016: Who Are You Without the Institution Behind You?

In this episode, Dr. Kristine discusses the insecurity many physicians face when stepping outside of hierarchical institutions and how institutional identity shapes self-perception. The episode explores the profound transformation physicians experience when they detach their professional identity from institutions. It challenges common fears about leaving institutional roles and highlights the importance of recognizing the inherent value and authority within oneself. Dr. Kristine dives into how physicians can redefine their worth, authority, and relationships by stepping beyond institutional roles and building independently.

Key Topics:

• The core insecurity physicians face about losing their identity when leaving institutions.
• How belief in institutional dependence influences decisions on leaving, speaking up, or charging for services.
• Hierarchical environments, particularly medicine, often embed roles so deeply that they become mistaken for the self.
• Key realization: your expertise and contributions create the institution’s credibility and value.
• Leaving a hierarchy can expand opportunities, income, and freedom, as the relationships are bidirectional.
• Recognition that many physicians generate millions annually for their institutions, yet their compensation is often a fraction of that.
• The shift from institutional dependence to recognizing personal market value in clinical and non-clinical income streams.
• How removing institutional hierarchy enhances authentic human connection with patients.
• Addressing fears of losing mentorships or professional relationships upon leaving.
• Reassurance that relationships built inside institutions belong to the individual and can continue outside.
• The importance of understanding who you are beyond the institutional role to reclaim your full professional identity.

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Transcript

SPEAKER_00 0:00

I recently got back from 10 days of silence, a vipassana meditation retreat, no phone, no patients, no books, no PTO being counted down. And with my travel, a total of 18 days away. And I want to be honest with you, if I were still inside a hospital system, I don't think that would have been possible. Not without those days being taken from me as vacation, not without the anxiety of who was covering, not without the institution having a claim on my time that I couldn't negotiate around. Today's episode is about something that made those 18 days, those 10 days of silence possible. And it has nothing to do with logistics. It has everything to do with how we think about our own authority outside of the systems that taught us we needed them. And if you want to create a remote income stream outside of your institution, the type of income stream that gives you that kind of time and location freedom using your current specialty and skills, book a one-to-one freedom call. The link is in the show notes. Let's get into it. You're listening to Doctors Abroad, the podcast for doctors who want to build remote income and create location independence. I'm Dr. Christine Goyant, founder of NomadMD. I've exceeded my hospital income while working part-time and living abroad. And on this show, we break down how to make hospital income optional. Let's get started. As physicians, I think one of our greatest insecurities is going off on our own. It's the question of who you are when the institution is no longer behind you. Not just what you'll do, but who you'll be. How we think about our own authority, whether we believe in our expertise and that it can stand on its own without an institution's name behind it, really determines everything. Whether we ever leave, whether we ever reach out to the right people, whether we ever charge or allow ourselves to be compensated what we're worth, speak in the rooms we belong in, or build the income and flexibility we actually want. If we believe that we are nothing without the institution, we will stay inside it. Even when it's hurting us, even when we know we want something different. Because leaving feels like losing ourselves. And that belief, that quiet, unexamined belief is what this episode is about. Because I think once we see it clearly, it loses its power. And what becomes possible on the other side of that shift is something most of us have never fully let ourselves imagine. When I left academia, I wasn't just leaving a job. I was leaving a structure that had shaped how I understood myself as a physician. I remember thinking, I'm still early in my career. I'm still learning. I still want mentorship, still want support, still want to be able to call these people with questions or ask for referrals or figure things out together. How do I go off on my own without that? How will I ever know enough? How will I ever be enough? And underneath those questions was a deeper one. Can my expertise actually stand on its own? My knowledge, my clinical experience, my network, is any of that enough without the institution's name attached to it? Will I still be invited to speak at conferences? Will I still have opportunities to grow? Will people still take me seriously? These are the questions most physicians carry quietly, not the financial ones. Those we are trained to calculate, right? But these, the identity ones, the ones that feel almost too vulnerable to say out loud because they touch something that we don't want to examine too closely. Am I the institution? Or was I always something separate from it? There is a perspective I want to share from a book I read 20 years ago called A New Earth by Eckhart Tole. And I want to offer it not as a self-help framework, but as a lens, because I think it describes something that happens to physicians inside hierarchical institutions that we rarely name clearly. Tole writes about what happens when we identify so deeply with a role that we begin to confuse the role with who we actually are in hierarchical environments, especially. And medicine is one of the most hierarchical environments that exist. The role can become so embedded in our identity that we lose ourselves inside it. So we play the role of attending, of department chair, of associate program director, of academic physician. And somewhere along the way, the role stops being something we do and becomes something we are. We take ourselves very seriously inside it. Our sense of worth becomes tied to where we sit in that hierarchy. And when we imagine ourselves leaving that hierarchy, it feels like a kind of death because we've confused the role with the self. And here's what makes it more complicated. In medicine, the institution reinforces this. It tells us that the name above the door carries authority, that the affiliation signals credibility, that the title communicates expertise before you've said a single word. And so we learn unconsciously over years to borrow our authority from the institution rather than recognizing that we were the source of it all along. The institution is not credible because of the building. It is credible because of the physicians inside it. We make the institution. And then we forget that we did. What I didn't see when I was inside academia, and what I only began to understand after I left, is this every committee I was asked to lead, every department I was invited to partner with, every seminar I was asked to run, every room I was brought into, none of that happened because of the institution's name. It happened because of my authority and my expertise. I was only ever in those rooms because of what I brought to them. The relationship was bidirectional. I was contributing to their excellence. They weren't conferring it on me. And when I left, I didn't lose the network. I kept the connections without keeping the limitations, without the rules that came with employment, without the ceiling on what I was allowed to do, without the sense that my work was building someone else's reputation instead of my own. In fact, the opportunities expanded. More speaking engagement, more income, more countries, more people, more ways to share expertise than I ever had inside the institution, because I was no longer playing a role inside someone else's structure. I was building my own. And here's what Tole says about the moment you catch yourself playing the role. When you recognize that what you thought was your identity is actually a pattern of behavior you've been unconsciously performing, that recognition itself creates space between you and the role. And that space is the beginning of freedom. You don't have to destroy the role. You don't have to abandon everything the institution gave you. You just have to stop confusing it with who you are. I want to ground this in something concrete for a moment because I think it helps to see the numbers. The average physician generates $2.4 million per year in net revenue for their affiliated hospital. Family physicians generate $2.1 million, general internists nearly $2.7 million annually. That is the financial value of what you bring to the institution, not what the institution brings to you. I am pretty sure that whatever your salary is at the institution that you work for, that your income isn't even half that amount. Likely, it isn't even a quarter of that amount. The institution is profitable because you are there, not the other way around. And when you understand that, I mean really understand it, the question shifts is no longer am I enough without the institution? It's why have I been giving so much of my value away to a structure that was never the source of it? Your expertise has market value. Your clinical expert, your expertise has market value. Your clinical experience has market value, your network, your reputation, your ability to see patients and solve problems and communicate complex things clearly. All of that exists independently of any institution's name. It travels with you. It always has. I want to tell you what happens when physicians actually make this shift. It's happened for me, my clients, and not even theoretically, but what we actually report experiencing. There is a change in authority, not a loss of it, but an expansion of it. When you are no longer operating inside a hierarchy that defines your position, your own voice becomes clearer. You speak differently, you show up differently. You are willing to be seen in ways you weren't before, because your credibility is no longer borrowed from a structure that can take it back. There is a shift in freedom. What you are willing to do, who you are willing to talk to, where you are willing to share your expertise, all of it expands. Physicians who felt constrained inside institutional roles describe feeling like they finally have permission to be fully themselves professionally because they gave themselves that permission. There is a change in income structure. Instead of a single clinical revenue stream that requires seeing a large volume of patients to generate meaningful income, physicians on the other side of this shift have both clinical and non-clinical opportunities. They make money from their expertise in multiple ways from multiple places, including places that have nothing to do with their geography, with where they're physically located or even licensed. And there is something harder to qualify, but equally real, a change in how they relate to their patients. When the dehumanizing pressure of institutional hierarchy is removed, when you are no longer a role inside a system, but a physician who has chosen the work that you do and chosen each patient or client that you see freely, something in the quality of those interactions changes. Authentic human connection, Tole would say, becomes possible in a way it often isn't when we're performing a role. And that's for the benefit of both you and the patient. I want to address one of the specific fears that I myself carried when I left because I hear it constantly from physicians who are considering this. I was afraid that leaving meant losing the people, the mentors, the colleagues, the referral relationships, the professional friendships that I had built over the years inside those institutions. I thought leaving the job meant leaving all of them as well. It doesn't. Again, you can keep the connections without keeping the limitations. The relationships you built inside the institution belong to you. They are not institutional property. Your mentors can still be your mentors. Your colleagues can still be your colleagues. The people who believed in you inside those walls will still believe in you outside them and refer people to you in your new venture. What you leave behind is the ceiling, the rules, the sense that your growth is constrained by what the institution allows, the feeling that your work is building someone else's name. What you take with you is everything that actually mattered. So let me come back to the question this episode started with. Who are you without the institution behind you? You are the physician whose expertise made the institution worth attending. You are the clinician whose relationships built the referral networks. You are the person whose name was in those rooms, not because the institution put you there, but because you had already earned the right to be there. The institution was the frame. You were always the picture. And when you step outside that frame, when you stop playing the role unconsciously and start building something intentionally, what most physicians discover is not a loss of identity. It's the recovery of one they didn't know they'd misplaced. You don't become less of a physician when you leave. You become more of yourself. So I hope this one landed in a place that maybe some of the more practical episodes couldn't quite reach because the identity question is very real and it deserves a real answer. So if you're sitting with this and you want to work through what building something outside of the institution actually looks like for you in your specific situation, your specialty, your expertise, your goals, book a one-to-one freedom call. The link is in the show notes. Next week, episode 17, how to practice medicine from anywhere without losing your license. Because once the identity question settles, the practical question arrives, can I do this legally? That is where we go next. And if the question of visibility came up for you today, the fear of being seen without the institution's name behind you. Episode 11 goes directly into that. It's called, I don't want to market myself. Do I have to? And the reframe in that episode connects directly to what we talked about today. Thank you for being here. I'll see you next week. Thanks for listening to Doctors Abroad. If this episode was helpful, share it with a colleague who's been thinking about building more freedom and flexibility in medicine. And if you're ready to make hospital income optional, book a one-to-one freedom consultation at thenomadmd.com. I'll see you in the next episode.