Starting From Scratch

Starting over is never easy. Ever. Starting medical school was hard. Starting your residency was hard. Having to start over yet again as a new attending physician may seem like the most amazing moment of your life when you’re an intern, but when you are actually faced with the reality of it at graduation, one thought fills your brain: This is going to be hard, too.

As a resident, you face long hours and difficult lessons to learn. There are patient questions that never showed up in any textbook. There are board exams that can make or break your career. Avoiding your malignant attending or chief resident can be an art form unto itself. After awhile, however, you start to get the hang of things. In fact, you start to believe that being a staff physician is going to be so much easier than scutting around the hospital at all hours on a holiday weekend. Being a grown-up doctor means enjoying the good life! Big salaries! Delegating menial tasks! A chorus of angels singing hallelujah as you walk down the hallway making your rounds!…

I’m not sure about you, but none of that happened to me on my first day. Or my second day. In fact, I’m pretty sure that I’m still waiting for that moment.

Don’t get me wrong. Starting a new job as a physician is an incredible and rewarding experience. I found, however, that there were a lot of aspects to the job that really never came up in all of my years of training. For instance, nobody told me that you can only delegate menial tasks if you have a qualified delegatee. If you’re like me, and you ended up in hospital that doesn’t routinely have residents to help you, you have to figure something else out. Also, we switched to an electronic medical record [EMR] about a year into my practice. More challenges! And nobody — and I mean nobody — informed me that the business model I was expected to follow would never succeed in my initial setting. More about that in the future, but that was an especially tough lesson to learn. It was one of the key factors that led me to pursue my MBA.

When I started in practice, I took a job with the same group where I had trained as a fellow. It essentially was a solo practice at a satellite hospital about twenty miles away from the main campus. My little hospital was the suburban community upstart — great reputation, lots of potential, but it needed physicians who were willing to develop the service lines out there. I was drawn to this opportunity because I was looking for a place I could create as my own. I didn’t want a job where I was expected to show up, operate and take call just as another warm body filling a gap. I quickly learned that what my suburban practice needed was very different from what my urban fellowship had offered.

As it happened, my slow starter practice afforded me ample time to go to meetings. I had never really been one for meetings in my previous life as a resident, but I had nothing to lose at that point. With the EMR installation taking up much of the system’s focus that year, I found myself well-positioned to help with physician support for the new platform. Slowly, the new faces around me became familiar. Over time, I started receiving invitations to be on other committees. Eventually, my presence started to matter more. Other physicians started to send patients my way or ask for consults. I was able to leverage my EMR side gig into some excellent opportunities within my hospital’s infrastructure.

Running the office was also a problem. I had staffing, but things were fragmented at first. Multiple personnel changes happened along the way. There was no feedback or quality metric system enforced regularly. The other physicians sharing that space were also essentially operating as solo practitioners. It took a few years and a lot of off-hours wrangling to get things into shape, but we were eventually able to develop a functioning department. These days, we actually run very well. That wasn’t an easy path to forge, but it was well worth the extra effort.

I will be starting my sixth year in practice later this week as I write this. As I reflect back on that first day, there are so many things I wish I could tell myself…

  • Think outside of the box
  • Don’t wait for opportunities — Create your own
  • Define your vision: Where you are? Where do you want to end up?

I think that last point may be the most critical. Take the time to truly understand your starting point. Decide where you want to be in the future. Then you can find the path between. If you don’t see the bigger picture, the details will get away from you before you know it.

Downloadable Thoughts:

I put together a brief worksheet just to spark a few thoughts for any physician starting a new opportunity. Please feel free to download the PDF for yourself and to share it with anyone who might get some benefit. And again, I always appreciate your thoughts and input! I learn so much from the shared experience. I’ll explore some other aspects of defining a practice with more of a business emphasis in the next few articles. Until then…

The Lonely Surgeon — Evaluating Your Role Worksheet

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