Union and family formation are occurring at increasingly older ages for women in the United States. From the 1940s through the early 1970s, women's average age at marriage was 20; it has now crept up to 27 (U.S. Census Bureau 2017). Over the past few years, the average age of first birth has reached record heights (Mathews and Hamilton 2016). Birth rates have simultaneously declined for women in their teens and early 20s and increased for women in their 30s and 40s (Martin, Hamilton, and Osterman 2017). Trends toward later transitions are even more pronounced for women with higher levels of education, who are now more likely to begin childbearing in their 30s compared to their counterparts in earlier decades (Livingston 2018). In the midst of these demographic changes, increasing numbers of women are using reproductive technologies-including in vitro fertilization (IVF) (CDC 2017) and egg freezing (Society for Assisted Reproductive Technology 2018)-to manage and manipulate time in the life course.

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Patient autonomy, or the right to make decisions about medical care, is usually examined either within clinical encounters with medical providers or outside of clinics via social movements to transform care. These perspectives, however, may miss how patients exercise autonomy outside of clinical encounters while remaining in conventional care. Through in-depth interviews with 61 people who pursued fertility treatment in New York City, this article argues that one important way that people exert autonomy in consumer medicine is by switching clinics. This study finds that nearly half of participants switched clinics to reorient their patient careers that were not progressing satisfactorily, attempting to reset, redirect, and escalate them. This article emphasizes that patients exercise autonomy not just over treatment decisions but also over the direction and progress of patient careers themselves. This article suggests that patients’ disparate opportunities to elect to switch medical practices represents an inequity in consumer medicine.