Your Well-Being First
The New York Times recently published an article about Millennials wanting to retire from work by age 50 and featured a physician in the story.
In one of my physician’s social media forums, there was some banter about this story including opinions about the idea of doctors retiring before age 50. It seems that the general public and Baby Boomer generation doctors deem this as selfish and a betrayal of our professional calling. Instead, they want to enslave doctors to their altruistic moral obligation to serve the public regardless of the personal cost associated with being pawns within corporatized medicine. In a previous post, I touched on this long-standing historical tension between our altruistic calling and our personal and professional autonomy (as a small private business). This is not new and has been a point of debate for physicians for centuries.
The overwhelming consensus from the doctors in the forum was that our primary obligation is to our own personal well-being more than any moral obligation to work for a system of medicine that soullessly casts us into burnout due to the pressures and demands of 3rd parties. Most physicians love the idea of using their autonomous professional skills to help patients while making a good living doing it (not to become rich), but patients and doctors have become increasingly separated by corporations that commoditize each of us. The current system of medicine has stolen our professional autonomy and thus is making our jobs non-sustainable. In the modern structure of traditional employment, doctors can barely endure 10-20 years in their job due to the pressures. In contrast, the prior generation could last 30-40 plus years as a professional-primarily because they were in control of their professional lives due to the small business structures that surrounded them. Millennial and Gen Z doctors understand this shift in the medical system and their job structures and thus wisely start their careers planning to not grind out work past their mid-50s. Most just can’t withstand the corporate beatdown any longer than this. In the end, the fundamental element that helps every doctor thrive is preserving control over your professional life.
Choose to Incorporate & Preserve Your Autonomy
One of the most important decisions that any physician can make to preserve their professional autonomy is to choose to individually incorporate themself. This simple move places you back in control of your professional life. It allows you a measure of control that supports your well-being whether you use your PC within a corporately controlled system or outside of the system by practicing off the grid (cash-only professional activity)
The Past Informs the Future
Your professional services are valuable, and when they are informed by their historical roots in the US, they automatically make you a medical business. You alone get to determine whether to unlock this business power for yourself or trade it to your corporate employer to use. In today’s world of medical employment, many physicians are unaware that they even possess this power as an earned asset.
Broadly speaking, you are part of a distinctive family of service professionals that exist in many different industries. These include lawyers, dentists, architects, accountants, financial advisers, and engineers, among others. Each one can offer customized, knowledge-based services to their clients within a business arrangement. Unlike other types of businesses, professional service firms sell knowledge and expertise – not visible, physical products. Their products are generally intangible and are not amenable to economies of scale on the “cost of goods sold.” But their services do have value, and this, in turn, generates revenue for their business.
The Importance of Small Business in America
You should let the past inform your future when activating your individualized small business. The importance of small businesses to the vitality of our nation was a bedrock principle when our Republic was formed by our founding fathers. They emphasized the prioritization of private ownership over government or institutional control. This principle reflected their understanding that the well-being of the individuals within the Republic would be threatened if there was too much institutional control over their lives. We have reached the tipping point in medicine whereby government and large corporations now are eliminating the small businesses on the playing field. The end result is the current burnout crisis because your well-being is threatened by too much institutional control. This is what our founding fathers were trying to avoid. Thus the solution to the crisis associated with the corporatization of medicine is to return doctors to forming and using a professional corporation (PC) to preserve their professional autonomy.
You may perceive that forming your own corporation is not needed if you are not going into private practice. That is a myth that has been propagated by employers who want you to believe you have no other option. But before you blindly accept this mindset, I invite you to learn why your assumptions about employment and PCs are wrong. I made this discovery a decade ago and adopting it into my professional life changed the course of my career. I wouldn’t exactly call it a secret path, but I wouldn’t say it’s easily visible to most of you either. So get ready to have your eyes opened.
Burnout Prevention and PC-Employment Lite
There is a loss of professional control that you will experience as an employed doctor, and it will come in many forms. Therefore, the preservation of your professional autonomy is a crucial ingredient to both preventing burnout and recovering from burnout. When the structural flaw of traditional employment’s erosion of professional autonomy is corrected, most of you can much more resiliently auto-correct yourself under the pressures of corporate employment and thrive again.
I know from personal experience that when my professional and personal autonomy were fading within traditional employment, I was heading towards burnout. But my autonomy was re-invigorated through the formation of my PC and the associated employment lite contract, or Professional Services Agreement. As part of this arrangement, I was required to have my own business entity—a PC. My employer then contracted with my PC for my professional services as I began to act as an independent contractor rather than an employee. The following illustration breaks down the difference between standard employment and employment lite.
A Systemic Change
To be clear, this employment model is still a flavor of employment and is not necessarily an escape from it. That difference is subtle but important. There are still aspects of professional life that I don’t fully have control over within the employment lite contract due to the requirements to function like a corporate citizen. However, the space created by the parallel operation of my PC has inspired a level of professional freedom and power that is not found in traditional employment alone.
And this is why you need to place PC-employment lite on your radar. It represents a needed systemic correction to the current state of employment that will go a long way towards helping you live your best life and avoid burnout. This is because it allows you to tap into the overarching benefits of small businesses and ultimately increases your professional autonomy. Simultaneously it provides all the benefits of employment while addressing one of the fundamental flaws of physician employment, which is the loss of professional control.
Your PC fills your autonomy tank and corporate work empties it
Your PC fills your autonomy tank, and corporate work empties it. Combining the two will help keep this crucial professional need properly balanced to support your well-being. This is a better version of employment than the traditional paradigm where your professional autonomy is constantly assaulted and your only recourse to fill your tank is personal resiliency interventions.
The New Modern PC
As I wind up this chapter about your small business power, I believe it is critical to address an aspect of PC-employment lite that is changing as the structure and use of PCs are evolving. Traditional PCs are slowly disappearing, and a modern version is now replacing them. The contemporary version doesn’t compete with large corporations like private practice PCs due, but instead collaborates with them as individual physician PCs,
The Old Private practice PC
Employers are more familiar with the private practice PC, which has historically been the home for most physicians. Thus the origins of the employment lite model are tightly connected to interfacing with this structure. With this in mind, when large companies recruit seasoned physicians that are in private practice, they come prepared to offer contracts that assimilate these doctors and their PC framework. This older version of a PC typically included a medical office building, medical equipment, the small business itself–including employees, and of course, the professional services of the physician owner(s). Each of these elements has to be addressed contractually when a private practice doctor becomes an employee, and the purchase of their small business assets is typically hard-wired into the deal. Thus large corporate employers used employment lite as a contractual bridge for private practice physicians to enter their safe harbor and provide professional services to their patients. It also freed up private practices from the costly and burdensome compliance issues that were being forced upon them by state and federal regulations. Visually it looked this:
This is in contrast to new graduates or long-time employed mid-career physicians who come to employers without any business wrap-around. They are more easily contractually integrated with their professional services. Rather than small business assets to be purchased, young doctors typically present to large corporations with personal liabilities (debt) that they hope will be bought by their employer as part of their recruitment. Due to this dynamic, employers don’t expect to deal with PCs for young doctors and physicians with a prior employment pedigree. In fact, employers often view this PC as a signal that you don’t intend to be employed long-term, and thus they may express concern for hiring you through your PC. They fear not having total control of you and are also unfamiliar with the newer version of a PC that doesn’t necessarily compete with them.
Micro-business
Thus, when I talk about starting your PC, I am NOT talking about the older PC version that is tightly associated with private practice and independent medical care. Instead, I am talking about a modern version that is more of a micro-business and virtual corporation that houses your intangible and tangible professional assets. It allows you to parse out your professional services, knowledge, and expertise to an increasingly diverse healthcare economy that is not geographically locked in. It has an employee of one (you) and is controlled exclusively by you. Like the white coat of old, your PC communicates that you are a professional ready to interact with the public as an individual.
the Bridge & the Modern Pc
I am pointing you towards your power to create a PC that can be either located and used within your employer’s safe harbor or can be located and used outside of it. In either case, you can form the PC and use the same bridge as your former private practice peers to work in an employer’s harbor and outside of it. This can include your primary job but also incorporate business interests outside your large corporate employer’s domain. We are now part of a global economy that is not constrained by local physicality which in turn opens the door for you to connect with people and organizations who value your professional services and knowledge anywhere in the world.
Modern Example of Micro-Business PC
As an example, I recently spoke to a specialist who resides in Southern California, but 75% of her professional services are delivered to patients in the Midwest through the power of digital communication. Her PC has a PSA with her hospital in Southern California, and the contract has a regional non-compete. However, in the new world of medicine, this has left the door open for her to connect with others outside their reach who value her virtual expertise. Her PC has made it easy for her to have two sources of professional income that are geographically separated by thousands of miles. By the way, you may ask why she just doesn’t move to the Midwest, and the answer is that lifestyle, quality of life, and family ties keep her anchored on the West Coast as her preferred home. In the end, her more elegant and virtual version of her PC is not tied down to a brick-and-mortar location where she must physically deliver her services. Instead, it opens the door of possibilities due to her PC’s ubiquitous nature and its ability to divide out her professional services.
This re-framing of a PC to a small and more personalized virtual container that wraps around your professional assets is what I want you to have in mind when you consider incorporating yourself and then contemplate the PC-employment lite structure.
Stop Doing Something Old
Peter Drucker is considered to be the founder of modern management theory and practice. His writings and philosophies heavily influenced government and corporate business management concepts in the latter part of the 20th century. I like how he elucidates the necessary component for systemic change when he says:
“If you want something new, you have to stop doing something old.”
Stop the INsanity
This same idea was said differently by the genius scientist Albert Einstein, whose theory of relativity provided new understandings of how everything in the universe worked together systematically. He is famously credited for defining insanity through the eyes of a physicist when he said:
“Insanity is doing the same thing over again, and expecting different results.”
Too many of you know that following your peers into the old path of traditional employment and believing you will avoid burnout is the same irrational thinking that Einstein associated with insanity. But, unfortunately, statistically, burnout will happen to more than half of you unless you quit doing something old.
You are at risk to miss out on your best life unless you do something different than is currently being offered with traditional employment.
Drucker and Einstein are both exactly right, and that is why I exhort you to stop the insanity of traditional employment and do something new to preserve your professional autonomy.
