The Business of Medicine: Empowering Physicians to Own

In this episode of From Print to Pod, we host a discussion based on the article Trained to Work, Not to Own: Why Identity, Not Math, Keeps Physicians From Thriving.

Physicians often move through training without ever questioning the path in front of them. By the time career decisions arise, employment feels familiar, while ownership can feel distant or undefined. In this discussion, Dr. Tod Stillson, Dr. Maria Sokolina, and Dr. Zara Chopuryan explore how early exposure shapes that mindset and why many physicians never fully see the range of options available to them. Here’s what to understand about how training influences career identity and what it means for those considering private practice.

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Participants:

https://doctorsonsocialmedia.com/tod-stillson-md/

https://doctorsonsocialmedia.com/maria-sokolina-dds/

https://doctorsonsocialmedia.com/zarui-zara-chopuryan-md/

Takeaways:

• The physician career path is shaped early by exposure to employed models, long before independent options are fully understood.
• The skills required to run a business are already embedded in daily clinical work.
• The biggest barrier to ownership is not financial or intellectual, but psychological.
• Comfort with uncertainty is one of the hardest shifts for physicians transitioning into ownership.
• Many physicians equate financial success with compromised values, which can limit career choices.
• Autonomy and control over patient care often outweigh income when physicians choose independence.
• Private practice allows for greater alignment between clinical decisions and personal standards.
• Choosing not to pursue ownership can carry long-term limitations that are often underestimated.

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Transcript

Dana Corriel: Hello and welcome to From Print to Pod 2. We're on season two of this wonderful series and we are very excited to be speaking today about the article, Trained to Work, Not to Own. Why Identity, Not Math, Keeps Physicians from Thriving. And with us are three fabulous physicians. I'm going to actually have them introduce themselves as soon as we ask the first question. I will, however, say that one of these three actually wrote the article. So that's really exciting. Question number one, when do you think doctors first start seeing themselves more as employees than owners? Is there a moment in training where that happens? Now let's begin with Dr. Sokolina.

Maria Sokolina: My name is Dr. Maria Sokolina and I'm an owner of the private practice in Clifton, New Jersey in Manhattan and I treat dental sleep. I was the employer right after I finished my education, but the constant constraint of being somebody employee. So I have my private practice for many years because I want to practice the way I feel right. So regarding the employee with all these guidelines, and I know a lot of dentists have to go into this avenue due to a lot of debt. I can relate certainly, but I did not have a long experience as somebody's employee, but it was difficult when I did. Thank you.

Zara Chopuryan: Hi everyone. My name is Dr. Zara Chopuryan. I think Zara it's easier. The last name is pretty difficult. I am the internal medicine board certified and palliative care physician. And I have my own practice where I'm practicing holistic aesthetic medicine approach. Actually I'm doing it for the last almost 20 years. To start my practice, I could say that it was not by the easy way because where I was trained in the country where I was trained actually, and that time it was USSR, Armenia, Russia. So private practice didn't exist even. So we couldn't even think about it. So then when we moved to Spain, I, we have been living in Spain for many years. So that's where I thought that, you know what, I want to have something for myself, my own practice, still continue working in federal system like in a hospital. But at that time I decided to open my own practice in aesthetic medicine because I wanted to own something that I never have had it previously. It was difficult, but I think it's really just to start and not give up.

Dana Corriel: Thank you for that. Now, Dr. Tod Stillson.

Tod Stillson: Yeah, so I'm Dr. Tod Stillson. I'm a family doctor from rural Indiana. I've been practicing for 30 years. And the big reveal is I'm the author of the article. And that conditioning of physicians, it begins early. And I believe it begins in medical school because the people who are influencing us in our medical school environment, faculty members typically, 99.9 percent of them are employed physicians by definition and work for large academic institutions. So you get a heavy dose of influence from those institutions. Then when you move into residency, same principle holds true, you're getting heavily influenced by faculty members who are employees themselves. You might get some exposure in both environments, in medical school and in residency to the periodic independent physician who works as a preceptor or might be a role model for you. But honestly, most exposures that all of the doctors have going through their training experience is to employed physicians. So it kind of only makes sense. That's what they're going to become.

Dana Corriel: Thank you for that. We're going to move on to the next question, and that's the following. What's something physicians already do every day that actually shows they could be owners, even if they don't realize it? Let's go backwards and start with Dr. Stillson this time.

Tod Stillson: Well, first of all, they're problem solvers by nature and they walk into their exam room every 15 minutes and organize and assess what's going on and then prepare a plan to address the problem. That's business 101. Identify a problem and create a solution for it. And so physicians do that all day long in creative, amazing ways. And it doesn't take a lot to move yourself into the concept of I can do that in the marketplace, not just in the exam room.

Dana Corriel: Fantastic. We're going backwards. Dr. Chopuryan.

Zara Chopuryan: The capacity to make a decision very fast, definitely it's helpful in business. The communication, we are capable to communicate with the patients, with their families. It's also very important in business setting also. And I think it's not just not giving up, but be able to continue our job that it's so emotionally difficult every day, it shows us that we are able to be ahead with any difficulty that we can find in business setting.

Maria Sokolina: Since I own the private business, when I was the employee, a lot of, you know, we practice as a business owner. I agree with previous stories. Yes, we have to make a decision and be responsible for those decisions. We have to also lead the staff. Even for somebody else, you do have a staff and you have to have a relationship with them and they have to follow your orders. Otherwise the game not going to play. So that's very important part, you know, in the settings, in the dental settings, we have a certain responsibilities for supplies. Even you work for somebody, you have to make sure, you know, the settings are also taken care of. At least, you know, that's how it work in the dental industry. But the truth is when you work for somebody else, you also have a next and next level, you know, of people who also responsible. It's both ways, you know, in one way you are private owner, but in the same time, you know, part of a economical responsibility on somebody else shoulders. But of course practicing your own skills, private office is a little bit better.

Dana Corriel: Now, Dr. Stillson writes in his article, the math of ownership is straightforward. The identity shift is not. What does that identity shift actually feel like for a physician that's going through it? Dr. Chopuryan, let's start with you.

Zara Chopuryan: I remember it. Even now, every morning wake up and tell to myself, say to myself, tell myself that you can do it. It's nothing bad. It's okay. It's okay if you can be the business woman, if you can be not so altruistic in your job, because you know, we are trained to be altruist, right? First thing is to help the patient, right? And then to think about the material part, like money, it's not so important. But actually it's important too, because you want to be really recognized with your, for your job, for everything that you are doing. And one of the part of this recognition is not just the ovation or, you are amazing, but also you want to win something, some money you want to want. So I remember it, it wasn't so easy to say myself, you have to do it. Think about the business. It's not just, it's not just the altruistic part. That's what was the first change of mind for myself. And believe me, I'm still doing it almost every day.

Maria Sokolina: Identity shift, but you have to wear two hats in one. You are physician and you are business owner in the same time. And the business owner skills, they were actually not taught in dental school. And I'm sure medical school didn't have those courses as well. Business part have so many components. I talk about the staff, the calculation, how are you gonna still swim when you have employees, when you have equipment and rent and taxes. So it's so many leaves what, yes, they are occupying significant part of your identity, but actually, when you are with a patient, you have to be devoted to the treatment part. As soon as you're not with a patient, you have to put the business owner part. And yes, again, so that's economical part and then leadership part, when it's yours, you don't have anybody who gonna be kind of guiding you or, you know, doing something for you. That's you. And in the beginning, true, it's very scary. But then, just like on any skills, you practice, practice make it, you know, I cannot say perfect, but make it better.

Tod Stillson: Yeah, so here's the deal. Physicians are used to winning with certainty and with authority. And every step of their educational journey, I mean, you can go, probably go back to elementary school. You're winning the award, you're the top person all the way through the system. When it comes to starting a business, there's uncertainty. And that's the part that stops the physician in their tracks because there is not the A plus B leads to C equation when it comes to running a business. Now, I tell physicians this all the time, the demand in the marketplace for your professional services are so crazy high right now, it'd probably be hard for you to fail, even if you tried to fail. There's just such a huge demand. But the reality is that we're used to operating in a sense of certainty. And then the second part of it is we don't want to look foolish. Physicians have a hard time saying to another professional, not even a medical professional, any professional, I don't know the answer to that. And what you learn in business, these two other doctors know this from operating a business, is you learn very quickly that you need a team of other professionals around you to have a successful business that you can depend on.

Zara Chopuryan: When I was in the residency program, I really like what Dr. Stillson said. My residency program director had sessions almost every week when we had to practice that sentence, I don't know. Because for doctor, I don't know. And in the beginning of my career, as a physician even, I had trouble saying those words because everybody questioning you. But now though, that's very big part of my vocabulary because medicine is not precise science, it's more in the science as well as business management. And there are a lot of questions. It's okay for physician to say, I don't know, I will figure it out.

Dana Corriel: It actually reminds me of the famous saying, it takes a village. It usually refers to raising children, but it can be applied to other places, of like raising your own business, which is sort of like a baby in some ways.

The next question is the following. Why do each of you think some doctors feel like owning something is selfish or takes away from being a real doctor? Let's start with Dr. Stillson. We'll go backwards.

Tod Stillson: First of all, again, I think we've been conditioned to believe due to things like Stark laws that physicians who own things are going to become greedy and it will be contrary to our altruistic purposes. And so there's sort of this mental mapping and structure that's built into the conditioning that if we're too successful, we become too greedy. And the reality is that's not the case. And I can tell you this, that I coach a lot of physicians in this space doing this. I've talked to a physician just this morning who makes less money doing a direct primary care practice than he did as an employed physician. But guess what? He is so happy because of the agency he has as an owner and as somebody who can practice medicine the way he wants to. So for physicians, being an owner is not just about monetary success. It's about success being defined in a different way that in many regards comes back to agency. Not greed, but agency. And that's the important word for us to kind of circle our brains around when it comes to this stuff.

Maria Sokolina: Dr. Stillson, you touch such a hot topic for me because I remember the years when I was employee. I cannot stand the atmosphere the other employer create. I didn't want to treat the patients in this type of environment. So how it look outside and how people, whatever people smell, whatever they feel, really critical for my treatment process. Very often people who own the facility, they don't practice themselves. So yeah, doesn't matter you practice do the best you can but that's not the best I can not the best for my patients how I see it. For dentists is a little bit different because it's also related to technique and material we use. And of course if you work for somebody they have to be very economical according and they have to do it according to they believe or I did not want to practice under somebody else believe so I think actually the ethical norms as a private business owner are much higher. About greedy or altruistic yes you have to be economically conscientious but you become a doctor for other principles otherwise that's just investment banking. You become a doctor to bring the meaning to your life and help to the other people and that's why making your decision how hard it is that's really representation what the dream was originally to become a doctor at least in my book.

Tod Stillson: Yeah Maria I want to just echo that again from my fresh conversation coaching a physician this morning. He provides lab services that are at cost to his patients as well as dispenses medicines directly to them in his clinic at cost. He knows honestly intellectually he could monetize this he could make a little bit of money by doing lab and medications he's chosen not to. Now that's his own choice but that has to do with his own ethos of the fact that he wants to provide that high value service to those patients and he feels really good about the ethos of that. And he doesn't need to monetize everything that he's doing in medicine. When we get into practice as independent physicians and begin to truly get back to our altruistic purposes of delivering care to patients we have the power again in the agency to do those things and not be filled with greed but in fact do good that's what physicians are meant to do they make the world better.

Dana Corriel: Thank you for that. I'm going to now throw it to Dr. Chopuryan. Why do you think some doctors feel like owning something is selfish or takes away from being a real doctor?

Zara Chopuryan: Because we were trained all of us I think it's independent of the country or medical school we were trained to be inside of the system. And for someone to go outside of this system from the box it feels very uncomfortable. And to find some kind of explanation maybe or justification for themselves why they are not able to do it they should find maybe something to blame. It could be one thing. And the second for example in my practice my practice is aesthetic medicine everybody sees a lot of money aesthetic medicine it means a lot of money but really for example in my practice I'm more focused in really collagen production and helping postmenopausal women to improve the skin quality. Ozempic patients now to improve the skin quality. I'm not almost doing like fillers or stuff not too much if it needed of course. But what I want to say that this kind of holistic approach is not about a lot of money. Why I did it because it was really my dream even from USSR that was absolutely impossible to do it. I always sincerely wanted to make women feel better to feel more confident. So why someone cannot see it as still an altruistic way to help patients because we can dedicate more time. I don't know maybe this is a problem.

Tod Stillson: Zara you're exactly right that's a myth and we've got to break the myth.

Zara Chopuryan: Absolutely.

Maria Sokolina: I agree with you. It's a lot of hours that we are putting into our business. It's like 24 hours nonstop. We are not getting paid for 24 hours. It's impossible.

Dana Corriel: Which do you all think is riskier in your opinion trying something on your own and failing or staying in a system that limits you? Let's start with Dr. Sokolina.

Maria Sokolina: Don't want to waste my life to stay in the system and for somebody going to tell me how I have to treat the patient. I think I didn't go to dental school for that. So that's not a question for me at all. Failing is a broad term. We always can have experience. We invest into the experience and experience is priceless. So I don't know like yes it's true you might not survive economically or you might not accomplish exactly what you want. Then you are just gaining experience.

Zara Chopuryan: I think Maria is right saying that experience is one of the very important parts of ownership. And if you are not gaining or you are not getting your goals it's still experience. But I think one very important part of this is also to understand where did you fail and not to repeat your wrong points. So that's the best that makes us better in ownership and even better people. For me not to try is the worst. You have to try always even if you fail. If we wouldn't try then how can we achieve how can we become better. I cannot see any other way. We have to move always move ahead.

Also flexibility to innovations. If I get something innovative I can implement it in my practice as soon as I learn that system. If I would be part of the hospital which was originally at certain point my dream it would take years before technology becomes available.

Tod Stillson: Well it's interesting for you to frame the question of ownership as a risk management consideration. As you think about that first of all our professional careers as doctors are usually around 30 years. Let's just use that as an average. Let's break down that 30 years into something a little more bite sized. Let's take those first three to five years. And here's what I would say about that. That needs to be your marketplace fellowship. Whether you choose to be higher risk and move into that as an employee or as an independent operator of your own business I would say the minority of doctors are ready to come out day one and be a business owner. I think they need some experience. And here's the deal. Let somebody else pay for your loans. Let somebody else help you establish yourself economically for three to five years. And in that same process understand the marketplace. And in the back of your brain be preparing for that three to five year mark when you can say I'm going to do this on my own. That's how I would frame it.

Dana Corriel: We are running out of time but such a great conversation. I'm going to ask one last question and I'm going to ask that everybody think of just a sentence that answers this. A single sentence. If you could change one thing about medical training to help doctors think more like owners what would it be? Now let's begin with whoever is ready.

Tod Stillson: Identify a mentor or role model that is not employed.

Zara Chopuryan: To have exposure to private practice during training like electives.

Maria Sokolina: Right now we have so many opportunities. There is so much information available. While in medical school or residency people can get business training. Mentors are very important. You can have multiple mentors through different sources including social media and coaching. To have more clarity on the business side and the courage to move forward.

Dana Corriel: That makes total sense. It sounds like there is a common theme and that is to diversify exposure and really take in different resources so that you can at least become aware of what is out there and what is possible. To start to think that you can set up your mindset toward private practice and not just stay in the box.

Well with that we're going to close the session. Thank you to each of you for joining us and thank you to our audience for listening.