Many physicians underestimate what independence actually requires and what it can offer, according to Marcelo Hochman, MD, a plastic surgeon in Mount Pleasant, S.C.
For Dr. Hochman, the transition is less about leaving a health system and more about rethinking the kind of practice a physician wants to build. Too often, he told Becker’s, physicians approach independence as a job change rather than an opportunity to design care delivery on their own terms.
Dr. Hochman joined Becker’s to discuss how employed physicians shouldn’t conflate independence with complexity and assume they must replicate large health system models.
Editor’s note: This interview was edited lightly for clarity and length.
Question: What advice would you give an employed physician looking to move to an independent setting?
Dr. Marcelo Hochman: A lot of it is mindset. It’s not just about leaving a system — it’s about deciding what kind of medicine you want to practice. It’s not really looking for another job; it’s about building the practice you want. When I talk to residents, one of the things I ask is: what type of practice do you want to create? What would make you happy? And if people are really honest with themselves, they start to see that they don’t have to duplicate the system. That’s a big stumbling block — physicians worry about how they are going to handle the billing, the administration, all of it. But you don’t have to replicate the giant hospital. You can have a very small office, or a surgery center, whatever your specialty calls for, and do it on a more human scale. That’s what doctors and patients want.
The most important question is really a professional and ethical one: do you want control over how you care for your patients? If the answer is yes, then you think about the logistics from there.
Burnout has become such a buzzword, but independent doctors don’t burn out — not in the same way. Burnout happens when you lose autonomy. It’s what people call moral injury: being forced to practice in a way that goes against what you would do if you had total control. Systems try to cure burnout with pottery lessons and work-life balance messaging, but that misses the point entirely. When you’re in control, things feel different. Autonomy is what drives most people in private practice, and those who decide to go back to it.
