For over forty years, I worked as a general and vascular surgeon. For the last ten of those years, I was employed under an RVU-based compensation model. That period is when my dissatisfaction with medicine truly began. Complex, life-saving operations were reduced to “productivity units.” The pressure was relentless, the system unforgiving.

And unlike primary care physicians, surgeons do not have the option of concierge or direct-pay models. We are necessarily tied to hospitals because major cases can only be done in operating rooms that they control. That dependence makes us uniquely vulnerable to the dictates of hospital administrators.

But one of the greatest, and least acknowledged, burdens of being a physician is the fear of lawsuits.

The weight of lawsuits, even when you did nothing wrong

The public has been convinced by attorneys that only “bad doctors” get sued. That is simply untrue. Attorneys know malpractice carriers often prefer to settle rather than fight. If a case has potential monetary value, the tactic is simple: Sue every physician involved, regardless of responsibility. Even if the case never reaches a courtroom, even if your role was peripheral, every lawsuit counts against you.

Most physicians do not realize until years into their careers that even baseless lawsuits stain their record forever. The financial cost may fall to insurers, but the psychological and professional cost falls squarely on us.

When expertise becomes an afterthought

After surgery, I transitioned into wound care, hyperbaric oxygen therapy (HBOT), and aesthetic medicine. Initially, I was employed on a straight salary contract in wound care, a model that made sense given the unpredictable flow of referrals and the complexity of patients.

But when my contract came up for renewal, administration attempted to switch me back to RVUs. I knew from my years in surgery exactly what that meant: a treadmill that rewards volume over complexity, and ignores outcomes.

I explained why RVUs do not fit wound care. We do not see high volume, routine cases. We stabilize unstable patients. We prevent amputations. We coordinate multi-disciplinary care. None of that is captured in an RVU formula.

I expected negotiation. Instead, there was none. My contract was simply not renewed. I was given just five weeks’ notice, and as of September 1, I am no longer employed.

Forty years of experience, dismissed without a conversation.

This is more than burnout.

We are told burnout comes from working too hard or not taking enough time for ourselves. But the truth is, burnout is fueled by loss of agency.

When your pay is dictated by a flawed metric, when you are discarded for refusing to sign an exploitative contract, and when lawsuits follow you even when you have done nothing wrong, that is not burnout.

That is moral injury.

Where do we go from here?

For surgeons, the options after leaving the OR are limited. We cannot simply open concierge practices or bypass hospital control. Once you step away from surgery, as I have, your choices narrow even further.

But I still want to contribute. I continue to practice wound care and HBOT. I have broadened into aesthetics and regenerative medicine, where I can see immediate results. I am exploring opportunities in locums, consulting, cannabis medicine, and patient advocacy.

Because what I know is this: after decades in medicine, I am not done.

A call to action

Physicians, and especially surgeons, need to start speaking openly about these realities.

• RVUs are not a one-size-fits-all metric.
• Contract negotiations should be conversations, not ultimatums.
• Malpractice reform must address frivolous lawsuits, carrier settlement practices, and the fact that physicians are penalized simply for being named.

Groups like Take Medicine Back, Physicians Advocacy Institute, and physician unions are beginning the fight, but they need more voices.

I share my story because I do not want to be the last physician pushed aside for refusing to play a numbers game, or weighed down by lawsuits that never should have existed.

Closing thought

Physicians are resilient. We may be bent by the system, but we are not broken. My journey has taught me that even when the OR is no longer an option, we still have knowledge, skills, and wisdom to offer.

The challenge now is finding and creating the spaces where we can continue to heal, advocate, and contribute with dignity.

Rene Loyola is a general surgeon.