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Oma, You’re Going to Soar!

Oma, You’re Going to Soar!

Sep 16, 2023

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!

You Were Meant For More Than Healthcare factory Work

You Were Meant For More Than Healthcare factory Work

Aug 23, 2023

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

Aug 18, 2023

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.

Truth – There Are 10 Administrators for Every Doctor

Truth – There Are 10 Administrators for Every Doctor

Oct 23, 2020

Hi everyone, it’s Dr. Incorporated bringing you the Truth About Employed Physicians. I want to thank you today for that PA that you worked on in your office or your clinical setting. I don’t know about you, but PA’s are such a pain in the rear. And I know that you’re probably getting ready to wind up your day, and before you know it, you got a fax on your desk or perhaps a note came across your desk or some message that was communicated to you that you had to complete some documentation that would allow a patient to get their medicine or to get their procedure done in the proper way for the insurance to cover it. And quite honestly, you may have been tempted to just say “I don’t have the time, or I’m tired of dealing with this.” But you didn’t. You realized that there was a patient behind that PA, and you remembered that patient, and what was going on with them. You reminded yourself, “if I was that patient I would appreciate the person working behind the scenes on my behalf to make the extra effort to get done whatever is needed to help them receive better health care”. And today you made that choice. You finished that PA before you went home, and even though it took you a few extra minutes. I want to thank you for that work–thank you for the way that you are taking care of patients, and thank you for the dedication, you have to a system that doesn’t always value you as a physician (or at least value your time or your medical decision-making). But I value you and I know what it’s like to keep battling on those front lines and keep remembering those patients are the reason that we do what we do.

10 Administrators

That brings us to today’s truth. “There are 10 health care administrators for every one doctor.” See the graph above, with 10 year old data and it pretty much says it all! This is probably not a surprise to most of you, but the question some of you are wondering is why does that matter? That’s what I’m going to unpack for you. Those administrators have a big influence over your life, your quality of life, and your sense of well being. One of the realities that this 10 to 1 ratio introduces is that you’re going to be micromanaged as an employee. There are going to be 10 people looking over your shoulder watching what you do, and not necessarily offering to help make your life better or more efficient or even more productive. Physicians are pressed for time, especially with the growing documentation demands that come between you and your patients.

Frankly, administrators have more time than you. They have sharp pencils, and they’re very interested in the productivity of one of their primary engines for profit-making, which is you, the employed physician. They can’t do what they do unless you are being efficient and productive. And yet, for that very reason, they find it beneficial to micromanage your work and what you do.

It Takes a Village of Administrative Helpers

Don’t you wish that some of those administrators could actually put on the white coat and wore a stethoscope around their neck in order to help your medical assistant, your RN, or your LPN in the trenches with patient care? That would certainly be more helpful than sitting at their desk and micromanaging what’s going on with you? It’s really a crazy time that we’re in right now. I saw a statistic recently that said it takes 16 healthcare employees to support what one doctor is doing with his average patient population. That’s up from about 14 healthcare employees two decades ago and this is even fewer than that 30 to 40 years ago when it was less than 10 support staff. For those 16 people in our medical office, six of them were involved with touching a patient, managing patients, and taking care of patients with a physician. The other 10 have to do with health care management and healthcare administration. That’s just an absurd statistic to me and it points to why health care is so goofed up today. But so be it. It is what it is, and as employed doctors, we’re very aware of all these elements that go on around us. 

Revolving Doors

Another element of having 10 administrators for one doctor is your direct report administrator will change frequently. I am certain that many of you have experienced this already, whether it be your office manager to change positions, or perhaps your area coordinator, the Vice President of Clinical Services, or even the hospital CEO. There are so many people involved in that chain of administrators that surround you and your fellow physicians that those people are changing all the time. They’re on a corporate ladder and they’re moving up or they’re moving out. It’s frustrating to finally develop a relationship with an administrator that understands you and the nuances of your medical practice, only to have that person move on with little warning. It’s just part of the normal process when it comes to corporate life. The movement of healthcare administrators is very different from most physicians who tend to stay in 1 location for an extended period of time. Much like a new head football coach who has to align with the starting quarterback he inherited, administrators and doctors have to go through the same dance. This can be exhausting and exasperating for many employed physicians.

Are You Known?

Being an employed physician you’re now involved in corporate life. It’s really an unnerving thing, yet it’s a normal part of the process that we’ve all had to learn to adapt to. The truth is that many administrators may not even know your name. I find it very fascinating that a lot of administrators really don’t know who you are and don’t know anything about you. Being known by your employer is akin to being valued. And when you are unknown, it makes a physician feel undervalued.

You Are A Line Item On A Spreadsheet

But here is what they do know, your name is associated with a line item on their corporate financial spreadsheet. They know how much money you’re either making the company or how much money you’re costing the company. Quite honestly, you are viewed through the corporate lens of P/L. You’re not viewed through the same lens that your peers or even patients see you through, but you’re viewed through the lens of an administrator. This keyhole always asks the question of “have you done for me lately?” and “what are you doing for me in the future?” It’s a harsh reality, but as employed physicians, we lose our personal identity in the process of signing up for employment contracts. We really become a line item in somebody’s spreadsheet.

Rising Costs Are Not Due To Doctors

The cost of health care is increasing due to the burgeoning cost of 3rd parties and administrators, not due to the doctor’s pay. Doctors don’t make millions in salaries and stock options like hospital and insurance CEO’s do. Many of you are paid well, just like I am paid well. But relatively speaking, my pay is not going up at nearly the same rate that healthcare administrator’s pay is. It’s unbelievable how much money the CEOs of these healthcare organizations make. If you are unaware, see the image below. There are all sorts of levels of administrators that are making oodles of money, it makes me as a physician ask why am I working so hard when these people seem to be making all this money off of my work? The funny thing is I think the general population, including the patients themselves, think because health care costs are going up the doctors are making more money. But you and I both know, as physicians, it’s not us that’s making more money, it’s our organizations, administrators, and those corporate shareholders that are actually making more money, not us. 

Majority Rules

We also know that when there are 10 administrators for every physician that you’re outnumbered in the organization. We are the minority in the healthcare organization. Those health care administrators bind together, they unify together, they follow the corporate line together, and being in the minority as you are, your voices are diminished. You lose your autonomy, you lose your control. You become subjugated to those 10 administrators that surround you in their corporate lingo, policies, and plans that drive them, which is a much different architecture than we’re used to operating under. We are used to taking care of patients and finding our satisfaction in helping patients every day and making an honest fair living out of that patient care process. It takes an emotional toll on physicians when are constrained to fuse corporate citizenship with clinical care, especially when tension exists between the two. When you’ve got 10 administrators sucking the life out of you by undermining the autonomy and control you have in our professional life, while cloaking it in corporate alignment, it can be quite frustrating and unnerving, if you’ve not figured that out yet. 

Loyalty To The Company, Not You

An administrator’s loyalty is to the corporate ladder, not to you. You may think that your administrator, who is your direct report, or the person who is a few levels above you, have a certain amount of allegiance to you. As much as you believe they are committed to resourcing your needs as a physician, they are not. While they should seek to place you in the best environment to succeed, their interest lies in placing you in the company’s best position for the company to succeed. You become a cog in a wheel that is about clinical service line inititatives and capturing market share. You will be placed as an engine to accomplish those goals, or risk being eliminated. It’s just how the corporate jungle rolls. Some of you know the pain of being eliminated from your employment simply becuase plans changed for your employer. And trust me, thjey are always changing.

You Are A Sherpa

Here’s the reality; administrators are aligned with the loyalty of the corporate ladder because they know their livelihood and their sense of job security comes from that alignment. Their desire is to move up that ladder because each rung they move up that ladder, they make a whole lot more money, gain more power, and gain more respect. (remember they have more opportunity to make a whole lot more money than you do as a physician). I can’t blame them for reaching for the corporate pot of gold, but physicians have to understand that this drive up the corporate ladder is on your back. You become their sherpa, so to speak. In that context, you are needed, but perhaps you are less personally valuable than you perceive, because, in reality, you are a replacable part of their movement.

Income Ladder

The reality is that your pay as a physician is relatively capped when it comes to patient volume (wRVU’s) or what the fair market value payment is for your clinical and non-clinical workload. But administrators don’t operate under that same corporate cap. As they move up the chain, they make more money. Thus for most, their goal is to typically move up. This process separates their alignment with you, as they become focused on other corporate assets that need to be managed. They get further from the front lines of healthcare and thus further from you. And when push comes to shove, they’re going to fall in line with their corporate superior and not you if there is a concern with your line item on their corporate ledger. Some of you have been burned by these experiences, some of you have learned the hard way that administrators can’t be fully trusted due to this natural process for them. And this doesn’t even take into account the fact their movement often occurs from outside of your employer’s corporate circle. Thus when they come on board, they know nothing about you and your value to your medical neighborhood. The process of being known by them, earning trust, and developing mutual respect gets re-hashed again until they move on in search of better income, and the same process repeats itself.

I hope your experience with administrators has been good and mostly positive, as mine has been. But don’t forget where their loyalty lies.  It’s not with you.

A Growing Pattern

There are a number of downstream consequences to 10 healthcare administrators for every one doctor. That’s not going to change any time soon. In fact, it’s probably only going to get worse as the number of administrators in American medicine grows. Employed doctors need to be aware of this landscape.

And even though we as employed physicians are in the majority among physicians in the workforce, we are among the significant minority within the health care playground. Understanding this minority position, as well as the growing awareness of its consequences should help us cope better with some of the challenges of our roles with our employers. Being employed has its benefits, but there is a trade-off.

What has your experience been in regards to this? I’m very interested in knowing some of your thoughts as well!

Leave a comment or leave a message on our speak-pipe inbox.

Truth – Predictable Paychecks Make Doctors Happy

Truth – Predictable Paychecks Make Doctors Happy

Oct 16, 2020

Hi everyone. Dr. Inc. here bringing you the truth about employed physicians. I want to thank you today for your hard work and dedication. As I’m writing this, it’s a holiday weekend here in this country, and what I know about doctors is there are thousands of you as physicians who are going to work on this holiday weekend and doing your job, just like you always have, in a dedicated way to take care of patients all over the country who are in need of you today. It’s an amazing thing what you do as a doctor. 

I’m thankful that I get to do this myself, and I’m thankful that there are scores of you who are providing care for patients when frankly, you might not even want to  (you’d probably rather be doing something else with your family or going to the beach or to the mountains or whatever it may be). But you’ve chosen this path, you’ve chosen this career, and you’ve signed up to do the work that you’re doing on days like this when many Americans are off. Thank you. Thank you for all that hard work. Thank you for that dedication. 

Today’s truth is that predictable paychecks make doctors happy. 

One of the things that I’ve really enjoyed in my career is collecting that regular paycheck that is really quite substantial and large. I’ve always found that to be a sweet feeling getting that paycheck. Of course, nowadays I don’t receive a paycheck, I just receive a direct deposit to my account. So the feeling of that paper being in my hand or looking at it has really sort of gone away, however, those monthly bank deposits also result in a wonderful feeling. 

Of course, this is not the reason that we do what we do as doctors. I really see it as being downstream of the beautiful thing that we get out of taking care of patients and doing what we do to provide care to people every day. 

But when it comes to getting that predictable and sweet paycheck, there are some assumptions that come along with it. The greatest of these is you’re getting paid at a fair market value. You’re also getting to practice in the community of your choice and preference. There are a few things that come along with that paycheck and the responsibilities that come with being an employee, but isn’t it sweet to have some confidence to know that you’re getting paid fairly and that you’re getting to choose where you want to live, and you’re getting to choose to do what you want to do? 

You know, it is the easy button for us as employed doctors, because quite frankly, we’re getting paid a guaranteed rate that allows us to know (when it comes to our own personal budget) that we’re going to have money in the bank every month. We’re going to know precisely what that amount is and we’re going to know what we want to do with that money. 

Some of you found out in the past six months though, that as much as you thought you had a guaranteed contract and income when COVID came and your health care employers began to bleed a little bit and began to feel the pressures of the financial shortfalls, for many of you they began to short your checks, or they began to change your contract or they wanted to renegotiate how much you’re being paid. Many of you felt that was an injustice. Many of you felt that was wrong. Many of you felt pretty bitter towards your employer. 

I’m not sure where you are in that or how that landed for you, but it certainly is a memorable event for each one of us. At the end of the day, most of us love receiving a guaranteed paycheck with a guaranteed rate as an employed physician. Many of us also enjoy the pre-packaged benefits that come with being employed. From our health insurance to our dental insurance, to our life insurance, to malpractice insurance, and all the way up to retirement programs, these are all pre-packaged in a nice HR product line that really provides some predictability to how we go about living our lives and our family’s lives and provides some of the substance that we have become used to as physicians. 

Although many of you as physicians may not realize this, the majority of physician employer retirement programs will really cause you to fall short of the range that you have come to learn to live out when it comes to your retirement. So I encourage you to take a look, do a little bit of the math, and see where you’re at with that. Maybe talk to your financial planner or financial advisor, or whoever works with you in regards to these things, just to make sure that you’re meeting the goals that you have for your financial future when it comes to retirement because again, most physician employers retirement programs will cause you to fall short. There are a number of good things about those programs, but again, you need to save a little bit more. 

I also love the fact that we get to forego practice management when it comes to being employed in positions. I have an office manager in my practice and she’s the one that manages all of those days today headaches that arise from having 25 employees and all the nuances that come with every Monday through Friday work week, the weekends, the sick days, the kids who are sick, and all the myriad of elements that come with employing people in today’s healthcare economy. I’m really thankful that I don’t have to deal with those issues. I’ve found that in my 25 years of practice I don’t mind being a leader and I don’t mind exerting my clinical influence in my own practice and own office, but I also don’t mind letting somebody else have the responsibility of managing all of the people that are there. I do enjoy the simplicity of simply practicing medicine and taking care of patients, and receiving a good income that comes from that. As long as I provide quality and safe care and meet the productivity requirements that my organization has set for me, I can simply enjoy those patients and enjoy practicing medicine and doing it in a quality way. 

And I think many of you feel the same way. That’s one of the great things that you do enjoy about being an employed doctor. You also probably enjoy the good life that comes from being a high-income earner and all the money that results from it. I find it a rich blessing to be an employed doctor in today’s world really provides massive opportunities for me to just enjoy patients and enjoy practicing medicine and do what I was made to do and do it in a way that provides a very good living for me and my family. 

I hope that many of you have found that the predictability of that paycheck and the predictability of all the benefits that come with being an employed doctor are true for you as well. And I invite you to give me your insight and your feedback on what it is that’s made you choose to be an employed doctor, and what you would like or don’t like about the paycheck, the benefits, the management, the guaranteed rates, how your contracts are arranged–there are so many nuances to it that are worthy conversations that we’ll have as continue to unpack these truths. 

One thing is for certain, the majority of us are happy that we have a predictable paycheck. 

And that’s the truth for today. 

Truth – You Must Prove Your Worth to Your Employer

Truth – You Must Prove Your Worth to Your Employer

Oct 8, 2020

Hi, everyone, this is Dr. Incorporated helping doctors maximize their personal and professional satisfaction. I want to thank you for everything you’ve done today. When you look around your home, I hope you see a wife, children, friends, companions, roommates, extended sources of relationships that you’re making happy that you are influencing for the better; that you are making a difference in their lives not just because of what you do for them medically, because of who you are. And because of the security and the provisions that you provide in their world because really, your life and your income and really what you do as a person. You are highly valued. And I know you don’t always hear that from your employer, I know you don’t always hear that from your patients. And I know, you may not even hear that from your family members. But I want you to know, today you are highly valued.

This brings me to today’s truth. Today’s truth is that you must prove your worth to your employer. You must prove your worth to your employer. This is a subject that took me a little while to get my mind wrapped around as a physician with 25 years of employment experience. I’ve always been driven by really an internal monitor that I knew that I was doing my best, I knew that I was making patients better and making them happy and satisfied with my care. And I knew that I was practicing good medicine efficiently and productively. And for many years, I felt like I could just sort of ignore all the stuff going on around me in terms of what my employer expected from me. Because, frankly, I wasn’t too concerned about it, I knew I was a good doctor. And I knew that being a good doctor the outcomes would be good in regards to my patients. But as time has gone on over the years, one of the things that have begun to eat away at me is just a sense that I have to prove my worth every month.

I don’t know about you, but we have these practice council meetings that are monthly in our office and have quarterly business meetings for our physician employment group. And each one of those meetings, we go over the myriad of numbers that have to do with our productivity and the economic forces that flow out of us and through us when it comes to the care of patients. We review our patient satisfaction scores, our safety and quality scores, and a host of other things that are scorecards that sometimes influence how much we’re paid. But sometimes they’re just sort of a scorecard or report card that gives us feedback about how we’re doing. And one of the great challenges of those meetings for me is, first of all, because I’m in primary care, our practice sites are often basically losing money. And it’s been a source of confusion to me for many years. Because I keep thinking to myself, how can I be working so hard and seeing so many patients, taking care of so many people, yet this practice is losing money?

As most of you have realized by now it’s because, as an employed doctor, you have given up the huge amount of downstream income that would have been contained in your office but has now been allocated to other sites within your healthcare employers organization. So your practice is set up quite honestly to most of the time, lose money.

It’s not about how much money you are making. It’s about how much money you’re losing.

Every organization wants to mitigate the amount of money that each one of its physician groups is losing in the outpatient environment. But that’s made up for the downstream revenue, because at the end of the day, most of those employers have chosen you as an employee, a physician employee in particular, because of the downstream revenue that you create for their organization. Not within the office, but outside of the office.

It’s amazing to me that the average physician generates about $2.5 million in downstream revenue per year, which is exactly why so many healthcare employers are working hard to employ more and more doctors because they realize that their downstream revenue is something worthy of capturing. That’s why they like you, quite honestly. I know for me in my practice, because I’m a traditional family doctor who does obstetrics, through surgeries, including c sections, and so forth, I provide about $5 million in income in my downstream to my organization. And you can bet your bottom dollar that they kind of like me, because of that. I do garner some respect within the organization. Because of that, I don’t get off the hook in terms of my accountability and my need to prove my worth to them every month, but yet, they are aware of what I produce and how much I provide to them.

I hope you’re aware of the downstream revenue that you provide for your organization. If they’re not providing those to you, those monthly reports or quarterly reports, I encourage you to reach out to your administrator and ask them for one of those reports that provide how much downstream revenue you’re providing for your employer.

I also know that many employers encourage accountability when it comes to corporate citizenship. Corporate citizenship can look like a lot of things when it comes to your loyalty to the organization, whether it’s diminishing the leakage of referrals that you’re making to doctors and organizations outside of your employer, or perhaps it has to do with how many times you’re volunteering to serve on committees, or perhaps how many times you’re speaking in a community environment or the number of medical students and residents that you’re hosting with you. There are just several things that are involved in corporate citizenship, that many organizations value, but they frankly hold you accountable and make you prove your worth by proving that you are a worthy corporate citizen.

I can tell you that I again found this a little bit strange because I enjoy doing things to help people and I enjoy doing everything I can to improve the quality and benefit of my community and help those who are interested in going and healthcare. But I never thought of it as sort of a ledger, that I kept track of, that put notches on my belt when I did that. But for each one of you, you probably know very well that some employ you who are watching over those elements for you. Then there’s the quality work element.

I know that I am doing good quality work with my patients. And the frustrating part of that process is I can know that I’m doing good quality work, that patients can know I’m doing good quality work, and even my staff that are working with me to support and transcribe my notes can know I’m doing good, quality work. But if it’s not in a mindful location on the patient’s EMR, or the insurance or third party is not able to gather that information of what I’ve done or not done in terms of my medical decision making and communication, then they act like I never did it. Which is so frustrating when it comes to quality of care. I know for many of you doctors, this is one of those things, just a thorn in your side. I know it is for me because I am very aware of my quality of care and I believe is as good as anybody else in the country. Yet, I get these reports back within the organization that just kind of makes me feel like I’ve forgotten to do things, whether it be the diabetic whose foot exam wasn’t done, although it was done – it just wasn’t documented in the right place to prove that it was done, or whether it be the patient who needed a mammogram and I ordered it when they left the office but the patient failed to show up to get the mammogram and I get dinged in a report because the patient didn’t follow through with what I recommended.

There are all these elements of quality of care that we’re measured by as physicians that quite honestly are so beyond our control and so frustrating at times, yet I know as employed physicians, you are constantly having people beat you down when it comes to this stuff. You have to prove your worth to those employers when it comes to the quality of care that you provide. And then, of course, there’s the whole EMR proficiency thing, which is just absolutely absurd that we are asked to waste our time populating EMR records with minimal data when we could be using our time so much more efficiently. That’s why I’m a big fan of team care, our scribed model of care for physicians because I think it’s only wise to have physicians use their brains and their resources to really provide patient care and to make medical decisions, to do the right things medically for the patient and let others help you with that documentation process. So that it is placed in the right place, in the right location, and documented in the right way.

I think there is a lot of good about EMRs, but man, there’s a whole lot of bad. And if there’s one huge physician dissatisfier that continues to come up year after a year, it’s the EMR and we all know that. Unfortunately, we have to prove our worth to our organizations and they expect us to be proficient with the EMR population and note-taking. They don’t care if we have to get our notes done at lunchtime, before the office or after the office or at nighttime, or on the weekends. They just know it needs to be done and they expect it to come.

If I’ve heard one administrator say it to me once, I’ve heard it 1,000 times- “Well, that’s just one more click. That’s just one more click here. One more click there.” And what they don’t realize is that those “one-more-clicks” taken are compounded by the scores of hundreds and thousands, really equate to another 10, 15, 20, even 30 minutes of extra time in my day, that lead to me getting home later for supper that leads to physician burnout and physician exhaustion and physician dissatisfaction. But this is the world that we live in. We have to prove our worth to our employers, that we can be proficient with EMRs, and get all the work done that they expect us to prove that we can make the money they need us to make.

So, employed doctors, I know there’s a lot of good about what we have going on. And there are many qualities to that, that that come along with that predictable paycheck that we love. These are a few of the things that are a little bit behind the scenes that we all know of. I invite you as followers on this journey with me to chime in. What are some of your frustrations or challenges or unique things that you’ve learned from having to prove your worth to your employer?