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We sit down with Tod Stillson, a family physician and entrepreneur, to discuss how physicians can regain control of their careers in a system designed to push them toward traditional employment. Tod shares his personal journey from being funneled into the corporate health care world to discovering the freedom and financial empowerment that comes with self-employment.
Tod Stillson is a family physician, entrepreneur, and Amazon best-selling author of Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy. He can be reached at SimpliMD. Follow him on Facebook, Instagram, and X @DrInc9, or join his Facebook community for doctors, Every Doctor Is A Business.
He discusses the KevinMD article, “Systemic collusion: How big business and government herd physicians into traditional employment.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Todd Stillson. He’s a family physician and entrepreneur. He’s the author of the book, “Doctor Incorporated: Stop the Insanity of Traditional Employment and Preserve Your Professional Autonomy.” Today’s KevinMD article is Systemic Collusion: How Big Business and Government Herd Physicians into Traditional Employment.
Todd, welcome back to the show.
Todd Stillson: Kevin, it’s great to be back with you and to be a part of your audience. I love what you do here.
Kevin Pho: All right. So before talking about your most recent article, just what led you to write it in the first place?
Todd Stillson: Well, I think that one of the challenges that we have in medicine today is that, you know, there’s a lot of things that are going on. If you look at things from the 20,000-foot view, oftentimes we lose sight of those things because we’re down in the trenches doing the work every day. And it’s easy to forget really what these other forces are going on around us. And so that was just sort of a revisit of a, of a bigger subject.
Kevin Pho: All right, perfect. So, of course, one of those 20,000-foot view items is big business and government herding physicians, as you say, into traditional employment. So let’s define some terms here before we go into your article. What do you define as traditional employment?
Todd Stillson: Traditional employment is really what the majority of doctors are doing right now, which is you receive a W-2 paycheck from a corporate employer of some type who pays you for your professional services and they take care of the rest. It’s basically, you do your work and you get a paycheck.
Kevin Pho: All right, and you’re right, that is the majority of physicians today. So talk about some of these outside influences that are making that happen.
Todd Stillson: Well, I think we all recognize—and some of us have varying levels of frustration over it—that there are larger forces that have entered in and really taken over the world of medicine and the business of medicine. And there are several forces involved. I think there are really four primary forces that we have to talk about.
One of them is the big business of medical education. So, medical education is a whole space of its own sort of entity in this process. Then there’s the IRS, or the federal government. There are also the large health care corporations and private equity groups controlling the marketplace. And then, of course, there’s us in our role in that. So all four forces sort of interplay with one another and affect this space of how we feel like we’re either in control of it or out of control of it.
Kevin Pho: And you talk about these four entities that are influencing physicians toward traditional employment. What’s in it for them? Why do they want physicians to be traditionally employed?
Todd Stillson: Yeah, that’s a fair question. You know, we could get into a whole conspiracy hole of entities working together to keep physicians under control. I think each one has its own built-in incentive that influences the process.
If I were to say, the big business of medical education has to do with growing their footprint and influence through health care. We all see the big departments, the large buildings that are going up, all the faculty being paid for, and the plans that, at the end of the day, come down on the back of the medical student. What that big business of medical education understands is that doctors can get loans, so they’re going to up the cost of their program knowing that a future doctor will take out a larger loan. It’s almost like they’re using it as a pass-through to access funds to fuel their business education plan.
Now, for the federal government, we all know—especially with an election cycle going on right now—that they’re interested in our tax dollars. They’ve been clear, particularly one side, about targeting people making more than $400,000 a year, high-income earners. And they prefer high-income earners to be W-2 employees because, frankly, as an employee, you don’t have a lot of latitude to reduce that tax burden.
And then, in terms of the corporatization of health care, we all know that we are basically commodities in the process. From a big-picture perspective, our physician labor is just another commodity for them to manage, just like patients are a commodity to manage. They take those two elements, along with third-party payments, and put it all through their business metrics to earn money. And so we just become commoditized in the system so that large corporations can do well from a profit standpoint.
So those are really, in general, the reasons behind those forces. They’re not necessarily working in unison, but they do play off one another a little bit. As an example, I would say physicians come out of medical training with large debts. So, what would a large health care corporation want to do to pull you into their orbit? They’re going to provide financial incentives for you to become a traditional employee, which they can control and manage as a commodity. They know you’re financially vulnerable, so they’re there to meet that need, but in the process, you give up a lot downstream. So they’re colluding, not overtly, but indirectly, they interconnect.
Kevin Pho: And you mentioned that fourth group, which is physicians themselves, right?
Todd Stillson: Yeah, exactly.
Kevin Pho: There is a group of physicians—some would say the majority—who would prefer traditional employment. Is that what you’re alluding to?
Todd Stillson: Yeah, “prefer”… I don’t know if I would say prefer. I would say they’re conditioned to expect that to be the norm. Now, so is that preferred? I don’t know. We’re so used to, as physicians, whether it’s pre-med training, med school, residency, we’re conditioned to follow. We’re told, “This is the way it is; this is what you do.” In that conditioning process, whether it’s the medical education world or the health care marketplace, we’re conditioned to believe that traditional employment is the only way to survive or do well because it’s simple, and the marketplace is too strenuous or difficult to navigate on your own.
So, are we being preferred? No, I think we’re being herded. That lack of business education—I mean, medical education doesn’t provide business education anymore, right? Is that on purpose? There’s so much competition for our time. I don’t know if it’s intentional, but it does get pushed to the side. Do the corporate employers want us to have business education? Probably not. They don’t want us to be empowered to leave them; they’d rather we stay with them. Does the federal government want us to see ourselves as small businesses? They like small businesses, but they also like the tax dollars that come from us being W-2 employees.
So, we’re indirectly influenced by these powers to think that the status quo is easiest, that we should just be employees. But my point is, there are other options available to doctors, and we need to think about those and think for ourselves. This is about empowering doctors, and the reason I wrote the article is I believe every physician needs to be empowered to think for themselves.
If you think about it and work through it, and decide, “Yeah, I prefer to be a traditional employee; it’s simpler, easier”—I think the majority will land there. But there’s a lot who didn’t really think about it and are just passive about it. I’m just encouraging doctors to be active so they can take control of their future, their professional life, and not passively give it up to these other forces. I believe these forces indirectly and directly influence the burnout crisis. Doctors feel powerless in the system, and really the best way to regain our power is to have autonomy. That’s how we can get out of this cycle of burnout.
Kevin Pho: And I think we mentioned this on a prior show, whenever you would go to a medical school to talk about some of these alternative pathways, you wouldn’t always be encouraged to do that, right?
Todd Stillson: Absolutely not. Those forces, again, have filters about what they want those they’re influencing to hear and receive. And that’s a good example. Those filters are placed on each one of those entities in terms of how they want us to be conditioned. My message to your listeners is, if you’re a physician, don’t passively let yourself be conditioned to believe this is the only way. There are plenty of other options.
Kevin Pho: So, how does one go about breaking that conditioning? How can you unlearn the conditioning from medical training that a traditional employment model, a W-2 model, is the only way?
Todd Stillson: I think information and inspiration are two elements we need. Just like we come out financially illiterate, we come out business illiterate. So, how can you correct that? Physicians love to learn; they love to read, to listen to podcasts like yours, and to explore. So, make it an intentional effort to read a book, sign up for a blog like SimplyMD, where I’m sending out blog posts on self-employment and independence every day. You start to see through stories and examples how other people are doing it.
Another way is to identify a mentor or someone in the marketplace who is a physician who has remained independent. Spend time with them, find out how it’s working for them. This process of building competency has to come from within. Your employer’s not going to give you business education. The federal government won’t. The medical education system won’t. You have to empower yourself. So, find resources for financial and business literacy—read books, find mentors, find people who can inspire you.
Kevin Pho: Now, how did you forge your own pathway? For listeners who aren’t familiar with your path, you are not traditionally employed. Were you at one point, and how did you unlearn that traditional thinking and forge your own path?
Todd Stillson: Yeah, I was traditionally employed for about 15 years, so I do have a compare-and-contrast experience, which is one reason I developed SimplyMD as a messaging community for doctors to know there are alternatives. For the past decade, I’ve worked as an independent physician in what’s called an employment-light agreement with a large hospital system. We’ve discussed this on your site before.
How did I arrive there? Because I didn’t have business awareness, having been a traditional employee, I sought out business consultants in health care who exposed me to the opportunity. Once I became aware of it and followed their advice, that’s when I transitioned to becoming independent.
Todd Stillson: So, once I became aware of the independent options available and followed their advice, I made the transition to becoming an independent physician and began the journey. I remember being anxious about it, to be very honest, when I made that transition, because I knew so little and didn’t feel prepared. But, like a lot of things, sometimes you just have to jump in and learn as you go.
It took a couple of years for me to really wrap my mind around the process of being a “micro-corporation” and operating as a business entity. And as I did it, I realized that this is something a lot of doctors can do. This isn’t rocket science. It’s not overtly complicated; you just have to take the initiative, dive in, and do it. I try to provide a host of resources, products, and courses on SimplyMD to help facilitate that and make it easier for doctors who want to go down this path.
Kevin Pho: So, with these larger forces—these entities influencing physician decisions when it comes to their careers—do you think there’s still room today for independent practitioners, or for practitioners who want to do arrangements similar to what you have? Is there room for that?
Todd Stillson: Yeah, 100 percent. In fact, I see a movement happening through my work with SimplyMD. There’s a shift, a trend of physicians who, after being in traditional employment, are looking for alternative options.
Here’s what typically happens: First, you have a small subset of doctors who, right out of training, know they want to be independent. They know from the beginning that’s what they want, but that group is relatively small. More commonly, what we see is that after three to five years of working as a traditional employee, doctors start saying, “I don’t really care for this; I don’t want to do this,” and they start looking for alternative paths.
That’s why we’re seeing growth in the marketplace—whether it’s telehealth, direct primary care, concierge medicine, various contracting options like employment-light agreements like mine, or even locum tenens positions. We’re seeing this growth that used to be in the 5 to 10 percent range; now it’s climbing more into the 15 to 20 percent range. And that’s not even mentioning private practice, which, though it has its challenges, still remains an option in many areas.
There are all sorts of opportunities that continue to grow. We’re in a high-demand profession, and the gap between what’s needed in terms of physician services and the number of physicians available isn’t shrinking. That demand is only going to increase, and the variety of options in the marketplace will continue to expand.
Kevin Pho: We’re talking to Todd Stillson. He’s a family physician and entrepreneur. Today’s KevinMD article is “Systemic Collusion: How Big Business and Government Herd Physicians into Traditional Employment.” Todd, as always, let’s end with your take-home messages to the KevinMD audience.
Todd Stillson: My message is simple: Take back control of your professional life. You’re not powerless, and you don’t have to be complicit. You don’t have to be passive. You have the power to take control of your own career.
Don’t rely on a large employer to manage your career for you. Take charge, explore the opportunities available, and enter the marketplace as a self-employed, independent doctor if that’s what aligns with your goals. There are many options out there today for physicians to practice autonomously, and I encourage every doctor to at least consider those options. Don’t ignore independence as a viable path.
Kevin Pho: Todd, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.
Todd Stillson: It’s great to be with you, Kevin. Thank you.
