Physicians as Self-Employed Consultants

What’s life like on the other side of the fence from where you can stick it to the man?

There’s not one among us who does not have those days where you’ve had enough of patients, partners, bosses, the clinic/hospital/system/university/organization, and you envision a world where the only boss is yourself. Perpetual green hills, blue skies, and a fair breeze.

Ah, I can see it now. We close our eyes and escape for a time to a land of peace, serenity, and prosperity. Oh, sorry, forget about the prosperity bit. Then, while we’re at it, let’s not presume that serenity is a given either.

And, now that I think about it, perhaps we should ease up on the peace ideal for sometimes you may feel at war with yourself as you try to fathom who you are, what exactly you are doing, and what possessed you to get into this situation in the first place.

There are good reasons why millions of Americans of all professional persuasions put on their corporate or institutional faces each morning and head in to work.

Reasons such as:
1. Humankind’s near universal need for structure and order in an otherwise highly dyskinetic world.
2. A reliable weekly or monthly paycheck.
3. Health insurance.
4. Retirement contributions or pensions.
5. Satisfaction of working with like-minded others.
6. Catching a break from domestic chores and routines.
7. Paid vacations.
8. 8-8,001 others.

So what does it take for a physician to break out on their own and be successfully self-employed outside of the clinical sphere?
I offer what I’ve learnt from my own experience and from listening to and watching others. And, so we’re clear, I’m talking about true gainful self-employment, not having enough lolly locked away in your Swiss bank account that you can choose to play at consultant in some dilettantish way.

A. Know what you are giving up.

First, let’s move from the general to some nasty specifics. My health insurance alone, not including the missus, costs about $600/month. If I take an arbitrary (if low) tax bracket of 25%, I’ve to earn $750/month just to meet that expense.

If you prefer to focus on stashing it away towards retirement, there’ll be no more employer contributions to paying your future grocery bills. In my former life, I had an employer who doubled my retirement contribution with ceilings of 5% (mine), 10% (theirs). That’s a lot of smackers to walk away from given the might of compound interest.

How about those sometimes annoying patients or colleagues or bosses, who viewed through another lens may seem much more benign and enlightened than when you were rubbing shoulders with them each day.

Enough, you say, I still want to press on.

B. Know what you are moving towards.

A requirement for self-discipline that exceeds anything you’ve dealt with before. Can you be at your desk at 7 or 8 am, five days a week, 46 weeks a year, year after year after year?

A real-world understanding of cash flow. With a regular paycheck, cash flow tends to be more of an abstract concept. It’s a harsher reality when you have monthly bills but organizations reimburse their independent contractors based on schedules that may seem more based on whimsy and caprice than your needs.

Pay for performance is becoming part of the healthcare playbook, but independent consultants know it at first hand. Salaried workers have a ho-hum day at the office or hospital but stay on the payroll. A sub-par day (and we all have them), as an independent consultant and you may not be asked back.

Multiple bosses. Right now, by a quick count, I’ve about a dozen. That’s a lot of accountability. Often, perhaps particularly for hard-driving physicians, the boss of bosses is themselves, the governor within. Self-criticism doesn’t help particularly when you’re dealing with all those extra qualities you need –

Qualities like patience, tolerance, the stuff of emotional fortitude that Peter Drucker spoke of when he said that the absolute sine qua non for success in consulting was this latter quality, far more important than the financial resources that most individuals exploring this career option get hung up on. My own experience echoes Drucker. How well will you deal with rejection for it will come your way? How will you feel when an individual or organization flirts with you then dances away? How will you feel when dismissed by some from the safety of their sinecures?

Excuse me, I’ve one of my many bosses to meet. I’ll expand/expound more tomorrow.