Building Your Practice: Pearls and Pitfalls

Matthew D. Beal, MD | Cara A. Cipriano, MD, MSc | Joshua C. Patt, MD, MPH, FAAOS, FAOA

July 22, 2020


You finally made it!  You have the perfect job, in the perfect location, and your significant other could not be more happy. If this is you, you can stop reading this article right now, but chances are this is only a really small portion of the population that starts their orthopedic career. Most of the time, the story revolves around a little bit of compromise. Here are some of the pearls of wisdom and pitfalls that I have encountered throughout the last 11 years of my career.

1The Perfect Job Does Not Exist.

Unfortunately, there is an exceptionally high number of surgeons that will change jobs within the first 2-5 years of entering their orthopedic practice. This probably reflects some changes in the way that we deliver healthcare, but also personal changes that happen as a family develops and grows.  When you are operating as a fellow, you have to remember you are working in a mature practice with a well-established surgeon in your area. For most of us, this isn’t the way our practice starts. For the most part, you will be dealing with the most complicated problems and sometimes the sickest patients. You are not alone. You have people around you that can help you, including internists that can help you manage the medical issues that arise. You should also lean on the experience of your senior partners and faculty. Remember you are never wrong when acting in the best interest of the patient. It’s not always comfortable to ask for help, but sometimes you need it.  Swallow your pride and make the phone call! 

2Know Your Staff

You want to get to know your own staff to assess their skill level in detecting issues that might negatively affected the patient. You are not that busy in that first job, so educate them on protocols and triage. It will take you some time to establish practice patterns, so use that time to review your equipment and meet with the people that will order and handle it.   Do an in-service session with the operating room staff if it is equipment they are unfamiliar with. In addition, go to your own sterile supply room and assess what equipment lives in the hospital versus the equipment that you need to order-in for specific problems that might arise during a given case. This will certainly change how you plan for cases and how you order equipment.

3The Perfect Location Can Change.

The things that are good for your career in the beginning may not be all that fulfilling when you are midcareer or nearing the end of your career. Some of that is based on location.  Working in a hyper competitive large urban market may be appealing as a young surgeon with an exceptional amount drive, but as you get older you may look to a smaller market in order to slow down your pace or add other elements to your career.

4Traffic is Tough.

It is tough for everyone, including the family you’ve located further away from, to see you. As easy as it is to say that it’s only a few hours drive or is only a plane ride to see family, that still puts barriers between you and your loved ones.

5Location, Location, Location

Always consider where you are operating, and where you are seeing patients. Measure that against the proximity to your home. Are you traveling a lot and spending a lot of time in your car? Can you become credentialed at a facility that’s closer to your home to ease your burden?  Do you need to accept clinic appointments at a satellite office that is further away from home for you, and what is the expectation of your group regarding developing that portion of the practice? These are thoughts that you need to consider that could be potential pitfalls that would make you become more dissatisfied with the job.

6Make Time for Your Family

Your family and your significant other still need to see you. As you start this next adventure in your life developing a practice, make sure that you take time to consider the folks around you that supported you the last six years in training. You will have more time to spend with them in the beginning, so do it and enjoy it! Set up your schedule and keep your calendar with all of your days in meetings in mind including soccer games and choir concerts. If it does not exist on your calendar, someone else will put something on your calendar. You need to control your time.

In conclusion, get beyond the day to day grind of operating and seeing patients in clinic and consider how these other factors could potentially assist or detract from your career. Always measure the pertinent positives and negatives of a job and then rank them based on how important they are to you. If you are considering changing jobs, which most of you will, consider the pertinent positives and negatives of the new job and assess if these new changes are actually improving your current challenges.


DISCLOSURES: Dr. Beal AAOS: Board or committee member, American Orthopaedic Association, Board or committee member, Medacta: IP royalties; Paid consultant; Research support, National Institute of Health (NIAMS & NICHD), Zimmer, Stryker, Mako Surgical: Research support, Zimmer: Paid consultant Dr. Cipriano KCI: Paid consultant, Link Orthopaedics: Paid consultant, Musculoskeletal Tumor Society: Board or committee member Dr. Patt American Orthopaedic Association: Board or committee member, North American Spine Society: Board or committee member.

Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s