Here’s a question I haven’t really seen discussed too well, and I haven’t been able to get a good answer from other sources.
We understand (mostly, anyway) how the process of medical education works - 2 years BS, step 1, 2 years clinical, step 2,residency, step 3, etc. Obviously, in a residency you learn the hospitals policies and procedures, and the laws that are pertinent to the state your residency is in.
How then do new doctors learn about the rest of the world? Learn what the more or less unique rules are for other states, licensing information, things like that?
And how do doctors at the end of their residency learn whatever they need to know, to be able to make a living outside of the hospital system? Insurance details, malpractice insurance tips and tricks, how to not get taken to the cleaners on a thousand and one things?
There are support organizations for other small businesses (chamber of commerce, networking groups, books, seminars, etc), are there similar resources for physicians, and if so, where are they?
Thanks!
One of the attractive things about my residency program is that residents are included in practice management discussions. There is a practice manager who regularly educates both the attending and resident physicians at the office about things like coding and billing… which is the difference between possibly operating in the hole and making a decent living. Physicians do have to be proactive about finding and using this information, and it is not easy to carve out the time to do this. There are whole conferences devoted to coding - not for physicians but for practice managers and billing specialists. Like so many things, this is a highly specialized area. It’s been my observation that physicians rely on experts to give them business guidance; it would be impossible to keep up with the rules & regulations and so you count on someone to guide you through.
The American Academy of Family Practice has a practice management journal which is short & sweet, comes out monthly I believe. I gather that other specialties have similar publications and resources. I know the AMA puts out a lot of stuff on this.
If you’re lucky, you’ll have time in medical school to work with a preceptor in an office setting where you can ask lots of questions and find out more about this aspect of medical practice. That was a strength of my education at GWU - during years one and two, we had a half-day with a primary care physician twice a month and in talking with my classmates, it sounds like a lot of us heard our preceptors’ views on money and medicine as part of our experience.
Hi there,
One of the most attractive things about my new residency program is that they will teach me how to make money in private practice. I am in a private practice-fellowship track that puts me primarily with some of the most successful private surgeons in Cleveland. My residency director told me that after I am finished, I would be totally comfortable running any kind of a practice from group to single. They take pride in making sure that their graduates are successful. If UVa has a weakness, it is that they are totally geared toward the academic physician and provide almost no training in practice management.
You have to make sure that your residency provides you with what you need. If not, you have to spend some money and take seminars (the most inefficient way to learn this stuff). Since the practice of medicine is quite variable from state to state, you really have to tailor your practice to the state that you are in. One of my attending physicians recently left a thriving practice in Philadelphia. He was part of a very successful group that easily pulled in seven figures for the chief partner. The last year that he practiced, his malpractice insurance premium was $200,000. He was grossing more than $400K in general surgery and his partnership covered about 5 hospitals to support themselves. He said that he was being run to death and watched his malpractice premiums climb through the roof. When he pulled out of Philadelphia, there was a huge hole that wasn’t easily filled because he was so high output.
In Virginia, where the malpractice is not quite as bad as Pennsylvania or West Virginia, there are many groups in Northern Virginia that are masters at running practices. That is why Mary RR has landed in a great residency program. Inova Fairfax is the most well-endowed private hospital in the country. She chose well!
What have I learned after two years of residency? That I will never practice in West Virginia or Pennsylvania (even though I love the Pittsburg area). I will probably cross a couple more states off before I am done.
Natalie 
Thanks, thats kind of what I suspected.
Are there any on-line resources (or suggestions) for group or practice management? I’m thinking of working on an MBA (online) if I can get it finished before I’m done with my post-bac, thinking that might be helpful.
Thanks, I’ll check out the journal.
I suppose the easy solution would be to pick a specialty that is hospital based and doesn’t work through groups (if there is such a thing) and just be a salaried employee. I’ve started and run my own businesses, and all in all, I’d rather let someone else take care of that hassle.