How self-ownership can empower physician leadership

Rebekah Bernard

Eight years ago, I was suddenly and unceremoniously fired from my job. While getting fired was shocking, hurtful, and felt incredibly unfair, it turned out to be the best thing that ever could have happened to me.

You see, this wasn’t the first time that I had gotten into ‘trouble’ for speaking the truth. Once, I was called to see the medical director of my hospital group because I had written a letter to the Editor of a local newspaper to support a physician colleague. It turned out that the hospital was in a dispute with this physician, and my letter didn’t look great for them. I had no inside knowledge of these political machinations—all I knew was my truth: That my colleague had gone out of his way to help me, and his help ultimately saved a patient’s life.

Fighting an internal struggle about when and where to speak out about injustices can take an emotional toll on physicians. While the repercussions for speaking out can range from a slap on the wrist (in the case of my letter to the Editor) to being fired (for threatening to quit when my employer let our staff’s health insurance lapse), I believe that not speaking out and holding our feelings inside is far more dangerous.

Failing to speak out takes a toll

Every time physicians suppress our feelings of righteous indignation, we feel more powerless, which can either build up and explode into inappropriate behavior (the ‘disruptive’ physician) or turn into learned helplessness, in which we completely give up. I find the latter to be far more common today—I can’t tell you how many of my colleagues just shake their head sadly and say, “It’s too late. There’s nothing we can do,” about any number of wrongs in healthcare today.

I was probably approaching that sense of hopelessness myself when I was shaken out of my ennui by being fired. Suddenly, I found myself confronting a major life decision: Find another job in an employment model where I would be forced to conform to corporate culture or take a chance at self-ownership.I made a deal with myself: I would try direct primary care for a year. If the practice wasn’t successful, I could always find a job back in the traditional system. Fortunately, because the direct care model is so simple and low cost to start, I was able to open my practice just three weeks after I was fired. Within a few months I had enough patients to cover my overhead, and in a year, the practice was full, and I was looking for a partner to keep up with the demand of new patients.

Eight years later, I have a full direct care practice with a generous income, but most importantly, self-ownership allows me the freedom to schedule time for activities outside of medicine. Because I own myself, I can write and speak openly about my thoughts on the direction of healthcare without fear of repercussions from an employer. I am able to participate in organized medicine and in forming grassroots organizations without concern about influence from any corporate interest. My focus is on advocating for patients.

Self-ownership allows physicians to set priorities

Physicians are increasingly choosing employed practice to counter narrowing profit margins and increased administrative demands. I did too—before opening my practice, I spent six years at a Federally Qualified Health Center, five years at a for-profit hospital group, and two years at a small corporate practice. There was one thing that all these employed jobs had in common: staff physicians like me had little if any control over their schedules. Sure, we had some say regarding vacation (if requested in advance and assuming there was enough coverage), but our day-to-day schedule was fairly set in stone. Physicians were viewed as hourly workers ‘on the clock,’ even though we routinely worked through lunch and late into the evening on charts. Asking to block an hour or two to listen to a webinar or attend a meeting was a non-starter—except, of course, for mandatory meetings on ‘corporate culture’ or ‘physician wellness’ scheduled by administration.

As a self-employed physician, you can set your own schedule to balance patient care with your needs: to spend more time with children or with aging parents, to pursue hobbies and interests outside of medicine, or to participate in leadership opportunities. Controlling your schedule is essential, because the first step to becoming a physician leader is simply having the time and energy to show up.

How to become a physician leader

Physician leadership starts with physicians engaging in healthcare discussions. A simple way to begin is by increasing your awareness of what is happening in medicine. Skim through news alerts that come from your medical organizations. Attend meetings offered by your medical societies to get to know your colleagues locally. Talk with physicians across the country by engaging in social media groups dedicated to healthcare issues.

If there is a particular issue in healthcare that piques your interest or nags your conscience, pay attention. If you see a post or article online that grabs your attention, save it to a computer file to review later. Then lean into the topic by reading articles or a book about the subject or spend time talking to others who might know more. Once you have gathered information, share what you’ve learned with family, friends, and colleagues. Join or build a coalition of like-minded physicians to support each other’s work.

The next step to leadership depends on your calling. I love this quote from Epictetus, the father of Stoic philosophy, who said, “If you would be a good reader, read; if a writer, write.” I would add, “If you would be a Tik-Tok video creator, create a Tik-Tok video.” There is a role for each of us, according to our drive, dedication, and talent. Do what you can, remembering that sometimes the smallest actions can reap huge rewards.

For example, many years ago I read a post on a physician social media site from a pioneering physician who had started his own practice, which inspired me to research direct primary care. I bet that this physician had no idea that he was acting as a leader: simply sharing his story led me and many others to better care for patients and ourselves. You never know who you will touch, help, or inspire by simply telling your story.

Don’t be afraid

Physicians must not be afraid to share our knowledge, experience, and truth. For the self-employed physician, criticism can only hurt us if we allow it to. We must not fear anonymous online critics or bad reviews by fake patients who oppose our viewpoints. Instead, view criticism as hitting a nerve—it means you got someone’s attention and you got them to think, which is much better than being ignored. Criticisms lead to discussion, which amplifies your message, and can galvanize your supporters.

I realize that not every physician is in the position to own themselves. Some of us work in specialties that require hospital infrastructure or institutional support, and legitimately fear losing our livelihood. I get it. These physicians must choose their battles carefully and decide when speaking out is nonnegotiable to uphold their ethical obligations to patients, the practice of medicine, and their own conscience. In such cases, it can be helpful to work with a professional—a psychologist, psychiatrist, or physician coach—to practice presenting your case factually and calmly, and to consider engaging legal counsel.

The world needs physician leadership now more than ever. Yes, it’s hard, can be scary, and sometimes it feels futile. But I do believe that physicians can make a difference to change healthcare for the better, especially when we work together. As Margaret Mead famously said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

Rebekah Bernard, MD is a Family physician in Fort Myers, FL, and the author of four books, most recently, Imposter Doctors: Patients at Risk (Universal Publishers 2023).