What if I don't like having a boss?

Hi Everyone,

A couple of questions that aren’t specific to being an older pre-med but might of interest to the community nonetheless:

  1. Is medicine a good profession for someone who doesn’t like having a boss. What are one’s options, if any, besides opening a clinic?

  2. On the subject of opening a clinic, are clinics scalable? That is, can you hire other doctors to eventually take over the operation and management of your clinic so you can have more free/family/hobby time?

    Thanks for any insights.

:smiley: I feel like this is a question for medical school graduates / finishing up their residencies… Because as premeds, we are not even n med school yet.

However, I feel like opening up your own clinic has high overhead and liability. Personally, my previous internal medicine physician was being sued for neglect for not recommending patients to specialists. One of the patients was diagnosed was stage 4 cancer. And then other patients started to find out and eventually her business slowed down significantly.

For physicians in hospitals or community clinics, seems like physicians are still employees who are influenced around by hospital administrators: controlling work schedule, shifts (full or part time or per diem), parking…etc

I don’t have an answer, but interesting questions here. I don’t think I’m very business savvy, but my initial naïve thoughts below.

There are surgeons who do cash only, and direct primary care (DPC) or concierge medicine physicians who could be considered self-bosses in some sense. You could also do locums (rent a doc) but you’d be moving from location to location every month or 3 (but you’d have the option to ride out or cancel your contract within a short time frame.) Be an expert witness for lawsuits (would take some business chops to make a career out of it.) I guess if you could make a reputation as top of your field, you can generally be self-employed. In my line of work (wastewater and water treatment), there are a few individuals who have a reputation and are sought after as expert consultants. One such I know clears a mil every year. But he had to pay decades of time into the system to earn this reputation and thus is only able to do so now, after 20-30 years.

My uncle went solo practice together with his wife, also a doc, after almost 30 years as an employee. I think he might even have 1-2 midlevels in his employ. He also chose to purchase the property and is a business owner, renting more than 50% of the property to other non-medical businesses. I am sure this come with the headaches of facilities management, maintenance, bill collections, cash flow, etc. Not going to be easy to do as a non-trad if you’re already old such that you can’t build up your savings to be able to sustain. Some have managed to do the DPC route a few years out of residency, but I would think that cash flow would be negative for 2-5 years depending on the market. As for scaling, I would imagine that it depends on cash flow. If a traditional practice that accepts insurance, would you be able to carry both the physicians and other ancillary staff such as coders, billers, nurses, office admin, etc, plus facility overhead? If not, you’d be dependent on your creditors, right?

As with any business, I guess it would depend on your business smarts (ability to deliver profitable services without farming them out, etc) and this would be no different in medicine than any other field. Two years ago, I got tired of being a 9-5 employee and wanted to strike out on my own. I quickly realized that I did not have the resources to bear a negative cash flow during startup (I don’t have significant savings and it typically takes 6 months between billing and collecting on top of 2-3 years to establish as a business.) I also did not have any niche skills to sell and have a low tolerance for risk. Thus, I prefer my paycheck-to-paycheck existence to a riskier solo business that might have a chance for better income.

Side note: I’m single. If I had a spouse with a decent income, I’d be more inclined to go solo.

I think there’s a lot that goes into that decision, and a lot of it will be based on startup/overhead costs and pay models. As a physician/owner, you’ll be contributing to the income of the business, so basically the “cost” of your employment will be offset by the work you do. As purely as owner, you’d be skimming what little there is off the top based on how your patients pay (medicare, negotiated insurance, self-pay model/“cash only”, etc). The wave of the future is trending toward payment based on condition, and whatever you don’t spend on patient care is considered extra. That being said, you’re also responsible for costs above and beyond the payment, and where that money comes from will depend on your business model.

I guess the bottom line is that it wouldn’t be very cost effective to simply “own” a clinic without contributing to its operations. Payment models are in flux right now, but again, the trend is going towards shifting more of the cost burden on physicians/hospitals. I think these days there are more clinics joining hospital systems than there are new startups.

As part of a physician group, you may not necessarily have a “boss” depending on the structure, but you’ll still be expected to conform to their practice model. There will probably be some sort of informal hierarchy based on seniority, vestment in the group, or ownership % anyway though.

That being said, there’s still some autonomy left in medicine and treatment, and either way you’ll ultimately be responsible for the decisions and actions you make or don’t make.