How the Medicine Field is Changing, and Why Entrepreneurship Is a Must

The following is adapted from The EntreMD Method by Nneka Unachukwu.

It was the most ordinary of mornings when my life changed.

If there had been a video camera trained on me at that moment, nothing special would’ve been recorded. It was in 2016, and I was just sitting at my desk in my home office, preparing for the day. The earth didn’t shake, a thunderbolt didn’t suddenly strike, and no trumpets blared.

But internally, it felt a little like all those things had just happened.

The words that came to me were simple, but the implications were not.

“The way medicine has been practiced is gone…forever.”

At the time of this insight, I had been running my own practice for six years, and it was doing well. But I still felt uneasy about the state of medicine. I hadn’t been thinking in any kind of systematic way about the direction of medicine, but I also couldn’t help noticing disturbing trends. It was bothering me more and more.

I also knew that very few doctors were facing up to the situation. When I talked about it, the responses were almost always things like, “We will always have jobs” or “The pendulum will swing back and things will go back to the way they used to be.”

I wanted to believe the same thing, but the evidence for deep changes in the role of physicians was everywhere, and the trends were picking up steam. Looking back, I think up to that moment I had wanted to convince myself that there was a way around it all. That maybe somehow, someway, things would go back to a time when doctors had more control over how they practiced medicine and had more economic security.

I would describe that morning in 2016 as the moment when I let go of that fantasy and accepted that things had changed permanently.

I also remember thinking that the time was coming when it was going to get really ugly for physicians who didn’t adapt to the new realities. The belief that physicians would have 100 percent job security — slipping away. The time when we had a virtual monopoly on practicing medicine — gone forever. The time when we could automatically expect to practice medicine on our own terms — that disappeared, too.

This insight should have shaken me up and depressed me. After all, I had just realized that the business side of medicine no longer worked for most physicians and that the trends were only going to snowball and become even worse.

But I didn’t feel depressed. Not at all. I felt absolutely galvanized.

One reason I felt that way is because I knew that, if I understood a trend accurately, I could figure out the best way to respond to it. Instead of getting carried under by the wave, I could stay on top of it and ride it to greater success.

The other reason I felt so energized was because, in that moment, I discovered something about myself. It would take some time to figure all of it out, but I found out what I was supposed to be doing next with my life. Call it a mission, a vocation, a calling — whatever word you want to use. But I suddenly wanted to shout from the rooftops to other physicians:

“Medicine as we’ve known it is gone forever. However, if we can pivot and learn the skills we will need to thrive in the new times we find ourselves in, we can become better versions of ourselves. There is no cavalry coming; it is up to us to get back in the driver’s seat and make our careers what we want them to be.”

That morning I felt like a “knowing” came over me, and I suddenly had the certain conviction that the time for trying to hold on to a vision of the past of medicine no longer made sense. The role of a physician in the field of medicine would no longer respond to mild treatments; full-blown surgery would be required.

Maybe you’ve already had a similar “aha moment” yourself about how the field of medicine has changed permanently. Or maybe you’re still clinging to the hope that somehow things will return to a time when doctors could count on complete career security and the ability to define how they practice medicine.

Whatever your current level of acceptance about the state of medicine today, it can be eye-opening to take a truly honest look at it.

Let’s start out with a basic level of frustration I hear from doctors all the time. The refrain usually goes something like this:

“I spent almost a decade to become a doctor. It cost a lot of money and I came out with a debt well in the multiple six figures. That’s fine — I chose this path, and I knew the costs in time, money, and stress would be significant. But now I’m out in the ’real world’ of medicine and it’s nothing like I thought it would be. I can’t do what I know is in the best interest of the patients and I feel like I’m on a hamster wheel. I can’t be sure I won’t be replaced, and I hardly have any time for family or friends or other things I love doing.”

I can’t help but sympathize when I hear stories like this. It’s incredibly frustrating to pour your whole self into becoming a doctor only to discover the reality of today’s healthcare landscape doesn’t come close to matching your dream.

These doctors go on to tell me things like:

• They have no control over how much time they can spend with patients (fifteen minutes is often the max).
• Getting time off approved can be challenging and feels almost like you have to beg.
• Evenings are often spent charting instead of having quality time with family or simply relaxing.
• Insurance dictates a large part of how care will be provided.

It would be nice to say that all of the above are exceptions, but we already know that these are usually the rules physicians play by now.

One big trend is that doctors own less than half of all practices in the US. That’s a dramatic change from decades ago when most practices were physician-owned. There is nothing to suggest that this trend will slow any time soon, because younger doctors are even more likely to work in a hospital-owned or investor-owned practice.

Hospitals and investors continue to aggressively buy up practices because it’s profitable. Because the profit incentive is strong, it’s not a trend that is just going to go away. And when doctors don’t own the business they’re working in, it’s inevitable that they will have less control over their patient care, their time off, and their financial rewards.

For more advice on medical marketing practices, you can find The EntreMD Method on Amazon.

Dr. Nneka Unachukwu is a board-certified pediatrician and the founder and CEO of Ivy League Pediatrics outside of Atlanta, Georgia. She graduated from the University of Nigeria College of Medicine and completed her residency in New Jersey before opening her own practice. After honing her entrepreneurial skills, Dr. Una created the EntreMD business school, podcast, and community to help physicians build personal brands around their expertise, open practices, and develop product lines. Featured in Forbes and a member of the Forbes Business Council, she has helped doctors all over the world leverage entrepreneurship to build lives they love.