For most of medical training, we’re told the same story:
Get a good job. Join a big system. Collect a stable paycheck. Live happily ever after.
But here’s the reality no one talks about:
Being an employed physician might actually be the riskiest career move you can make.
I know—that sounds backward. But I lived it.
In fact, the “stable” job I started with almost broke me. It limited my income, controlled my schedule, burned me out, exploited my work ethic, and made me realize I was nothing more than a cog in a billion-dollar machine. That experience ultimately pushed me to build my own multi-million-dollar private practice here in Texas—Thrive Medical Clinic. And today, as I prepare to open my fifth location, I can confidently say this:
Starting your own practice may be one of the safest long-term decisions you can make as a physician.
This blog post dives into exactly why.
After residency, I started as a full-time hospitalist. The job had its perks:
Zero startup costs
Immediate patient volume
Predictable paycheck
Clear schedule
For a while, it felt perfect.
But as months went on, cracks started forming—and those cracks quickly became red flags.
When private equity took over my group, everything changed:
Medicare cuts hit.
Administrative layers multiplied.
Pressure skyrocketed.
Volume expectations grew.
Patient care quality was de-prioritized.
Suddenly, I had to work harder just to make the same income, and even then, my pay still went down.
This is when I first learned the harsh truth:
What you want:
→ Time with patients
→ Quality care
→ Reasonable schedule
→ Competitive compensation
→ A sustainable career
What your employer wants:
→ Higher throughput
→ Lower cost
→ More billable encounters
→ Maximized profits for investors
Those two worlds clash. Hard.
Here’s the moment that shook me:
I discovered I was billing nearly 12,000 wRVUs per year—99th percentile productivity.
But my income?
62nd percentile.
Let that sink in.
That meant one of two things:
My employer had terrible billing practices, OR
They were making an absolute fortune off my work
Either way, I was getting the short end of the stick.
It all culminated in a bizarre meeting with the chief medical officer.
Why?
Because I dared to spend time having meaningful palliative care conversations with families.
Not rushing.
Not pushing consults off.
Not treating dying patients like throughput units.
Their response?
“You should have been admitting and discharging more patients. That’s how we make money.”
In other words:
“Stop practicing good medicine and start producing more billable units.”
That was the moment I realized something profound:
This environment will never let me practice medicine the way I believe is right.
You know what feels horrible?
Pouring everything into your job…
Sacrificing weekends, holidays, sleep, and mental health…
And then being guilt-tripped for saying no to a last-minute shift.
I remember being offered a $100 bonus to come in on my day off.
When I declined, they made it $200.
Two. Hundred. Dollars.
And during some of those shifts I was admitting up to 25 patients in 12 hours.
They knew exactly what they were doing:
Your loyalty is their leverage.
But your schedule?
Your autonomy?
Your personal life?
It all belongs to the employer.
That’s the reality of being employed.
Here’s a harsh truth no one tells you:
As an employed physician, your income is permanently capped.
That might feel fine in the beginning.
But over time, you’ll see what I saw:
More patients
More documentation
More bureaucracy
More administrative tasks
More hour creep
More burnout
…all while making the same (or less) money.
Because when Medicare cuts rates…
When private equity wants more ROI…
When your system decides to “optimize staffing”…
Guess who pays the price?
You.
And that’s why entrepreneurs have a different mindset:
Your earning potential should scale with your effort—not be dictated by a committee.
One of the most psychologically damaging parts of my employed job?
Empty promises.
“We’re getting more staff.”
“We’re hiring more hospitalists.”
“Help is around the corner.”
“We’re onboarding soon.”
Months passed.
Nothing changed.
Meanwhile:
I was caring for 30–40 patients a day
Nights were brutal
Holidays were gone
Weekends disappeared
Burnout became the norm
And through all of it, the hospital repeatedly acted like it was:
Understaffed
Underfunded
Barely surviving
Yet they were simultaneously undergoing a $900 million expansion project.
Funny how that works.
This might be the darkest part of the story, but it’s important.
When you’re employed:
Your work can’t be sold.
Your role can’t be passed down.
Your family gets nothing from your job if you die.
Your employer replaces you immediately.
I remember thinking:
“If I drop dead tomorrow, the only thing my family gets is a life insurance payout. That’s it.”
No equity.
No assets.
No brand.
No ownership.
No legacy.
That realization hit hard.
You’re building:
Financial stability
A company name
A legacy
A service to your community
Jobs for your staff
Something that has value even when you’re gone
The very idea that a job could give me none of that was unacceptable to me.
People think entrepreneurship is risky.
But here’s the truth:
Working for someone else is risky when they control 100% of your income, schedule, and destiny.
Starting my own practice removed that risk.
Because I built the control.
Today:
I own a thriving multi-million-dollar practice
I have five clinic locations
I control my schedule
I control my income
I decide how I practice medicine
I’ve built something that outlasts me
I’m no longer replaceable
This didn’t happen because I’m special.
It happened because I refused to let an employer dictate my life.
Physicians message me every day saying things like:
“I’m tired of being overworked.”
“My employer keeps cutting my shifts.”
“I’m making less every year.”
“I want more control.”
“I want to treat patients the right way.”
“I want something that grows.”
“I want a legacy.”
And I tell each of them the same thing:
Maybe your employer is limiting you.
Maybe you’ve hit your income ceiling.
Maybe the bureaucracy has worn you down.
Maybe the schedule is killing your personal life.
Maybe you’re tired of being replaceable.
Or maybe, like me, you simply want more.
I’ve never met a physician who’s afraid of hard work.
We survived:
Organic chemistry
Step exams
Residency abuse
80–100 hour weeks
Constant scrutiny
Traumas and tragedies
We’re built for challenge.
So when people ask me:
“Was opening your practice risky?”
I tell them:
It was less risky than staying somewhere I knew I didn’t belong.
What’s actually risky?
Staying in a job that limits your potential
Trusting your income to administrators
Letting Medicare cuts dictate your earnings
Working for companies driven by investor profit
Ignoring burnout until it’s too late
Spending your life building someone else’s dream
Compared to that?
Opening your own practice is liberating.
At the end of the day, here’s the truth I wish more physicians knew:
Entrepreneurship is not about ambition—it’s about survival.
If you feel undervalued…
If your employer limits you…
If you’re working harder for less…
If your schedule controls your life…
If your legacy is nonexistent…
If you want to practice medicine the right way…
You owe it to yourself to consider private practice ownership.
I did it with no business background, no special skills, and no formal leadership training.
Just:
A willingness to work hard
A willingness to learn
A willingness to fail forward
A willingness to break out of the system
And today?
I’m living proof that it’s possible.
The riskiest thing I ever did was stay employed.
The safest thing I ever did was bet on myself.
