Ask a physician what she accomplished today and listen to what comes first. Most of us reach for a number: patients seen, notes closed, inbox cleared. Rarely do we say we went for a walk, ate lunch sitting down, or left on time. That reflex isn’t an accident. Through years of education and training, we were programmed to believe that our value lies in constant productivity, and that slowing down means failing to meet expectations, whether our own or someone else’s.
It started early. In school, worth was measured in grades, test scores, and class rank. In medical school it became shelf exams, board scores, and clerkship honors. In residency it became how many patients we could carry, how quickly we could finish our notes, and whether we could keep going at hour twenty-eight of a call shift without complaint. At every stage the message was the same: you are only as good as what you produce, and someone is always measuring.
Measured by metrics we didn’t choose
Then we went into practice, and the measuring became formal. Patient visits per day. RVUs. The percentage of our panel up to date on vaccinations. Well-child visit completion rates. Notes closed within 24 hours. Patient portal messages answered within a set window. Patient satisfaction scores. Each one arrived in a report, often color-coded, sometimes ranked against our colleagues. And we were taught, explicitly or not, that being a “good” doctor meant hitting them.
These metrics weren’t just information. They came with rewards and punishments attached: annual bonuses, pay raises, quarterly incentives, or the conspicuous absence of them. The cruel part was how little control we had over so many of these numbers. We can’t make a family show up for an appointment. We can’t decide for a parent whether to vaccinate after a thoughtful conversation, or fix the transportation problem that keeps a toddler from his 15-month visit. We can’t control how many messages arrive on a Monday morning. Yet our pay, and our sense of our own competence, were tied to outcomes shaped largely by forces outside the exam room.
A goal post that kept moving
I learned this firsthand at a community health center in California serving a large Medicaid and uninsured population. I had 28 patients scheduled per day, and the company expected me to see 3.0 patients per hour or more to earn my quarterly bonus. Given the population we served and the high no-show rates, I usually came in just a hair under that number. It didn’t matter how hard I worked. It didn’t matter that my clinic manager double-booked me without my consent to try to close the gap. Quarter after quarter, the target stayed just out of reach.
Then the monthly metric reports would arrive. As far as I could tell, they were designed to make me feel inadequate, to motivate through a low, steady hum of not-good-enough. It would have been easy to internalize that feeling and start believing the problem was me, rather than a system whose targets were unattainable for the very patients it existed to serve. The frustrations mounted until I eventually left, and thank goodness I did. Nothing I did would ever have been enough for my bosses there, and I knew that staying would only deepen my burnout.
What strikes me now is how much of that I had absorbed: the belief that I was supposed to keep chasing a number designed by people who had never sat with my patients, and that falling short said something about my worth as a physician.
Choosing our own measures
Direct Primary Care changes this, but only if we let it. When we leave employed medicine, no one sends us a monthly report anymore. That silence can be disorienting, and many of us rush to fill it with the old yardsticks: How many members do I have? How much revenue came in this month? How many patients did I see this week? Those numbers matter for keeping the lights on. But if we let them become the measure of our worth, we’ve simply moved the old system into a new building and put our own name on the door.
DPC gives us something employed medicine never did: the freedom to decide what success means. We can choose to define our worth by metrics that reflect our own values and what brings us joy, rather than by someone else’s external, and often poorly aligned, measures. The question shifts from “Did I produce enough?” to “Did I live and practice in a way that reflects what I care about?”
What that can look like
One of my core values is taking care of myself as well as I take care of my patients. So one way I measure success is how well I balance my hours at work with hours spent on the things that sustain me: exercising, preparing healthy meals, and spending time with the people I love. A good week isn’t one where I squeezed in more visits. It’s one where I worked my scheduled days, got my exercise in, spent an hour or two in my garden, and was actually present with my husband at home. I don’t have to see more patients or generate more revenue to feel good and worthy.
Another of my values is being a lifelong learner. So I also measure success by whether I allow myself the time to attend conferences where I’m learning a new topic or skill set. A year in which I learned something that changed how I practice is a successful year, even if it meant closing the office for a week and earning a little less.
Your values will be different, and so will your measures. If connection matters most to you, success might look like families who feel truly known in your practice, or the visit where you had time to sit with a worried parent until the worry eased. If creativity matters, it might be the new program you built or the article you finally wrote. If presence matters, it might be how often you left work at work. A simple exercise: name the three values that matter most to you, then ask what evidence would tell you, at the end of a month, that you lived them. Those are your metrics. Write them down, and check in on them as regularly as the old reports once arrived.
None of this is an argument against caring about the business. Sustainable revenue is what lets us protect our time and keep serving our families well. But revenue is a means, not a verdict on who we are.
Enough, on our own terms
Many of us spent years trying to earn a sense of being enough from systems that were never designed to give it. The bonus came or it didn’t, the report was green or red, and either way the goal post moved again next quarter. Leaving that world doesn’t automatically undo the programming. We carry it with us, and it quietly reasserts itself every time we glance at our membership numbers and feel that old flicker of inadequacy.
The work, then, is to notice that flicker and ask whose standard it’s measuring us against. In DPC, we finally get to write the scorecard ourselves. Let’s make sure it measures the things that make us whole, including our health, our learning, our relationships, and our joy, alongside the care we give our patients. We were never only as good as our productivity. It’s time our metrics reflected that.
If you’d like more guidance launching or growing your own direct care practice, DPC Pediatrician offers a startup guide, coaching programs, on-demand courses, and even one-on-one consulting.
