Doctoring Reflection

Five simple rules for July’s new doctors

Medical people know that July is a pivotal month. Things change, big time.

In the academic world, July 1st is the day when graduated medical students wake up as doctors. Well, at least officially an intern is a doctor. I seem to remember internship feeling like a demotion.

In my world of private practice, July is when you start seeing new faces in the hospital. Young faces, which, sadly, look younger all the time.

My colleague, Dr Wes, recently posted about the other side of July, in which new doctors, especially specialists, enter a much different medical arena. He contrasted the good-old days, when specialists happily delayed gratification, knowing that a lucrative and respected private practice job awaited, with the current medical climate. Some might call Dr Wes’ position on the current climate a tad pessimistic.

He rightly describes the likelihood that specialists will be hired by a large hospital rather than a small group of established doctors. He also points out that hospitals face an increasing degree of uncertainty. Will their referral sources continue? Will procedure volumes justify new specialists’ salaries?  He adds a cold wind to an already rainy parade, by reminding young specialists that their large loans that will soon come due.

His advice to new specialists: Rent, don’t buy.

Now, you all know how I feel about pessimism. Such gloomy thinking only accelerates inflammation—which causes sticky platelets and irritable arteries.

Let me add to my esteemed colleague’s advice with an additional five, slightly more optimistic nooggets of wisdom for new doctors entering the private world.

1. Ignore your pay-stub. It is true, unless you were a heck of moonlighter, you just got a pay raise. Congratulations. But, I implore you to keep living as if you were still in training. Drive an inexpensive car. No, check that, embrace that clunker like it was a pink phone case— something that sets you apart. Don’t add to your debt by buying a huge house. Say no to the country club. Live close to the hospital. Use the extra monthly income to pay off loans. Think of the word: cushion.

2. Keep an open-mind: Yes, we know that you are up on the latest techniques, having seen, and perhaps even used the latest laser, balloon or robot, tools that our hospital cannot afford. You are also well-versed in spread-sheets and abstract writing, and you probably know many well-published people—maybe your former teachers were “thought-leaders.” That’s great. Nifty even.

But the thing is, now you are on your own. That humble technician scrubbed-in with you has seen many young docs flail. She has seen the mistakes you are about to make. Listen to her, respect her, pretend she is a professor. She wants to help you; she will help you, if you let her.

Likewise, the older docs around the hospital will help you too. Though many of us trained when procainamide was still available, and taking night call meant carrying a bag-phone around, we have probably done your primary procedure 7,399 more times than you have. We have limped out of the hospital in dismay after causing the complication you have yet to cause. We look at your newness with envy. We want to learn from you. You have capital, don’t blow it by acting too much like a cardiologist.

3. Be nice to people. Not just the obvious people, like the woman who sets out lunch in the doctors’ lounge or the procedure schedulers, but everyone else too. This hospital will be your new home. You will see these folks at the grocery, on the ball fields with your kids and soon enough you will need medical care—sooner if you are a bike racer. You are the new kid in class, people want to make friends with you. Let them.

4. Call your referring docs. To folks of my era, this came naturally. The phone call to the referring doctor after a consult or procedure served two purposes: one was to keep the primary care doc in the loop, and the second was to introduce yourself, and perhaps your new specialty. (For me, electrophysiology barely existed in 1996.) But now, the alliances between hospitals and doctors act to create barriers between medical colleagues. I would urge you to call a primary doctor even if they are owned by another institution. Not only because it is right-minded, but also because the changing marketplace may soon make partners of you two.

5. Have fun. Don’t let the checklists, forms, protocols, cubicle-doctors and metastasis of quality measures get you down. At the end of the day, your special skills which came from years of hard work will ultimately help you better mankind. This is a large treasure indeed. And it is immensely fun.



4 replies on “Five simple rules for July’s new doctors”

From one private practice guy to another, very nice! I particularly like the part about being nice. It’s just too easy to do, and the ROI is not only infinite but works like compound interest: the payoff way downstream is so much bigger than the investment of the moment.

But, I implore you to keep living as if you were still in training. Drive an inexpensive car. No, check that, embrace that clunker like it was a pink phone case— something that sets you apart. Don’t add to your debt by buying a huge house. Say no to the country club. Live close to the hospital. Use the extra monthly income to pay off loans. Think of the word: cushion.

Nicely said, John. Seriously, who couldn’t like what you had to say?

But I also think there are some important changes that have occurred recently to medicine that impact specialists like us in particular. The Accountable Care Act’s intended consolidation of doctors offices with hospital systems as “Accountable Care Organizations” creates heretofore unmentioned consequences to the specialist marketplace. This was the intent. As such, the market for specialists out there is more competetive now. I agree with you that most specialty-doctors can still find jobs, but there is no question that it’s harder now than it was when I left training. Does this mean we should be oblivious to this fact? Of course not.

For example, “According to recent studies, over 10 percent of the physician workforce change jobs annually. Why? Some top reasons include professional dissatisfaction, tightening controls in how they practice medicine, and diminished job security. As job change becomes more of a standard practice in all industries, this will also affect the medical profession, especially with young doctors and residents.”

So it’s just not all optimistic out there. “Rent, don’t buy” given these data seems prudent to me, especially with the added challenges with resale currently in the real estate market.

Finally regarding the optimistic thing: good for you. But my concern as a fellow-physician blogger is that I feel there is a huge push by many to put the happy face on the changes that are occurring to health care so that physicians will become nothing more than subserviant purveyors of the system, rather than remain true advocates for their patients. Granted, we’ve got to make changes to the way we’re doing things now and balance with the changes ahead is reasonable, but keeping a healthy dose of skepticism is warranted since prior attempts at managed care (and this is what we’re dealing with here) have historically failed miserably.

Yours in sunshine –



First, thank you for the nice words.

Second, my staff will tell you that the farcical things that are happening in medicine–in the name of patient care–inflame me more than I would like to admit. I, like you and so many other doctors, hang a lot of our self-esteem on how well we can take care of patients. That’s why many (too many) of the well-intentioned changes in our system that you so poignantly write about are a source of frequent consternation–because they get in the way of us taking care of people.

Without droning on too much, the top two ironies of these changes is the notion that one can checklist and protocol-ize out all human error in medicine, and that reducing the spiraling costs of care will come by reducing compensation to doctors–or maybe worse yet, increasing the administrative hurdles that doctors have to overcome to practice medicine.

But underneath all the inane clicks, infinite forms, and attempts to make doctoring a commodity lies the beauty of what we do. I sign (and date and time) five forms for a procedure that needs only one because doing so allows me to be use my skills to help someone in need. This positive thinking, as they say, gets me through the ever-thickening morass of healthcare improvements each day. Successful doctoring is like a salve for the inflammation that reform creates in us masters of the obvious.

If only the policy-makers would listen to real doctors. Maybe if we keep telling blogging our stories, a fraction of what we say might eek through to the cubicles.

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