I’m just back from a round of how-to business lectures to physicians. I have to say, the experience is getting to be a little dispiriting, even for an energetic, glass-is-half-full person like me. It’s just room after room of hollow eyes and anxiety-driven questions.

The rare innovators and bright-eyed optimists stand out like shining beacons. I love you guys, but geez you’re depressing.

Don’t get me wrong; I empathize.

It’s absolutely true that reimbursement is bad, compensation is too low, risks are high, and all the rest. You have every right to feel the way you do. What’s worrying is the sense I get that some of you are just so used to it that you aren’t seriously trying to find solutions. I seem to meet more and more physicians in a downward spiral — so overwhelmed that they don’t have the energy to, say, figure out what’s going on with their collections. One primary-care physician, who started our conversation asking questions about Medicare billing, ended up angrily challenging my assertion that there are some contented family physicians. She has given up trying, but still plans to keep practicing the same way.

I’m not the only one to notice such patterns. Charles Bond, a partner with the law firm Physicians’ Advocates in Berkeley, Calif., says the level of despair among doctors is worse now than he’s ever seen before. He wonders why such intelligent professionals seem so paralyzed when it comes to thinking differently about business.

“A dispirited acceptance of one’s individual fate seems to be the dominant mood of physicians nowadays rather than a motivated mobilization toward a better lot for the individual practitioner and the profession as a whole,” he writes in a recent article for Medscape entitled “The Training of the ‘Helpless’ Physician.” His hypothesis is that the world of medical school and residency depends on subservience and delayed gratification. It trains physicians just to accept it, at a certain level, if things aren’t working out. More education about business in medical school would help, as would a change in the culture of medical training, emphasizing empowerment.

Changes to America’s reimbursement systems could shake things up, too, but proposals from the most promising presidential candidates from each side would hardly do more than stir the surface of the brew. Regardless, if you’re waiting for politicians to come along and “fix” everything, I think you’re in for a very long wait. So why not fix things yourself? Not “the system” as a whole, perhaps, but just your own small corner of it. You don’t have to allow your happiness to be subject to forces outside your control. So don’t.

It may be naïve of me, but I keep thinking that part of the solution is just for each physician to take matters into her own hands and shape a practice that makes her happy.

It’s just a business — at least when it comes to the issues that so bog down physicians. You can make it what you want. There is little in the way. Hate managed care? Stop taking it. Want to see fewer patients a day? Well, take a look at how you could lower expenses or change your model to make it possible. Love your Medicare patients? Fantastic. Devise a business plan that makes it possible for you to keep seeing them. The only joy I see is in practices where physicians have innovated, focused on what they love, and remained inspired.

It’s in your hands.

Pamela Moore, PhD, is senior editor, practice management, of Physicians Practice. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the February 2008 issue of Physicians Practice.