Tuesday, October 11, 2005

To Tell You the Truth...

Private practice found me -- not the other way around. However, being my own boss was probably engrained in my blood since childhood. Go ahead and ask my parents -- I was quite stubborn as a child. My Cuban parents came to this country as political refugees (please note, this is the correct use of the word "refugee" -- not to describe our own hurricane-ravaged citizens, displaced from their homes within this country). That was many years ago -- 1960 to be exact. And my father initially was not his own boss, but he had dreamed of it for years while working for the international elevator company, Otis. When my dad was in his early 30's, Castro took over our homeland and smoked it up real good! My father had attempted to start a company, but had to abandon the efforts due to the rapidly changing political climate. Approximately 10 years later, he got to live his dream. Having returned to the U.S. after a sojourn in several Latin American countries, he established his first elevator installation and maintenance company in the same month I was born. Whereas most small companies fail in the first five years, that company, and two others he started thereafter, thrived for the next 31 years, at which time he sold it.

That was a year ago. My dad was selling his life's work, and I was about to begin mine. The opportunity to open a private practice in Internal Medicine fell upon my lap. As a resident in training 2 years prior, I had never given any thought to the possibility of running my own private practice. After all, they don't teach you entrepeneural skills in medical school! We're only supposed to take care of sick people, right? In fact, the ensuing institutional mentality of residency made me think that as a doctor you have no choice but to work for somebody else, be it a hospital network, a clinic or established practice. No one seems to talk about hanging your own shingle and starting from scratch nowadays. The task seems almost implausible and quite daunting if you have no business sense. At the time, I was the product of that thinking, working first in a research project for a year following residency, then selling my soul (as it came to feel) to a large group practice that operated more like a factory than a doctor's office. I was assimmilated as one of many pawns in that multi-million dollar operation, but learned a great deal in the process. It was the latter experience that opened my eyes to the potentials of private medical practice.

Rather than ferrying patients through like cattle, as I dutifully did previously [and yes, at times, it felt like a cattle-call, calling 3-5 patients back at a time]-- with the endless stream of complaints from patients frustrated with the process, I knew I would enjoy a different patient care paradigm. This is not a criticism of that system, more so an insight into who I was. It was simply not the way I wanted to practice medicine. After all, I had become a primary care physician to care for people, really get to know them, and form enduring physician-patient relationships. That's what medicine was all about for me, especially when choosing to pursue a career in primary care. Having decided that in spite of the alluring salary, this would not be my life, I was simultaneously mortified and delighted to hear from one of the partners, after 9 months of employment, that they would not be renewing my one-year term of employment. As Martha Stewart says on her version of "The Apprentice," I simply "did not fit in." It was the catalyst I needed. I was simply not willing to compromise my values in patient care. The truth is that as distraught as one may have been knowing that they were losing their job in another 3 months, after the initial shock wore off, I actually felt a sense of joy inside. This was the sign that I was on the right path. The possiblities were greater than working for somebody else. Now I had no choice but to charge forward into my future.

Two months prior, that future had made itself known to me. I had called a former colleague from my training hospital who had been chief resident during my first year in residency. He had recently completed a specialty and had opened his own private practice. I wanted to pick his brain for advice. It was more than just advice I got. It was the opening of a new door -- new possibilities. He explained to me how everything could be done, and helped lead the way to my new path. While the main initial worries were obtaining hospital privileges, becoming credentialed with the major insurance companies [a very, very long gruesome and annoying process taking anywhere from 6 - 12 months; but more about this later], and obtaining the funds to finance the start of a new business [Yes, a private doctor practice is a b-u-s-i-n-e-s-s, and must be thought of as such!], nothing could be put into effect without a physical space. In our city [to be revealed later], medical office space is scarce and expensive. Albeit, I began the process of calling the major insurers, applying for privileges, and trusting that things would somehow work out. The funding was resolved with part loan and part angel investor. Starting off required a full-year's predicted expenses in loans. Wow! I had never dealt with that much money all at once. My heart nearly jumped, but a voice inside kept telling me this is it. Things seemed to be moving in the right direction, even when the road became quite bumpy. Luck was on my side! What is luck anyway(?), but the meeting of opportunity with preparation. I would say it was more opportunity first, and preparation that scrambled to catch up! It took a lot of hard work and preparation to reach that day doors opened for business. If capital were the only thing one needs to start a practice in medicine, then it would have been very easy. Determination, planning, flexibility, adaptability, and a willingness to keep going when things didn't turn out the way one expects -- the same character qualities that kept me going through premed, then medical school, then residency -- were being called into action once again to fulfill this dream. Perhaps an M.B.A. would have been useful, if I had the forethought. But there was no time to waste anymore. The time was ripe. The time was now!!

And as if I didn't have enough to do, I was busy certifying as a subspecialist in acupuncture as well. To top it off, my first child was on the way. Sometimes one's plate is FULL. Mine was OVERFLOWING!!! Nevertheless, tackling so many things at once is what you do when you're following your dreams. As scary as it was, I wanted to have my own practice so that I could create a venue of care that reflects my personality, philosophy of integrative medicine and the strong attention to quality of care I learned in residency. It was the freedom I was looking for.... [MORE TO COME]

Please keep tuning in for the next installments in The Solo Practitioner.

This blog is meant to show a path of possibility to those who have thought about opening their own practice, but have yet to put it into effect. It's meant to open the eyes of those who have never thought about it. And it's meant to share common and unique experiences with those that already have. Medical students and established doctors alike will find it fascinating and educational to read about my specific trials and tribulations in starting a private practice and my recommendations on what works and what doesn't work. I welcome you to continue to tune in as I write about my first year's experiences and what I have learned from them. Your feedback is encouraged and appreciated!


Blogger D.P. said...

I hope this means better patient care . . .managed care doesn't work well for patients--nothing like being a number and a potential liability. People don't care about numbers . . .

1:08 AM EDT  

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