How observing and learning before speaking can go a long way when joining a practice

Coming out of a private practice fellowship, I thought I knew how things “should” be done. After all, I’ve seen it work successfully firsthand. Coming out of fellowship into my first job, there were so many things that were different from what I was used to. My first reactions were: “They’re doing it all wrong,” and, “You should be doing it like this.”

Well, needless to say, taking that attitude did not serve me well, and I learned a few hard lessons along the way.

OBSERVE THE NEW PRACTICE

When starting at a new practice, it’s important to be humble, to observe and understand how things run before you critique it. Understand that systems have developed in a certain way for a certain reason even if they might not make sense at first.

As the new person, no one wants to hear you say how their practice is doing it all wrong or, “We used to do it this way at my practice.” So, be mindful of what you say because everyone is watching and these types of comments can be misunderstood as negativity instead of an attempt to improve the practice. All of a sudden, you’ll find out that the manager heard a comment and what you may have thought was just constructive feedback came off as being critical or demonstrating a negative attitude — which may not have been the intention. This was a lesson I learned when I commented on the workup of new patients/patient flow prior to understanding the practice.

You could have great ideas, but they’re not going to really hold a lot of weight until you’ve spent time at that practice and until they know that you understand the practice. You have to earn and build up credibility before you offer any feedback.

As a result, I began to listen a lot more than I spoke and I really took the time to learn about the practice and see their perspective — why they had patients flow the way they did, how they framed their premium lenses, etc. Not only did I find myself seeing their rationale more, but things began to make a lot more sense.

SPEAK UP WITH SUGGESTIONS ...

Once I understood how the practice worked and developed credibility there, I began to offer more nuanced suggestions.

Staff could see by my conversations and by my time spent learning that I had thought this out and had a better understanding of the practice. Everyone from the techs to the office manager to the senior surgeon were more open to my suggestions because they looked at it more as constructive criticism/feedback.

For example, I suggested we invest more in digital marketing as well as work to increase our comanagement. After being at the practice for longer, I had a better grasp of how to mold these ideas to our specific practice.

... OR WHEN THERE’S A PROBLEM

A colleague once told me that it’s okay to be the squeaky wheel a little, to voice your concern; it shows that you care about your work and that it is a priority.

Be willing to express if there’s a problem you’re having — for example, if you feel that you should be busier or have more OR time. Don’t be afraid to talk to the higher-ups about it, because sometimes they may not even know that you’re having an issue or it may be on the back burner. If you don’t mention it, it’s not going to get addressed — or at least not in a timely manner.

CONCLUSION

When joining a new practice, remember to be humble, to observe and understand how things are run. Take your time and really focus on the fundamentals of just doing a good job in clinic and make sure that you’re well-liked by the staff and by the other surgeons before you offer any feedback.

Also, don’t be afraid to speak up if you are having an issue — it’s how you’ll grow as an MD. OM

Joshua Frenkel, MD, MPH, is a fellowship-trained anterior segment specialist and currently practices at Evergreen Eye Center in Seattle, Wash. He specializes in cataract and refractive surgery as well as microinvasive glaucoma surgery. Email him at joshua.frenkel@gmail.com, and find him on Instagram @dr.frenkel.