My most recent column in ACEP NOW is entitled You, Incorporated (print version,page 18). (Online Version) I wrote this post to help those who are “stuck” as employees, probably for their entire career, to think of themselves as a business, with multiple sources of revenue and expenses. The entrepreneurial mindset of being an owner is valuable, even for an employee. Here’s an excerpt:

The percentage of emergency physicians who are partners in small democratic groups decreases each year, and it’s easy to understand why. Not having to worry about “business stuff” is attractive to many doctors. The growing debt burden for new residency graduates has increased the need for higher initial salaries—perhaps at the cost of lower long-term income. That means that coming up with a financial, or “sweat equity,” buy-in for a heavily indebted graduate could also be difficult, especially with the prospect of a small democratic group becoming part of a contract management group (CMG) before the investment could be recouped. In addition, there are now so few small democratic groups that many doctors interested in that model no longer have the option in their desired geographic areas and are faced with the likelihood of being an employee for their entire career. This puts numerous emergency physicians in the same position that many employees in corporate America have been in for some time. Loyalty to “the company” isn’t rewarded in the same way it might have been decades ago. Employees are unlikely to stay in the same location, working for the same employer for their entire career, and then retire with a pension and health care provided by the company….

There are many situations where hospitals, CMGs, and other employers have difficulty staffing the emergency department. It may be a relatively undesirable town to live in or a difficulty in covering night, weekend, or holiday shifts. (You might be amazed to learn the going hourly rate for covering Christmas Eve in a difficult-to-staff location.) Maybe the emergency department has poor levels of support staff or call coverage. Or perhaps the CMG just acquired the contract and is still scrambling to find doctors interested in working there in the long term. Whether you relocate your family or simply commute to fill these shifts, they’re all opportunities to increase the revenue of You Inc. and gain benefits you might not have as part of a small democratic group. As a “gunslinger” for a CMG or locum tenens company, you can set up your personal finances such that you spend much less than you earn. This will allow you to take sabbaticals lasting weeks or even months, which a partner in a small democratic group could never do. For many docs, this extreme flexibility can more than make up for the inconveniences of not knowing what emergency department you may be working in six months from now….

You Inc. should also keep its eyes open for additional revenue streams. By virtue of the fact that most ED shifts don’t occur during banking hours, emergency physicians have discovered the value of having multiple weekday mornings off each week. While this time is often used for resting, recovering, and recreating, it can also be profitably used to develop other revenue streams.

Read the rest of the article here (on page 18) and then come back and let me know what you thought. Do you think of yourself as a business? How has that helped you? What benefits have you seen from an entrepreneurial mindset? Comment below!