Practice Building for the Young Surgeon: Putting the Three A’s into Practice
By Feibi Zheng
It is often said that the keys to building a successful new practice are the three A’s: availability, affability, and ability. But what does that actually mean? What are the practical steps a surgeon can take in order to operationalize the 3 A’s? I’ve spent a lot of time over the past few months collecting advice from mentors and senior surgeons at my hospital, observing how others run their clinic as I set up my own, and have tried to consolidate the principles into the following:
Provide fast and good service. One of my senior partners told me that I should be prepared to see patients in clinic every day. While I have not gone to that extreme (as it it creates too much chaos for our clinic manager) I do have clinic multiple days a week so patients requiring urgent appointments can be accommodated within 48-72 hours.
Find the gaps and move upstream. Understand where your referrals will come from. Is it primary care or GI or nephrology or endocrinology? There is a shortage of endocrinologists in Houston, leading to long wait times for new appointments. After meeting with multiple endocrinology groups in my area, I realized that they don’t mind if I do my own fine needle aspirations of new thyroid nodules or do the biochemical work-up for an adrenal incidentaloma because otherwise these patients would have to wait months for an appointment. Furthermore, I have the luxury of onsite adequacy check for FNAs whereas many private endocrinology groups do not. Therefore, I also am referred more complex biopsies or biopsies that were previously inadequate for interpretation.
Communicate. When meeting a new physician, always exchange cell phone numbers. Ask them how they want to receive information after they send you a patient. Do they want a quick text after surgery or do they want a faxed copy of the operative note report and path results? Make their jobs easy. I use a templated H&P but I also make sure to write something of substance in the assessment and plan to the primary care and the referring physician. Referring physicians care that you are a thoughtful surgeon.
Organize. Actively look at your clinic schedule on a weekly basis in order to maximize convenience to the patient and the referring physician. Can you schedule tests and other consultations on the same day as the new patient appointment? Make sure that your medical assistant and schedulers have a good working relationship with other offices so that you can consolidate appointments for your patients.
We hear all the time that “networking is key!” As a relatively introverted person, one of the most challenging social situations for me is to stand in a room full of unfamiliar faces, trying to approach a friendly group to make small talk. There are a couple of strategies I use to overcome this issue:
Find a buddy. I joined my practice around the same time as one of my partners, a surgical oncologist. We take new physician meetings and go to networking events together. Women are often too modest to talk about their accomplishments or if they do, they can be perceived as being “too confident.” When we meet new physicians, we talk each other up.
Network virtually. Most of my referrals come from young women physicians. Where did I meet these physicians? Online. There are bevy of online groups that can be sources of contacts. The popular Facebook group Physician Mom’s Group has regional subgroups in your area. Additionally, there are patient support groups who welcome physician members. As an endocrine surgeon, I am part of a Facebook group dedicated to promoting awareness of primary hyperparathyroidism. There is undoubtedly a Facebook or Google group for the condition(s) that you have dedicated your career to treating. Ask your colleagues at national meetings if they know of these secret groups. Additionally, if your institution helps you put on a webinar for a topic that you are an expert on, you will have a ready audience from the support group.
Network the old fashioned way. Even when you meet someone online, it is still a good practice to shake their hand in person and visit their office and meet their staff. Their medical assistant may be the person who processes the referrals so it is crucial that they know how to reach you or your medical assistant if they are having difficulties scheduling with your office. Other networking opportunities include events put on by your local medical or surgical society, university or company sponsored health fairs and church events. It is unlikely that I am going to find a thyroid nodule or a patient with primary hyperparathyroidism at a health fair, but I go to meet the other physicians.
Know what makes you different. Most young surgeons will be fellowship trained. Make sure that your website and other marketing materials clearly articulate any special skill sets you may have. If you are fortunate enough to have a business development office or marketing department, meet with them regularly. They are not clinical people and have no idea what you do. Similarly, if you have a centralized call center, meet with the schedulers to give them a quick talk about the types of patients you wish to see.
Know your limits. It goes without saying that you should do all you can to avoid having a major complication in your first years of practice. There is a good chance that unless you are in rural practice, you have a senior partner who will be happy to mentor you and help you with difficult cases. They may not be fellowship trained like you, but good surgical technique is good surgical technique. Look for these people before accepting a job. Know who you’re going to call in the middle of night to help if you need it.
I’d love to hear practice building tips from others out there!
Dr. Feibi Zheng is an endocrine surgeon at Houston Methodist Hospital in the Texas Medical Center. She attended medical school at the University of California, San Diego. During her surgical residency training at Houston Methodist, she helped to establish the General Surgery Leadership and Health Care Administration Track, an 8 year program which blends clinical surgery training with practical experience in optimizing hospital systems for improved patient care and safety. She then completed her endocrine surgery fellowship at UCLA. In addition to her clinical practice, she is the Assistant Clinical Program Director of Surgical Quality and Population Health for Houston Methodist Hospital, where she is leading the development of a telemedicine program for surgical patients who live long distances from specialized centers of care. She also currently serves on the Committee for Perioperative Care of the American College of Surgeons which works to improve the quality of care for surgical patients across the country.
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