Welcome to the 2nd part of our discussion about the great life of physicians. I realize that I am biased, but I would not trade my life as a doctor for anything. Now that doesn’t mean I am opposed to retiring. In fact, I look forward to that day sometime in the next 10 years.
However, if I were retired I would have missed out on the patient I saw today that came in for evaluation of hip pain. When I asked her why it hurt, she said it was due to her mother-in-law. Of course, many of us know that a mother-in-law can be a real pain in the posterior part of your body, but that is more figurative than literal. So I asked what she meant. Sadly she said that her mother-in-law passed away and when she was at the graveside service, she got too close to the open grave hole and slipped and fell into it! She banged up her hip and arm in the process, and thankfully her husband was able to help her get out of the hole. The whole story kind of made me smile. This is the kind of stuff I get to be a part of every day in medicine. Story after story in the life of a rural family doctor.
This post will pick up the conversation between my son, who is in medical school, as we talk about our separate views and experiences in the medical world. If you missed part one, click here.
Two Medical Lives
Dr. Inc: John, you probably saw my medical life is split in two. There are your younger years that you were pretty oblivious to what my professional world was like. It was a mixture of some of my favorite years in medicine, but also sad because it began the slow march towards burnout. And then there were the later years in our home after I started my own PC and entered into an employee lite contract that restored my autonomy and vitality as a doctor. During those years you were a little older and probably were more aware of my personal and professional satisfaction.
John: Yeah, obviously there’s been a lot of things that have happened in the later years where I was busier and less in the home as I was in my later years in high school and went to college and all that stuff. But I think that was a measurable improvement in the amount of stress and enjoyment and satisfaction with your career between when you were going through all of the difficulties more than 10 years ago, and where you are at now. Honestly, I didn’t fully understand the personal and professional changes that led to that, but I could see it in your life.
Now I can see in the last few years now that you’ve settled into your new business model and professional model. I think it’s been a huge improvement for you. I think it’s probably one of the best things you ever did for your career was to make those changes. You are so much happier both at home and at work now.
just feel like you’re able to live your best life while still getting to do what you want to do, which is being a doctor because you love doing that.
Dr. Inc: It’s, really interesting to me because I do think I have a great life as a doctor, but when I started to practice medicine, I thought I had a great life as a doctor, too. My clinic colleagues and I were a great team and great friends, but as the business of medicine began to encroach upon all of our success, it split us apart. It wasn’t just the compensation piece, there was a whole bunch of other EMR related stuff and a bunch of other staffing and administrative junk that just really ruined it.
In retrospect, I think that I benefitted from seeing how satisfying professional life can be. But I realize now that if you don’t address the business of medicine part, and simply leave the blindly to your employer, it will eventually decrease your satisfaction with your job and increase your stress. Medicine is a business and your employers will happily make a revenue-generating asset that they will control, regardless of its effect on you personally.
You are a business
Your employer recognizes that, unlike virtually any other employee they have, you are a revenue-producing machine for the company, both indirect patient care, and downstream revenue creation through your patients. That is why they are interested in you. It’s not about you personally, it’s about your business potential. Because you are a mini-individualized business, their goal is to harness you and leverage you for their profit.
But when you properly address the business side and view it holistically as a personal and professional dyad, you will realize that you must construct a job model that leads toward a more sustainable and enjoyable career. The key ingredient to your satisfaction as a physician is autonomy as it provides you with a feeling of control over your life.
At its core a standard physician employment model erodes your autonomy, In the short run, you are oblivious to the loss of control due to the predictable paycheck and safe harbor provided to you to practice medicine. But over time, the corporate oversite beats you down as you feel your professional and personal life being boxed in as you mechanically work for “the man”.
YOu Are A Small Business
Dr. Inc: If you are able to get your mind wrapped around the fact that you are a small business that both supports your professional and personal endeavors, you will take great strides in holding onto your autonomy. Taking this a step further, it doesn’t prevent you from entering into an employment contract with a large healthcare employer. Rather, through an employment lite contract (rather than a traditional employment contract), you are able to have the best of both worlds. Operating your own small business that is solely about you, called a PC (Professional Corporation). Your PC can then, in turn, contract your professional services with an employer through a professional services agreement (PSA). In this contractual relationship, both parties still get what they want.
This physician employment model called “employment lite” is an unknown option for most doctors and I feel it is a needed market correction that helps restore physician autonomy, and thereby also helps prevent burnout.
Having personal and professional autonomy is the key to living a great life as a physician. Employment lite contracting leads to this, traditional employment contracts typically erode your autonomy.
preventing Pain
The truth is that I didn’t realize how important keeping control and autonomy was to me until I went through the whole experience with my group practice breaking up. So it’s nice to be able to be twenty-five years later, to look back and share with you as a father to a son. I hope my story prevents you from going through the same pain that I went through as a result of my standard employment contract.
That’s why you’ve heard me say to you on a few occasions, ” John, you’re going to form your own professional corporation, or, John, you’re going to learn to maximize the business side of life in medicine.” I was naive to this, and it nearly cost me my career. But if choose a path that is different than standard employment, you’ll have greater autonomy and have the best life that you can have as a doctor.
John: You are right, I don’t want to go down the path that nearly led to burnout, and I would rather go down this better path.
Hospitals and healthcare employers have become big businesses, and their physician employees have become their pawns. They’ll use you until you are burned out and then replace you.
Fight for yourself
Dr. Inc: This is why doctors have to be proactive for themself and not trust their employers to correct this issue for them. It’s time to swing the employment pendulum back to a more favorable middle-ground for doctors. The autonomy gained in this middle ground will allow doctors to flourish personally and professionally. It turns out that this is a win-win proposition for both employers and doctors. What employer doesn’t want a happier, more productive doctor?
John; With all the burnout and pressures associated with being employed in medicine, it’s like, why would anyone go into medicine? The rates of depression and suicide are just higher than the general population within our profession. Sure, doctors get paid well, but there’s a lot more in life than just making a good income.
I feel like what you have done through your employment lite approach, you have demonstrated that it can be different. You can change it for yourself and make it better.
Hire an Agency
Dr. Inc: Exactly, don’t wait for your employer to come up with this for you, you must pro-actively bring this to them. I think the best approach is to hire a physician-centric agency to represent you in this process. Not only can they negotiate with your employer, but they can also help organize every element of your small business PC. I chose a comprehensive agency called SimpliMD for this. I rec you do the same.
In fact, what I hope for our audience is that they see there are different employment models out there for doctors. I’m all for employment as it makes sense on many levels. Most doctors are going to really benefit from the Safe Harbor of employment.
But within the safe Harbor employment, there are a host of different models that are better than the traditional employment model. My experience is that Employment Lite is one of the better options.
It breaks my heart to see my peers and my friends and medicine getting burned out, getting depressed, just getting worn down by all the pressures of medicine. They are missing out on the great life we have in medicine.
Choose Innovation
John: Now we can benefit from the work that others have done with any innovation in the world. There are the people who really went through the trenches and the dirt to learn about something to make it happen. Due to pioneers, we can fly internationally, and now we can have antiviral medications, anti-bacterial medications, anti-retroviral medications, and all of these medical advances. Why would you go back to an old wives’ tale remedy like a traditional employment contract when you could use a more progressive model like the one that has been battle-tested by you and we know it works?
Dr. Inc: Yes, that’s exactly right. And so this is the model that I think all new graduates and young professionals should use. Because it will lead to their best life in medicine.
John: What I like about this model is that it provides both greater time and money in addition to autonomy. The net is a better personal and professional life.
time and money
Dr. Inc: I agree it’s more than just increasing our autonomy, when I made the transition to form my own PC and an employment lite contract, it increased my retained income by nearly $2 million over 10 years. That’s a lot of money! It was solely based on fair market value compensation in addition to smart business modeling and its associated small business tax strategies. So many physicians are just unaware of this. Their ignorance is costing them a lot of money, and a lot of freedom.
Financial Independence is a natural outflow of this model and by following it there is no doubt that most doctors will arrive there earlier.
The best life comes when financial independence is coupled with great job satisfaction and maximized personal and professional autonomy.
It is possible to have this, and I want to point young doctors to this progressive path that will lead there. So John, as a young physician to be, make good choices in regards to this information and don’t fall into the traditional practice model of employment where you think that’s the only choice that you have regardless of the specialty you go into.
To my audience, I hope you are enjoying the great life of a doctor.
I invite you to share your own experiences or suggestions that maximize embracing our best life.
So I invite you to use SpeakPipe with your questions or jump into our social media channels at doctor incorporated.
I hope you have a great week.
