Transitions: from being in training to staff

[olafa]

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It's that time of year - new transitions in training to staff. I wanted to start a discussion to get ideas from those who recently made this transition. What was the most difficult aspect of this transition for you?
If people could give their opinions or insight, i.e. things we all could learn from to make our lives easier. As you transitioned from fellowship or residency to becoming staff weather private practice solo or with a group large or small -- what were the biggest barriers or key learning points that could help all us in the future?
It could potentially be an endless discussion, but key ideas I can think of may be - Joining the group, picking a good group, how to tell based on a superficial impression if it is a good fit, contract issues, negotiating the practice, equipment setup, purchasing /leasing, vendors, practice management issues, EMR. How do people find practice consultants specific for our specialty when setting up a practice, seems it could be worth it?

Sure would be nice to have that ideal job from the begining and not have to go through trial and error, changing jobs, etc.😀 or am I just dreaming....

 

[RUOkie]

Why don't you narrow it down a little? I could write a tome about my mistakes in my first 13 years in practice and not come close. That is why it is called practice.

Briefly,
1) don't sign anything unless you know what it says
2) hire a good attorney when doing any contract negotiations (if you can't tell who the sucker is in the room--it's probably you)
3) Do what you love and love what you do.
4) If you are unhappy in your job, figure out why, then start looking for something else (unless you can change that issue). Do not wait until you are miserable.
5) Don't buy ANY EMR/computer software until you are sure it works for you (I made that mistake, and it took me 5 years and a threatened lawsuit to finish paying off the mistake)
6) Ask questions of everyone you meet. Learn something new every day.

is that enough for today?

 

[PMR 4 MSK]

Don't go solo from the start unless you have business experience - like owning one. Spend your first years honing your medical skills and learning some business before striking out on your own. Otherwise, everyone takes advantage of you long before you ever become aware of it.

Shake hands with every doctor you meet. Introduce yourself and what you do and how you might help them. Best 2 ways to get new patient referrals - meet the docs in person, word of mouth from the patients you treat.

Be prepared to eat a lot of **** sandwiches in the early years. You are back to the bottom of the totem pole until new guys come along.

Everything is about money. Don't fool yourself - you went into this for the challenges and the love of medicine and the patients. Now you have to be able to make money to keep doing it. No one wants to help you make money except people making money off you. And most of them don't care how much you go home with, as long as they get their slice of your pie.

The government will **** you every chance they get. Hospital admins will too. Do not get into bed with a hospital. They don't use KY.

Treat every patient you meet as if they were a member of your own family, unless you hate your own family. Use the mom rule - "What would I recommend my mom do if she were the patient?"

Family first, then work.

In all probability, you are soon going to make more money than you have ever seen in your life. Put as much of it away for retirement and savings as you can. Balance that with paying off debt as fast as you can.

 

[SSdoc33]

great advice so far. agree with everything thats been posted.

also, your new practice will likely be very different than the old one, and the people working there will not be used to your style. dont try to change too many things too fast, and be patient when you want things done in a specific way. i learned (after about a year or 2), that i came in like a tornado and was very demanding.

also, you are really only as valuable as the revenue you generate. it is very important to do a good job, but i would say equally (if not more) important to collect. if you make your practice some money, you will have more power and say in how things run. also, you SHOULD be earning more this way. make sure your contract doesnt make you a slave

 

[specepic]

Negotiate a good salary up front. Lots of places will low ball the salary and tell you that you'll bonus no problem. Make the success of your practice their problem, not yours.

don't be too hard on yourself for not knowing something or for making a mistake

eat some bananas b/c your stools may be loose those first few months 🙂

 

[olafa]

Good advise all around. Its always good to learn from others - why re-invent the wheel, right? Sometimes I feel that all these years in training have made me institutionalized and that I am going to be facing a serious learning curve ahead.
When negotiating salary- isn't that a touchy subject sometimes. What's a typical bonus structure? Seems in old posts- sometimes people will offer a percentage after reaching a certain amt, they get a percentage but then also deducting things like overhead and other expenses etc, then is there really anything left after all that?

If joining a group- who covers the insurances? Malpractice, health etc. is that usually your expense or the group?

 

[specepic]

Good advise all around. Its always good to learn from others - why re-invent the wheel, right? Sometimes I feel that all these years in training have made me institutionalized and that I am going to be facing a serious learning curve ahead.
When negotiating salary- isn't that a touchy subject sometimes. What's a typical bonus structure? Seems in old posts- sometimes people will offer a percentage after reaching a certain amt, they get a percentage but then also deducting things like overhead and other expenses etc, then is there really anything left after all that?

If joining a group- who covers the insurances? Malpractice, health etc. is that usually your expense or the group?

I am just out of fellowship. The main learning curve issue is speed. you know how to take care of pts, but can you do it fast and well? get them to slowly ramp you up.

Salary should not be brought up by you as question #1. Usually it plays out like this. Recruiter, friend, or ad makes you aware of job. You have a phone chat with them. Let them bring up pay. If they ask you to name a number, don't (what if you say 180 and they were thinking 200?), just say "Happy to hear what YOU have in mind but right now I just want to see if this is a good fit". But on a susequent chat get some idea from them on $$ before you take a bunch of vacation days to interview if its far away.

Make your contract be specific where it counts (pay, hours, etc.) Get help with your contract. Keep in mind that no matter cool they seem most of the recruiting talking points are total BS. I'm serious. If its important to you make them put it in writing, period. If they don't want to walk away.

 

[lobelsteve]

I am just out of fellowship. The main learning curve issue is speed. you know how to take care of pts, but can you do it fast and well? get them to slowly ramp you up.

Salary should not be brought up by you as question #1. Usually it plays out like this. Recruiter, friend, or ad makes you aware of job. You have a phone chat with them. Let them bring up pay. If they ask you to name a number, don't (what if you say 180 and they were thinking 200?), just say "Happy to hear what YOU have in mind but right now I just want to see if this is a good fit". But on a susequent chat get some idea from them on $$ before you take a bunch of vacation days to interview if its far away.

Make your contract be specific where it counts (pay, hours, etc.) Get help with your contract. Keep in mind that no matter cool they seem most of the recruiting talking points are total BS. I'm serious. If its important to you make them put it in writing, period. If they don't want to walk away.

Numbers are OK. Tell them you want $650,000 to start but willing to negotiate down. If you have a big smile on your face, they know you might not be an idiot.

 

[WongBaker10]

Any advice for a fellow who wants to do locum tenens to ease into it all?

 

[drusso]

Did you ever read House of God as a medical student? Do you remember one of The Fat Man's rules, "They can always hurt you more?"

The private practice equivalent would be, "If they had two dicks they'd f*ck you twice." Try to keep that rule in mind...

 

[DigableCat]

The private practice equivalent would be, "If they had two dicks they'd f*ck you twice." Try to keep that rule in mind...

Hospital administrators must have three then... And they don't even buy you flowers.

 

[olafa]

Hospital administrators must have three then... And they don't even buy you flowers.

This person you describe sounds scary and must wear mighty big pants for all that artillary...

I came across this medscape article on tail insurance.
http://www.medscape.com/viewarticle/725938?src=mp&spon=21&uac=116315BR

 

[rysa4]

It's that time of year - new transitions in training to staff. I wanted to start a discussion to get ideas from those who recently made this transition. What was the most difficult aspect of this transition for you?
If people could give their opinions or insight, i.e. things we all could learn from to make our lives easier. As you transitioned from fellowship or residency to becoming staff weather private practice solo or with a group large or small -- what were the biggest barriers or key learning points that could help all us in the future?
It could potentially be an endless discussion, but key ideas I can think of may be - Joining the group, picking a good group, how to tell based on a superficial impression if it is a good fit, contract issues, negotiating the practice, equipment setup, purchasing /leasing, vendors, practice management issues, EMR. How do people find practice consultants specific for our specialty when setting up a practice, seems it could be worth it?

Sure would be nice to have that ideal job from the begining and not have to go through trial and error, changing jobs, etc.😀 or am I just dreaming....

Your specific list falls largely under the category of practice management consulting as you say. I actually do consulting, but I have no issue responding to PMs if you have any specific issue you want a freebie opinion on. I tackle the issues you list as a daily experience. The MGMA probably could quickly give you a veritable wealth of consultant recommendations.

On the other part - fellowship ideally already involves a lot of resident teaching - when you go to the attending level - just buy a nicer suit and everyone will buy into your authoritative treatise. 🙂 Seriously though - if you are into teaching it should come naturally. Start a journal club, teach anatomy with the cadaver, teach physical exam etc - residents are often quite receptive when attendings go out of their way to take extra time to teach. I gave tons of lectures when I started.

Have fun!

 

[olafa]

Thanks for your reply- I never said i was interested in acedemics not sure where that came from. I am probably leaning more toward private, ideally I think a multispecialty group would have a nice fit. How does one find a lawyer specific for our specialty group (PMR-pain) when looking at contracts etc.. or does it matter? Is there a resource with AAPMR?

Your specific list falls largely under the category of practice management consulting as you say. I actually do consulting, but I have no issue responding to PMs if you have any specific issue you want a freebie opinion on. I tackle the issues you list as a daily experience. The MGMA probably could quickly give you a veritable wealth of consultant recommendations.

On the other part - fellowship ideally already involves a lot of resident teaching - when you go to the attending level - just buy a nicer suit and everyone will buy into your authoritative treatise. 🙂 Seriously though - if you are into teaching it should come naturally. Start a journal club, teach anatomy with the cadaver, teach physical exam etc - residents are often quite receptive when attendings go out of their way to take extra time to teach. I gave tons of lectures when I started.

Have fun!