By Suzanne LaKamp, OD, FAAO
Jan. 27, 2016
Succeeding in your first year with a new practice requires a plan. Set a career trajectory, and plan how to work with other doctors in the practiceto support your goals.
PROTECT YOURSELF IN CONTRACT. Set expectations for how many patients per day and responsibilities and pay.
SET GOALS. Decide what you would like to learn in your first year in practice, and how you can work with the rest of the staff to do that.
NURTURE RELATIONSHIPS. Take the time to get to know the other doctors, and see if the one with the closest focus to what you’re interested in could take you under their wing.
Your first year with a practice can be challenging as you get to know the doctors and support staff and patients. Think carefully about what you want to achieve that first year, and how you can use the resources of the practice to get there. Here are some of the ways I achieved a successful first year at my current shared MD-OD practice. I am currently working as an associate in my second practice since starting my career.
Protect Yourself in Contract
Contracts should be written to protect both the employee and the employer. Verbal agreements are not legally binding, so if something is important to you, be sure to have it written into your contract. For example, the number of maximum patients per day should be established for a busy practice, and stipulated in your contract. It is also worth stipulating at the time you make the agreement the amount of assistance you can expect from technicians and scribes. If your patient maximum is breached, without compensation, for instance, that would be a violation of your contract. Having staff assistance pulled on a whim, and with regularity, also can create negative feelings, so that, too, should be addressed in your contract.
Discrepancies should be resolved. It is possible to achieve a win-win strategy between the employee and employer. Do not settle for anything less. Move on if a compromise in your contract cannot be achieved, and if the situation seems like it will be unbearable.
In joining a new practice, it was my goal to learn as much as possible about clinical management of surgical patients, as well as the business of running a large practice. I wanted variety in my schedule, which was verbally communicated starting with the interview process. In a typical day, I could see refractive surgery patients followed by glaucoma examinations, acute care, and specialty contact lens fits. I also learned more than I expected about the operations of a large ophthalmology clinic from observation and listening to partner discussions. As an associate, I was always treated as integral to the group. The partners of my first practice graciously included me in some of their partner meetings. This is not standard for most practices.
Decide on Areas of Focus
My residency training was devoted to ocular disease, surgical patient management, contact lenses and low vision. I sought job opportunities that could utilize that training. Residency training, which is increasingly sought after, provided me with additional opportunities beyond my degree. Working with ophthalmologists would allow me the best experience to follow my residency training, as the patients are overwhelmingly medical or surgical. I was very fortunate to join some exceptional MDs in my first year of practice. I learned a great deal alongside experts of refractive surgery. My experience was invaluable. I’m confident and capable of working with the most challenging cases because of their knowledge, additional training and the experience.
My first practice involved working alongside five MDs. In many ways, all of the MDs became mentors to me. I was treated very respectfully and greatly enjoyed the working relationships with those doctors. They were always eager to teach me techniques and involve me in interesting cases. One doctor, in particular, really helped me during my transition from resident to employee. Learning office politics and working in a managed care setting is far different from a typical resident schedule in three ways:
1. As a resident, schedules are tailored to a clinician’s individual growth plan and objectives. For a new employee in a private practice, the focus shifts to how a new doctor can contribute to and help grow a practice. The workflow reflects the interests of the clinic.
2. Residency supervisors guide and mentor the resident. Supervisors in a managed care setting are not your mentor, but rather, the overseer of entire clinics.
3. Paid time off is awarded to residents and new employees alike. It’s much more difficult, however, to call out in a private practice. Entire clinics have to be cancelled if a doctor falls ill, for instance, in a managed care setting. Residencies, on the other hand, usually have multiple residents, or interns, who can provide coverage for absent colleagues.
It is important to demonstrate respect at all times for the other doctors and staff. The new doctor should learn as much as possible about the practice, as well as about the other doctors. By being extra helpful, and willing to take on more responsibility, the new doctor can demonstrate his or her dedication to the team. The doctor should not just add volume to the practice; they should enhance the quality of the other doctors’ work experience.
For instance, a colleague may need to leave the clinic early to pick up a sick child from school, or may arrive late due to car trouble. Covering the other doctor’s schedule is very helpful, can help decrease a co-worker’s stress, and facilitates rapport between the doctors. We all feel better knowing that someone has our interest in mind. Working as a team also ensures clinic coverage and protects the business. Acknowledging that we have lives outside of work, and through trying to understand our colleagues, we can better relate to our co-workers and begin to build stronger teams.
Introduce Yourself to Patients
Patients are often curious to learn about a new doctor. Practices typically announce new hires to the practice on the web site or through office literature. Doctors and patients can build mutual trust with experience and familiarity. Empathetic listening and solid communication can foster the early development of trust.
Know When to Consult With Practice Owner
Employees should strive to contribute to a great work environment. It is worth mentioning to a supervisor or owner if the doctor is having a difficult time with any staff, which can jeopardize good work culture. There will be personality conflicts, and these are often evident within the first year. The owner or partner should also be aware of any strained relationships among staff, before the work culture degrades into bickering, negativity and poor attitudes. A doctor should never have to overhear a supervisor make unkind remarks about him or her, for instance, in the hallways where patient care takes place. Negativity in the office is toxic and should never be tolerated. People will treat you the way you allow them. If negativity persists, move on.
Assess Where You Are At End of First Year
Here are two good questions to ask the owner after your first year with a practice: How do you see my position evolving next year? How about five years from now? If the answer is “I don’t know,” take that as a sign to look for another job. If the answer is “I don’t know, but I’m willing to listen to any suggestions,” that would be very positive. Jobs can easily become stagnant. Repetition and boredom are stifling. A good position should evolve, as well as encourage growth. We all want to be proud of our work.
Identify Points for Discussion for Second Year
Ideally, any major bargaining should take place during initial contract negotiations for any new practice. A great employer, and a solid contract can create mutual satisfaction for many years. I always argue that everything is negotiable, but frequent tweaks to contracts may be perceived negatively by an employer. The employee should have something to offer, such as improved skills or more responsibility, for the employer to make a contract change. Good employers recognize and reward employees accordingly, so I would find contract tweaks uncommon. Yearly reviews would be a great time for an employee to discuss with a supervisor any goals or expectations.
Stay Philosophical: First Job is a Stepping Stone
Your first job will not be your last, and may not be your best. Your first job will probably disappoint you in some ways. It’s a learning process. You learn what you need and want from a job, your career. You will hopefully still have many fond memories as the first job leaves a deep impression. Work hard, and if you are lucky, your first job is your launching point. Use a good job to get yourself a great job. Most importantly, a highly positive work culture outweighs any tangible benefits.