within these jobs.

There are two obstacles that hinder the implementation of this functionality in today's employment climate:

1. Corporations have a responsibility to the IRS to classify every worker as either an employee or an independent contractor. However, when it comes to doctors and traditional labor views, they tend to want to classify any long-term working relationship as an employee. Not only is this option safer and easier, but it also saves money compared to the more common independent contractor physician labor with locums. The bottom line is that you will be considered an employee by default.

2. Most physicians are unprepared for the moment when a prospective employer approaches them about a contract. Frankly, most of you lack proper coaching and understanding of why you would even want to become a contractor. And, most importantly, you likely lack the necessary proof to confidently classify yourself as a contractor in the judgment of the IRS, which is crucial for anyone considering hiring you. As I mentioned in a previous blog post, Empower Yourself To Choose Your Worker Classification, the classification of whether you will be considered an employee is subjective, and historically has been the responsibility of the employer to determine. However, the IRS does offer some objective guidance for you and your employers on this matter. Ultimately, you will by default be considered an employee because that is safer to employers—unless you can provide compelling proof that you are truly a contractor.

Why Does It Matter That You Are An Employee?

As you all know, there are numerous benefits to physician employment, which include:

Just like there are two sides to every coin, the downsides of employment become more visible a few years into the job. Over time, these negative elements begin to inflict harm on you as an employee. Some of these moral injuries include:

The Power to Choose

Regardless of the employer you choose to work for, what I am advocating for is your empowerment to make the decision on whether to be classified as an employee or an independent contractor, based on what is best for you. The decision of whether you are an employee or not should not be solely determined by the business that hires you. However, unfortunately, that is the current status quo—where large corporations have the power to define your employment status. The issue at hand, for both them and you, boils down to one critical word: control. Employees are subject to the control of their employers, whereas contractors are not. Therefore, the aim is to establish a relationship with you from the beginning that involves mutual control on their part.

At first, the control will seem subtle, but over time, it can become suffocating.

To gain a better understanding, let's explore how corporations have traditionally perceived physician labor.

The Past Views of Physician Labor

In the past, there was a strong and resounding preference for all of a company's physician labor to be primarily called permanent employment by default. Long-term professional services enable corporations to establish predictable and sustainable service lines that are not only more reliably profitable but also scalable.

Long-Term Work Horses

This notion is based on the belief that physicians are reliable and hardworking individuals in the business world. They can be trusted to generate revenue for the corporations that employ them over extended periods of time. Employers prefer to view this as a long-term relationship with you, which typically includes 2-3 contractual terms. These contracts, however, often have 90-day no-cause opt-out clauses.

Doesn't that sound permanent, does it?

Short-Term Gap Fillers

Additionally, corporations will also hire temporary labor to meet their physician staffing needs. Non-permanent or non-employee labor has always been synonymous with locum tenens. In most instances, hiring locum tenens will result in additional costs for that type of physician labor for a corporation. Furthermore, locums often lack the necessary ingredients to sustain and grow a service line. Essentially, they serve as temporary gap fillers—which is consistent with the literal definition of a locum: a person who stands in temporarily for someone else of the same profession.

A New Space

However, the combination of non-employee labor with long-term positions has traditionally been an uncommon combination offered by employers. This is because they preferred to have control over you and then prefer to call you long-term physician labor. This need for control over your business powers is one of the fundamental reasons why most employment contracts include some sort of non-compete clause. Employers often have concerns about losing control over you and the fear of the loyalty of patients towards you personally rather than their corporate brand. This emphasis on brand loyalty over a relational bond with your patients can often leave you feeling like a transactional commodity, where the focus from your employer is solely on generating revenue from patients.

In recent years, we have begun to witness the emergence of a new physician labor space called "employment lite." This space combines non-employee labor with long-term positions in a unique manner, and it is quickly gaining recognition as a viable alternative to traditional employment.

It is a space that I think you need to know about, because to be honest, discovering this space saved my career.

I invite you to learn more about employment lite here or you can also download my free guide about why it’s best here.

It's time for our tribe to put an end to the insanity of traditional employment and embark on something different! If you want something a little meatier on this, subject, you can check out and purchase my book on this topic right here.

Don’t Repeat Your Mistakes

Regrettably, many of you as employed physicians will find yourself trapped and held co-dependently hostage by the large corporations you work for.

However, you have the option to break free of this unhealthy professional relationship by seeking a new job opportunity—albeit acknowledging that this can be a challenging and arduous process. However, if you choose to do this, please consider not signing another long-term labor contract as a traditional employee. Instead, consider working as a long-term independent contractor through an employment lite agreement.

4 Steps

Whether you are at the beginning of your career or considering a transition, I encourage you to take the following four steps as necessary ingredients for preserving your professional autonomy through the formation of a professional micro-corporation.

These steps will empower you to seize the moment and confidently sign your contract as an independent contractor rather than as a traditional employee.

1. Choose to become business competent by joining a community of like-minded physicians who are determined to grow in their business knowledge. SimpliMD can provide you with a complete menu of free and paid resources that all have one mission—to grow your business competency—through courses, content, coaching, community, or consultation.

2. Decide whether you plan to view yourself as a professional micro-corporation rather than as an individual taxpayer for your professional services. I highly recommend the former and I also suggest using someone familiar with physicians to help you set up our micro-corporation. This legal entity should be highly personalized and shaped around your personal and professional life. The process of personalization and the inclusion of built-in fringe benefits in your micro-corporation will come at a cost—with the amount ranging from $5,000 to $12,000 depending on the fringe benefit structure you choose. However, those dollars will undoubtedly prove to be a worthwhile investment in the long run.

3. Outsource the management and operation of your micro-corporation. I recommend you choose a physician-centric agency that can help you manage your micro-corporation, develop a personalized fringe benefit plan, provide your accounting services, supply tax, and legal advice, give wealth management counsel, and provide business coaching. Through these comprehensive services, you can ensure that your needs are met with expertise and tailored small business solutions. You can get all of this under one roof with SimpliMD. We offer you the option to hit the easy button and let us handle everything for you. Alternatively, you have the option to assemble your own team of professionals to provide the needed support for your micro-corporation.

4. Diversify your income channels by considering side work through your professional micro-corporation that is outside of your primary job. Start slowly and create a combination of primary and side jobs that align with your personal and professional goals. By following this approach, you can ensure that all your efforts will contribute towards successfully achieving your goals. In the past, the traditional mindset involved having only one job. However, the more progressive approach is to diversify and stack combinations of jobs. Having a professional micro-business will make this much easier and more efficient. This empowers you to adjust the volume controls for each of your jobs, giving you even greater flexibility and control over your professional life.

Do you think someone on one professional business coaching from a fellow physician on how to do all this would be helpful? I invite you to check out my micro-business coaching options that we offer exclusively to our SimpliMD community.

Or if you just need some help setting up your corporation to get things off the ground, you check to follow this link to make a FREE introductory appointment to SimpliMD consultative services with me.

Tod