Private Practice Out of Fellowship

[MrFlyGuy]

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I don't know if anyone else is in this situation but does anyone else not really feel like they're not really attendings because they aren't surrounded by trainees or part of a hierarchy?

For the past 8-9 years we've been cogs as part of the medical institutional wheel and now that that's gone being in private practice it just feels hard to feel like I've reached a certain milestone for some reason.

 

[randomdoc1]

being an attending is only the beginning. every ending is a new beginning. the trick is always being ready to embrace knowledge gaps and learn...forever. When I got out in practice, I realized there is still a hierarchy and the world is vast. Money is hard to come by, everyone has bills to pay and we're all trying to make it. First two years out of training was extremely humbling, but I did reach my goals. actually, in my late 30s and hit a financial state to be ready for retirement. I plan to make my own post. Out of will, I will not be retiring because business management is my passion and I have so many things I still want to try out. But yes, trick is always being on the ready to acknowledge how vast the terrain is, and the more you learn, the more you realize how little you know. That applies to all of us.

The danger lies in believing we "have it down" or that we are "set." It's like the tortoise and the hare story. It tempts one to let the guard down and the tortoise will win ; ). There is always competition. Even though I own a practice, work for myself, I have to keep my skills and performance to a certain standard. I don't have to worry about being fired per se, but I can lose to competition.

Society in some ways feels like Squid Games to me. We're always a part of something bigger. Dying off of characters is much slower and the money does not accumulate as quickly though.

Welcome to the real life squid games my bruh! But there is a way through! Prevail! x D

 

[lobstar]

I feel that way too. We've been reaching the next goal, next rotation, next test, next call shift, etc since we were about 7 yo when we figured out grades mattered. Now it's just the same routine--see the patients, write the notes--without an end or artificial goal or some kind in sight. Certainly a strange feeling. I'm even doing my hobbies now, spending more time with family, making money and it's a bit of an adjustment to just have a job that pays you and you go home. No advancement or other strings.

 

[randomdoc1]

oh, and as some people may have gathered from my prior threads, if you have not already, get a prenup and/or post nup. Highly recommend. That's probably a major thing I'd do different. Everyone thinks they won't be one of the marriages that ends in divorce. But 50/50 is a big cut. Kind of like a living will for the marriage. Hopefully never needed, but good to have and could save a lot of troubles down the line. If I was working a regular physician job, I'd be financially screwed. So I'm lucky that business wise, I had that buffer to protect me. Give things a few to several years to evolve. It can stay the same, worsen, or get better in life in general. And we are the drivers.

 

[comp1]

I would definitely feel that way and it's why I avoided leaving the hierarchy.

 

[Sushirolls]

Before I started medical school I wanted the greatest gift of medicine. Independence. Freedom. The ability to show up in a town, start a practice. And limit the bosses...
Patient, Insurance, Gov regs, license regs, board cert stuff, etc. are the extent of my bosses. Limit the number of bosses. Maximize the independence and freedom. No hospital privileges, no committees, etc.

You know what my meetings are? Coming here to SDN to post/read.

Bureaucracy kills.

Glad I've side stepped the academia and hierarchy. It's a mirage, and none in those systems truly care about you and will replace you. Even if you make a name for yourself, 30+ years get an honorary name for a room, a building, a department, by 5 years later, no one will know who you were. But you live in middle of nowhere? Your neighbors for darn sure, will know who you are and even some time after your dead and buried.

Embrace the freedom.

 

[randomdoc1]

Before I started medical school I wanted the greatest gift of medicine. Independence. Freedom. The ability to show up in a town, start a practice. And limit the bosses...
Patient, Insurance, Gov regs, license regs, board cert stuff, etc. are the extent of my bosses. Limit the number of bosses. Maximize the independence and freedom. No hospital privileges, no committees, etc.

You know what my meetings are? Coming here to SDN to post/read.

Bureaucracy kills.

Glad I've side stepped the academia and hierarchy. It's a mirage, and none in those systems truly care about you and will replace you. Even if you make a name for yourself, 30+ years get an honorary name for a room, a building, a department, by 5 years later, no one will know who you were. But you live in middle of nowhere? Your neighbors for darn sure, will know who you are and even some time after your dead and buried.

Embrace the freedom.

great to see ya! I know, these SDN moments are my "meetings" too! And yes, PP is as free as it gets. Although not every physician can pull it off. imho, the biggest potential barrier is a physician's willingness to continue to learn or lack of. Yes, there are always things we have so much limited influence over like parts of insurance contracts, laws, etc. But ultimately there is a way. It's about how persistent and willing to learn the provider is. But...those are my thoughts. We're a unique breed ; ). Being independent and all!

 

[mistafab]

I just want to say YOU ARE READY. The only difference between you and your attendings is years of practice, not years of training.

Fellowship seems to have a way of stealing confidence with an exchange of providing certificates. I promise you are already better than 50% of psychiatrists if you've completed a fellowship. If not you... then who?

Good luck out there. You will do well

 

[Merovinge]

Semi related to your question, but I strongly recommend joining a monthly peer-supervision where other people from your fellowship meet up to discuss cases (with Zoom this is pretty easy to facilitate these days). It will help you hear other perspectives and also better understand if they match yours.

 

[Sushirolls]

Do people not pick up the phone and call anymore? First few years out of residency, former co-residents and I would just call.

Yo, Sushi, got XYZ, conflicts MNOP, plan ABC; not sure, thoughts? Meh, BCD be my approach. Good luck.

Doing a monthly meeting misses acuity of seeing patient that day or previous day. Becomes more of watered down M&M for psych, rather than an in moment 'I need help/reassurance.'

 

[TexasPhysician]

You could always volunteer to teach classes at the local residency or medical school. You could give talks at conferences. Could allow pre-meds to shadow. There is a lot you can do to fill that desire.

 

[FatherPsychiatry]

I feel that way too. We've been reaching the next goal, next rotation, next test, next call shift, etc since we were about 7 yo when we figured out grades mattered. Now it's just the same routine--see the patients, write the notes--without an end or artificial goal or some kind in sight. Certainly a strange feeling. I'm even doing my hobbies now, spending more time with family, making money and it's a bit of an adjustment to just have a job that pays you and you go home. No advancement or other strings.

I've been curious about this as well, especially as I raise my own spawn in the social milieu that glorifies the above. Maybe its because I missed out on that, that I never really felt the kind of ennui espoused by OP (and partly why I'm worried about it for my kids). I was sort of a slacker in college, and was out of school for four years before starting medical school. I worked during those four years but it was still "just a job" and I focused on hobbies, discovered new ones, hung out with friends, so I was well out of the academic feel for that time Even when I was in college my roommates/friends group was not pre-meds so they were not part of that hamster wheel either. So going through med school, residency, fellowship - I did enjoy some of that academic feel but still felt it was secondary to the rest of my life, and I carried that to my first job (and still current job) out of fellowship - I enjoy it and am passionate about (yeah yeah call me lame but I do feel its my calling), but I don't feel any kind of "FOMO" from not having a next rung or not having any trainees regularly around me. Just coworkers, mostly psychiatrists, and even though we discuss cases, we probably spend more time talking about restaurants, vacations, sports etc.

I agree with all the replies above. Private practice - is it solo? Might be a kind of loneliness, so joining up with a local medical society might help. Or reconnecting with co-residents. Otherwise, might just have to accept that THIS is real life, and what like 95%+ of the population deals with on a daily basis, but we high-achieving nerds never really experienced because we were always climbing that next step and formed our whole identities around that. "go get some hobbies" is a little over simplistic, but could help...

 

[Dr. Pookie]

The pharma reps keep me company 🙂

Just kidding (sort of).

I strongly disliked the bureaucracy (read: circle jerk) of academic medicine. That's why I started solo private practice right out of training. I couldn't imagine doing it for another second.

I had one extremely overbearing attending hear about my plans to start PP out of training and mockingly told me, "Won't you miss working with everyone!?" during CL rounds. I couldn't even hide my disdain.

To each their own.

 

[FatherPsychiatry]

I had one extremely overbearing attending hear about my plans to start PP out of training and mockingly told me, "Won't you miss working with everyone!?" during CL rounds. I couldn't even hide my disdain.

I like some of academics and all but damn some of the really entrenched people like that are flat out weirdos.

 

[randomdoc1]

I like some of academics and all but damn some of the really entrenched people like that are flat out weirdos.

"Welcome to the real life squid games my bruh!"
Why did I hear that being said in the voice of Thanos? lol

I agree. Pros and cons of academics. What I find interesting is that they are the main figures in residency programs but many don't know a darn thing about how the psychiatry market actually is. I'd love to see more people teaching in these programs that have more experience outside of academia to round it out and truly inform the earlier career physicians well. I'd love to see the teaching unfiltered, uncensored and blunt xD. But I've been told my approach is a bit direct for some. However, it's made a great brand at the practice here. We're known for telling it like it is and our treatments work. They may not feel good (e.g. exposure therapy), but do you wanna get better or not?! I feel the same way about teaching. I don't endorse being mean but I am .... direct.