14. When “Patient Access” Becomes a Trap: The Hidden Guilt of Leaving Corporate Medicine

For many physicians, the hardest part of leaving corporate medicine isn’t the uncertainty of starting a new practice, it’s the guilt. After years, sometimes decades, of caring for the same patients, walking away can feel like abandonment. 

You might tell yourself, “I love my patients and don’t want to leave them without care,” or worry about their continued access to healthcare services.

But when you use words like “access” and “equity” to justify staying, you may be unknowingly echoing corporate language that keeps you trapped in a system built for volume, not quality. And it comes at a cost to your own wellbeing.

This post explores what patient access really means, why equity is more subjective than most of us realize, and why these concepts were never meant to be individual responsibilities. If you’ve been struggling to reconcile your love for your patients with your desire to leave corporate medicine, it’s time to take a closer look at the language (and the guilt) that may be holding you back.

What “Patient Access” Really Means

When physicians talk about patient access, they often mean something deeply personal: their ability to be there for their patients. But in the healthcare industry, patient access has a much more operational definition.

Patient access is measured by how easily and efficiently patients can get access to healthcare. And when you look at how the industry actually measures this, it becomes clear that it's not about individual physicians at all.

The five key metrics of patient access are:

1. Seamless registration process – Digital platforms that allow patients to independently input information
2. Efficient appointment scheduling – Online scheduling systems that don't require phone calls
3. Robust insurance verification and prior authorization – Systems to handle the endless back-and-forth with insurance companies
4. Patient education and communication – Information about costs and billing (not medical education)
5. Data analytics and continuous improvement – Tracking metrics and improving processes

Notice what's missing? The physician's clinical hours… the burden of seeing as many patients as possible… your willingness to sacrifice your wellbeing.

Patient access, as defined by the industry, is determined by the operations of the clinic or hospital, not by how hard individual physicians work or how much they sacrifice.

Yet somehow, physicians are made to feel personally responsible for it.

The Problem with “Equity”

Equity is another word that physicians often use with the best intentions. It reflects a deep commitment to fairness and to serving those with fewer resources. But when you start to unpack what equity means in practice, things get complicated.

The same principle applies to healthcare equity. When your corporate medicine employer tells you the clinic prioritizes health equity and patient access, how are they defining it? Most importantly, how is progress toward these goals actually being tracked?

There are countless ways to think about equity in a clinic setting:

• Should we prioritize patients based on income level?
  
  
• Should we prioritize based on severity of illness?
  
  
• What about patients who haven’t seen a doctor in years?
  
  
• What about primary wage earners in households?
  
  
• What about parents with children to care for?
  

There is no one clinic, let alone one doctor, who can prioritize all types of patients equally. What feels equitable depends on perspective, circumstance, and resources. Yet many physicians hold themselves accountable to impossible standards, trying to balance the unbalanceable.

The Hidden Cost of This Mindset

Prioritization doesn’t just apply to patients. It applies to you, too.

Have you been using the concept of patient access or equity to force yourself to keep going? What if the physical toll of your clinical work requires you to shift how you practice?

There might be a nagging voice in your head saying, “How dare you stop doing surgeries. People need you. You’re cutting off access to important procedures.” But the reality is, if you have an injury or illness that prevents you from standing for long periods or manipulating tools safely, that’s not healthy for you. And frankly, it’s probably not healthy for the patient either.

This mindset can harm you in more ways than one:

• Physically, through injury or chronic pain
  
  
• Mentally, through burnout and exhaustion
  
  
• Emotionally, through resentment and guilt
  

And it doesn’t stop there. How is it affecting your family when you tell yourself to keep going because you’re committed to patient access and equity? Are you really showing up as the best version of yourself when you work a nine-hour day, come home with paperwork, skip your run, miss dinner with your family, and lose time with your partner and kids?

There is a cost to all these choices.

This Was Never Your Burden to Carry

From an outsider's perspective, when I hear physicians use the words equity and patient access when talking about their careers, what I hear is code for "I don't get what I want."

What I hear is corporate language that cuts them off from being creative, from compromising, and from figuring out if there are other ways to practice medicine.

It seems that everyone is trained to think, "That's my job, to take care of that." But from what I can tell, that's actually the system's job. That's corporate medicine's job. And that's insurance's job to make sure patient access is working. And frankly, if we look at the healthcare outcomes in our country, I don't know that they're doing a great job of it.

My clients, when they first start working with me, have taken on the responsibility and burden of shouldering equity and access to healthcare. One of the first things I do is give them a big hug, because this wasn't their burden to carry.

Then we spend time talking through how it's actually not their responsibility. It never was.

Two Questions to Move Forward

So how do I help my clients exit corporate medicine and build a clinic they love and are proud of, while still honoring their beliefs in equity and patient access?

I ask them two questions:

Question 1: If healthcare equity takes both the patient and the physician into account, what needs to be true in your future clinic for you to show up as the best version of yourself so you can provide the best care possible to your patients?

Question 2: Since you physically can’t serve all possible patients in your specialty and geography, who do you feel compelled to serve? Who needs you the most? Why do you want to serve that population? What excites you about serving that population?

This second question not only helps describe your target patient population, but it also connects you and your clinic back to your mission and values.

And if you find yourself feeling guilty for not being able to see more patients in your own clinic, just remind yourself: you can always go back to corporate medicine, where cheaper and higher volume always trump quality medical care.

Ultimately, the best way to contribute to a fair system as a physician is to practice medicine in a way that allows you to show up as the best version of yourself. When you care for yourself, you can care for your patients more deeply, more effectively, and on your own terms.

This is part one of a mini-series on mindset challenges physicians face when transitioning from corporate medicine to entrepreneurship. If you want to discuss your specific situation and how to navigate these challenges, book a complimentary discovery call—I'd love to hear about your vision for independent practice.