Key mindset shifts to becoming a self-employed physician

Although most of what follows will apply to all people employed in helping professions who transition to self-employment, I can only speak to my own experience. I was a family medicine physician who transitioned to freelance medical writing and editing. At 5 years in, I have a few reflections for those just starting on the path. 

Here are my top 4 mindset shifts to becoming successful as your own boss.

When I worked for a giant academic medical center, I often thought my introspective nature worked against me. I was acutely aware of how much I missed having time away from work to write, which parts of my job I wished I could hire someone else to do, and which parts someone else did which I could do better. Although this might have led to dissatisfaction when I couldn’t change my work environment, when I could, these insights were a gold mine.

Here are some insights I’ve formed around skills, interests, and assets so far in my career.

There are certain parts of my job (e.g., marketing) that I’m not good at and I don’t enjoy. Those are the parts that make sense for me to hire someone to do for me. There are other aspects (e.g., accounting) that I didn’t have the skill for initially, but I was excited about learning. Those are areas where I’ve sought more education.

But most of all, I knew going into self-employment that I was good at writing and explaining difficult concepts to regular people. I also knew those were skills that not everyone with a doctorate has. The things that make me unique helped me find my market niche and become profitable, quickly.

Being the boss means that I decide who I want to serve in my work — whether that’s low-literacy patients or fellow professionals. I choose how I want my work life to look, and what would best serve the people I’m ultimately accountable to now: my clients.

Initially, I wasn’t honest with myself about what I was interested in doing, and took work in other fields; although I did an acceptable job, I didn’t enjoy the work any more than being employed. Just because I can do something doesn’t mean I want to or should. Sustainable self-employment means that I need to feel good about the work I’m doing.

As an employed person, you have benefits like paid time off and private health insurance that you will not have when you’re self-employed. Add to that lack of a safety net the fact that many businesses take 18-24 months to become profitable, and it’s hardly a surprise that 1/3 businesses fail in the first 2 years. Part of being self-employed is being honest with yourself about your financial assets.

For me, taking a part-time job helped ease the transition, as it provided me with a stable revenue stream — regardless of how my “real business” was going. Other people have relied on their working spouses, used their savings, borrowed money from family or outside investors, or deployed other creative solutions.

When I first started working for myself, I wanted to give everyone a discount, either because I liked them or was sympathetic to their situation. However, after a few months, I realized that I would go out of business if I kept up the way I was going. I had to set my prices to make sure I could cover my own expenses and meet my financial goals. 

If you don’t earn a profit, you don’t get to stay in business, or keep up on your mortgage, or plan for retirement. If you go out of business, you likely have to go back to whatever you were doing before or take an even less desirable job. To make self-employment work, you have to be committed to earning more money than you spend. That’s what people call a “business-mindset.”

It does not mean that you have to try to extract every cent from every human you meet, especially if that’s not consistent with who you are. It doesn’t mean that you can’t work with certain groups. You don’t have to compromise what’s important to you to become and stay profitable, as long as you can balance money in and money out. 

Making money is not shameful or dirty. It’s a good thing, and it allows you to help more people in different ways. In my own work, for instance, I am financially sound enough to accept a lower rate, or even the occasional pro bono job, from a nonprofit once in a while. 

(Note that I have been influenced by these 2 people who sometimes talk about this topic: Nicole Broadhurst, Lisa Wallner.)

One of the potential pitfalls of my particular personality is that I sometimes self-isolate. I love sitting alone in my home office – but that isn’t always where I can find help if I get stuck on something. I need a team of people to support me when I run into new-to-me issues. That means a mentor from my local SBA, and plenty of professional contacts to refer clients to when they aren’t a good fit for my services. (This is also good for my business — the client will speak highly of me and the other professional will refer to me.)

For those who want to start their own practice, it may mean looking into collaborating with other private practices, meeting the people who can give you referrals in your community, tapping into the resources of your professional organizations, or finding someone who has already mastered what you are just learning (e.g., starting a business). 

You’ll also need to build a team of people to call when you have questions — for example, your accountant and lawyer. Vendors can also play a big role in supporting your business growth.

Even though this is the last one, it may be the most important. As a doctor, I was vigilant about errors. I knew medical errors killed people, so I double-checked labs, vitals, and medication lists, scouring for potential problems. But, as a business-owner, most of the decisions I make have much milder consequences.

In my first year, for instance, I didn’t set up a business bank account. If I had, filing my taxes would have been easy — but I didn’t. So instead, I got to dig through every single receipt and statement from the year to find business expenses. I cost myself some time, certainly. I probably missed some business expenses and paid a little extra tax. However, no one died. I didn’t have to shutter the business. 

You will make mistakes in your business, too. I guarantee it. It might be a marketing campaign that doesn’t pay off, or a partnership that doesn’t pan out — but these mistakes can be corrected. My rule of thumb is to feel about 80% confident that I can do something well, and then go for it. If I wait until I’m 100% certain that I’m doing the right thing, I’ll never act.

That kind of perfectionism can be useful in a medical field when there is a lot at stake, but it is toxic to a business. Doing something and getting it a little bit wrong is almost always better than waiting for perfection.