au-ton-o-my

Autonomy: from the Greek roots: autos = self and nomos = law. Oxford English Dictionary definition "freedom from external control or influence; independence".  In childhood, autonomy is when one understands oneself as a self-governing individual.

A world-wide epidemic of physician burnout exists according to an editorial published in The Lancet (Physician burnout: a global crisis, The Lancet, July 13, 2019). Doctors are retiring earlier than planned. Suicide rates for physicians are higher than for any other profession. Not only does burnout affect physicians' personal lives, but also affects patients' care and safety. Why is this happening? Rising educational debt, increasing administrative tasks, long hours, professional competition, demanding patients, erosion of physician autonomy...

There is a sentiment brewing that our country's healthcare crisis may be aided by establishing a system modeled after the NHS in the UK where physicians are employed by the government. According to The Lancet article, 80% of doctors in a British Medical Association 2019 survey were at high or very high risk of burnout. Is this really the only practice model that should exist for our physicians?

I have worked under almost every practice model available to a physician: multi specialty group practice, hospital employed, academic medicine, small group private practice, locum tenens, solo private practice, full time, part time and for two brief periods in my career, I didn't work at all! Each model has its strengths and weaknesses and I chose each model for a particular reason (work-life balance, financial, benefits...) at a specific time in my career. But none has afforded me as much autonomy as solo private practice.

I realize that not every physician desires to be a solo practitioner, but feel that preservation of physician autonomy is essential to combating burnout. By encouraging a variety of practice models to co-exist, physicians' professional longevity as well as patient care and safety will be improved.