For much of my medical training, I assumed there were two basic career paths for physicians. You could become an employed physician, trading some autonomy for stability and institutional support. Or you could own a practice, accepting the administrative and financial responsibilities of running a business in exchange for greater control.
I ultimately chose neither.
For approximately a decade, I have built my clinical career primarily as an independent contractor. As an oculoplastic surgeon, I work with multiple ophthalmology practices and surgery centers rather than deriving my professional identity and income from a single organization.
Over time, I realized that independent contracting was not merely a different way to get paid. It could be the foundation of an entirely different way to construct a medical career. I think of it as the physician portfolio career.
The concept is familiar in investing: Rather than concentrating everything in one asset, you build a portfolio. A physician can apply a similar principle to professional life. Clinical work may remain the largest component, but it does not necessarily have to occur in one place, or eventually even represent the entirety of the portfolio.
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My own career now includes clinical medicine alongside teaching, speaking, consulting, industry collaborations, and educational projects. Importantly, these opportunities did not require me to leave clinical medicine. They grew around it.
Autonomy became more valuable than I expected
Early in a physician’s career, compensation understandably receives enormous attention. After years of training, physicians finally have an opportunity to earn meaningful income. But as my career progressed, I discovered another form of compensation: control over my time.
Independent contracting allowed me to gradually redesign my schedule as my priorities changed. Instead of waiting for an employer to approve a reduced schedule, I could decide which clinical relationships remained worthwhile and how much of my week I wanted to devote to each one. That flexibility has become increasingly valuable as I have raised a family and developed interests outside direct patient care.
There is an important distinction, however, between working less and building flexibility. My goal was never simply to reduce my workload. It was to gain greater control over what kind of work filled that time. A portfolio career can allow a physician to replace some clinical hours with teaching, consulting, entrepreneurship, writing, leadership, or simply more time outside medicine.
Diversification applies to physicians, too
There is another advantage that became apparent only after years of working this way. Traditional employment can appear highly secure because a physician receives one predictable paycheck. But that stability also creates concentration risk. A change in leadership, compensation structure, productivity expectations, ownership, or organizational strategy can suddenly alter a physician’s professional life.
Working with several organizations distributes that risk. If one clinical relationship becomes less attractive, it does not necessarily require a dramatic career change. It may simply become a smaller part of the portfolio, or disappear from it altogether.
This changes the psychology of professional negotiations as well. When no single organization controls your entire income, schedule, or professional identity, it becomes easier to evaluate opportunities based on whether they genuinely make sense.
The same principle can eventually extend beyond clinical medicine. Consulting income, speaking, education, expert work, industry relationships, and other professional activities can create additional diversification.
Flexibility is not the same as freedom from responsibility
There are meaningful disadvantages to this model, and physicians considering it should understand them. Independent contractors generally need to manage their own benefits, retirement planning, insurance, taxes, credentialing, contracts, and administrative infrastructure. Scheduling across several organizations can become complicated. Income may be less predictable. Physicians also need to understand the legal distinction between a legitimate independent contractor relationship and employment that has simply been mislabeled.
Most importantly, a portfolio career requires physicians to think more like business owners even when they do not own a traditional medical practice. You need to understand what your time is worth. You need to read contracts. You need to track revenue and expenses. You need to know when a professional relationship is working, and when it isn’t.
That responsibility will not appeal to everyone. And that is precisely the point.
Physicians need more than two career templates
Medicine has changed dramatically since many of today’s career structures were created. Consolidation and private equity have transformed physician practices. Administrative burdens have increased. At the same time, physicians have unprecedented opportunities to teach, consult, create educational content, work with industry, advise companies, and build businesses outside traditional practice.
Yet our career advice often remains remarkably binary: Find a good employed position or build a practice. There is a third option.
A physician can construct a career from multiple professional relationships, adjusting the proportions over time as financial circumstances, family responsibilities, interests, and ambitions change. For a younger physician, that portfolio might initially be almost entirely clinical. Ten years later, it might include substantial teaching or consulting. Later still, clinical medicine could become the minority of the portfolio.
The proportions are less important than the underlying principle: A medical career does not have to be a single job.
After a decade of independent contracting, that may be the lesson I value most. I did not have to choose between practicing medicine and pursuing everything else that interested me.
I could build a career that had room for both.
Paul B. Johnson is a fellowship-trained oculoplastic surgeon, entrepreneur, educator, and physician career strategist. He is the founder of Paul B. Johnson, MD, PC and has built a portfolio career as an independent physician, practicing across multiple clinical settings while pursuing interests in consulting, medical education, public speaking, and industry collaboration. He is affiliated with Thomas Jefferson University Hospital.
A graduate of Sidney Kimmel Medical College at Thomas Jefferson University, he completed his ophthalmology residency at the New York Eye and Ear Infirmary and fellowship training in oculoplastic surgery at Wills Eye Hospital. His published work spans orbital fractures, rare eyelid and orbital conditions, and glaucoma laser therapy and patient education, with research appearing in Ophthalmic Plastic and Reconstructive Surgery, the British Journal of Ophthalmology, and the Journal of Glaucoma. He also contributed chapters to The Wills Eye Institute 5-Minute Ophthalmology Consult.
He writes and speaks about alternative physician career models, independent contracting, and creating professional autonomy beyond traditional employment. He shares updates on Instagram and Facebook.
