How Physicians Can Take Back Control: Agency vs. Autonomy in Modern Medicine | Ep28
What if the “agency” being offered to physicians isn’t empowerment—but a more polished way of staying inside the lines?
In this episode of Better Physician Life, Dr. Michael Hersh examines the quiet shift from physician autonomy to what is now being labeled “agency,” and why that distinction matters more than it sounds. He unpacks how autonomy once meant real authority paired with responsibility at the bedside, while today’s version of agency often amounts to influence within systems physicians don’t control.
Dr. Hersh explores how this mismatch (being held accountable without having true authority) drives burnout, moral injury, and a loss of purpose that many doctors struggle to name. He reframes agency not as something granted by organizations, but as something claimed through daily decisions, personal standards, and leadership from wherever you are.
The episode also highlights physicians who are no longer waiting for permission—those building micro-practices, choosing locums, pursuing direct care, coaching, or nonclinical roles—not as escape plans, but as deliberate ways to practice medicine with integrity. This is a call to stop waiting for autonomy to be handed back and to start reclaiming ownership, one decision at a time.
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About the Show:
Created for physicians who want more than clinical competence, Better Physician Life is a space for honest reflection, reinvention, and reclaiming purpose beyond the pager.
Hosted by Dr. Michael Hersh, each episode dives into the questions we didn’t learn to ask in training, offering tools and conversations to help you live and lead with intention
Top 3 Takeaways:
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Autonomy is authority; agency is influence: Autonomy means having the authority to make final clinical decisions based on judgment, training, and ethics. What’s often labeled “agency” today usually means operating within pre-set rules, metrics, and constraints. Notice when language is being used to soften the loss of real authority, and be clear about what you still control within your role.
- Agency is practiced through daily choices: You may not be able to change every policy, but you can choose how you show up, how you advocate, how you connect with patients, and what you’re willing to tolerate. Real agency shows up in standards, boundaries, and the willingness to speak up, even when it’s uncomfortable.
- When autonomy is limited, design your own path: Many physicians are already reclaiming control by building micro-practices, choosing direct care or locums, moving into consulting or nonclinical roles, or redefining how they practice within existing systems. If autonomy isn’t coming back from the top, start building it yourself—one decision, one boundary, one calculated risk at a time.
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