Few professions require more education and training than that of a physician. After four years of medical school, three to seven years in residency, often followed by a fellowship, when physicians emerge from training and enter full practice, they have earned the right to make decisions for their patients without influence from non-physicians. And yet, growing administrative demands, managed care limitations, and productivity requirements often infringe upon this right, and the loss of autonomy is detrimental to professional satisfaction.
As Regional Vice President of Recruitment for Jackson Physician Search, I hear from physicians daily leaving jobs due to a lack of autonomy. They want to be sure their next employer provides more of it, but this can be difficult to decipher during the interview process, when everyone puts their best faces forward. Evaluating physician autonomy with a prospective employer requires strategic investigation and is critical for future job satisfaction.
The Importance of Physician Autonomy
Multiple studies document the connection between physician autonomy and job satisfaction. According to Simbo AI, physicians who report greater independence and control over the pace and content of their clinical work consistently experience higher levels of professional satisfaction, reduced stress, and improved capacity to manage the demands of their roles. I’d argue this causal relationship reflects the significance of one’s sense of purpose, a topic recently explored in a joint study by Jackson Physician Search and LocumTenens.com. For physicians to feel they are living out their purpose, they must be able to use their skills and talents to improve the lives of patients. When they are told how to treat patients, rather than decide using the skills they have spent so many years developing, they often begin to ask, “Why am I even here?”
This was the point made by an insightful physician I met at a conference last month. In a conversation about the aforementioned purpose study, the surgeon expressed her belief that a physician’s sense of purpose erodes when other people or influences strip away their autonomy. This loss of independence is one of the most frustrating aspects of modern practice.
6 Tactics for Evaluating Autonomy with a Prospective Employer
The significance of autonomy is clear. Similar to physician compensation models, physician autonomy isn’t always straightforward when evaluating a prospective employer. However, there are effective measures you can take to ensure you make a well-informed decision. Leverage the following tactics for assessing physician autonomy during the interview process.
1. Speak Directly with Physicians in Your Prospective Department
One of the most revealing steps you can take is to talk to current physicians in the department or specialty you’d be joining. Ask the employer to connect you with at least two or three peers. If possible, request a mix of newer and more senior physicians for a well-rounded view. Focus your questions on two areas.
- Clinical practice: Current physicians can offer candid perspectives on the day-to-day realities of autonomy within the department. Ask them specific questions about their freedom to make clinical decisions, order tests, prescribe medicines, and manage patient care as they see fit.
- Organizational decisions: Autonomy encompasses more than just clinical decision-making. It includes control over scheduling, patient load, the ability to spend adequate time with patients, and participation in organizational decisions that affect clinical practice. Ask potential peers for concrete examples of how administrators and higher-ups include physicians in decision-making processes and whether they feel supported advocating for patient needs.
2. Investigate the Organizational Structure and Practice Model
In a 2023 joint study of early-career physicians conducted by Jackson Physician Search and MGMA, the most commonly cited reason for leaving first jobs was the “practice ownership/governance model.” The report concludes that new physicians don’t always go into new jobs with a clear understanding of how their new organizations will be managed, and how that may impact their job satisfaction. This can be true for physicians at any stage of their careers. Take an opportunity during the interview process to investigate and consider the following points.
- Ownership: Research indicates that physicians in physician-owned practices or partnerships report higher satisfaction and greater autonomy than those in hospital or corporate-owned settings. However, not all physicians desire ownership responsibilities, and employed positions can offer meaningful autonomy if structured appropriately.
- Practice Size: Larger group practices and health systems typically employ more standardized processes and protocols, allowing for less individual discretion.
- Governance and Decision-Making: Find out how decisions are made within the organization. How many physicians are on the board? Are practicing physicians involved in setting policies that impact clinical care? Higher levels of participation by practicing physicians increase the likelihood of retaining autonomy.
3. Meet with Physician Leaders and Administrators
Physician leaders — such as department chairs, medical directors, or the Chief Medical Officer — can provide a unique perspective on how much influence physicians have within the organization. Good physician leaders serve as advocates for their colleagues and work to create environments where clinical expertise is respected. Leaders with clinical experience are often more attuned to the importance of physician autonomy and may be better advocates for your interests.
Meet with physician leaders to discuss their approach to balancing organizational goals with physician independence. Look for evidence of two-way communication and collaborative problem-solving.
4. Investigate Physician Retention Rates
Finally, one of the most telling indicators of physician autonomy is how long physicians stay. High turnover, especially among early-career physicians, may be a red flag that physicians feel disempowered or unsupported. Ask questions such as:
- What is the average tenure of physicians in this department?
- Have there been any recent departures, and if so, why?
- What is your retention strategy for physicians?
Organizations with a strong track record of physician retention are more likely to offer an environment that preserves autonomy and satisfaction.
5. Ask Targeted Questions During Interviews
Prepare questions that go beyond surface-level culture talk. Consider asking the following, and compare how physician peers answer versus how leadership responds. For example:
- “Can you describe a recent situation where physicians influenced a major clinical or operational decision?”
- “How are disagreements between physicians and administration typically resolved?”
- “What mechanisms exist for physicians to provide feedback or suggest protocol changes?”
- “Do physicians have control over their schedules and patient panels?”
6. Observe and Listen Carefully
During physician interviews and site visits, pay attention to what is said and how it is said. Are current physicians comfortable discussing autonomy, or do they seem hesitant? Do leaders welcome tough questions, or do they deflect? The tone and openness of these conversations can be as revealing as the content.
Finding the Right Fit
Physician autonomy is fundamental to physician job satisfaction, yet evaluating the degree to which a potential employer can offer autonomy is highly nuanced. Unlike the proposed work schedule or details about the patient population, physician autonomy requires some active investigation to fairly assess how much an organization empowers its physicians to act in the best interests of their patients.
As you evaluate potential employers, prioritize environments that value and protect your ability to practice medicine according to your best judgment. By speaking directly with potential peers, understanding the organizational structure, meeting with leadership, and asking the right questions, you can make an informed decision supporting your professional satisfaction and your patients’ well-being.
The right fit is one where your expertise is respected, your voice is heard, and your autonomy is preserved. Choose wisely.
If you are seeking a new opportunity, the recruitment team at Jackson Physician Search can guide you in the right direction. Reach out today to learn more or start searching physician jobs online now.
About Neal Waters
Neal’s career in retained physician search began more than 15 years ago. Early on, he recognized the strain an entire community feels when there is a shortage of physicians to meet patient demand. Since his first successful placement, Neal’s passion for identifying the best providers for each healthcare organization with which he recruits has grown.
Neal serves as Regional Vice President of Recruiting. In his role, he serves as a mentor to a growing team of Jackson Physician Search recruiters. He also enjoys collaborating with in-house recruiters who are dedicated to optimizing their physician recruitment and candidate acquisition strategies. Likewise, Neal specializes in helping physicians, especially residents and those early in their careers, advance their professional careers by finding the right fit.
