Convenience Is Quietly Undermining Physician Autonomy

 A few days ago, a recruiter pitched me a W-2 clinical role. When I mentioned preferring to manage my own insurance and retirement structure as an independent contractor (rather than being a hospital employee), he replied with a sentence I've heard before but never quite processed the way I did this time:

"Most doctors like to be taken care of."

It sounded harmless. But it reflected a deeper assumption built into modern healthcare employment -- an assumption worth examining more closely as our profession faces record levels of burnout, consolidation, and workforce instability.

What Do We Mean When We Say Physicians Are "Taken Care Of"?

Across the industry, W-2 employment is marketed as stability. Physicians are told they will receive: predictable pay, malpractice coverage, support with credentialing, health insurance, a retirement plan, and administrative simplicity.

All of these are important. Many doctors genuinely value convenience and would not want to manage these elements themselves.

But the reality is more complicated. The same structures that simplify a physician's life can also limit autonomy, because W-2 benefits are typically employer-owned, employer-controlled, and employer-dependent.

These arrangements often determine which health plans a physician can access, how much they can contribute to retirement, when their funds vest, whether their savings are portable, and how disruptive it would be to leave a position.

These are not small details. They shape the conditions under which physicians can change jobs, negotiate fairly, or adjust their careers based on evolving life circumstances.

How Dependency Develops: Quietly and Rationally

Physicians are trained to minimize risk, protect continuity of care, and prioritize stability -- both for themselves and for their patients. Healthcare organizations understand this psychology, and they design benefits around it.

This is not malicious. It is simply how large systems function: benefits become a workforce retention tool, not just a support mechanism.

Over time, a physician may remain in a misaligned role because leaving would mean losing or interrupting health insurance, sacrificing unvested retirement contributions, restarting a long credentialing process, or facing months of income uncertainty. In a profession where burnout is already high, these hidden frictions matter.

Why This Matters in 2025

We are in a period of rapid change across the health industry:

• Independent practices continue to decline.
• Large systems and private equity groups control increasing market share.
• Physicians are switching jobs more frequently.
• Administrative workload continues to climb.
• Workforce shortages are growing across multiple specialties.

In this environment, autonomy is shaped less by clinical authority and more by structural design -- particularly the design of benefits.

When a physician's financial stability is fully integrated into an employer's architecture, leaving becomes costly. As a result, many physicians stay in positions they would otherwise exit earlier.

This has downstream effects on job satisfaction, patient care quality, retention, burnout trajectories, and professional identity. We talk often about "moral injury," RVUs, documentation burden, and staffing issues. But we rarely talk about the architecture of dependency created by insurance plans, retirement structures, and exit friction.

Are W-2 Jobs the Problem?

Not at all.

For many physicians, W-2 employment is the right choice. It offers predictable overhead, simplified logistics, lower administrative burden, and the sense of being part of a larger structure.

The point is not to criticize W-2 roles. The point is to encourage transparency about the tradeoffs.

Awareness of these tradeoffs often differs by experience level. Physicians who have practiced across multiple settings (independent, academic, hospital-employed) tend to recognize how benefit structures shape autonomy and mobility. Newer physicians (including myself when I was just out of fellowship) may not encounter these limitations or understand their impact until they change jobs, negotiate contracts, or restructure their careers. This gap is not a failure of individual physicians, it's a reflection of how rarely employment architecture is discussed during medical training.

Medical training rarely teaches physicians which benefits are portable versus employer-bound, how vesting schedules impact mobility, how retirement plan design affects long-term wealth, how insurance choice influences negotiation power, or how employment status shapes exit risk. Without this knowledge, physicians often make decisions based on perceived comfort rather than actual control.

A Path Forward: Honest Framing and Informed Choice

Healthcare employment doesn't need a revolution. It needs clarity -- especially if we are to preserve our current workforce and encourage more trainees to enter the field.

Physicians deserve to understand:

1. How their benefits impact leverage and independence
2. What they gain versus what they surrender in a given employment structure
3. Which conveniences create long-term constraints
4. How to evaluate autonomy in concrete, structural terms

These conversations are not anti-institution. They are necessary for a stable, empowered workforce.

My recruiter's comment stayed with me because it revealed a widespread belief: that physicians should value being "taken care of" more than being structurally empowered. But at a time when many physicians feel increasingly constrained, understanding the mechanics of autonomy has never been more important.

Support should help physicians practice better medicine -- not quietly bind them to organizational structures they don't fully understand.

Sriman Swarup, MD, is a hematologist/medical oncologist and founder of Swarup Medical PLLC. He writes about physician autonomy, health system design, and the intersection of clinical practice and policy.

https://www.medpagetoday.com/opinion/second-opinions/119110