I suppose I have the same split personality most doctors have toward their careers. There are days I love it. I’m a cataract surgeon, I give people back their vision, and it’s almost like having a Marvel superpower. I don’t shoot LASIK lasers out of my eyes or sprout scalpels from between my knuckles, but give me an operating microscope and good things will happen to your vision. And then there are years when all I want is to leave the profession. The stress. The never-ending call and responsibility. The managerial duties. The mountains of inescapable, self-regenerating paperwork. Twice I took serious steps to leave medicine, and both times I came back.
I suspect that feeling is familiar to a lot of you. We all started wanting to help people with our knowledge and skill, every one of us wanted this, wants this. Even after recent declines, more than four in ten U.S. physicians still report at least one symptom of burnout, and in the American Medical Association’s 2024 prior authorization survey, 95 percent of physicians said the paperwork burden somewhat or significantly worsens it. The proposed fixes are almost as tangled as the problem.
Some say, get control of Congress and legislate the stacks of busywork away. Sounds good, but powerful lobbies have very different aims than most physicians. Some say, expose more physicians to mental health awareness and help systems. Prudent, but whatever happened to solving the underlying problem? Why should physicians be miserable to the point of needing intervention?
These remedies are well-intentioned, but they miss the mark I am aiming for.
I don’t want to be critical of any physician or advocate suggesting real change. They matter. I just want to restart the conversation with something fresh, not an idea, not a thought, but what I am doing right now. I’m not going to tell you what might help next year. I’m going to describe the system I’ve put in place over the past two years: what my practice does today, and where I’ll happily go to work on Monday morning, for myself and my patients.
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A critical question for every physician: when was I happiest?
In 2011 I decided I didn’t want to be an employee anymore. I opened my own practice and ran it solo. For almost six months, before I hired full-time staff, I learned every position in the office, then replaced myself with staff and focused on the medicine. That practice grew until I sold it in 2023. Afterward I asked myself which role had made me happiest. Employee? Employer? Solo? Group? The answer was strange: I was happiest at the very beginning, in 2011, when I ran the whole thing like a one-man band, strumming the guitar and banging the drum. It just felt right. So I restarted a small solo practice and planned to do everything myself, billing, insurance, scheduling surgery, scheduling patients, no full-time staff. A lot of work, but the overhead would be so low I’d only need to see a few patients a day. That’s what I began in 2024.
From novelty to utility
Then something I didn’t plan for happened. Around early 2025, the AI tools I’d been tinkering with crossed from novelty to genuine utility, not the kind that writes you a poem, but the kind that takes a stack of administrative busywork and quietly makes it disappear. One by one, the tasks I’d braced myself to do started taking care of themselves.
Incoming faxes were the first to go, they were so tedious. How could we be living in 2025 and still copy one column of information into another on a screen? The answer was, you don’t have to, not at all. I found a HIPAA-compliant program I could guide, and it routed each incoming fax to the right place in my EMR. Patients scheduled themselves once I set up the software. Recalls went out on their own. The insurance-verification math I used to dread got done before the week began, handled by a “billing mind” that knew everything I knew and applied it to the coming week’s patients’ insurance. I wrote about exactly how this works, in HIPAA-compliant detail, in a recent Doximity Op-Med piece.
Removed, not delegated
Removed is the word that matters, and it’s why I’m writing this. Those tasks weren’t delegated. They weren’t outsourced to cheaper labor or a call center in another state. I didn’t hand them to an employee I’d then need a manager to supervise. They were removed, or reduced to a few keystrokes.
As each task shrinks, it offers the physician community a new alternative. What if you were your own boss? What if you could see patients on a schedule you decide is right, and still support your family? What if you could run most of a clinic with a peripheral mind alongside you?
I’ll be honest about the limits, because hype helps no one. This is early. I’d already made my peace with doing every office task myself, so every reduction is a pure win, though I still handle more paperwork than most physicians would prefer. The rules around AI in health care are still being written, and every implementation takes forethought, time, and has a learning curve. I’ve spent that time because every hour up front relieves a repetitive task for the foreseeable future.
There are things I still do myself. I answer the medical questions. I handle refills. I help elderly and non-tech-savvy patients scan their paperwork. And I’m not telling anyone to fire their staff; the better move for most practices is to free good people from the mundane so they can grow the practice. I happened to want to practice alone, a personal preference, not a prescription.
The variable we keep missing
What I do isn’t for everyone. And yet I can’t stay quiet, because the burnout conversation is missing a variable. I keep hearing rehashed solutions that can’t imagine a new way of practicing, one I live and teach every day. No one seems able to peer over the wall of the box they’re in. I want to cut away part of that box and show my fellow physicians something they haven’t considered. One question: what if your entire career were designed with you at the center, to make you happy? What if the founding mission of your practice were “MD must feel great every day”? What if every Wednesday-morning business meeting were between you and yourself, and the only agenda item was, “How are you doing?”
None of us can predict the future, but change is clearly coming. Artificial intelligence isn’t just a change in how much work gets done; it’s a change in kind. Many assume that means giant bureaucracies joining hands while the little guy runs scared between the closing gaps. I see it differently. The clear path forward involves individualism, creativity, entrepreneurialism, and spirit. For the first time, one dedicated practitioner can do the work of several people. Will that turn physicians into even lower-level cogs in the corporate machine, or let them slip between the fingers of corporate health care’s giant, closing hands and start fresh, where they and their patients are the final word on what matters?
This article is discussed on The Podcast by KevinMD: Staying salaried may now be the riskier bet for doctors.
Oren Fass is a board-certified ophthalmologist and cataract surgeon and the founder and sole owner of Denton Eye Consultants in Denton, Texas. Over more than two decades he has performed over ten thousand surgeries and has held every role in a medical practice twice, from biller to front desk. He has been an employee, an owner, a seller, and now an owner again of an automated practice. In 2011 he built a multi-office group from scratch, sold it to private equity, then started over in 2024 with a deliberately small solo cataract practice. Using AI, he has automated nearly every administrative function, from fax intake to insurance verification, and now runs the clinic with no full-time staff.
He is the author of The Autonomous Physician and the creator of the course The Autonomous Practice Blueprint, where he teaches physicians how to build a practice that works for them. He shares updates on Medium, YouTube, LinkedIn, and X.
