How to set up shop as an independent MD

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

There was a time when moonlighting and working per-diem was only for physicians who wanted to achieve certain short-term goals, such as paying off debt at the beginning of their careers, or killing some time toward the end of it. Those days are long gone. Now physicians everywhere are realizing the benefits of breaking free from the drudgery of full-time employment with a large healthcare corporation. As the healthcare pendulum has swung away from private practice to employed physicians-the desire has escalated to return some autonomy back to those once independent doctors. In most specialties, but particularly the generalist ones, there is a huge supply-demand mismatch that works in physicians’ favor (estimated to be a shortage of over 100,000 doctors by the end of the next decade). Demand for healthcare is surging due to various factors, including an aging population and an unfortunate increase in chronic comorbidities. If any doctor is savvy about it, they have the following options at their disposal to get away from full-time clinical work:

• Work part-time at one particular institution

You may have simply had enough of the administrative headaches and duties (especially electronic health records, which are the number one cause of burnout these days). You can’t do it full-time anymore, but will work part-time for your own sanity-with or without other clinical gigs and side ventures.

• Get credentialed for different facilities

At this time of heightened need for your services, you choose to work in multiple hospitals or clinics, doing different types of work. This can help keep things more varied and interesting, like doing a mixture of inpatient and outpatient work. You will be able to set your own schedule, typically months in advance, and easily arrange things such as extended time off-if you want to. You will never “put all your eggs in one basket” this way, working at only one healthcare facility. Neither will you necessarily need to travel long distances or be away from home for extended periods of time, as long as you take advantage of all the likely opportunities that exist around you (assuming you don’t live somewhere very remote or rural).

Not only can you quickly regain a sense of autonomy and independence again by breaking free from regular employment and going this latter route, but you can also earn more while working less. Especially if you do it on your own, and avoid a third-party recruiter or locums agency. 

The above options come with the obvious question though-how will you go about getting benefits and making the most of tax incentives that become available as essentially a small business owner? Well, with any regular employer, you don’t really have much choice as you are always going to be paid in regular employee status. If, however, you want to be a true independent contractor physician, and have worked out a way to make this feasible (easier than you may think!) you can form your own LLC or corporation (depending on your state) and choose to be an independent contractor instead. You will be able to take advantage of multiple small business tax breaks that go with this, which your accountant can talk you through. Getting benefits such as health insurance will depend on your individual circumstances and where you live, but is something that many doctors who have taken this path have done successfully.

The lesson is this: If you desire more independence, autonomy, flexibility, and above all else-freedom to set your own schedule-this really is a path worth exploring.

Suneel Dhand, MD, is an internal medicine physician and writer. He is the cofounder at DocsDox, a service that helps physicians find local moonlighting and per diem opportunities, bypassing the expensive middleman. He also works as an independent healthcare experience and communication consultant.