Starting out in medical practice, whether as an employed physician or a practice owner, is one of the most exciting and rewarding events in the professional development of a new family physician. Having started up several practices and re-engineered dysfunctional ones over the years, I have experienced many of the emotions that come with the territory. I have also learned a lot along the way, mostly through trial and error, but also from the experiences of colleagues young and old.
It is my experience that many physicians struggle in their first professional endeavor after residency training because they aren't prepared. The formative years for many medical students and residents focus on polishing clinical skills, with only an occasional lecture on what to expect after residency. Although many new physicians are opting to pursue employed positions with hospitals and health systems rather than start or join independent medical practices, I've noticed that they are sometimes placed in offices by themselves or with other new physicians. With income guarantees for two to three years before productivity agreements begin, these newly minted physicians are told by administrators to go forth and build a practice with little guidance on how to actually be successful.
My recent transition back to full-time family medicine practice in a rapidly growing area of southwestern Ohio involved starting up a new family medicine practice for a large health system. One of my additional responsibilities was to mentor young physicians who join us out of residency training. In thinking about what made my transition from residency to medical practice successful, I have compiled some “lessons learned” that may seem common sense to many but, to the neophyte physician, are valuable insights on how to start off on the right path.
Strike a work-life balance
In my opinion, new physicians today focus on work-life balance more than any other generation of physicians before them, but achieving that balance can become the search for the “holy grail.” Before you begin seeing patients on day one, make sure that your personal life is in order. For example, take a well-deserved extended break when you finish training; it may be the last extended break you will have for a long time. Large student loan payments, possibly new house payments, and the need for income during this transition period will weigh heavily on the decision, but options like signing bonuses may help cover your expenses.
If you have a significant other in your life, include him or her in much of what is happening during this transition. Chances are that he or she has the same questions about your new job and practice that you do, or may have questions that you have not thought about.
Leave the problems of patients and staff at the office. Home is a place for you to unwind, decompress, and focus on friends and family. To protect your home life, learn how to manage your workflow efficiently, finish charting by the end of the day, resolve interpersonal conflicts immediately, and do not let uncomfortable situations fester.
As they are beginning another chapter in their medical careers, I remind young physicians to check their egos at the door. Humility goes a long way with others who are wary of a new physician right out of training. Even though graduating from residency is a great accomplishment, you are beginning all over again, and your learning curve will be steep. Do not lull yourself into thinking you know more about the practice of medicine than you do. You may be well-versed in the clinical treatment of disease, but you are really just beginning to learn how to manage patients and their expectations. Your receptionists, billers, and medical assistants collectively know more about how to run a practice than you do at this point. Obviously, you have the final say regarding how you want your practice to run, but you need to be open to new ideas on workflow, communication, and teamwork.
Your staff can make or break your practice. How you behave in front of them will set the tone for expected behavior. Stay calm and cool when faced with troubling problems. Be gracious and apologize to patients and staff when you are wrong or have made an error. Never raise your voice in the public areas of the practice. If you feel the need to share your concerns with someone, do it in private. Be courteous and empathetic. Your office manager should always be present when you need to address a staff member regarding a performance issue.
If you are unsure of what to do or how to approach a problem, do not be afraid to ask for help. Call a trusted physician colleague and get another opinion before you make a decision. Find a physician mentor as your practice is just getting underway. You will make mistakes over the next several years, but mitigate those mistakes by having the ear of experience on your side.
Avoid office politics with policies
Because you probably do not have a lot of experience on the administrative aspects of practice, let your office manager assist you in handling such things as insurance questions, billing, finances, staff behavior, and office decorum. But make sure you still have a significant hand in these areas to protect your practice from mismanagement or fraud.
Developing sound policies and procedures on how you want your practice to operate is a critical success factor. Use your administrative team to help you with this. Develop a welcome letter for patients that explains your expectations regarding scheduling and canceling appointments, after-hours contact, and clinical services available in your practice.
Tread lightly when managing office politics. Practices can implode because the physician feels obligated to get in the middle of quarrels among the staff. People will invariably take sides, and schisms will develop that often cannot be repaired. Emotions can run high, and patients sense if there is tension in the office.
In addition, be very careful about developing friendships with staff. Organizing an occasional office outing to build unity and camaraderie is great. But the best way to think of socializing with your office staff is “everyone or no one.”
Sit down at lunchtime and eat with the staff. Listen to their conversations. You learn a lot about people just by listening. You will be amazed at how much it means to the staff that you are engaged in the goings-on in the office. This builds staff loyalty and improved performance.
Use social media with caution
As social media has become a way of life for many, you must realize that as a physician you are held to a much higher standard when using it. Professional medical associations have developed guidelines to help physicians with the ethical and professional use of social media. For example, the American Medical Association's guidelines boil down to this: Anything that you share via social media is fair game to come back and negatively affect your practice and your professionalism.
A few caveats: First, do not embarrass yourself in public. You must always have your guard up and be on your best behavior. Rest assured that others would be more than happy to chronicle inappropriate behavior for everyone to see on websites like YouTube. Second, avoid discussing medical problems in unsecured chat rooms and email. You are accountable for any medical advice, whether intentional or not, that someone may follow. In addition, paying penalties for discussing protected health information can be a very expensive lesson to learn. Only use secure patient portals to discuss medical issues with patients online.
Create growth opportunities
“If you build it, they will come” may not necessarily apply to your new medical practice. Work hard at creating your own opportunities to help your practice grow. Continue to obtain certifications related to clinical skills. This may require you to leave your comfort zone. Shadow your colleagues to learn how to do new office procedures. Identify other areas of medicine that you can incorporate into your practice such as women's and men's health, nutrition, sports medicine, occupational medicine, or aesthetics.
Speaking to community and professional groups is a great way to reach many people, including your peers, in a limited amount of time. If you have not done a lot of public speaking, you may be awkward and anxious at first. However, the more you do it, the more comfortable you will become at marketing yourself, your skills, and your practice. Your physician network and hospital marketing department can help identify formal opportunities for you to speak about your practice and general medical topics. The local Rotary Club, Chamber of Commerce, special interest groups, and schools are frequently looking for physicians to speak on a wide array of medical topics. Consider doing some volunteer work, such as serving as team physician for the local high school – but check with your employer and obtain permission first before accepting any opportunity. In addition, you may need to have a written agreement with your malpractice carrier to ensure coverage as you perform volunteer work.
Chance encounters with people at the grocery store, the ball game, or parent's night at the school may also provide opportunities to tell others about your practice. Always have your business cards with you. Notify your office staff if someone you met may be calling for a new patient appointment.
You might also want to buy some blank thank-you notes and have them printed with the practice logo. When a current patient refers a new patient to your practice, send a handwritten thank-you note. If one of your patients' families celebrates a graduation, wedding, or other celebratory event, send a short, handwritten note of congratulations. Most patients will appreciate the extra time you took to acknowledge them. Over the years, I have been invited to attend many of my patients' family functions. I have always been honored to be included in these events. I have learned over the years that when you treat your patients as if they are your family, you will never go wrong.
From a marketing perspective, word of mouth is what will build your practice, not expensive marketing campaigns. In my experience, sending out mailings and placing advertisements in the local newspaper announcing the opening of your new practice rarely produce much in return.
Respect your professional colleagues
I caution new physicians to be very careful not to make derogatory remarks about other medical professionals in the area. You may not agree with the competition's clinical acumen, but keep it to yourself. A new patient may be looking for an opinion from you in order to initiate litigation, but remember that you are only getting one side of the story. Avoid making broad and sweeping comments and judgments about another physician's clinical skills and practice philosophy. You do not want to get into a contest with other physicians in the area about who knows best. Your professionalism is a critical success factor for establishing your practice.
Easing into your new practice after residency will be one of the most exciting times in your professional career. The many challenges you will encounter are very manageable. Maintaining a realistic work-life balance, embracing your community, working with a peer mentor, and creating your opportunities for growth are critical to building a successful and rewarding career in family medicine, and practicing humility and empathy will enable you to establish good relationships with your office staff and your patients for many years to come.