The good, the bad, and the ugly

As I was sitting at lunch between sessions of my family medicine board exam, I was debating which was more shocking to me:

1. How much nit-picky information I had somehow lost in my memory banks. (I mean really, if I need to know the exact hand muscles the radial nerve innervates, I will look it up....)

2. Had it really been 7 years since I have taken a real exam-and what happened to number 2 pencils and Scantrons?

In the relatively short time since I completed residency, I have seen the good, the bad, and the ugly of a range of medical practices, from a large group setting to a partnership to my own practice. Each practice setting has had its advantages, and each has had its drawbacks as well, as I came to learn the hard way.

I have taken my licks and learned my lessons, but when it is all said and done, I have acquired more practical knowledge about the practice of real medicine than any board exam could ever test. In sharing my experiences here about practicing in these different environments, I want to say upfront that the stories are only meant to convey my personal trials and tribulations-they are not meant to generalize what others might experience in similar settings. Every doctor, and every practice, is different, and your mileage may vary.

I am definitely not a natural-born businessperson. I hated our mandatory practice management course in the last year of residency. It was late on a weeknight and the pizza wasn't that good, and besides, there was no way I would ever end up having to deal with any of that stuff: billing, coding, hiring, firing, retirement, insurance, etc.-who needed it, anyhow?

I hated "business and money stuff" and was completely clueless about all of it. I hated even balancing my personal checkbook or budgeting. I just wanted to take care of patients, and have other people handle all the rest of the stuff for me. I was going to join a large group practice where all I had to do was show up, see my patients, and take home the paycheck-or so I thought. Life has a funny way of changing your plans.

"ALL I HAD TO DO WAS PRACTICE MEDICINE"

When I started practicing in a large group, single-specialty setting, I thought I had it made. All I had to do was practice medicine: take care of patients, write some prescriptions, and "wing it" when trying to figure out if the correct code was a 99213 or a 99214, since I was sure that someone in the front office would correct it if I messed it up. (I'm hoping that no one in the coding department of Medicare reads these articles.) We had a 12-doctor group that was well established and respected in the medical community. My practice was full from the other doctors' referrals, and I had become a partner in less than a year and a half.

Because the practice was well established, it was relatively easy to jump right in at nearly full-throttle. Members of the practice were experienced at getting "the new doctor" up and running, and I was willing to do my part. The benefit was that I really didn't have to make any decisions. My lack of business knowledge did not hurt me, as the very efficient office manager knew exactly what to do to make me successful.

I did not have to worry about hiring and firing employees, let alone the nitpicking details of their contracts, health insurance, retirement accounts, or day-to-day activities. As long as my nurse worked well with me and the patients were in the room, I wasn't asking questions about what was going on in the front office. As a matter of fact, if I even stepped in to the front office, I would get strange looks. The whole employee management process seemed like a huge human resources headache to me, so I stayed far away from those decisions.