Private Practice Deftness

[Bougie]

The honorable JPP states in a recent post:

"We (residency programs) could be turning out better, faster, stronger residents who LEAP into private practice instead of crawl."

As an upcoming CA-3, I feel that our academic institutions are staffed by attendings who have never been in private practice or have left private practice on bad terms. No disrespect to these physicians; they make huge committments to our field often at great personal and financial loss. The attendings at academic institutions who have actually had successful private practice experience are rare so it's hard to get a sense of how to set yourself up to "leap" rather than "crawl" into the private sector.

To the private practice folks, what are some rookie mistakes that you made or your junior colleagues currently make that beg the question: "what the heck was he thinking?" What particular skills or techniques do you wish greenhorns would have been better at fresh out of residency? What is the one thing you wish you had known or had been better at your first month out?

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[Planktonmd]

The honorable JPP states in a recent post:

"We (residency programs) could be turning out better, faster, stronger residents who LEAP into private practice instead of crawl."

As an upcoming CA-3, I feel that our academic institutions are staffed by attendings who have never been in private practice or have left private practice on bad terms. No disrespect to these physicians; they make huge committments to our field often at great personal and financial loss. The attendings at academic institutions who have actually had successful private practice experience are rare so it's hard to get a sense of how to set yourself up to "leap" rather than "crawl" into the private sector.

To the private practice folks, what are some rookie mistakes that you made or your junior colleagues currently make that beg the question: "what the heck was he thinking?" What particular skills or techniques do you wish greenhorns would have been better at fresh out of residency? What is the one thing you wish you had known or had been better at your first month out?

The most annoying thing that you can do as a new private practice anesthesiologist is trying to apply the same rules they taught you in residency on which cases should be canceled or delayed.
Always ask yourself: what can I do to get this case going and keep the OR flowing without taking unreasonable risk.
This is one thing you will not learn in residency and you have to discover it on your own.

 

[Gas]

The key is to be good at procedures. Do them well, and fast. But at the same time, never rush safety. You don't want to get the reputation as the guy that cancels cases, but you definitely don't want the reputation of the guy that kills patients by not practicing safely. I feel the pressure to put people to sleep and wake them up quickly, but not so much with sicker patients or kids. At the same time, you always have to keep moving. Don't screw around, and keep the cases/OR going.

Practice your skills during residency. Refine the techniques you are already comfortable with such as central lines, A-lines, difficult airway, regional, etc, and learn some new approaches too in case one technique does not work.

The other thing you want to do is not be dramatic. Don't complain about the late afternoon add-on. Don't pick fights with people, such as your other partners, surgeons, nurses, etc. People joke around a lot in private practice - it's a different mentality than the typical high-stress academic center. And if you get into trouble, be cool. Obviously, this comes with time. When you are a young attending, like I am, you will be scared. That is human, and everyone knows it. But just don't freak out - call for help instead. And just focus on one thing: taking care of the patient.

In summary, the three important things are speed, safety, and sanity. Be quick, be safe, and don't be a drama queen.

 

[pd4emergence]

Things to know that help make a successful private practice anesthesiologist especially in the first year or two of practice.

1. Know when to ask for help.
2. Your way is not the only way to do a case. Be flexible.
3. Remember that the surgeons and other physicians you are working with now, you will be working with for a long time. If you have a disagreement (and you will), don't burn any bridges unless you have to. The more bridges you burn the closer you get to the bridge headed out of town.
4. Treat you partners as you would want to be treated, relieve them as soon as you can, don't ask them to do something you would not be willing to do
5. If one of your partners needs a favor, try your best to make it happen. Someday you will need a favor.
6. Remember that there is more to running a successful group than working in the OR. Try to do your share or be open to spending a little more time in the OR so that others in the group can.
7. You will learn new stuff everyday. Be open to it. You did not learn everything in just the 4 short years of your residency.
8. You will probably work harder in private practice than you did in residency.
9. Complications happen.
10. Learn everybody's name. Treat them with respect.

 

[kmurp]

The suggestions above by emergence are both eloquent and accurate. Without thinking about it in that much of a systematic fashion, I think that I have followed them in my 20 yrs in practice and it has helped me a great deal. i always figured that i wasn't god's gift to anesthesiology-I struggle at times; but I also thought hat if I worked well with others and helped them out as much as possible that others would overlook my various shortcomings. It's worked out so far.

 

[coprolalia]

Great tips, guys. Anyone hiring?

-copro

 

[Gas]

PM me if interested in upstate NY.

 

[Tenesma]

i remember during residency how nice it was to have a handful of attendings that were out in private practice and came back into the academic fold... those rooms were always the most fun with tons of tricks and out-of-the-ordinary approaches that were quick and easy (ie: sevoflurane breath-down for cysto/turps, etc..) - it was also nice to have one or 2 surgeons who would do 11 cases in 7 hours to practice turn-around proficiency

i strongly believe that if a residency can't generate that type of private practice exposure then there should be mandatory 2-3 months during CA-3 year where you do some fast paced stuff in the community....

that type of exposure is worth gold...

1) Always be available
2) Always be amiable
3) Always be flexible
4) Never say no - ever... unless a patient's life is at serious risk (however in private practice, most surgeons would rather cancel a case as they are seriously risk adverse and don't want to deal with potential ICU, telephone calls, etc...)
5) Never hide and always offer your services even if it means giving breaks to everybody

 

[m3unsure]

You work harder in private practice than residency meaning the responsibility issue or something else particular to your private practice motto/model.

I'm not looking for the high-price job. I can't keep up this kind of grind forever. I was hoping for better hours overall. I don't expect to be on my arse all the time, but I certainly would like to limit my hours per week even if it means not being the BIG partner. 12 hour days, not a problem. Just give me freakin weekends for once.

Everyone has their own view on what they want in their career. I want mine to certainly be less stressful.