Hey everybody. This is Dr. Incorporated bringing you the latest episode of the truth about employed physicians. I’m so glad that you chose to join my son, John, and me as we continue our dialogue about the young doctor’s life and some of the interesting parts of being a doctor. The premise of this series has been to illuminate conversations between a father to a son on life in medicine. I hope we can share some ideas and concepts that are beneficial to physicians from all generations as we discuss things together.
I want to start by saying thank you if you are a physician. I’m really grateful for the work that you do every day. I know I am thankful to the physicians who care for me. It’s just to assumed that you will bring your “A Game” to work every day with every patient. And most of you do this. Thank you for the effort as you really do make a difference in people’s lives.
The Great Life as a Physician
We’re going to talk today about what I called the Great Life of a doctor. Our profession is special and provides a great life for us that ranges from its high income to the power of helping heal patients every day. We have job security and a sense of cultural esteem that feels good on many levels. But you all know the path to our great life is not easy, and today there are many forces that can steal this great life and can thrust you into the deep, dark chasm of burnout. The risk for any physician to miss out on the great doctor’s life is greater now than it ever has been, with burnout rates nearing 50%. As I watch you, John, emerge as a physician, I want to do everything I can to help you avoid burnout and fully embrace your best life as a doctor.
Choosing the Path of Employment
One of the Ys in the road that I made 25 years ago was that I chose to be an employed physician. This was back in the day when a lot of the physicians were just beginning to make that transition from private practice models into the traditional employed physician model. I caught that wave at the beginning of that transition and it’s really worked out great for me. I love virtually every element of being an employed physician. And in fact, when I came to my practice community and began working here many years ago, there was a group of us physicians that began working together. We had a great group practice together that grew rapidly in part due to our competency, care, and chemistry. There were four to eight of us at various times that worked together at the clinic. A lot of their kids were peers of yours John. Many of us were of similar ages and in similar stages of life. The group was together for 8-10 years until the forces of employed medicine separated us from one another.
Dr. Inc: I consider myself very fortunate to practice medicine and to live the life of a doctor in a small community. That’s my chosen gig. I liked being in a smaller community. I actually grew up in this county and I really enjoy all the elements of being known and familiar with the people of the county. I live right on the main street in the center of the county seat, and my clinic is within walking distance of my home. Medicine has provided a great life for me over the past 25 plus years. And I believe has provided a great life for you, John, as you grew up here, went to public school, and got to partake in all facets of the small-town doctor’s life.
John: Yeah. Your clinic partner’s kids and I went to school and church together, we were neighbors, we did sports together and a few of us were pretty tight including one who was one of my best friends. Yes, it was a good life.
Dr. Inc: In particular two of us doctors were great friends and we did a lot of life together including vacationing together and various family outings-events together. Raising families alongside one another, practicing medicine together, and watching our kids develop mutual friendships was a rich part of our life. The bottom line is we enjoyed being together beyond medicine. I used to say to your mom, I can’t believe I’m being paid all this money to do this. This is the best thing in the world. I love going in and doing this job every day. You probably remember those days. Those were a lot of fun memories, weren’t they?
John: Yeah. those were great times. I used to come with you on the sidelines at the high school football games and the basketball games. I thought was pretty cool to have the best seat in the stadium. I would catch the field goals and extra points. It made me feel pretty special.
Dr. Inc: And you were young enough to mostly be blind to the professional side of things, but you were certainly aware of the benefits of the doctor’s life.
John: Yes, I was young enough that I had no idea of you were getting paid to do this, or it was just community service. All I knew was that I got to be with my dad in the middle of what was considered a major community event.
Dr. Inc: Back in that day, it was just part of my volunteer world. I did it because it was the right thing to do for the community, it’s what you do in a small town. But it was a great life.
John: I saw you really enjoy those days, you were not stressed and there were very few performance pressures. You were a very important fiber in the tapestry of our community. You did not flaunt it, you just served humbly as part of life as a rural family doctor. Having me and my brother next to you was part of your desire to both mentor us and spend time with you doing things you loved.
Dr. Inc: Yes, you are right, there was a desire for both mentoring you by simply spending time with you. But also I wanted to share my passion for my profession with you and all of your siblings. So it’s no surprise that you chose to go into medicine, and orthopedics in particular. It’s been said that kids will often love what their father loves, and there is some truth to that.
John: Yes, I saw you prioritize your love for mom, our family, your faith, and your profession while growing up in our home. This has influenced my similar values to the same.
All good Things Come to an End
Dr. Inc: But the day came when my employer came to our group and basically said “you’re going to get a pay cut. ” through a change in the compensation model plan. Our group was very productive due to our provision of inpatient care, ob, newborn care, and full-spectrum outpatient care and this led to a nice paycheck every two weeks. In addition to our compensated RVUs, we provided a lot of volunteer work for the employer with our community service and ER coverage. Our group was very successful and we were beloved in the community. When we asked our employer why they were doing this, they basically said our compensation performance metrics made us outliers within their physician network. They felt this was a necessary adjustment by placing a cap on compensation as it reduce their risk of a federal audit, and also re-align our compensation with the other physicians in their network.
John: At that time, I didn’t know about any of the business elements that you mentioned above. But I did recognize the EMR had been introduced and you were not getting home later, as well as doing much more work on the computer after you got home. You were definitely more stressed and it just seemed like you were gone more.
Dr. Inc: No question that I was more stressed. The complexity of medicine increased as our practice grew, the number of doctors grew, and the number of patients we covered grew. 3rd parties were beginning to exert their influence on medicine, and EMRs created a large administrative burden for us. Professional pressures were starting to steal my most valuable asset, time, away from my personal life. I didn’t like it, but I pressed on by reasoning the pay was good and I enjoyed full-spectrum medicine with great partners. But looking back, I can see that many forces were converging to push me towards the currents of burnout, and push me further away from the great life as a physician. All those forces seemed to systematically reduce my personal and professional autonomy.
John: And then when the other doctors at the clinic started leaving, I knew something was wrong, and I definitely saw the changes in you and your peers. But, other than not seeing you as much, I was still pretty oblivious to things due to my young age.
Dr. Inc: Yes, as much as I liked my employer, this was my first realization that by choosing employment I had lost control of a major element of my professional life. I had always viewed life through a lens of fairness and professional respect. Now I began to better understand that I was simply an expense to manage for them. It was not personal, it was business. And with that in mind, they could unilaterally change my compensation formula regardless of how I was viewed by my patients, community, and even myself. It was a wake-up call for all of the doctors employed in our group.
break up
Dr. Inc: In rapid fashion, due to these employer changers, members of our group left and took jobs elsewhere. This left a shrinking pool of doctors in the group, myself included, to take care of a large number of patients. The burden was heavy. The workload was growing at a time when the compensation was unfairly being capped by my employer. That is a bad combination for anyone, to be asked to work harder and get paid less for it, but that is what was being asked of me. Time away from home increased and my off from medicine, while I was home, was also being eroded. I could feel the malodorous smell of burnout breathing down my neck. It was not fun as the joy and pleasure of the great doctor’s life were evaporating and being replaced by the burden of medicine. This is what I want you to avoid, John. In fact, I want all physicians to avoid this miserable state of burnout, or near burnout. I think our employed state makes us more vulnerable to it.
John: Yes, I saw you go through that, and I want to avoid it as well.
Burnout and Prevention
Dr. Inc: 50%. That is the current rate of burnout for physicians. That is an absurd number for our esteemed profession. It needs to change. And I am happy to say that in the midst of my crisis, I was able to make some changes that saved me from burnout and restored me a great life as a doctor. It took several years to get it all hammered out, but I want to share with you the secrets to that process so you don’t have to go through what I did.
John: Yes, tell me more!
Progressive Employment Models
Dr. Inc: It all begins with employment. Don’t get me wrong, I think you should be employed as a doctor in today’s environment. But I think you need to be aware that a traditional employment contract does not favor you, and it actually increases your risk for burnout in the future. So consider alternative business structures and employment contracts like an “employment lite” contract to help you maintain personal and professional autonomy. Because when you sign that traditional employment contract you don’t fully realize the downstream loss of autonomy that will result from this move. This loss of control, in turn, is a major factor that will lead you to burnout.
John: We learn so little about the business of medicine in medical school that all of this is new to me. I do know the kind of doctor’s life that I want to live, but I just kind of assume that if I do what my peers are doing, it will eventually lead there. It’s a kind of “trust the process” concept. But because I know from watching your experience, and from your conversations with me, that trusting the traditional employed physician path will place me at substantial risk for burnout. There is a better path than you discovered, and I plan to follow a similar alternative path that still includes employment.
Dr. Inc: Honestly that is my goal for our conversations about this. That you will learn from my mistakes, blind spots, and discoveries. That this will translate into steps that allow you to safely and rapidly arrive at the great physician’s life. I really think this is possible for most physicians, but they simply need to be informed about more progressive employment models that restore their autonomy. Employment Lite is one of those models.
My transition involved keeping my same job, staying with my same employer, but converting to an employment light model that involved the formation of my own professional corporation. Through some wise business structuring via SimpliMD’s help, I was able to leverage this into greater retained income (kind of like getting a raise). To give you some idea of how much I was being underpaid as a traditional employee, for the same amount of work, my pay nearly doubled when it flowed through my own corporation in a PSA contract.
I also bought a nonmedical building and converted it to a medical building and moved my practice there. This led to passive income through real estate ownership which was all aligned with my employer. My employer planned to lease medical office space somewhere for me, so why not lease it to my own company? But this was not possible if I was a traditional employee, however, by transitioning to an employee lite contract, it was possible.
Now, do you remember that happening?
John: Yeah, I do remember that. It was quite a process to remodel the building into a medical office space and then move your practice. I don’t think I fully understand the economics of it all, but I did see your move into the community. Your employer didn’t change, so it basically looked like an expansion of your clinic locations to better serve the community.
Dr. Inc: That was the goal within the community. To make it looks seamless and even strategically positive. But behind the scenes was a personal business evolution for me that supported it all, and led to greater personal and professional autonomy. I won’t go into the gritty details, but the core of it involved an employment lite contract, the addition of Team Care Medicine to my clinical flow (scribes to help manage the EMR), and a business structure that maximized my cash flow, taxes, benefits, and retirement account.
restoring the Great Physician Life
Dr. Inc: All of this added up to the restoration of living the great life of a physician. Burnout was placed in a rearview mirror and my personal and professional autonomy was fortified.
At the end of the day, most employers are not too concerned with the contractual model you are in as long as it is fair market value and the contract creates alignment with them so that your patients are funneled through their health system. Market share and downstream revenue are the ultimate end-games.
You aren’t taught this in medical school, nor is much said about it in residency. But the sooner you become aware of what employers really want, as well as progressive employment models out there as options for you, the more likely you will be to reach your best life as a physician.
Satisfied doctors make for better medical care which makes for more satisfied patients and employers.
What are you doing in your world to make your life the best doctor’s life?
