During and after the pandemic, I was actively looking for a non-clinical position. Despite my love of medicine and two decades as a partner in a busy, prestigious OB/GYN private practice, I would have left clinical medicine entirely if the right opportunity had come along. That is how depleted I was. That is how broken the system had become for me.

It didn’t come along. Eventually, I stopped waiting for an exit and started building something different instead.

When I left to launch a membership-based practice, the murmurs from some of my colleagues were not subtle. They predicted failure. I heard it. It was hurtful. And I went ahead anyway, because I had done the work that made the decision rational rather than reckless.

What we don’t talk about enough is what that moment actually feels like. I was most afraid of financial failure and public humiliation. I worried that no one would value this model. After decades of working in a system that did not value my time or expertise, I started to question my own worth. The imposter syndrome was real. And yet, I moved forward anyway.

Thankfully, I had enough financial runway to support my staff before I opened my doors to a single patient. I had confidence in my clinical abilities, a community of professional relationships built over decades, the right financial and operational partners in place, and, perhaps most importantly, the humility to know exactly what I did not know how to do, and the wisdom not to pretend otherwise. This last part is what most physicians skip. And it is what determines almost everything.

The system isn’t broken; it’s working exactly as designed

The RVU model does not reward time, complexity, or relationship. It rewards volume and procedure codes. A 45-minute visit with a perimenopausal patient sorting through sleep disruption, cognitive changes, cardiovascular risk, mood shifts, and sexual health concerns reimburses at a fraction of what a five-minute refill visit generates. That is not an accident. It is architecture.

Hospital administrative costs now exceed direct patient care spending by nearly two to one: $687 billion versus $346 billion in 2023. Hospitals spend an estimated $18 billion annually just fighting claim denials. Physicians are not at the center of this system; we are part of its overhead. And we are not responding accordingly. Two in five physicians plan to leave their current practice within five years. In 2024 alone, 27 percent of medical groups lost a physician to burnout or early retirement. We are not a workforce in decline. We are a workforce in revolt.

The burnout-to-entrepreneur pipeline is a trap

There is a narrative right now that if you are burned out, you should just leave and build your own practice. I understand the appeal because I lived it. But leaving a broken system while depleted and immediately trying to build a business from scratch is not a solution. It is a different kind of crisis.

Burnout is not just emotional. It is a physiological and psychological state that impairs judgment, narrows your thinking, and erodes resilience. It is one of the worst possible states in which to make high-stakes financial decisions or absorb unfamiliar operational complexity. And yet, that is exactly what we romanticize when we tell burned-out physicians to “go independent” and what many physicians are doing.

A physician who leaves an employed or insurance-based position to build alone is suddenly expected to become their own COO, CMO, CTO, CFO, HR department, and membership sales team simultaneously, without training and often without capital reserves. That is not liberation. The conditions that predict failure are not mysterious: a depleted physician, no operational support, no financial runway, and an unfamiliar business model.

Many physicians will not succeed in this transition. Those who underestimate the business side, overestimate early demand, or try to build alone while burned out are at real risk of failure.

What actually works: The right partner changes everything

What changed the outcome for me was not going alone. It was alignment with the right operational support. There are models that provide the operational infrastructure so physicians can focus on practicing medicine at the level they were trained to practice, such as Monarch and MDVIP.

My job is medicine. Everything else is handled by people who are trained to do it well, and that clarity is what made my practice sustainable. In my previous practice, I saw more than 25 patients a day. Today, I see closer to eight with a 96 percent average member renewal rate. Demand did not disappear. It was realigned. That does not happen by accident. It requires thoughtful design, financial planning, and the right partners.

And it requires discernment: Not all organizations are created equal. You need to ask hard questions. Do they share your clinical values? Is the financial model transparent? Can you verify their track record with physicians who joined before you and made the transition successfully?

Before you sign anything

If you are thinking about stepping outside the traditional system, here is what I will tell you:

• Assess your own health first: Burnout is clinical information about yourself. Address it before making structural decisions because a transition built from depletion will have a cracked foundation.
• Plan your finances conservatively: Build runway and do not rely on immediate patient volume. Advance financial planning and membership development created a sustainable cushion for my practice before I saw a single patient.
• Know your existing contracts: Non-compete and non-solicitation clauses are enforceable in many states.
• Clarify your purpose: Not just what you’re leaving, but what you’re building toward.
• Be honest about your limits: You do not have to do everything yourself and, in fact, you should not. Know what you’re good at and what you are not. Join an organization that fills the gaps with actual expertise rather than good intentions.

The larger point

Physicians who leave insurance-based practice are not abandoning medicine. They are returning to the version that requires presence, relationship, and depth. The fact that our system has made that version economically unsustainable is a policy and system failure, not a personal one.

But the answer to a system that extracted too much from us is not to extract even more from ourselves by going it alone. I left a two-decade partnership, walked past the skeptics, and built something I am proud of. Not by being fearless but by being prepared, honest about my limitations, and surrounded by the right people.

I did not leave medicine. I found my way back.

Suzanne Gilberg-Lenz is an obstetrician-gynecologist and integrative medicine physician.