Navigating the Murky Waters of The Medical Business…

I am not a business expert. Some days, I don’t feel like an expert in much of anything…  I do believe, however, that I am not the only physician who says this.

When I was fresh young resident, my attendings would tell me to buckle down and learn how to take care of patients. This was great advice at the time. I think that every resident gets the basic principles of patient care pounded into his or her head as the years go by. Eventually, you graduate. You pass your board exams. You get your first job.

And then you realize that you’re all alone…

You don’t have that attending surgeon barking orders at you across the OR table at 2am anymore.  You can’t just fill out the discharge summary and tell the patient to follow up in some random clinic like you used to do. Now, that random clinic belongs to you. If someone needs to board your case, that person is probably yourself. And that means that you have to check off all of the boxes ahead of time – your schedule, the patient’s insurance authorization, preoperative medical clearance… The list goes on. Yes, you will have an office full of staff who may be able to help you with these things, but that’s another problem. How do you manage all of those people? How do you get them all to work efficiently? And how do you keep them all from killing each other when the inevitable drama occurs? How do you keep them from killing you when you aren’t feeling especially sensitive to their needs?

After awhile, you usually figure these day-to-day issues out. Some things may be better than others, but you will eventually find an equilibrium. Then your accountant or business manager will call you for a meeting. He or she will tell you there’s an issue. There’s always an issue. Some issues are easier to solve than others, but something will always pop up. Often, that issue stems from some decision you inadvertently made months earlier as you were developing your practice. You never even saw it coming. And that was something that your attending surgeon forgot to mention during that 2am trauma case…


I think they missed that part of medicine. Physicians, and especially surgeons, are often viewed as the captain of the ship. Sometimes, however, the captain’s book is missing a few pages.

In chatting with colleagues over the years, I believe that this is a common experience. I can’t say that I have any magic formula to fix this, but I have made a few observations along the way that I have found to be helpful. My goal is to present a series of articles here that address a few topics that I hope might inspire some discussion. I believe that some shared insight might clear a path for us to navigate that gap that exists between medicine and business.

Someday, with any luck, no surgeon will feel so lonely.


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