RxForSuccess Podcast- David G. Armstrong: The Storyteller

What do physicians really mean when they say, "I just don't have enough autonomy anymore"? Is autonomy something we either have or don't have? Is more always better? Or is the issue more complex than we've assumed? In this thought-provoking episode of Life Changing Moments, host Dr. Dael Waxman is joined by Dr. Mark Greenawald—professor, vice chair of Family and Community Medicine at Carilion Clinic, medical director of the Carilion Clinic Institute for Leadership Effectiveness, and a fellow coach and teacher at the Healthcare Coaching Institute. Together, they challenge one of medicine's most common assumptions and offer a richer, more nuanced framework for understanding autonomy. Drawing from their recent series of articles in Family Practice Management, Dale and Mark explore the six domains of autonomy—clinical, operational, ethical, economic, policy, and interpersonal—and explain why autonomy lives on a continuum, not a binary. They discuss how your "sweet spot" shifts across seasons of your career and life, why autonomy can become a "trigger word" for administrators, and the liberating paradox that by giving up some autonomy, you often gain more influence. Mark also shares his powerful coaching tool—pause, turn down the volume, and get curious—for anyone feeling their autonomy has been stripped away. Key Topics Discussed: Dael's personal story of being "shut down" after raising autonomy at a physician leadership retreat. Why autonomy has become a "buzzword" and a "trigger word" for administrators. The six domains of autonomy: Clinical – making clinical decisions in and beyond the exam room. Operational – influencing schedules, benefits, and workflow. Ethical – practicing in alignment with your values. Economic – controlling the business and compensation aspects. Policy – influencing organizational policies and procedures. Interpersonal – having a say in who you work with. Why autonomy lives on a continuum—and why more autonomy means more risk and responsibility. How your ideal spot on the continuum changes across seasons of life and career. The mismatch problem: when what you need economically conflicts with what you want operationally. Why the training model still primes physicians for independence, even as 90% of graduates enter employed practice. The developmental arc of residency: survival → identity → independence → interdependence. The paradox of autonomy: by being a team player and helping shape culture, you often gain more influence. Why operational autonomy is the most common source of frustration for employed physicians. "Treat me like an adult": the importance of sharing the why behind organizational decisions. Mark's three-part coaching tool: Pause, Turn Down the Volume, Get Curious. The difference between "What do you want?" and "What do you need?" Why physicians—who are trained as helpers—often struggle to acknowledge their own needs. Guest Information: Dr. Mark Greenawald, MD – Professor and Vice Chair, Department of Family and Community Medicine, Carilion Clinic; Medical Director, Carilion Clinic Institute for Leadership Effectiveness; Virginia Tech Carilion School of Medicine Articles in Family Practice Management: "How to Be Well Employed" (2022); Autonomy series (late 2025–2026) Dr. Dael Waxman, Physician Coach, MD Coaches – Host, Life Changing Moments Relevant Links: MD Coaches: mymdcoaches.com Family Practice Management – Articles by Dr. Mark Greenawald and Dr. Jason Marker Healthcare Coaching Institute Companion podcast: Rx for Success with Dr. Randy Cook