Seven tips for a rewarding career in private practice

Completing residency or fellowship should be one of the most exciting milestones in a physician’s career. If properly planned for, this experience may lead to a most fulfilling and stimulating journey and wonderful life-long friendships. I teach medical students, residents and fellows about the process of planning their careers, so that most may have a terrific experience with as few “do-overs” as possible. What follows is my advice for MDs/DOs considering entering private practice.

1. HAVE A WORK ETHIC

First and most important, the most significant determinant of your success is work ethic. Regardless of training, or even career path, nothing builds a practice and prepares us for future uncertainty more than the willingness to roll up our sleeves and be a consistently hard worker. My father, now deceased, was a successful plastic surgeon. When I was a pup in medical school, he taught me the three “A”s of success: Availability, Affability and Ability. I took these to heart, and they have guided me well.

2. HIRE A LAWYER

Do not hire a family friend or relative who is an attorney to review and sign off on your contract for a discounted fee. Only work with a lawyer who does nothing but medical contract law. As one smart lawyer once told me, “A legal contract is a worthless piece of paper meant to become yellowed in your files. But God forbid you ever need to pull it out — it will not be for something good. So it better be iron clad.”

3. WORK WITH CONSULTANTS

Never skimp to save money. Surround yourself with consultants (business advisor/CPA, lawyer, marketing, IT, etc) who are the very best in what they do. Without strong counsel, missed opportunities, bigger cost savings and complete lack of awareness of important medical business concepts will cost physicians tremendous income or other benefits. My business consultant of 28 years told me that if his guidance and oversight does not bring in or save money equivalent to what I pay him, then his advice to me would be to terminate his services.

4. CALL REFERENCES

Always call references about the doctors and practice you are considering joining. This may be OR nurses and staff and the relevant medical society office and must include past physicians or partners who have left the practice. This is the most significant piece of advice I wish someone had taught me as I was coming out of fellowship. Had I known that checking out the person I joined straight out of fellowship was appropriate (I thought it would offend them), I would have never joined that practice.

5. WATCH FOR SCAMMERS

As another wise physician once told me, “There are two kinds of doctors: those who have been embezzled, and those who do not know that they have been embezzled.” The opportunities around you in practice to be embezzled are numerous. Historically, the most common incidents of embezzlement have occurred by administrators or billing agents. Embezzlement can also occur in the form of not filing charges, not scrubbing and re-posting a rejected patient bill or “working the time clock.”

“Retail items such as glasses, contact lenses and Botox are also commonly stolen by employees.”

6. AUDIT YOUR CHARTS

It is imperative to perform regular internal and periodic external audits of your charts and billing practices. We perform internal audits annually and external audits every three years — more often if the most recent audit uncovered major areas of concern like improper coding habits or over/under billing. Proper coding and its justification are critical for legal compliance and will often help your bottom line as well. Far too often, doctors under code in an effort to stay compliant.

7. JOIN MEDICAL SOCIETIES

Be a participant in your local, state and national medical societies. This will help you stay current with the non-medical issues and policies affecting our specialty and give you an opportunity to make positive contributions about the future of medical care in your demographic.

CONCLUSION

Regardless of the challenges, ophthalmology is a most rewarding career. Enjoy and be proud of what you have accomplished and always be aware of what a wonderful service you provide your patients. After 30 years, I am stilled humbled to be in this specialty and awed by the advancements in diagnostics, pharma and surgical technology. You will be as well! OM

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. Dr. Silverstein has been in private practice with an academic affiliation for 30 years. He invites comments. Email him at ssilverstein@silversteineyecenters.com.