Physicians helping physicians reclaim autonomy through direct contracting

A 2025 Doximity poll of nearly 1,200 U.S. physicians found that more than 63% of respondents were working in locum tenens or considering it within the next five years. As interest grows in this alternative to employed practice, a group of physicians is helping colleagues explore another option: contracting directly with hospitals and clinics rather than working through a staffing agency.

"Most physicians believe that they have to go through locums agencies. I don't think that's always necessary," says orthopedic surgeon Aaron Morgenstein, M.D., co-founder of FlexMedStaff, an educational platform that helps physicians explore flexible work arrangements and negotiate their own agreements with facilities. The goal: to help physicians remain in clinical medicine while gaining more control over how they practice.

Building a community

Morgenstein connected with internist Corinne Rao, M.D., through social media. Both recognized a knowledge gap among physicians interested in working independently. "All I knew was that I couldn't be in that employed pathway anymore," Rao recalls. After successfully applying what she learned about direct contracting from Morgenstein, Rao wanted to teach others the same.

OB-GYN Holly Shen, M.D., found FlexMedStaff while searching for resources to help her work independently. She had already created a Facebook group for women OB-GYNs interested in locums but wanted to learn how to negotiate directly with facilities. "I posted a comment on a YouTube video that Aaron and Corinne had made, and Aaron reached out to me."

A lengthy discussion with Morgenstein helped Shen to see a path forward. Learning how he and Rao approached hospital leadership and negotiated agreements gave her the confidence to secure her first direct contract.

Shen joined Morgenstein and Rao at FlexMedStaff, connecting her community of nearly 1,800 women OB-GYNs with additional education and resources, including educational videos, free webinars and an annual summit covering subjects such as direct contracting, locums and financial considerations. The group's physician-only Facebook group, Physicians Helping Physicians, allows doctors to ask questions and share practical knowledge about how to achieve autonomy through independent work.

Making independent work a first choice

Shen wants physicians to reconsider the idea that locums is merely a temporary fallback between permanent jobs. Independent work can be a deliberate career choice, with recurring assignments and coverage arrangements tailored to a physician's interests and availability. "Now, plan A can be that you work independently," she says.

For Morgenstein, that flexibility has allowed him to continue orthopedic surgery while making time for family and other professional interests. He says that he discovered that full-time employment did not suit him within a few years of practice. After working with several locums agencies, he began approaching hospitals directly to find arrangements that fit his schedule. The change, he says, helped keep him in medicine. "It allows me to continue to be an orthopedic surgeon, but on my own terms."

For physicians who want to work independently but encounter facilities unwilling to contract directly, Morgenstein says FlexMedStaff has also partnered with a staffing company. He describes the arrangement as emphasizing transparent pricing, lower agency margins and physician participation in negotiations. "We represent the physician," he says.

What keeps physicians from making a change?

Rao identifies three major barriers to physicians leaving employed practice: isolation, fear and lack of information.

Physicians may not know anyone practicing outside conventional employment. They may worry about supporting their families, maintaining benefits or finding enough work. Without practical examples, a different arrangement can seem out of reach.

Having a physician community can help turn those concerns into specific questions. "How do independent contractors obtain health insurance? How do they manage multiple state licenses? How do they approach a hospital administrator or negotiate compensation?"

Shen encourages physicians to ask colleagues how they have handled those challenges. "Find a group and ask those questions."

While many physicians seek employment for a sense of security, Shen points out that most contracts only offer the illusion of security. Morgenstein agrees. "Physician contracts are not sports contracts. You're not an athlete where you're signing a guaranteed five years for $50 million. These are literally just 90-day contracts."

Working at more than one facility can also reduce dependence on a single employer, Rao notes. Instead of placing their entire livelihood in one organization's hands, physicians can develop several professional relationships.

Bringing physician care to underserved communities

Flexible contracting can benefit patients as well as physicians, providing services to rural and underserved communities.

Based in Colorado, Shen travels to critical access communities to provide obstetric and gynecologic care. Rather than relocating her family, she negotiates coverage based on each facility's needs. "I call it OB boots on the ground," she says.

Her conversations with administrators focus on what the community is missing: clinic appointments, surgical access, hospital coverage or a combination of services. She then considers how to tailor her work to meet those needs.

Although she initially worried that patients might be reluctant to see a visiting physician, Shen has found the opposite. Patients and staff frequently express gratitude that she has come to help. That appreciation has made the work particularly rewarding.

Similarly, Morgenstein urges physicians to consider the value of providing care in underserved areas. "There are so many hospitals in rural America that need your services," he says. "If you live in a big city and you're disappointed with your work arrangement, just know that there are other opportunities out there. You just have to be willing to travel." Morgenstein adds that working in these communities can be very rewarding. "Not only will you find health care systems that will treat you better and treat your patients better, but also your patients will treat you better."

Recognizing physicians' value

Direct contracting requires physicians to understand and communicate the value of their services. Shen describes candid conversations about compensation, working conditions and what she needs to provide care at a particular site. She approaches those discussions with an understanding of the market and the facility's needs.

Teaching other physicians how to have these conversations has changed the market, says Shen. "We have really reshaped the way that OB-GYNs work as independent contractors and locums physicians. Many of us are now finding absolute autonomy, flexibility, freedom and financial sustainability, alongside a huge increase in satisfaction with our work."

Rao acknowledges that administrators unfamiliar with direct contracting may initially be skeptical. Some need an explanation of how an agreement with an individual physician would work. Not every conversation leads to a contract. But when both sides are willing to explore the arrangement, they may find a workable fit.

Start with a conversation

For physicians interested in changing how they work, the first step is to find people who can help them understand the possibilities.

"You're not going to understand everything on day one," Morgenstein says. He encourages physicians to seek mentors, ask questions and learn from colleagues before assuming they must remain in an unsatisfying position or leave clinical medicine altogether.

Morgenstein describes FlexMedStaff as a passion project. What keeps him involved is hearing from physicians who have regained time with their families, improved their working lives and found a reason to stay in practice. "The return on my investment is when I get a text message from someone that says, 'Thank you for helping me. The trajectory of my life has been changed. My relationship with my significant other. I get to see my kids more.'"

Most importantly, he says: "I don't want to see doctors leave medicine."

For physicians who still want to care for patients, direct contracting may offer a way to keep practicing with greater control over their careers — with the help of a community of colleagues willing to teach them how.

Rebekah Bernard, M.D., is a family physician in Fort Myers, Florida, and the author of several books on health care topics.

To learn more, visit FlexMedStaff or Physicians Helping Physicians.

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Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 Cold open. Bernard on a survey finding that more than 63% of physicians are working in locums or considering it within five years.

0:56 Meet Aaron Morgenstein, M.D. An orthopedic surgeon who jokes that he's a part-time surgeon.

1:02 Meet Corinne Rao, M.D. A board-certified internist with more than 20 years' experience whose focus is physician autonomy.

1:23 Meet Holly Shen, M.D. A board-certified OB-GYN who works full time as an independent contractor for rural and critical access facilities she chooses.

1:46 How FlexMedStaff started. Rao on how Morgenstein reached out after seeing her comments in online physician spaces, and the knowledge gap they both saw.

2:39 Shen's way out. A practice she joined became private equity-owned, leaving her with no autonomy and poor pay, so she tried travel assignments and then went direct.

5:43 What FlexMedStaff teaches. Morgenstein on running the platform basically like a nonprofit and teaching physicians to contract directly with hospitals.

6:35 Why consider direct contracting. Shen on what locums really means, its old reputation and making independent work plan A instead of plan B.

10:32 A community of 1,800 OB-GYNs. Shen's Facebook group for women OB-GYNs working independently, and how it has reshaped their market.

11:48 Cutting out the middleman. Morgenstein on leaving a full-time role after two years and what he learned about locums company profit margins.

13:34 What holds physicians back. Rao on the three biggest barriers: isolation, fear and lack of information.

15:16 Filling gaps in rural care. Bernard on the physician shortage in rural and critical access areas.

15:50 OB boots on the ground. Shen on tailoring her coverage to what each small community needs, and the gratitude she gets from patients.

19:25 Treated differently as a contractor. Bernard and Shen on how facilities value contracted physicians compared with W-2 employees.

20:37 Skeptical administrators. Rao on approaching facilities that have never contracted directly with a physician.

21:55 "What's the catch?" Shen on the myth of job security and asking colleagues how they handle health insurance and multiple state licenses.

24:30 Taking medicine back. Bernard on physician employment and burnout.

25:00 Not sports contracts. Morgenstein on 90-day contracts, staying financially flexible early in a career and why he keeps doing this work.

28:44 Googling how to quit. Morgenstein on leaving his first job without a plan and why he'd likely have left medicine without this path.

30:30 First steps. Morgenstein on finding mentors, skipping expensive courses and the rural hospitals that need physicians.

33:15 Closing. Bernard signs off.