Before starting your own practice, do these 3 things first

If you’re a young doctor reading this, chances are you are employed by someone else. Your paycheck may come from a hospital system or a group of other doctors, but you’re not your own boss. This may be working out just fine for you: I hope you are happy and have a well-balanced work and personal life, and are getting a fair paycheck. I hope you have a sense of professional and personal satisfaction, and can see yourself working for the same organization for the rest of your days with a smile on your face each day! If this describes you, you can probably stop reading now because you have found a unicorn job! Keep it!

However, if you’re like the majority of doctors I know, there may be something that you feel is lacking in your life. Maybe you feel overworked with no time left for yourself or your family. Maybe you feel under-appreciated, under-valued, and think you have more to offer your patients but can’t make it work in your current job situation. Perhaps there is pressure on you from above to see more patients per hour than you think is reasonable, and you are being forced to rush your patients in and out without giving them the time they deserve. Maybe your senior partners aren’t using you to the best of your abilities, and see you as cheap labor to feed their endless desire for more of everything … more money, more patients, a bigger practice, fancier cars, more expensive toys, whatever.

Does any of this sound familiar? When the honeymoon period is over and you realize you’re running uphill everyday chasing promises that are actually lies, trading your hard work and sacrificing more of the prime years of your life to make more money to stuff into someone else’s already fat bank account, what are you going to do about it? Have you thought about where this path will lead you in ten years? You’re not going anywhere good; I can tell you that with certainty!

If you’re employed by a hospital or private group and have thought about leaving them behind and going solo or finding another employer, this article is for you! Even if the thought of opening up your own medical practice seems completely overwhelming right now, keep reading. A few years from now the idea of going out on your own will seem less scary. If you ever actually make the move, you will be happy you did the following three things NOW. Think of yourself as planting trees that will take many years to grow — you can’t wait until you’re sweating in the sun and desperately looking for shade to plant the seeds!

1. You need to build an internet presence centered around you. Doctors need a digital footprint on the internet. This should be built around you personally, as your employer may change in the future, but you are a constant. Patients increasingly use Google to find their doctors and read up on all kinds of health-related topics. If you are relying on your current practice’s website as your internet presence, as soon as you leave that practice *poof!* you’re gone from the internet too! How will patients find you? Will your patient’s even look for you? Do they remember your name? Are you engaging your patients in some meaningful way or are you just another doctor following an algorithm that any other “health care provider” can do?

How do you build an internet presence? Start by signing up for social media accounts as your professional self. Use your title in the profile name and use a professional headshot as the profile picture. Try to post regularly and let patients know where to find you. This is super-easy and you can literally do this right now. (Make sure to adhere to professional guidelines about social media usage for professionals. Don’t even think of sharing inappropriate content or making comments online that you wouldn’t share with an actual real patient in a medical setting. HIPAA still applies online too. This should go without saying.)

If you want to take things to the next level (and you should), start your own website, blog, or whatever you want to call it. Think of a name for the site (you can just use your name for now, for example fredgandolfo.com), buy the URL for $10 on GoDaddy.com, and put up something basic on there. You can learn how to do this by searching Google, but you can also just pay someone to set up a website for you. Either way, there are many ways patients can engage with you on your own site, and a few years from now when you make the move your patients should have no problem remembering your name and finding you on Google. (I should mention that you actually need to like writing, otherwise having a blog will almost surely fail after a few months.)

Just to illustrate how long it takes to generate some real traffic on your blog, here is a snapshot from Google Analytics for Retroflexions (this site). As you can see, it takes time to get the traffic going, and it’s not a linear growth, it’s more like a punctuated equilibrium. This is why it’s important to start your site now, not a month before you are starting your new position.
If you don’t want to commit to having your own blog-type site, you can also write some high-quality articles and shop them out to other blogs, news sources, websites, etc. Many places are happy to publish your stuff for free as long as it’s well-written and pertinent. Make sure you can put links back to your own website (which can simply be a static page with your picture, credentials, contact information, and social media links) in the biography and these articles will continue to serve you for years to come.

2. Evaluate your financial situation now, save money, avoid lifestyle inflation. This can’t be stressed enough. Don’t paint yourself into a corner where you are forced to stay in a job that is crushing your soul because you desperately need the money to pay for things that you have no business owning anyway. Do you really need a $90,000 luxury car? Do you truly get enough enjoyment out of it to justify the cost? Are you running yourself ragged, putting your own health and your family’s well-being at risk, just to afford all this bullshit that you don’t need? Be honest with yourself!

What if you drove a nice $30,000 car instead, and instead of working all of those extra hours, you put that time into some productive activity, like taking care of your body or your mind? Would your family be happier if you were home a little earlier each night to spend time with them but didn’t drive a 362-hp Mercedes S 450? I think you already know the answer to that question!

It will take a bunch of your own money to make a career change, especially if you choose to go solo and start your own practice like I did. You will basically need to live on savings for a while since even if you start out busy it will take months or longer for your accounts receivable to ramp up to the point where you can take home a reasonable paycheck. Sure, you can amass more debt and take out big loans to pay yourself from, but why? Make things easier on your future self by cutting the fat out of your spending today, and save the money you’re making now to help with your escape later!

3. Keep kicking ass every day! Continue to work hard for your patients and build a good reputation among your colleagues. If you are a rockstar physician, your patients will find you and follow you no matter where you go or who you work for in the future. Your reputation with your colleagues and co-workers (other doctors, nurses, office and hospital staff) will follow you wherever you go. You are not defined by your employer, you are a professional and it’s your name on that medical license…not your bosses name. Don’t forget that!

Truth be told, it’s easy and somewhat natural to become bitter and feel burned out when you’re not happy with your job. These feelings can quickly turn into apathy and other counterproductive behaviors, which can be self-sabatoging in the long run. Don’t let your circumstances define you. Focus the energy from these negative emotions and use it to start a fire in your heart that burns for a brighter future. You are moving on to bigger and better things, so act accordingly!

Two years from now when you finally pull the trigger on your new life, your future-self will be happy you did these three things today.

Frederick Gandolfo is a gastroenterologist and founder, Precision Digestive Care. He blogs at Retroflexions.

I didn’t become a physician to do data entry

The trouble began when I needed to open the electronic health record (EHR) system for the tenth time that day. EHRs have significantly changed the way we practice medicine. They have completely eliminated the need for storage and transport of paper charts, reduced prescription errors secondary to illegible handwritings of physicians and provided an excellent platform to maximize billing for services rendered. However, in terms of creating a smooth workflow for physicians and in facilitating meaningful face to face encounters with our patients, all EHR systems have completely failed.

Sara, the nurse for Ms. Tucker, called me saying, “Doc, Ms. Tucker is back from the cardiac catheterization lab. She is complaining of a mild headache.”

“It must be from the nitroglycerine I gave her in the lab; please give the ordered Tylenol, it will resolve soon,” I said.

“I don’t have any orders, Doc. All the orders for this patient are on hold,” she replied.

“On hold? What do you mean?” I said surprised.

“Yes. All orders go on automatic hold when a patient goes for a procedure and comes back unless you reorder. It’s the new EHR upgrade,” she said.

“OK, I will do it as soon as possible,” I said, taking in a deep breath and involuntarily rubbing my forehead.

To reorder Ms. Tucker’s medications, I needed to log into the EHR system again. I had to do it remotely, as I was at another hospital in town that used a completely different EHR system, though it was only ten minutes away. I had to enter my username and password carefully and slowly three times in response to three different prompts in addition to entering the secret code that was texted to my cell phone. After what felt like an eternity, I logged into this most sacred, highly-classified, triple-password-protected space of EHR. I wondered if the FBI have to enter their passwords thrice to log on to their everyday workspace. As I was able to log onto the EHR system without seeing the prompt “Incorrect username and or password,” anytime during my three-password entries, I regarded it as my greatest success for the day. The fact that Ms. Tucker’s procedure was uncomplicated and smooth faded in comparison to this success.

I opened Ms. Tucker’s chart. There were twenty-one tabs vertically on the left-hand corner of the screen and eighteen tabs horizontally on the top of the screen. I quickly glanced through the cluttered twenty-one vertical tabs; I clicked on the one I am looking for — “transfer medication reconciliation” in the 19th slot. A new grid showing sixteen held orders opened. I selected each of them separately and clicked on “continue.”

Select and continue.

Sixteen times two: thirty-two clicks.

I was fidgety. I was not sure of even reviewing each order. I just clicked and clicked. Final tab. Review and sign. Clicked. End of my rendezvous with EHR for today. I hoped. The age of “clerical” physicians continues, I mused.

A few weeks ago, when there was EHR system breakdown, patients were still taken care of. Nurses took verbal orders. It was unquestionably chaotic, but for me, it was bliss. I was on call for acute heart attacks that day. Ms. Copper drove her husband to the hospital with sudden-onset chest pain. Mr. Cooper had a cardiac arrest in the parking lot of our hospital. He was revived after a brief period of cardiopulmonary resuscitation and taken immediately to the cardiac catheterization lab. I opened his occluded left circumflex artery successfully, and he was transported to the intensive care unit in a stable condition. No one pestered me regarding entering orders before doing the procedure.

After the procedure, I wrote down the report and all the orders on a single plain sheet of paper in fifteen minutes. Zero clicks. I then went to meet Ms. Cooper in the family lounge. Usually, I am interrupted by messages from the nursing staff that family is waiting for me when putting orders or vice-versa that there is some problem with order entry when I am meeting with the family. This didn’t happen that day. Ms. Cooper had my undivided attention for a full twenty minutes. Her eyes filled with tears of gratitude at the end of our conversation. She hugged me and said, “Thank you for saving my husband’s life.” I didn’t have to rush to correct orders or type in my notes. The bliss, unfortunately, lasted only for twenty-four hours, and once the software was uploaded again, the usual “digital” drudgery continued.

I chose to be a physician to care for people. I value my direct face-to-face interactions with my patients. I want to hear their stories told by them in their own words. I cherish their smiles, their tears, their gratitude, their handshakes and hugs. I did not sign up for screen time with a computer, speed typing or clicking. I did not sign up to type passwords multiple times.

The leading, if not the only, cause reported for physician burnout is workflow issues related to the use of EHR systems. Instead of providing meaningful clinical documentation for easy communication among health care providers, it has evolved into this massive, cumbersome giant with so many interfaces, cluttered screens, redundancy and duplication requiring innumerable clicks, selects, templates and passwords with no added clinical value but only frustration and burnout for physicians. The software has to be re-designed for clinicians to efficiently gather data, enter orders and communicate relevant clinical information without having bloated notes and cluttered screens that are catered for easy billing and coding. Clinicians together with hospital administrators and information technology professionals should be actively involved in the development, testing and optimization of new electronic features to streamline the workflow. For me, there will be no joy in the practice of medicine until my frustrating rendezvous with EHRs end.

The names used in essay have been modified to maintain anonymity. It is a fictionalized account of true events.

Jaya Mallidi is an interventional cardiologist.