Over the years, I have learned that in order to be present and to continue caring for the needs of others, I must first commit to taking care of myself. This means that I must love myself.
Physicians are controlled by healthcare overlords who erode our autonomy one click at a time. Although we voluntarily signed up for this through our standard employment contract, it is important to understand that our employers and hospitals will not love us back. Our employment contract began an impersonal journey through which our identity becomes a line on a spreadsheet in the business of medicine. Even if you have a good relationship with your administrator, that relationship will most likely change because they will move on. The corporate ladder of healthcare administration leads to short life spans for most. And most of you know, the new administrators do not know who you are, nor have any sense of your value to them. This zeroing effect results in you having to prove your value to the organization once again. These administrators only feign love for you if you prove your value, and we all know that their kind of love is conditional and based upon their interpretation of your performance.
This process of having to repeatedly prove ourselves to healthcare stakeholders is exhausting and undermines our egos. We are accustomed to a resourceful self-confidence that is positively reinforced in the holistic bond of the patient relationship. This emotional intelligence feedback loop cannot be measured by the best patient satisfaction scoring systems. But patients tend to be a wellspring of love for most physicians. Spitting out “give me 5 stars” at the end of each patient encounter is an absurd gesture that further feeds the stupidity of the corporate view of our value, and only further denigrates our esteemed profession.
We have become commodities that are managed by the government and non-government overlords that control healthcare.
They have hijacked the once sacred and private domain of the physician-patient dyad.
The end result is that physicians are generically organized into descriptive terms like “providers” and “service lines”. Patients are now called “populations” and herded into management schemes that leverage their wellness, chronic disease, and acute processes with no sense of individuality. All of this is veiled in health, but dominated by economics.
Doctor, you are more than a “provider”, and your 10-20 fold intensive training sets you apart from all other “providers”. This is a business term for us, that belies our true value to the system.
As strong as we are, physicians are trained to be followers of those in authority and learn healthcare through intricate algorithms. So we are easily led into employment agreements that place us under the authority of an employer, who then require us to dutifully follow their scripting for the rules of engagement in delivering healthcare. It is a typology that makes sense to us, and we naturally navigate to this architecture.
But, our well-being, professional satisfaction, sense of purpose, and autonomy are surrendered the moment we sign that standard employment agreement. You are just unaware of it happening, until a few years later.
As the parent-child relationship unfolds between our employer and ourselves, our high achieving persona is beaten down into a “not good enough” scripting. Although it seems impossible to the general public that the confident doctor can lose his/her “mojo”, it happens. Our self-confidence, control over our personal and professional lives, connection to patients, and altruistic ethos are eroded month after month. It is an insidious process that leads to a place that has been called a lot of things, but the collective term burn-out is often used. That is the wrong term in my opinion, as it implies we have caused the problem by working too hard, or have unknowingly allowed the work to overwhelm us. That is most commonly not really the case. Hence, why yoga and mindfulness are not the solutions.
The problem is self-inflicted, however. Although the system is ruthlessly dysfunctional, we signed up for this. We chose to give up control of our professional lives, and the autonomy of medical care with patients, when we signed up to become employees.
Some have called this a moral injury, indicating that our employers have injured us in the arrangement. They have, although I do not think intentionally. We have contributed to it ourselves, and continue to contribute to it by flocking to standard employment agreements that lead to us losing control and autonomy over our professional lives.
Our employers are going to come up with a host of solutions by pouring billions of dollars into the new cottage industry addressing physician burnout. While I am thankful they care enough to do this, what they often fail to see is that their control over our professional and personal lives is the problem. Restore our autonomy and move us closer to patients, and this burnout crisis will be lifted.
Seeking a safe harbor from the turbulent healthcare system leads us to employment, but it turns out to be a mirage. In the long run, it can be harmful to us.
Physicians thrive best when there is a healthy balance of self-governance, autonomy, and inter-dependence with other stakeholders in the playing field. The current employee-employer model does not strike this balance.
Ultimately, the closer you can bring physicians to patients, with the least amount of regulation, the more satisfied you will make the physician and the patient.
Restoring our autonomy and control over our professional and personal life is a key step in this process.
Ultimately, you can’t leave it up to your employer to solve this. You have to love yourself enough to make a change that increases your professional satisfaction and well-being. Your employer is highly unlikely to arrive at this conclusion, as it is not in their nature to give up control of you. Control is fundamental to the employer-employee relationship, and this is especially true for employed physicians.
Many physicians falsely believe changing jobs will fix the tension associated with losing autonomy. It may be for a short while, but the standard employment contract will ultimately lead you back to the same onerous dissatisfied state.
Changing your employment contract to an “employment lite” PC-PSA is a critical step in restoring your professional and personal autonomy as a physician. It allows you to stay in the “system” and not go off the grid. For many physicians, this simple contractual transition makes all the difference.
Back in 2010-12 when I teetered on burnout, transitioning to an employment lite contract radically changed my personal and professional satisfaction for the better. It was a great option that allowed me to stay with my current employer, without moving. It provided a fair market wage and kept me aligned with my preferred healthcare system. It was a much better alternative than starting my own practice or migrating to a Direct Primary Care (DPC) practice. These models require me to manage the practice, unlike an employment lite arrangement where all of the practice management elements are still taken care of by the employer.
You should check out this option yourself. Agencies like SimpliMD will be happy to walk you through this.
At the end of the day, you have to love yourself enough to make a change that restores to you the joy and love of practicing medicine. I am convinced that the path I took is a great option for many employed physicians who are dissatisfied and who sadly see no other options.
Dr. Inc
