Autonomy isn’t something you either have or don’t have. It’s a continuum, and the optimal amount is a matter of individual preference, risk tolerance, and sustainability.
“Professional autonomy does not mean absolute freedom, but rather, it lies on a continuum and comes with responsibilities.”
— Doctors of British Columbia policy statement1
In the midst of a busy day at work, you may often find yourself thinking, “If I could just be more in control of my work, my life would be so much better!” If this is true for you, please know you are not alone. Many physicians understandably believe that greater professional autonomy is always desirable and will naturally lead to elevated well-being. At a time when it often feels like the system is conspiring against us, such a position is enticing. However, we have found that the concept of professional autonomy is more complex and nuanced than it might first appear.
Professional autonomy, broadly defined as having self-directed freedom and moral independence, is better considered on a continuum across multiple domains rather than something you either have or don’t have. Whether you work in a small, private family medicine practice or a large, multi-campus, multispecialty health system, it’s worth your time to understand the complexity of professional autonomy and explore whether your level of autonomy is optimized for your personal and professional well-being.
KEY POINTS
- Professional autonomy exists on a continuum across six domains — clinical, operational, ethical, economic, advocacy/policy, and interpersonal.
- More autonomy isn’t always better, as it often comes with greater responsibility and risk. Finding the “autonomy sweet spot” is essential for sustainable satisfaction.
- Physicians should regularly assess their autonomy levels based on personal values, workplace dynamics, and life circumstances, with the understanding that well-being and autonomy influence each other.
THE COMPLEXITY OF PROFESSIONAL AUTONOMY
Professional autonomy can have multiple domains. The following six domains are common and relevant to physicians’ daily work:2,3
- Clinical autonomy — choosing diagnostic and treatment approaches based on individual patient needs and your individual training and expertise without external interference or undue influence,
- Operational autonomy — having significant (or complete) input into scheduling, workload, documentation practices, and workflow design,
- Ethical autonomy — upholding professional values and self-regulating standards even when they conflict with policies or cost-saving measures,
- Economic autonomy — influencing or controlling the financial aspects of your work,
- Advocacy/policy autonomy — advocating for system changes or influencing policies,
- Interpersonal autonomy — having a say in team composition and function, including hiring and other personnel matters.
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