I Just Started Practice and Only Have 1 Surgery This Week – Will I Ever Get Busy?

Gabriella Ode, MD | Milton Little, MD, FAAOS

September 13, 2021


Congratulations on the new job! You’ve made it through years of residency and fellowship training to get to this point. You are now the boss. But now you’ve entered the next realm of learning and be prepared — this one is a doozy. Ask any practicing orthopaedic surgeon and they will universally tell you that the first few years in practice are tough, especially the first one. You’ve crossed an imaginary threshold where you were previously operating under the guidance of your mentors and now you are operating under the guidance of…yourself. Those first few days, weeks, months of practice are different for everyone. For some, you’ve joined a practice with a critical need for someone with your skillset, whether that is to fill a position previously held by another surgeon or to expand the footprint of your practice or hospital in an area of growing need. Other times however, you may be the new kid on the block in an established practice and you may not be walking into a full clinic and a full OR schedule. Regardless of the circumstances, early in practice you are going to have light weeks where you don’t have many patients in clinic and by proxy, you don’t have many patients scheduled in the OR. Below are some tips and pearls for handling those early slow days in practice.

Make the most of your non-busy week.

  • Research the practices that your referral base comes from and send them an email introducing yourself and offering your contact information. If you can be a source of contact for them when they have a specific musculoskeletal question, they are more likely to send patients your way.
  • Introduce yourself to local emergency rooms and urgent cares; this can be an invaluable source  of  patient referrals early on in practice ; make sure to  talk with your partners in your practice about your areas of expertise and referrals they can make to you.
  • Set up meetings with local physical and occupational therapists. This is of particular importance if you practice sports medicine, shoulder and elbow or hand. Make sure they have all of your current therapy protocols (Put together your physical therapy and post-operative protocols!). Discuss any areas of ambiguity and ensure they know when to reach out to you directly about patient concerns. Coordinate educational offerings for physical therapy groups – either in-person or via zoom. These can be webinars with other specialists, or you can present a topic on your own.
  • Set up presentations to primary care clinicians, emergency care clinics and relevant subspecialty groups (ie. rheumatology, non-operative sports medicine)
  • Connect with marketing department to help push novel techniques that you have expertise in
  • Work on building your website and/or social media presence. Very often early in practice, you will not have enough patient reviews to build up a star rating through various physician review websites. Being an unknown presence could make potential patients apprehensive. Build a website about yourself and your credentials and highlight your practice philosophy. Provide general orthopaedic education for patients about the surgeries that you perform. Tout your knowledge base and expertise and the patients will come.

When you have cases, be thoroughly prepared and make the most of them.

  • Before the case, discuss with your OR staff your needs for the case. Do you perform your surgical prep a certain way? Do you need your patient positioned a certain way? Be an active participant in this process. If you don’t know what’s going on in your room before timeout and incision, then you don’t have full insight into the entire case and where you can improve.
  • Take time to debrief with yourself and your staff after the case. What worked? What didn’t work? How can you as the surgeon communicate your needs better? How can the staff help you get through the case more efficiently? What instruments are critical to have in your instrument tray? What instruments might you need to get out of a tough situation? Did you take any inefficient steps? How can you minimize them the next time? Being critical of yourself is appreciated by the staff, your residents and colleagues. 
  • How long did the case take you? – Don’t get hung up on the time. It’s going to take you much longer to perform a case that seemed simple and fast when you were a fellow – that’s because your fellowship mentors have streamlined those cases over time and their staff knows them and their workflow. Focus less on the time it takes you to perform a case and focus more on doing the procedure correctly. Cutting corners early in your career will perpetuate bad habits.  Continued attempts to achieve perfection will lead to incremental changes which make you more efficient while not satisfying quality. You will get there in time.

Be patient.

  • Do not panic that you are not busy. As you build up your presence in your community, patients will come.
  • Do the best that you can for the patients that you have. Treat them with kindness, empathy and patience and they will tout about you among their friends and family.
  • Treat your staff with care and kindness as well and they will do the same.
  • If a significant time has passed and you are still not busy, speak with your department leadership and get their perspective on how you can grow your patient volume. Ask where there may be opportunities for growth – whether through satellite clinics in areas of need or specific marketing strategies. They hired you because they want to see you succeed. Take a collaborative approach with leadership to foster your future practice growth.

Be Proactive

  • Take the down time to maximize efficiencies in your practice. Create templates for your electronic health record to streamline office visits. Make sure you understand E/M, billing, and collections to understand the business aspects of medicine.
  • Make sure that the OR has all your preference lists (steal these from your fellowship mentors!)
  • Finish up your “to do” list from fellowship – get everything off your to do list now when you do have a bit more time because you will get busy soon enough and then likely find it difficult to complete those tasks.

DISCLOSURES: Dr. Little Globus Medical, Consultant: Depuy Synthes, Committee Member: AO Fellowship Committee; OTA Membership Committee; OTA Diversity Committee; OTA Wellness Committee Dr. Ode This individual reported nothing to disclose.

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

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