In the late 1960s, the psychologist, Prof. Martin Seligman ran an experiment that has haunted management theory ever since. Dogs were divided into three groups. Group 1 dogs received no shocks. Group 2 dogs received mild electric shocks but could stop the shocks by pressing their nose against the lever. Group 3 dogs received the same pattern of shocks as Group 2, but nothing they did could stop the shocks.
Later, the dogs were moved to a box with a low partition, easily clearable, that let them escape the shocks completely. The dogs who’d had the lever or who had never been shocked jumped out of harm immediately. The dogs who’d learned that nothing they did mattered, didn’t try. They hunkered down and took it, inches from an open exit.
Seligman called that doing nothing “learned helplessness”. But look closely and it isn’t helplessness. It’s a belief about helplessness. And it was installed, deliberately, by the design of the first experiment. The second box was irrelevant. The Group 3 dogs had already been taught the only lesson that mattered: don’t bother.
I think about that experiment every time a physician tells me, with real conviction, that building something of their own “isn’t realistic anymore.”
The Story, and Who Sells It
Here’s what I don’t believe: that the near-universal conviction among physicians that the only sane career path runs through a large hospital-owned group or a PE-backed practice management platform arose organically, as an honest read of the market. I think, in significant part, it was manufactured. Not by any one villain, but by an ecosystem of players, hospital systems, PPMs, private equity, staffing agencies, and yes, some of my own colleagues in the consulting and legal professions, all of whom have a direct financial interest in you believing that the lever doesn’t work.
Call it what it is. It’s cognitive warfare, waged not with weapons but with conference panels, glossy recruiting decks, and a steady drumbeat of “no one does that anymore.” Every one of those messages serves someone’s balance sheet. None of them are required to serve yours.
The tell is always the same: “there’s no other way” is repeated most insistently by the people who most need you to believe it.
Nobody Told My Clients It Was Impossible
Meanwhile, in my actual practice, physicians keep doing the thing they’ve been told is impossible. Regularly, I work with hospital-based groups that expand, or even form from scratch, and take on one or more service lines directly, building leverage and scale on their own terms rather than surrendering either to a system. I work with office-based physicians acquiring practices outright, and others founding practices from scratch, with no platform, no PE sponsor, and no one’s permission but their own.
I suspect no one told any of them it couldn’t be done. Or someone did, and they didn’t listen.
None of this is easy. I’m not selling a fantasy in which independence is costless or risk-free; it isn’t, and anyone who tells you otherwise is selling something else. But “hard” and “impossible” are different words describing different things, and the entire architecture of the manufactured consensus depends on physicians never quite noticing the difference.
It’s Not Actually Binary
The other piece of the story worth dismantling is the false choice itself: join the group, or go it entirely alone. That’s not the real menu.
There is real room between full absorption into someone else’s structure and total solo exposure, and it doesn’t run exclusively through a management services agreement with a rent-seeker who wants your equity and your decision rights in exchange for a logo and a call center. Physicians can align with each other, within a group or across groups, through service-line co-management arrangements, shared back-office and administrative cooperatives that preserve clinical and governance control, or structured alliances built around a specific opportunity rather than a permanent surrender of control. The tools exist. Most physicians have simply never been shown them, because the parties who could show them make more money if you don’t ask.
Your Answer, Not the Answer
I’m not telling you to leave your group. I’m not telling you to found a practice, acquire one, or do anything else in particular. There’s no right answer here, and there’s no wrong one either, only your answer, arrived at with open eyes rather than inherited conclusions.
What I am telling you is that the belief that you have no real choice is itself the product, engineered and distributed by people who benefit when you buy it. The lever has always worked. Most physicians have simply never been told to press it, and quite a few have been told, at length and with great sincerity, not to bother.
The partition was never as high as you were led to believe. You are allowed to check.
If you’re weighing whether to build something of your own, whether entirely independently or in alignment with others on your own terms, I welcome the conversation. You can reach me at markweiss@weisspc.com.
