Ask anyone who has ever owned rental property a simple question: who takes better care of the house, the owner who lives in it, or the tenant leasing it for a year? The tenant calls about the leak. He doesn’t fix the fence. He doesn’t repaint a porch he’ll never see again after the lease ends.
That’s by no means a character flaw. It’s a rational response to the incentives in front of him. Nobody maintains an asset they don’t own for the benefit of someone who does.
Now consider this: Physicians are the subject of the same experiment, at scale, without recognizing it as an experiment.
I’ve written before about the rent seekers (for example, see The Rent Seekers Are Doing You a Favor, How to Escape the Factory-ification of Healthcare) and the hospitals and investor-owned platforms that employ the overwhelming majority of American physicians and extract the economic surplus of their labor while calling the arrangement a partnership, or worse, a “family”. As of this year, 82% of practicing physicians are employed, hospital and corporate entities own 63.9% of all physician practices, up from 29.8% in 2018, and just 18% of physicians remain in physician-owned practices.
Today I want to talk about the other half of that relationship. The renters.
A renter, in this sense, has nothing to do one’s particular title. You can be called a partner, a medical director, a shareholder in a professional corporation that exists on paper but is controlled by someone else. If you hold no real equity, if there’s no asset that grows in value because of the work you personally do, and if there’s nothing left to sell or pass down when you walk away, you’re renting. You’re exchanging labor for a paycheck, full stop.
For a physician who wants exactly that, clean, defined, no interest in the administrative or financial machinery behind the practice, renting is a completely legitimate choice. That physician isn’t who this post is about, and isn’t, in my experience, where most of the noise about burnout is coming from.
The noise is coming from renters who never chose to be renters, or who didn’t understand the trade when they signed up for it. Every year, they’re asked to move faster: more RVUs, more patients per day, more quality metrics, more call. And every year, they arrive at exactly the same place. Employed. No equity. Further from ownership than when they started, because the cost of building something of their own kept climbing while they were busy generating someone else’s margin.
That’s the wheel. Speed without distance.
They’ll tell you it’s their practice. But the reality is that it isn’t.
Ask what happens to that practice when the physician leaves. The patient panel stays. The facility or office stays. The brand stays. The entity keeps functioning, unbothered, and collects whatever it’s worth when it’s eventually sold to someone else, none of which the renter has any claim to. If the thing survives your departure intact and you own no piece of what it’s worth, you don’t have a practice, you just practice. You have a job description with a nicer waiting room.
Here’s the part the rent seekers haven’t figured out, or have figured out and priced in anyway: renters don’t treat a business like their own, no matter how many times leadership calls it a family at the annual retreat. That’s not disloyalty. It’s rational stewardship of finite energy toward the things that are actually yours. And the institution feels it. Engagement erodes. Quality softens at the margins nobody’s measuring yet. Turnover climbs. The prescribed fix is always more oversight, more dashboards, more productivity targets, which is to say, more speed on the same wheel. Physician burnout increases. Institutional underperformance blossoms. At its heart, this isn’t a physician wellness problem. It’s a doom loop, and it’s structural.
Most of what gets marketed as the solution to physician burnout treats the symptom, not the structure. Meditation apps. Resiliency training. A newly created Chief Wellness Officer with a nice title and no authority over any of it. Some of that may genuinely help at the margins. None of it answers the actual question, which is why a physician who owns nothing would ever feel invested in anything beyond their own effort, and why effort alone was ever supposed to be enough to prevent exhaustion.
None of this means everyone should own. Ownership carries real capital risk, real administrative burden, and a real learning curve, and it is legitimately not the right call for every physician, or for every stage of a career. But that has to be a decision made deliberately, with the numbers in front of you, not a default you arrive at by never choosing anything at all.
Most of the physicians complaining loudest about burnout have never asked themselves the one question that would actually change something: would owning even a piece of what I do change how I feel about doing it? Most have never run the numbers to find out. Most never will, because complaining about the wheel is considerably easier than getting off it.
Some Timely Tips For You
- Separate the wellness conversation from the ownership conversation. They get bundled together constantly, and they are not the same problem. One is a coping strategy. The other is a structural fix.
- Check what you actually own, not what you’re called. Titles like partner, medical director, and shareholder mean nothing here if there’s no equity attached and nothing to sell when you leave.
- If you’re a renter by genuine choice, own that choice. There’s nothing wrong with wanting a paycheck and nothing else. Just stop describing the arrangement to yourself as something it isn’t.
- If you’re not a renter by choice, run the actual numbers. What ownership would cost you, what it would be worth, and what you’re currently forfeiting by not pursuing it. Treat it as a real decision, not a fantasy you’re too tired to consider.
- Listen to the language. An institution that calls it “your practice” or “your patients” while retaining every actual decision right is telling you exactly what you are. Believe it.
The wheel doesn’t slow down because you’re tired. It slows down when you stop being the one turning it for somebody else.
If you’re trying to figure out what ownership, in whole or in part, would actually look like for you, I welcome the conversation. You can reach me at markweiss@weisspc.com.
