Will self-employment really give you the autonomy you crave?

By Joe Hannan | Fact-checked by Jessica Wrubel
Published March 9, 2023

Key Takeaways

  • A Medscape survey asked self-employed physicians what they valued most, and a majority said autonomy.

  • As the popularity of private practice wanes, it may offer an opportunity for entrepreneurial physicians to structure their work the way they see fit.

  • Physicians can familiarize themselves with the Medscape report, as well as the views of self-employed physicians, to determine whether private practice is a good fit.

Medical school prepared you to be a doctor. Did it also prepare you to be a small business owner?

A lack of training has not deterred the estimated 26% of physicians who work in private practice. Overall, physician-owned practices now account for less than 50% of all practices.[] What’s keeping these intrepid, entrepreneurial doctors in the private practice game? Medscape’s 2022 Self-Employed Physicians Report offers some insights.[]

Flexibility and responsibility

The majority of the doctors in the Medscape report wanted one thing: autonomy. 

Sixty-four percent cited autonomy as what they liked most about private practice. Control over my productivity (38%), no mandatory performance targets (19%), potential income growth (19%) and fewer workplace rules (16%) followed.

According to Amanda Zeglis, DO, autonomy can be a double-edged sword. The psychiatrist, who is in independent practice and a member of the MDLinx advisory board, said that with great autonomy comes great responsibility.

“While there is a large amount of flexibility and fluidity gained by creating your own private practice, there is also an increased level of responsibility (inclusive of administrative tasks) that come[s] along with it,” Dr. Zeglis said.

Those tasks include scheduling, insurance coverage, liabilities, and small mountains of paperwork—digital and otherwise. Many employed physicians don’t have to worry about these things, Zeglis said.

The Medscape survey data suggests that these responsibilities definitely cause friction for self-employed physicians.

When asked what they liked least about being self-employed, 28% said managing staff, 27% said running a business, 26% said dealing with more government regulations, 26% said income uncertainty, and 21% said work-life balance issues.

These factors are among the most challenging aspects of private practice, according to Maryna Mammoliti, MD. The psychiatrist said that her education on the subjects was practical.

“The most challenging part is not having a manual or an organized course that one can take to prepare to run a medical practice as a clinic owner and relying on word of mouth and possibly some mentorship,” Dr. Mammoliti said. “However, even mentorship is someone's personal experience and may not necessarily present the physician with the facts and laws applicable to running the business.”

‘Opportunities wax and wane’

Regardless, an overwhelming majority of surveyed doctors said they’re better off in private practice. Ninety-three percent said their job has unique advantages, compared with employed physicians. Moreover, 81% said they felt financially secure—which speaks volumes in the aftermath of the COVID-19 pandemic. 

And finally, 65% of self-employed doctors said they were satisfied or very satisfied with their income. Compare that with 56% of employed physicians who said the same.

But, Dr. Zeglis cautioned, things can always shift.

"Opportunities wax and wane without any predictability. "

Amanda Zeglis, DO

“The reality is this: The job can always change, she added. "That is a motto I’ve adopted in my practice that often rears its head at some of the most inopportune times. But, unfortunately, that is the trade-off to having autonomy in your practice.”

Dr. Zeglis is not alone. Fifty-three percent of surveyed physicians said they were very concerned or concerned that uncontrollable events will affect their income.

To cope with this uncertainty, Dr. Mammoliti said that it helps to maintain some perspective, chiefly that financial insecurity is common in medicine, regardless of how doctors choose to practice. For example, a doctor’s illness or disability could affect their ability to practice and, therefore, their income.

“My response is to accept financial insecurity as a norm and focus on living within one's means … learn more about finances that we do not learn, and save like everyone else who is a business owner or non-salaried employee,” Dr. Mammoliti said. 

Better work-life balance?

Accepting that risk may prove beneficial in other ways. One is physician work-life balance, a priority in light of a 2022 Mayo Clinic Proceedings study, which assessed burnout and work-life satisfaction about 21 months into the pandemic.[] 

Researchers found that during the study period, the 2,440 participating physicians exhibited a mean emotional exhaustion score increase of 38.6% and a mean depersonalization score increase of 60.7%. In 2021, 62.8% of doctors had at least one burnout manifestation, compared with 38.2% the year prior.

The Medscape findings suggest that self-employed physicians may have a leg up here—at least a perceived leg up. 

Among the surveyed physicians, 49% said their work-life balance was better than employed physicians. Thirty-four percent said it was about the same.

Compare that with Medscape’s Employed Physicians Report, which found that 44% of employed physicians thought their work-life balance was better (33% indicated it was the same).

Regardless, 81% of self-employed doctors said their hours were predictable, and 67% said their administrative duties are never too much to handle.

Dr. Zeglis said that whether work-life balance is inherently better or worse in private practice isn’t so much a matter of circumstance as it is a matter of the doctor’s priorities.

“The ability to maximize your work-life balance is strongly baked off the structure you create,” she said.

Dr. Mammoliti offered similar advice. She said that in the age of virtual care, time can get away from you. 

“To keep my life balance now, I ensure that I regularly take time away from patient care and act like a human, a mother, a person, a wife, a friend.”

What this means for you

Physicians who value their autonomy may find private practice to their liking. However, self-employment may come with an additional administrative burden, as well as some work-life balance challenges. With the right structures in place, doctors who have been there and done that said both can be managed.

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