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The Vision Of A Community For Empowering Micro-Business Physicians

The Vision Of A Community For Empowering Micro-Business Physicians

 

My Dream, My Passion

My dream is to empower every physician with the knowledge and skills to establish their own micro-corporation as the foundational step towards preserving their professional autonomy.

With the power you have earned through your professional license, you don’t have to passively enter the marketplace as an individual and resign yourself to accepting the high burnout rate associated with traditional employment. This co-dependent work relationship is characterized by control, and ultimately, business owners have control over you as an employee. This is not a fulfilling way to live as a professional, and you have so much more potential! Instead, you can actively choose a better path that will enable you to thrive.

Self-employment through a micro-corporation offers you greater control over your life and can greatly benefit your personal and financial well-being. By entering the marketplace as a micro-business instead of an individual, you can effectively preserve your autonomy.

When you add the support and empowerment of like-minded doctors who come together in a community, it adds a greater power and inspiration to the entire process.

My vision for our SimpliMD community is this:

To inspire every US physician to empower themselves as a micro-business within the marketplace.

Imagine the Possibilities

It is time to ignite a movement within our physician tribe that helps each and every one of you see what is possible.

Avoiding burnout is possible, but it requires more than just wishful thinking. You cannot simply rely on luck to avoid becoming a victim of systemic burnout, as the odds are stacked against you (1 in 2), nor can you cannot depend on your employer to provide you with meaningful solutions. Instead, each of us needs to band together to take back control of our healthcare.

The system is rigged against us, and now is the time to rise up and take control of our future.

Imagine a future where you are not dependent on an employer or third parties, but instead, you can practice medicine with the professional autonomy you have earned. This means truly helping patients and enjoying the lifestyle you have always envisioned.

We Need To Band Together and Invite Others to Join

You are one of over 2000 doctors who are currently part of our SimpliMD community. Thank you for joining me on this empowering journey for our profession!

Today, I am reaching out to you for your help because I have a vision to grow our community to 10,000 members over the next year. Why? Because there is power, momentum, and inspiration in numbers when it comes to changing the mindset of doctors.

Yes, I know 10,000 members is a big, hairy, audacious goal. However, I firmly believe it is possible because doctors across the country are exhausted and frustrated with the current insanity of traditional employment. They are actively seeking solutions and answers.

Sadly, young doctors who have recently completed their training often have limited knowledge of what lies ahead for them, as they are often pushed into employment without fully understanding the implications.

Knowledge is power.

Every doctor needs to know that they have options beyond traditional employment.

You might be wondering about our plan to get this message out and grow our community five-fold in one year. Will we buy a bunch of email lists, create clever lead magnets, or pay a media company to assist us?

Nope, simply put, I want to do it with YOUR help.

No matter where you are on your micro-business journey, being connected to our SimpliMD community empowers you with valuable knowledge. Our stream of content consistently keeps you informed and equipped, hopefully empowering you to thrive!

Now is the time for you to share your knowledge and empower your physician friends who may be lacking business literacy and are unaware of what they are missing out on.

I Need Your Help

The reality is that physicians have a deep respect for and listen to their colleagues, particularly those who possess similar knowledge and expertise. This mutual understanding forms the foundation of effective collaboration among doctors. The secret lies in one doctor sharing trusted professional solutions with another doctor.

The most effective way to grow our community is by reaching out to YOUR professional peer network and inviting them to join us in our valuable community. There aren’t many strings attached or any fancy affiliate links involved.

The first step is to invite others to join our movement by signing up to receive our regular emails that will provide information and inspiration about physician own micro-corporations. You can easily do this by sharing the following link: https://www.simplimd.com/doctorvirtualcommunity

As an added bonus, when they sign up, they can also download my best-selling book“Doctor Incorporated: Stop The Insanity of Traditional Employment and Preserve Your Professional Autonomy” for FREE here. (Yes you can download it too)

Please send them the links to our virtual community and the free book. Encourage them to join you in our community!

But wait there is more! If you send out 5 or more invitations to your peers, just email me at tod@simplimd.com and I will send you the link for a FREE annual membership to SimpliMD worth $2500.

By the way, I would like to suggest that you become a SimpliMD member and then sign up to become an affiliate before sending out your invitations because it could be financially advantageous for you.

To ensure the best experience for my affiliates, I prefer you to become members first. As an added incentive, I’m pleased to offer you a 50% off coupon for your membership here. Simply use the code “MEMBERSHIP50” at checkout.

I invite you to take your next step now by committing to become a member of our SimpliMD community now.

The Mission

Now let’s come back to exploring my dream of our community being one that empowers and supports physicians everywhere in their micro-business endeavors.

Imagine a community where physicians who own micro-businesses come together to share their experiences, challenges, and triumphs. This community would serve as a safe haven where doctors can find resources, advice, and inspiration to navigate the often turbulent waters of running micro-corporations that intersect with their lives as healthcare professionals.

It is a mission born out of my personal experience that there is a hidden professional space for doctors that needs exposed.

Our Mission at SimpliMD is to inform, inspire, and support physicians to flourish through micro-business competency, which in turn will empower doctors to thrive in their roles as both healers and entrepreneurs.

In the upcoming weeks, I will delve deeper into this mission for our SimpliMD community and thoroughly review the Roadmap for achieving this mission and vision.

Following that, I will examine what I refer to as the SimpliMD Way—a set of 9 practices that are critical to flourishing as micro-business owners in the marketplace.

I look forward to having you join me and help shape the future of our micro-business community.

Oma, You’re Going to Soar!

Oma, You’re Going to Soar!

Rural Family Medicine

I am passionate about providing comprehensive family medicine care, including surgical obstetrics, to my beloved community. I have been dedicated to this for nearly 30 years. I must admit, it’s not easy being on call frequently or having unpredictable deliveries interfere with a clinic schedule or home life. However, the joy of bringing a life into the world and caring for the baby, mom, and the entire family throughout their life cycles far outweighs any challenges.

Freedom To Stop Working

For several years now, I have been envisioning my retirement next summer, and I owe a big part of that to achieving financial independence a few years ago. My arrival at FI was dramatically accelerated 10 years ago when I started my PC and transitioned to an employment lite contract. It restored my professional and personal autonomy and has brought newfound freedoms that have culminated in this beautiful plateau, where I no longer have to work. Now, I have the wonderful opportunity to pursue my passions, which include sharing my experiences with fellow doctors and helping you thrive with the incredible range of products and resources available at SimpliMD.

In fact, my experience reveals what is possible for you, and it embodies the most fundamental message and mission that I have at SimpliMD.

Your professional micro-corporation will preserve your personal and professional control over your life and significantly improve your financial well-being.

This message is the very reason why I embarked on this business journey – to reignite and inspire the possibilities within our profession. Instead of passively allowing the big 3 of government, corporate medicine, and insurance to control us, I am here to empower and help our profession regain control of our own destiny.

This opportunity is available to every one of you, and each should seriously consider starting your own professional micro-corporation.

Succession Planning

As I prepare to retire, my plan is to continue living in my little town, with my home nestled along a tree-lined main street. My wife and I absolutely adore this community and have formed deep connections with many of the people who live here. Our house will continue to serve as our home base for fulfilling our dreams of traveling to experience the wonders of the world and visiting every national park.

In that context, we will transition from being providers of healthcare to becoming consumers of healthcare in our little town. I am personally motivated to ensure that there are quality healthcare providers in our community who can take care of me, my family, and the thousands of citizens I have shepherded over the years.

But I’m not just looking for any doctor or NP to come on board and replace me. I’m specifically seeking those who are willing to go the extra mile by providing maternity care. With that in mind, I have dedicated myself to diligently working on succession planning. My goal has been to identify and recruit family medicine doctors who are not only passionate about practicing rural medicine but also have a specific focus on obstetrics. This includes the challenging task of finding rare doctors who specialize in surgical obstetrics. Unfortunately, the pool of doctors who fit this profile is shrinking every year. Recruiting doctors can be challenging, and retaining them can be equally tough. I consider myself fortunate to have found two doctors who fit this profile. Over the past 4 years, I have worked diligently to mentor them and prepare them to eventually take over my role completely.

Granted, since I don’t own the practice (I work under an employment lite contract), it’s not my responsibility to make this happen. While it is ultimately my employer’s responsibility, I also see myself as an ambassador of sorts in the process. Therefore, due to my long-standing passion for family medicine, obstetrics, and rural medical care, I have a mission to ensure that my little community has exceptional doctors to take care of its families.

Perfect Match

Oma completed her OB fellowship in New York and was looking to relocate to Indiana to join her fiance, who works here. She has a great personality, loves delivering babies, performs surgical obstetrics, and has a strong desire to come to Indiana. I am so happy that she chose our site for her first job as an attending. I promised her that when she arrived, I would spend time teaching her the art of rural medicine, and mentor her in her role of being an attending physician.

It’s Lonely & Hard

Mentoring her involved learning the practical skills of surgical maternity care in a remote setting. It also included navigating the personalities and preferences of the many obstetrical and non-obstetrical doctors she had to interface within her professional network. For example, knowing whom NOT to call for assistance can be just as important as knowing whom to call. In other words, not all OB/GYNs, Perinatologists, or Neonatologists are fans of family medicine obstetrics.

One aspect of mentoring involves learning how to manage the pressures and tensions that come with working in a rural hospital, where one may often feel isolated and alone as the sole doctor on the unit. During the daytime when most of the medical staff is available, things are pretty straightforward. But the feeling is vastly different when it’s 3 a.m. and you find yourself alone in the hospital, performing an emergency c-section while simultaneously providing medical care to both the mother and baby. Everyone in the operating room and nursery is looking to you for leadership and guidance. Doing this requires confidence, courage, and skill. It’s certainly not for everyone. You must learn to lean into and trust the support of ancillary staff to assist you, while always maintaining your awareness of risk management and safety issues. It is a truly learned art, and having experienced colleagues available to provide advice and help process the events of the prior days is crucial for the professional development of all doctors. We are all humans after all and we need safe and caring physician mentors who genuinely care about the unique day-to-day experiences we have as doctors. We are not machines, nor are we superheroes!

Mentoring

During the past year, I dedicated my time to mentoring Oma, helping her embrace this community and develop the necessary skills to thrive in this unique rural setting. She has been embraced by everyone, from patients to staff, and quickly learned what was needed to thrive. Mentoring in a rural community involves more than just helping a new attending manage various aspects of a clinic and hospital setting. It also includes teaching them how to connect with the community at large. Oma has done this, and it’s an absolute joy to work with someone who is a fearless, quick learner and has a strong drive to succeed.

Unexpected

But in the midst of all this, just a little over a year prior to my retirement, our employer began making changes due to “financial losses after COVID”. This led to significant changes in both the clinic and the hospital, culminating in the difficult decision to close our hospital’s OB unit just over 4 months ago. It was primarily a financial decision, but it was also influenced by the challenges we faced in recruiting and retaining OB/GYNs and 24-hour anesthesia services in our rural area. Of course, this is a national issue, and now we officially become just another of the growing maternity desserts in our nation. Our community was devastated by this loss, especially after nearly a century of having maternity care in the hospital. I was devastated after investing my entire career in rural maternity care here. Oma was devastated because her first job turned out to be a bust, and her dream of taking over my thriving family medicine maternity practice was now shattered. I couldn’t help but feel a deep sense of guilt for bringing her here, only to have all of this unfold. It was a situation that was completely beyond my control, and it became an unimaginable chapter in the story of our community hospital.

The end result was the loss of two doctors whom I helped bring to our community to provide maternity care. Unfortunately, this has only exacerbated the physician shortage crisis that is already common in rural communities. My hospital is working hard to replace these two doctors, as well as myself. However, there are currently no prospects on the horizon, as younger doctors are simply not as interested in living in rural areas as they were in the past.

Adapt

Over the past 30 years, I have learned many things as an attending physician, and one dominant theme that stands out is the necessity of adapting to market changes in modern medicine. That’s how I ended up starting my self-employment journey as a long-term independent contractor a decade earlier, due to changes at the hospital and with my employer. Therefore, drawing from my past experiences with corporate medicine, I mentored Oma and guided her through her options to help her adapt to this sudden change. The bottom line was that we both knew she would need to find a new location to practice surgical obstetrics and ideally, it would not be extremely disruptive to her and her husband. Fortunately, she was able to find a new position nearby, working with another family medicine doctor friend of mine who specializes in surgical obstetrics. Even better, it was less than a 30-minute drive away.

Coach and Thrive

I am confident that she will thrive in her next job. She is a great young doctor. Her experience has taught her that she can’t trust employers, as change happens all the time. Preserving control over your professional life is an important part of thriving as a doctor. I have mentored her and assisted her with the transition into her first year—including these unexpected changes.

Now, I am excited to take on a new coaching role with her and she moves away from my day-to-day influence. Although neither of us knows exactly how things will unfold for her, I am eagerly looking forward to guiding her through my SimpliMD coaching program.

I wholeheartedly believe that every doctor should have teachers, mentors, and coaches in their circle. Life is truly better when we have others to support and guide us.

I invite you to take the next step yourself and strengthen your professional circle with one of these options:

  1. Grab my free e-book on Why Every Doctor Needs Teachers, Mentors, & Coaches

  2. Become a Member of our SimpliMD community and actively partake in the many teaching resources we have for growing your micro-business competency, as well as imbibe mutual mentoring through our FB community “Every Doctor Is A Business”

  3. Sign up to allow me to coach you through one of my SimpliMD Coaching programs

  4. Sign up to join our live stream webinar on September 29th at 8:30 pm EST “Are You Ready To Take Control of Your Future?”

Don’t wait, take one of these steps now!

Business Coaching & DURP Compliance

Business Coaching & DURP Compliance

Coaching and Compliance

One of the benefits that my micro-business coaching clients receive is micro-business updates and coaching on how to use guardrails to comply with various business and tax laws that interface with small business owners.

In this context, there are published Federal, State, and IRS documents for small business owners that align with what we refer to as “standards of care” in medicine. In medicine, we inform our clinical decision-making with standards of care, but we also include our experiences and shared knowledge through what are known as published “case reports”. These narratives provide us with valuable information on how to manage emerging or unusual medical conditions. This combination of these information sources leads to the application of our medical knowledge to patients in what is commonly known as the art of medicine.

In the small business world, there are similar case reports that are filtered through tax and legal professionals as they file IRS audits and monitor court cases. In turn, these case reports inform how federal, state, and IRS officials are interpreting the application of various standards with small business owners. It’s this combination of guidelines/laws/IRS code and the experiences/case reports that inform professionals on how to guide their small business clients.

At SimpliMD, we are dedicated to closely monitoring the ever-evolving and ever-changing business and tax laws. Our commitment is to stay up-to-date and well-informed on matters that directly impact physicians and their micro-corporations. We take great pride in sharing this valuable knowledge with our physician clients.

This is one of the areas that sets us apart as an agency that offers physician business consultation, courses, and coaching to our community. It’s what makes us truly unique. The ever-changing nature of small business laws, regulations, and tax codes emphasizes the importance of having a professional agency to monitor these factors and assess their impact on your financial well-being. This is especially crucial for doctors and their micro-corporations. We are a niche agency and online community solely focused on your unique life as a doctor.

Tax Planning

I hear it over and over again in our SimpliMD community, Due to your high income, tax planning, and strategies are a significant concern for all of you. This is particularly true for those of you who are traditionally employed as W-2 workers. But the W-2 planning also affects micro-business owners because they too receive W-2 income—in the form of salary from their own business.

So, keeping in mind that both traditional workers and self-employed doctors interface with W-2 tax planning, let’s take a global perspective and remind ourselves of the tax planning options available for W-2 workers.

Helping W-2 Employees

Generally speaking, high-income income-earning W-2 workers have fewer options for tax planning. However, there are still some effective methods that can be utilized, including:

  1. Maximize your opportunities for itemized deductions.

  2. Maximize your retirement accounts

    1. Take advantage of pre-tax contributions and employer matches.

    2. Use after-tax contributions such as a Roth, or for most doctors a Back-Door Roth.

  3. Open an HSA account—make sure it is maxed out because it’s essentially a stealth IRA.

  4. Rental properties— these can be a powerful tool to accelerate your wealth and minimize your tax burden. I highly recommend a Semi-Retired MD to resource you in this area.

  5. Start a small business—the easiest and most natural option is to start your professional micro-corporation. However, any small business can be helpful.

Helping Professional Micro-Corporation Owners

As I work with various types of doctors, I have noticed a growing trend of doctors engaging in job stacking. This involves combining a W-2 job with 1099 side jobs. Those doctors will utilize all the tax planning strategies mentioned above. However, by utilizing a micro-corporation for their 1099 income, they will unlock numerous additional tax planning options. It’s beyond the scope of this blog to delve into those options, but suffice it to say, that it typically involves the wise utilization of pre-tax business deductions.

Coaching Corner & Dwelling Unit Reimbursement Program (DURP)

I had a quarterly coaching meeting with a client whom we helped convert to a PC-Employment Lite program a few years ago.

He is extremely pleased with his transition from traditional employment. One of the tax-saving business expenses we incorporated into his micro-business structure is what we refer to as a Dwelling Unit Reimbursement Program (DURP), commonly known as an Augusta Rule. It’s an excellent opportunity to generate tax-free income from your business to your household through the periodic rental of your home to your business. However, it’s important to consider the legal, tax, business, and documentation aspects to ensure proper execution. At SimpliMD, we offer comprehensive guidance to our business consultation clients in navigating these considerations and also work with our legal network to ensure that your dwelling unit rental plan is properly embedded into your corporate bylaws. Both elements are essential to have in place in the event of an IRS audit.

One component of our program is to review our clients’ DURP meeting minutes for compliance adequacy, paying close attention to any evolving federal, state, or IRS changes.

When it comes to DURP interpretation from the courts and IRS, there have been some recent updates, and here is what I discussed with my coaching client.

DURP Compliance Update

After collaborating with our legal & tax professional network and based on recent IRS cases that have scrutinized DURP meetings in the small business community, we are making the following recommendations for SimpliMD members and clients, effective immediately:

To ensure compliance with the changing IRS interpretation of dwelling unit rental for your business, you must include the following elements for your 14 meetings DURP meetings per year:

  • General considerations that have not changed:

    • Schedule Meetings at Your House

    • Take Corporate Minutes

    • Find Comparables

    • Invoice the Business

    • Pay the Expense

    • Document Income/Expense Write Off

  • A DURP meeting requires a disinterested person, as defined in section 672(c) of the Internal Revenue Code, who must physically attend the meeting at your dwelling for a business purpose. A disinterested person refers to someone who is neither related nor subordinate to the business owner(s) involved. This means that owners, employees, and family members who attend your business meeting do not qualify for this designation.

  • As a professional micro-corporation owner, there can be a host of business purposes to have someone come into your home, and here are some suggestions:

    • corporate financial, wealth management, benefits services, banking, legal, and marketing services that are connected to the operation and management of your professional micro-corporation.

    • Business development that includes:

      • Management of your professional network and PC business contacts, professional peer relationships with other doctors

      • Business opportunities

      • Business medical market monitoring and analysis for changes, and threats. and challenges.

      • Professional relationship development & maintenance with teammates, staff, and management who are not employed by you. For example, if you are in a PC-Employment lite contract this would include all of your support staff.

      • Recruitment of staff, providers, and management that support your contracting work but are not employed by you.

      • Patient panel development growth, maintenance. Patient loyalty, pride, and attraction to your PC brand.

      • Charitable giving and advertising interests for your professional micro-corporation.

      • Your global mission to community health through monitoring and improving the health & wellness of your neighborhood, town-city, region, state, nation, or world.

  • The person who is disinterested in attending does not need to participate in other aspects of your micro-business or any associated meetings. Even though you may choose to document your micro-business meeting on the same day that the disinterested party visited your dwelling, it’s important to note that your business meeting and notes are not considered part of the DURP meeting.

  • You are allowed a maximum of 14 tax-free meetings per year for your DURP.

  • These meetings do not need to be held monthly but should be scattered sporadically throughout the year. For example, you might have three DURP meetings in one month and then none for the next two months.

Frequently Asked Questions

Q: Can a disinterested person attend a DURP meeting via Zoom?

A: While the COVID pandemic significantly changed the landscape of in-person meetings, businesses are now shifting back to pre-pandemic face-to-face meetings. While we understand that some CPAs and attorneys may suggest that Zoom meetings qualify, we prefer to take a conservative approach and advise against using Zoom to support attendance by disinterested individuals. The only exception to this would be a person who initially planned to attend in person but, due to unforeseen circumstances, had to switch to a Zoom meeting.

Q: What if my business doesn’t have the cash flow to pay my household for 3 DURP meetings in 1 month?

A: You can work with your accounting professional to suspend, hold, or partially reduce your paycheck or some other reimbursable business expense until your micro-corporation has the cash flow to make up the deficit.

Q: What if I don’t have 14 disinterested individuals come to my home for business purposes throughout the year?

A: You can only be reimbursed for the meetings that qualify for a DURP, regardless of the number. The simple solution is to invite a person/persons to your home who has a business purpose mentioned above. However, there may additional tax-efficient options for transferring money from your business to your household beyond DURP meetings. We recommend you speak to your tax or legal professional about this.

Q: Does the uninterested party attending the meeting in my home need to know that it’s a DURP meeting?

A: No, they do not need to know this information. However, if asked during an audit, they should be able to discuss any personal or professional business matters that were discussed. Ultimately, it’s all about the narrative of why someone was in your home. It is possible to mix business, entertainment, and hospitality.

Q: I’m not sure if I have 14 disinterested people in my social circle who would want to come to my home to discuss personal and professional matters. My life is pretty busy and quiet, and I don’t have many non-family members visiting my home. Can the same person visit 14 times?

A: We don’t recommend having the same person every time, but it’s possible to have a repeated disinterested person throughout the year. The easiest way to approach this is to consider your professional network and periodically invite someone over for a coffee, drink, or dessert. The conversation doesn’t have to be too formal or strictly business-oriented. You can discuss virtually any aspect of your medical-professional life, just like you would in the old-school doctor’s lounge. Of course, other businesses may visit you to discuss the intersection of personal and business matters, such as your wealth manager or insurance salesman. Once again, it all comes down to the narrative of why they were there.

Q: Do I need to purchase food and provide a receipt for this type of meeting?

A: No, you don’t have to do this. However, we do like the idea of providing some sort of food (it can be simple) as evidence that food or beverages were provided to the disinterested person who attended. This is a common practice in business meetings, further evidence of a business meeting is that food is catered or provided to facilitate a comfortable and efficient meeting. One more thing to note: since your household is renting the space to your business, the cost of the food & beverages needs to be covered by your personal or household funds.

I hope you have found this information helpful, especially if you are utilizing the DURP meetings in your micro-business.

If this concept is new to you and you would like to use it as a great tax planning strategy in your micro-corporation, let us help you with a SimpliMD business consultation.

If you are already using a DURP, but after reading this, you realize that you need a professional to help beef up your by-laws and audit-proof your process, let SimpliMD help you with a business consultation.

If you are unsure and would like to discuss whether it can work for you, please reach out to me here for a FREE-minute business consultation to review your particular situation.

Lastly, if you don’t have a professional micro-business coach, I highly recommend signing up for my popular micro-business 4-pack coaching program here—our community members love it. It’s worth noting that it’s tax-deductible to your micro-corporation:)

Choosing To Work For Yourself Rather Than A Factory Owner

Choosing To Work For Yourself Rather Than A Factory Owner

Choosing To Work For Yourself Rather Than A Factory Owner

This is the final post in a three-part series on our role as workers in the healthcare factories of America. The first two posts were:

You Weren’t Designed To Be Healthcare Factory Workers

You Were Meant For More Than Healthcare Factor Work

We will conclude this series with my passionate exhortation for you to choose to work for yourself instead of being an employee in a factory.

Classifying Your Work As A Doctor

When you accept your worker classification as an “employee” to a large corporation, it puts you in a position where your professional status can slowly be eroded. Essentially, they gain control over you.

In contrast, establishing a micro-corporation and becoming self-employed is the most crucial step to maintaining your professional autonomy. It allows you to maintain control over your professional life and empowers you to define the type of worker you prefer to be: either an employee or a non-employee.

When it comes to your work as a doctor, there are multiple ways to view and organize it.

  • Length of work: Permanent (i.e.: long-term) job or Non-Permanent (i.e.: short-term) Job

  • Your worker classification: Employee or Non-employee (i.e.: self-employed, contractor, etc..)

  • Contractual Structure: Business to Individual (direct care models), Business to Business (old style private practice, contractor work, PC-employment lite, etc…), and Individual to Business (traditional employment)

  • Physician Labor From Corporate View: Employee vs Contracted-Temporary Labor

For a number of business reasons, factory owners will want you to be permanent(long-term) employees.

For a number of professional and business reasons, you should want to be a non-employee micro-business whose work could be either long-term or short-term. This will allow for maximum flexibility in your work and professional life and is consistent with the evolving view of work for Gen-Z and Millenial physicians—who prefer to job stack as illustrated below:

The Changing Reality Of Physician Labor

In the modern world, the concept of permanent labor is changing. Workers no longer seek to simply find a job and stay with it until retirement. Instead, they are actively seeking ways to enhance their career paths and pursue personal growth. They are embracing agility and adaptability, recognizing the importance of continuous learning and development. This is also true for physicians who are merging into the marketplace.

You can do this through a combination of long-term and short-term contracts or by starting your own micro-business. For physician workers, it’s all about having the flexibility and freedom to pursue your dream life and seize the opportunities that your professional status has to offer.

In line with this new physician-worker mindset, medical corporations are increasingly inclined to hire independent contractors or remote workers for their labor, rather than relying solely on permanent staff, whom they refer to as employees. This is especially true for jobs that require specialized skills or tasks that can be easily outsourced. Add in the layer of location-independent work, and you can see why the telehealth industry is experiencing rapid expansion, creating a plethora of job opportunities for you in this niche.

Moreover, employers have also become more open to offering a percentage of full-time equivalent (FTE) positions as an alternative to traditional full-time employment. This not only provides individuals with flexibility but also opens the door for them to potentially become long-term independent contractors rather than employees.

Long-Term and Short-term Non-Permanent Professional Labor Is Rising

You possess a unique superpower – the ability to function as a micro-business. In this evolving labor landscape with high demand for your professional services, you need to adapt and manage your medical career in a different way.

You have the power to embrace the modern view that all labor is non-permanent, while also reflecting your preference for flexibility, work-life balance, and quality of life as fully functional independent contractors.

There is a growing realization that designating your work as permanent professional labor is truly an oxymoron. While some may still be okay with being identified as an employee, others prefer to be called long-term independent contractors.

The concept of long-term independent contractors is a relatively new idea that deserves recognition and legitimacy as a distinct job category. It should be seen as separate from both traditional employment and short-term independent contractors.

Long-term independent contracting truly adds an important third category for workers and embraces the evolving cultural views of the labor force & this includes doctors

It is highly probable that newer generations of doctors will choose to embrace all three categories and shape their medical careers around a self-directed combination of employment, long-term independent contracting jobs, and short-term independent contracting jobs. The total workload will be self-determined and will support individuals in achieving their holistic personal and professional goals.

How To Earn The Right To Help Choose Your Worker Classification

Properly organizing yourself from the beginning of your career is crucial for several reasons. The most important reason is that once you become an employee, transitioning from being an independent contractor with the same employer later on becomes significantly more challenging.

Take These Steps To Preserve Your Autonomy

As you prepare to enter the marketplace, I enthusiastically encourage you to get ready for this exciting moment by following these steps to take control of your professional life and determine exactly how you want to interface with any job option. Doing it as an individual taxpayer (W-2) is easiest but has the most negative downstream consequences. Doing it as a micro-corporation (1099 contractor) requires some extra steps, but will lead to your best life as a doctor.

I highly recommend starting here to embark on your journey towards self-employment as a contractor through your own micro-corporation:

  1. Create a micro-professional corporation that can be utilized for your professional services in both long-term and short-term jobs—whether it be for a primary job or side jobs.

  2. Identify multiple sources of income for yourself. For most doctors, this will include a primary job along with additional side work. The monetary value of these side jobs is less important. What truly matters is having multiple income streams. This is not only beneficial financially, but it also solidifies your contractor status as you offer your professional services to multiple sources through your business. There are three general categories of income that can and will be created:

    1. Active Income-The income associated with your professional status as a physician typically requires your physical presence to generate revenue.

    2. Passive Income-Income generated from sources outside of your professional status may or may not require your physical presence to manage.

    3. Retained Income-My personal favorite is the approach that requires no extra time or work. It’s all about working smarter, not harder. In fact, a micro-corporation can typically unlock 10-15% of retained income for the average doctor.

  3. Once these two ingredients are in place, you have fulfilled what I would consider the minimum necessary characteristics for a company to recognize you as a contractor when they onboard you for work.

    It is crucial to note that by establishing your status as both an individual taxpayer and a micro-corporation, you now have the flexibility to be referred to as either an employee or an independent contractor by both yourself and any employer. This power is critical as you enter the marketplace.

  4. Next, if this were your primary job, I would highly recommend expressing your desire for a long-term relationship, if that is indeed what you’re seeking. However, it is important to discuss with your employer whether the job could be classified as permanent or non-permanent.—Your desire would be to be labeled as a “long-term non-permanent laborer.” Don’t be afraid of this designation, as virtually every physician contract is valid for only 90 days, regardless of whether it is permanent or not.

  5. It is important to note that, although they may refer to you as an employee, the contract they are offering you is legally a 90-day renewable contract that can last anywhere from 1 to 3 years. The terms of this type of professional agreement are ultimately more aligned with non-permanent labor.

  6. You & the employer can classify non-permanent labor as either an employee or a contractor.

    1. At this point, if you prefer to be an employee, you can walk through that door. However, please be aware that once you accept this classification, it may be challenging to be reclassified within the same company in the future.

    2. If you prefer working as a long-term independent contractor, you can present your evidence and confidently walk through that door. However, please be aware that you always have the option to later convert to an employee with the same corporation.

  7. There are several other characteristics that will clearly demonstrate to a corporation that you are a contractor. Check out this 11-point key graphic covering things:

Start Your Micro-Corporation & Consider Employment Lite

For several compelling reasons, I firmly believe that every one of you should establish your own micro-corporation right from the start of your career. Then you will have the opportunity to maintain control over how you want to utilize, or not utilize, a business structure in any job situation.

If your primary job is to provide professional services for the patients of a large corporate employer, it would be wise to consider receiving your earnings as an independent contractor (1099) rather than as an employee (W-2). Before you jump to the assumption that this means you’ll be going into private practice, let me introduce you to the hidden yet most rewarding form of employment available to doctors. It’s called “employment lite,” and it’s a fusion of employment and independent contractor work through a professional services agreement. Think of it as long-term independent contractor work.

This arrangement offers numerous benefits and one of the most compelling reasons to consider it is the significant impact it can have on reducing your effective tax rate as well as preserving your professional autonomy.

Here’s a graphic of what it looks like:

Prepare For The Future

Don’t wait to start your micro-corporation, because the hard truth is that once a large employer hires and designates you as an employee instead of a long-term independent contractor, it will become very difficult to change your designation back to an independent contractor. Over the years, while coaching physicians, I have repeatedly witnessed this scenario play out. No matter how much you may desire to change your job title, your current employer will often be hesitant to allow you to transition to the status of a long-term independent contractor.

Force The Decision

I firmly believe that opting to be called a long-term independent contractor will offer you the predictability and security you desire, while also providing the flexibility and quality of life you need.

I can personally attest to this because I made the transition from being a traditional employee to a long-term independent contractor at the same job with the same corporation about 10 years ago. Let me tell you, it was the best decision I ever made, beyond the decision to marry my dear wife. My best-selling book walks you through that journey.

Be Ready For The Opportunity(s)

To be recognized as an independent contractor in the marketplace, it is essential that you prepare yourself to make the best possible choices. This involves organizing your work and being prepared to take the path that suits you best.

The question of whether you are a contractor will come up repeatedly throughout your career, especially when it comes to side jobs. That’s why it’s valuable to start a micro-corporation for your professional services early on because you will inevitably need it.

In my opinion, during the latter half of your residency is ideal You can not only use it for moonlighting but also position yourself to secure your first attending physician job.

Action Steps

The latest generation of doctors has become convinced that traditional employment is in their best interest. Corporate employers are also making strong efforts to persuade you that it is the best option, especially with the attractive financial incentives they offer at the beginning of your career.

But it’s time for doctors to wake up from their passive slumber about their professional lives.

Here are 4 action steps for you.

  1. Become a member of SimpliMD.com and join a community of physicians who are on the journey of becoming micro-business competent. Our newly revamped website will provide you with a wide range of free and paid resources Membership unlocks $2500 in savings at the site.

  2. Purchase a copy of my best-selling book “Doctor Incorporated: Stop The Insanity of Traditional Employment and Preserve Your Professional Autonomy” and read about my personal journey to a micro-corporation.

  3. Join my live webinar scheduled for September 29th at 7:30 pm CST called “Are You Ready To Take Control of Your Future?” where I will be speaking to residents and fellows in the Dallas-Fort Worth area.

  4. Reach out to me to schedule a FREE 45-minute business consultation to discuss your professional life.

We must take back control of our profession by establishing a micro-corporation and leveraging it in the marketplace. This will empower us and liberate us from the grasp of corporations that seek to manipulate and dominate us!

You Were Meant For More Than Healthcare factory Work

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.

Four 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.

Doctors weren’t Designed to Be Healthcare Factory Workers

Doctors weren’t Designed to Be Healthcare Factory Workers

by Tod Stillson MD

You can also find this post at SimpliMD.com

Learning To Work In The Factory

Since the age of 10, I have been working for large corporations. It all began with my first paper route, where I would ride my bicycle around, delivering the local news to the citizens of my quaint little town. I come from a family of factory workers, and during my primary school and college years, I earned paychecks by doing the most challenging job at the factory. That is because short-term and part-time workers in factories often have to take on the “leftover jobs” that no one else wants. I’ve taken on many difficult tasks to earn a few dollars, and some of those dirty jobs in the factory are simply unimaginable. But that’s just how it rolls when you’re starting out in life or working part-time. You simply accept the job, do as you’re told, and remind yourself that it’s all temporary.

The Balm of Payday

The joy of payday momentarily erases all the mental and physical pain that comes with a demoralizing job. For me, working at the factory wasn’t the end, but rather a means to acquire the assets needed to reach the next goal. The demoralizing work could be made tolerable by acknowledging that it was only short-term. On the other hand, long-term factory work was a completely different game that required a higher level of selectivity, patience, time, and luck in order to be promoted to a better shift, machine, conveyor belt, or job. This was demonstrated to me by my dedicated parents, aunts, uncles, and grandparents who faithfully punched their time cards week after week, and then joyfully embraced their time outside of work.

The Job Pool

Ultimately the factories were where the predictable, higher paying, and benefit-laden jobs were located in comparison to retail jobs or small businesses. These large corporations were the go-to locations for employment opportunities. The factory owners had significant control over the job market, making them the default source of work if you weren’t in management, professionally trained, vocationally trained, or owned your own small business.

In a strikingly similar scenario to my factory working days as a non-professional, our tribe as modern doctors are being compelled to select from a limited range of job options that are dictated by large corporations. In the past our status as a professional earned us the power of autonomy and self-determination. For most that included joining the ranks of other small businesses in a community and then delivering a professional service to the free market of patients/citizens in that community.

A Commodity and Corporate Asset

Today, as you transition into the role of an attending physician, you essentially receive a job board that is controlled and manipulated by large employers. These employers, in collusion with recruiters, offer enticing job offers filled with incentives to attract employees to the healthcare factories of America. While they may not be referred to as “factories,” they are commonly known as “health systems. This may sound better than a factory, but essentially, that’s what they are when you become their employee. You are reduced to a nameless, faceless corporate commodity, labeled as “physician labor.” Here, you are treated like a mere machine on their assembly line, where your skills and expertise are exploited solely to generate revenue for others.

By willingly entering the economy as mere employees, we diminish our professional status to a level that is comparable to our non-professional counterparts. Their job opportunities are limited to being loyal employees of someone else’s successful business, and unfortunately, we find ourselves in a similar situation.

In American culture, generally speaking, the more educated and professionally successful you are, the higher the likelihood of gaining the power to be self-employed and function autonomously as a micro-business or service professional.

Unless you are a doctor.

Our conditioned training often leaves us business illiterate, comfortable with being subjugated to the control of others, and accepting of a healthcare system that has been hijacked by the government, big corporations, and insurance giants.

Thus we blindly accept the “safe harbor” of employment because it’s for “our benefit—all the while not understanding the harm that this “safe” space will eventually cause us with a greater than 50% burnout rate.

When we clock in at these healthcare factories, we often find ourselves unaware of the self-imposed mouse traps we enter. It’s amazing what we don’t know about the challenges that lie ahead—always assuming the burnout would happen to someone else.

Industrial Workers In Medicine

Our tribe has transitioned into becoming industrial workers in medical factories operated by large corporations, which have a strong grip on the job market. This has become our primary job pool.

Those of you who are becoming new attendings are overwhelmingly choosing to work in medical factories because it predictably helps you absolve your educational debt. Just like in my younger years, employment offers the essential elements for achieving independence. Many of you aspire to attain a level of freedom that will liberate you from the burdens of debt and working for someone else.

The Trap of Inter-Dependence

However, employment can sometimes feel like a bit of a trap. Once you begin depending on your employer for support, it becomes progressively more difficult to break free, even if the situation is detrimental to you. You will quickly become accustomed to “punching the clock” by fulfilling your contractual hours. This will enable you to enjoy a high quality of life, a predictable paycheck with benefits, and the pleasure of a non-work lifestyle that you can fully define and control. This piece will increasingly serve as your escape valve from work that can sometimes feel soulless, monotonous, and devoid of purpose or meaning.

Don’t let your hope and dream of being the captain of your professional life, making a good living while altruistically helping others, be lost as you become a mere medical machine in your employer’s enterprise.. Don’t limit yourself to seeking control over your life only outside of work. Even in your non-work space, you may find yourself dreaming about a professional change that can bring you the level of autonomy you desire at this stage of your life.

Most of you won’t intend to work at the medical factory for the C-suite executives for your entire life. You see it as a temporary means to an end – a stepping stone towards professional and personal independence. The goal is to achieve autonomy, not rely on interdependence or co-dependence.

Newton’s Law of Inertia

According to Newton’s Law of Inertia, once you start working in a healthcare factory, it is unlikely that you will change paths.

Newton’s first law of motion, also known as the Law of Inertia, states that an object at rest will remain at rest, and an object in motion will continue moving in a straight line at a constant speed unless acted upon by an external force.

This law has had a profound impact on our understanding of physics and can also be used to explain human behavior.

When it comes to human behavior, Newton’s first law is particularly relevant. People often find themselves sticking to the same habits or routines until they are compelled to break free from them, whether it be through a significant event or the influence of someone else.

For example, when a person is stuck in a rut and unable to find a way out, an external force must come along to break them out of their funk and help them change their trajectory.

Change Becomes Harder

For you this means that making any changes becomes increasingly difficult throughout the span of your 30-plus-year professional career. Your large house mortgage, kids in schools they don’t want to leave, a spouse who doesn’t want to move “again,” and a revved-up lifestyle that strains your finances all make it difficult to make professional changes. Moreover, doesn’t leaving a job look unfavorable on your resume and reflect a sense of moral failure that can be psychologically detrimental to your career?

All of this will culminate in invisible forces that dismantle your dream of independence and transform your interdependence into an unhealthy co-dependent employment relationship. You find yourself in a situation where you can’t live with them or without them.

Coping Mindset: Things Will Get Better When…

As you revisit the delayed gratification mindset that carried you through all the difficult years leading up to your life as an attending, you will remind yourself that you have consistently made successful decisions, demonstrated high-level performance, and displayed an impressive ability to overcome any hardship that comes your way.

Thus being informed by this mindset, you will remind yourself that “things are going to get better, when…” This arrival script will create a futuristic mental escape that will dissipate the current pain.

While this powerful mindfulness technique does work, it may be a little misguided due to the risk of the arrival fallacy.

The arrival fallacy is a cognitive bias that often tricks us into overestimating the ease and speed with which we can achieve our goals. It is a false assumption to believe that once we reach a certain point, things will magically become easier and success will effortlessly follow. This bias can lead to unrealistic expectations, disappointment, and frustration when progress toward our goals takes longer or proves to be more challenging than anticipated. By recognizing this fallacy and understanding its effects, we can become better prepared for the unpredictable nature of life’s journey and learn to appreciate every step along the way.

In medicine, the arrival fallacy is particularly common during the first five years as an attending physician. The feeling becomes especially prominent in years 2-5, as the initial excitement of starting a new job (typically as an employee) wears off and the realization of having limited control over your professional life becomes clearer.

At this point, you can rely on the mindfulness technique that has carried you for years and label the disappointment with your job as a temporary adjustment that will be resolved in the near future.

You can confidently shift and re-formulate your expectations for the next arrival point, knowing that your frustrations will improve when “x” happens in the next 6-12 months.

You will tend to trust yourself to overcome the employment obstacles and inform those close to you that positive changes are on the horizon.

You Must Do Two Things

I am not gonna lie, my wife is tired of hearing me talk about this annually for the first 15 years of my career. Like a giant chess board, I would make adaptations to my employment environment only to feel like my employer simply responded with their next move. Back and forth we went til ultimately I felt backed into a corner by my employer, out of moves—-thus making me feel helpless, controlled, and undervalued.

This reminded me of when I was younger, mindlessly making widgets on the assembly line of the factory—controlled by the time clock and production quotas. I would cope by engaging in mental gymnastics to make the day more bearable, immersing myself in daydreams about what I would do after punching out of the time clock.

Unfortunately, my dream job as a doctor now evokes the same feelings as when I was a factory worker. We are stuck doing someone else’s stuff until we can be set free to autonomously do what we really want to do. Our work just becomes a monotonous job and our meaning & purpose are found in our non-work lives.

You were meant for more, don’t settle for less!

The combination of meaningless work and the loss of professional autonomy are the key ingredients of the most sinister employment consequence of all-burnout.

The paradigm I have described is one of the fundamental reasons our tribe is experiencing significant burnout. It is a systemic problem that requires a solution focused on restoring our autonomy.

But the government and the healthcare systems are not going to do this for you. You have to take responsibility for two things yourself:

1. Do not give up your professional autonomy in the first place.

  • This involves creating your own professional micro-corporation as a virtual shield to protect your professional life.

  • This involves resisting the urge to follow the herd and blindly signing up to become an employee of a large corporation..

2. Fight to preserve your professional autonomy throughout your career.

  • Choose self-employment through our micro-corporation and contract out your professional services, whether it’s for short-term or long-term engagements.

  • Take proactive steps to establish yourself as a contractor in the marketplace, and ensure that those who seek your services engage in a business-to-business relationship rather than an employer-employee dynamic.

What should you do with this information, proactively take a step to make yourself micro-business literate by becoming a member of the SimpliMD physician business community.

Go here to download my free e-book “7 Business Hacks For The Modern Physician” which describes more reasons to take this step.