Physicians Finding Freedom Through Independent Work

Leaders, take note: The move to autonomy appeals to physicians exhausted by the demands of organizational employment.

Moonlighting and working per diem are popular these days. Physicians, especially generalists, are in short supply, and jobs are plentiful as demand for health care continues to soar. By some accounts, there will be an estimated shortage of more than 100,000 physicians by the end of the next decade.

Leaders in health care know this is creating the perfect storm for savvy physicians to take advantage of the supply-and-demand mismatch and regain a semblance of their independence again.

Although the economic pendulum has swung during the past 20 years toward physicians working as employees in a controlled corporate-type environment, rather than in a traditional physician-owned practice, that doesn’t mean there aren’t a multitude of other options for physicians to explore.

Here are three potential scenarios:

1. Have a full-time position and moonlight on the side.

Pros: Have a secure, steady and (hopefully) significant income, and then earn extra money on the side by picking up extra gigs. This could be either within, or outside, your current health care organization.

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Cons: You will have the gamut of administrative stresses and headaches that go with being a full-time employee. You might also be exhausted working beyond what is already a busy, consuming job.

2. Become a complete independent contractor physician.

Pros: Arrange your own schedule, get credentialed at many places that have high demand for your services, and create your own schedule. Negotiate your own rates and earn on a tax form 1099 (instead of a W2) basis, taking home significantly more income if you incorporate as your own independent business (usually an LLC).

Cons: You might have to move around a lot and might not like the (relative) insecurity of not knowing if the place will need you again down the line (an unlikely, but understandable, concern).

3. Work part time somewhere and make up the rest yourself.

Pros: You have roots somewhere, but don’t feel quite so tied to an organization. You can then pick and choose what you do the rest of the time, and still overall work less and earn more than what you would as a regular full-time employee.

Cons: You have to be savvy about negotiating a part-time work contract, and still need to be flexible about traveling the rest of the time.

Increasingly, physicians are realizing that in today’s stressful health care environment, the first option is a tough one because of how much time they work by moonlighting on top of a full-time job. If your goal is to work less, earn more, and feel like you’re regaining your freedom and autonomy—options 2 or 3 undoubtedly are better for you.

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How can physician leaders and health care organizations respond to these trends? Well, it’s no secret there’s an epidemic of job dissatisfaction and burnout among physicians, topping 50 percent for some specialties. The reasons physicians seek more independence are mainly related to the dramatic loss of autonomy that the profession has experienced during the last 20 years.

By ensuring physicians work in a supportive administrative environment, which understands what’s important to them in their everyday work life and care for patients, it will make it less likely that any doctor will want to leave the organization or seek other career avenues. This requires strong physician leaders who never lose touch with the front lines and always want to engage with practicing clinicians.

Ben Levin, MD, is a board-certified internal medicine physician based in Massachusetts and co-founder of DocsDox , an online service that connects physicians and health care professionals with independent job opportunities.