Starting Your Practice

Gabriella Ode, MD | Daniel Osei, MD, MSc, FAAOS

May 4, 2022

After spending most of one’s residency dreaming of being done with the long nights and the lack of autonomy and control, few young surgeons are prepared for the start of their practice being even harder than their training days. All of a sudden, one realizes that there is so much more to caring for patients than was ever apparent. Moreover, the realization that you are responsible for everything that happens to your patient can lead to anxiety, fear, and worry. In addition to “imposter syndrome” which is ubiquitous amongst young surgeons who both care about their patients and are also acutely aware of how much they don’t yet know, the lack of business training creates another seemingly overwhelming layer of concern for young surgeons who are trying to figure out how to run an efficient and ultimately viable practice. After spending years believing that “getting through” the sleepless nights in medical school, residency, and fellowship will inevitably lead to better times once in practice as a surgeon, it turns out that for a young surgeon, the most important educational lessons occur during the first few years of practice.  Here are a few tips to help ease the transition.

Meet with departmental or group leadership and discuss strategies and expectations for your practice growth.

  • This includes meeting with your partners in the same specialty or office location and communicating with them about your surgical interests and your surgical and clinical volume goals. Make sure there is a strategic plan in place to accommodate your growth – which may include increasing clinic capacity and/or OR surgical block time as you are ramping up.
  • Understand where your patients may be coming from and fortify those pathways
    • If patients will most often be referred to you from primary care physicians within your hospital system, then reach out directly to those offices and make sure to introduce yourself to their physicians and other providers. Make sure they have a means of direct contact with you for patient questions or concerns. Access builds trust in these critical referral relationships – do not be afraid to give them your cell phone.
  • Thank you goes a long way
    • If you do receive referrals from other providers, make a point to send a thank you correspondence to the referring physician. Be sure to include your patient note. Not only does this demonstrate to the referring provider that you appreciate their vote of confidence, it also helps them understand the type of patients that you like to see as well as your usual treatment plans for various conditions. This helps them to set expectations for these patients prior to them seeing you in the office for a new visit. Referring doctors want their patient taken care of – see the patient, send the thank you, close the loop – this will establish a pathway by which they know their patients will be well taken care of by you.
  • Get to know your allied health groups in town – this can include physical therapists, chiropractors, nutrition and/or fitness services. Make sure they know that you are accessible. Also if there are certain nuances to the care of your patients (ie. personal PT protocols), then take the early opportunity to set those expectations at the start of your practice.
  • Meet with those in charge of marketing within your department or hospital and work with them to create a strategic plan for presenting you to your patient community
    • This can include development of your bio page for your institution. Additionally, participate in community outreach initiatives which can include educational seminars for local communities or community groups, contributing to local health blogs. Often marketing departments will offer the opportunity for you to create a brief video bio, which allows you to talk about your clinical interests and also who you are as person.
    • Have your own website (if allowed). Having your own website serves several purposes. The majority of practice-based websites will carry minimal information about you beyond your brief bio, your office locations, your general areas of clinical expertise and insurances covered. Your personal website allows you to further demonstrate what makes you unique as a physician. This can include additional information about your clinical expertise. Additionally, personal websites make a great resource for patient education. Make it a repository for your postoperative instructions, PT protocols, patient FAQs as well as vetted information about the orthopaedic pathologies that you treat. If you can guide patients to your website to learn more information about their orthopaedic condition, they are less likely to explore other websites with inaccurate information or disinformation. Furthermore, while creation of a website seems very daunting, there are several website building firms that specialize in physician related content and include services that maintain your website year round and also provide professional social media management

Take time to organize your clinic flow

  • At the start of your practice, you typically won’t be very busy unless you are directly inheriting the practice of an established surgeon. In either case, spend time meeting with your office manager and clinical staff to create a workflow that allows for you to see patients efficiently. Walk through the patient encounter from beginning (appointment booking) to end (patient check out) and put your workflow preferences in writing whenever possible. Make sure that your scheduling staff knows how much time to allot for new, established and postoperative patients. Remember that at the start, nearly all of your patients will be “new” to you, so be sure to account for longer patient encounters for the first few weeks or months of your practice. It’s better to have downtime between patients than to keep your next patient waiting because you didn’t allocate enough time to see your last new patient.
  • Make sure that your radiology department knows what Xrays you will need for specific conditions and make sure that when patients are scheduled for appointments, that the time needed for Xrays is accounted for when patients are told when to arrive – for example, if a new patient has a 2:00 appointment but needs to fill out intake forms and obtain xrays, make sure that staff informs the patient to arrive early to complete these tasks.
  • Be patient with your staff — there will be some trial and error need to create an efficient workflow. Create a work environment that values the opinions and expertise of your team — be sure to debrief with your team after clinic days and discuss any challenges to efficiency that need to be worked through. There are often roadblocks that you may not be directly aware unless you maintain open communication with your office staff.

Take time to understand your EMR

  • Documentation is a critical part of your job. Take time to understand how to use your EMR. Ask for assistance from a partner or staff member who is savvy with your EMR. Often, you can ask for personalized tutorials from your EMR liaisons – use these opportunities to build in favorite settings for orders, clinic notes, operative notes. Save commonly used phrases as you are using them. Over time, this will help you become more efficient with each patient encounter and cut down on time at the end of your day spent creating documentation.

Above all things, remember the 3 A’s: Availability, Availability, Availability. While most people know the aphorism Availability, Affability, Ability, in the beginning of practice, it has been proven true time and time again that being available, showing up, and making patient access easy for referring physicians will always result in getting patients into your office and eventually, into your operating room. As challenging as early practice may be, thankfully some things remain simple. As terrifying as early practice may be, take reassurance that almost every single one of us make it and become an integral part of our patients’ lives. With a healthy dose of patience, courage, and hard work, you will too!

DISCLOSURES: Dr. Ode This individual reported nothing to disclose. Dr. Osei has no active consultant relationships, Committees: ASSH Council, Member at Large; ASSH Publications and Products Advisory Committee; ASSH Diversity Committee; Co-Chair ASSH Research Management Committee; Associate Editor, Journal Hand Surgery.

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

Copyright© 2022 by the American Academy of Orthopaedic Surgeons

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