The Audacity of Physician Autonomy

Melissa Welker, MD MPH shares thoughts about how rediscovering physician autonomy might help fix the physician staffing crisis.

February 7, 2024

Recently I transitioned to a new job structure.

As part of the growing number of physicians that have found themselves wrapped up in waves of transition that keep sweeping medicine these days, I also have found my day to day life altered once more. I found myself chatting to another physician about treatment plans and soon the topic turned to job transitions.

Several months prior, in another hospital system, and both in different jobs, this physician had told me they were leaving medicine forever. However, here they were, back working clinically and looking years younger.

They found a way to stay on their terms.

I can barely think back to a time in which medicine did not feel mercurial.

Soon after leaving residency a number of my co-residents were caught in private equity buyouts and forced to reevaluate how their work lives would continue. Then as we all are likely tired of hearing, there was COVID.

We all learned we could work, or not, get paid, or not, all in a matter or days and our realities continued to change…for years (what is not on backorder or short staffed today?). The one change I do hope remains is the emergence of the relaxed and empowered physician.


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Short staffing has become a mainstay of figuring out logistics in medicine for some time.

With physicians, nurses and staff leaving for traveling, non-clinical jobs or just leaving medicine in general short staffing will likely persist as a seemingly insurmountable challenge for some time. And as with any good market economy, when supply becomes low and demand remains high and even grows, those that control supply (people) can use that leverage.

The curious piece of this economic study is that the physician shortage has been impending for some time.

I distinctly remember a lecture in medical school in which we were all described as paddling a raft upstream going down a river towards a waterfall…soon we simply would not have enough physicians.

However, starting early in training physicians were instructed to do more with less.

Someone out sick? I guess you’re on call tonight.

Supply chain shortage? Time to find a less ideal creative solution.

No PPE? Can you use garbage bags?

You get the picture.

It took a global pandemic for many of us to realize we could no longer keep paddling harder and maybe it was time to find a new solution.


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For me, the change came slow and fast.

After months of patching staffing together for a hospital system during a rough contract negotiation, the contract was given to a private equity group. And that’s when I finally learned, it was not just the hospital system that thought of me as a replaceable widget, I believed it too.

I believed my worth was tied to how many calls I could take, how many patients I could see, how hard I could work. And the reality is, especially now, only I get to decide if I am replaceable. And with that I jumped out of the boat, swam to the shore, and decided to remake my career outside of frantic paddling.

As I finalized patient treatment plans, I asked my colleague how they felt now and their answer struck me. They said now that they were working reasonable hours and finally had more control over how they worked they realized, they could do this for years if they wanted. And maybe they did not have to leave clinical medicine after all.

And here is the irony in it all. Deciding to leave medicine may have saved their career in medicine. In finding their own autonomy, they

I would be remiss if I said I knew how to fix all of medicine and all the staffing and supply shortages we still have. However, I do think we have missed a big piece of the solution, remembering we still have power in a capricious medical system by stepping back and realizing we are only irreplaceable to ourselves. We can find the empowered physician, even if it is just ourselves.

And maybe, just maybe, autonomy will be contagious and more of us will realize, to the medical system we will always be replaceable, until we aren’t, but none of us have to continue to believe that lie.

Melissa Welker, MD MPH

Melissa Welker, MD MPH

Thinking creatively about how we can make Anesthesiology and healthcare work for patients and those that work in healthcare.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.


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