Choosing a new practice

I have been at my practice for seven months and thoroughly enjoy where I am. I have practiced in a variety of settings over the years. Some situations have certainly been more rewarding than others but I have learned much everywhere that I have ever been. Although residency and fellowship teaches us to manage patients with complex disease, it does less well at preparing us for the practical and business side of clinical medicine.

What is it exactly that makes one practice a better fit than another?

This is a difficult question to answer because each of us has unique needs and preferences. What may be a dream practice for one, could be a less-than-optimal situation for someone else. I do not have any inspired words of wisdom because I am still learning the answer to this question myself.

The most important advice I have for those about to leave fellowship and enter clinical practice is to know yourself and what you are looking for. In what kind of practice would you like to see yourself in 10 years? Some may be interested in a career that includes research and teaching whereas others may prefer clinical practice only.

What type of clinical practice is best? That depends. Some individuals may do well in a solo practice. Being a solo practitioner takes initiative and good business sense. The reward is the freedom to make one’s own decisions. Others do better in a group practice which has the benefits of shared expenses and call. There is also something to be said about the camaraderie of working within a group of like-minded colleagues and having someone down the hall to share fascinating cases with. Employed positions have advantage of not having to focus on every aspect of running a practice but a downside of less freedom.

When you are interviewing prospective positions keep in mind that which is important to you. Questions you might consider include: what are the call responsibilities? What is the patient and payer mix? Will you be expected to do inpatient diabetes calls? How will you be reimbursed? Is your salary base purely in income collected, will it be a guaranteed salary, or is it based on some formula of production such as calculated by relative value units? Other questions to consider may be about time off for meetings and vacation, will you be permitted to do the procedures you are trained in, and what kind of support staff will you have?

This is only a short list of what you might think about.

Do not forget that when it comes to contracts, everything is negotiable. Always enlist the expertise of an attorney to review your contract before signing anything. If a practice does not fit your needs, then look somewhere else. One advantage of being in a relatively underserved specialty is that there are many opportunities to choose from.

Good luck!