10 real-world tips for managing your career

Floating along the river of changing practice in internal medicine, I feel that I have become the typical internist, balancing a career and a personal life, which in my case includes a husband and two children. It hardly seems that 16 years have passed since I joined my current group in Clearwater, Florida.

Then suddenly, coinciding with my first pregnancy and the decision of my call group, I stopped doing hospital work, other than to make nonclinical visits for the next two years to help patients feel less isolated dealing with a new group of doctors and residents. The birth of my second son made doing such work more difficult. And so, here I am, an outpatient internist with limited contact with the specialists to whom I refer and a work life that revolves around a three-doctor office.

1 There is no substitute for paying attention to your office staffing. Fire those people who are difficult or nonproductive as quickly as possible. The longer they are with you, the more difficult it is to get rid of them. You cannot be efficient if your staff is not well-trained, capable, and able to assist you in providing high-quality care in a welcoming environment. Bad attitudes on the part of your staff members imply that either you don't care or that you condone their behavior.

2 Economics and running a business are subjects not taught in medical school, but it is important to understand your overhead. Minimizing expenses is the easiest way to increase your income. There are many ways this can be done without decreasing quality. I realized, after many years of staffing at a higher level than I do now, that excess staffing led employees to shift responsibility from one person to the other, often creating delays that are fewer with a smaller staff. That being said, having fewer employees can mean difficult staffing situations caused by illnesses and vacations. The employees you have must be cross-trained to help with this reality, and you need to be flexible enough to take patients to exam rooms and measure their vital signs when you are short-staffed. Both the patients and your staff will appreciate it.

3 Although you should be in charge of your practice, you are the leader of a team rather than a boss. Leadership carries the responsibility of kindness and compassion to your employees. Allowing employees to take a reasonable number of personal days for their children, parents, or other commitments-planned or unplanned-is a good decision. More employees will leave your office if they are unhappy working for you. You will be more productive if you are not constantly training new employees.

Also, the relationship of your staff to your patients is important. Patients appreciate familiar faces who are knowledgeable about their histories.

4 If you choose to start your own practice, set a designated time to take care of the administrative responsibilities you will have. Otherwise, those important tasks may not receive the attention they deserve.

5 If you join a group, get involved in the administrative side of things in some capacity. For many years, I did not do so. My group was small and simple enough initially. Being overwhelmed with picking up a practice and doing hospital work, it was easy to avoid those responsibilities. Later, I had young children and felt very obliged to spend all my spare time with them, despite having a supportive spouse.

Eventually, I began to participate in committees. At that point, our group had become much larger, and I faced the undertone of being someone who had not participated for many years.

To have a voice, you must have a presence, which is much easier if your practice begins from scratch and you are an outpatient physician only. Nevertheless, as a member of a group, prepare to accept a variety of decisions with which you may not agree. Some will be to your benefit, and some will not.