A New Practice – Here's the Situation
by Jarrod Shapiro, DPM Joined Mountain View Medical & Surgical Associates of Madras, Oregon July 2008	I’ve made my move to sunny and beautiful Madras, Oregon. This move marks not only a new practice location but also entrance into my 3rd year of practice as a podiatrist. I’ve completed 24 months of private practice since graduating residency; I’ve learned a lot since graduation and am still very satisfied with podiatry as a profession. I’m looking forward to many more years of practicing podiatric medicine and surgery, and I figured I would start another year of New Docs on the Block with an explanation of my new situation. I’m supplying this information not because my life is so important to you, but rather to elucidate the decision-making process that may affect some of you in the future.

I have begun practice in a rural community as part of a multi-specialty group practice associated with a small local hospital.

As in all decisions we make, I had multiple reasons for making this change.  As I’ve mentioned previously, the primary reason I moved was to be closer to family.  I found over time that it was becoming increasingly difficult to stay in close contact with my immediate family and for them to interact with my son.  Returning to the West reduces travel time, making it easier to see family.  Additionally, I found Mid-Michigan to be a little cloistering with the cold winters and humid summers.  I enjoy the outdoors, but found myself restricted.  Michigan is a beautiful state, but the West and its mountainous terrain was calling. 

Finally, and no less importantly, I was having increasing qualms with the way in which I was practicing medicine.  As an associate to another physician, I was restricted to accepting certain insurances (for example, denying Medicaid patients) without any control of choice.  I had started to see Medicaid patients (as a courtesy to local attendings) but was not billing for these patients at all, which did not make any sense.  When I was training to be a doctor ,this was not my view of how I would practice medicine.  Now, I’m not naïve; I know much of the care patients receive in this country is based on insurance.  However, I did not want to add insult to injury, and I managed to find a group of people who feel as I do: treat everyone with need, regardless of insurance. 

So, with partnership in a successful practice looming, I decided to make a change.  I’m now working for Medical and Surgical Associates, a multi-specialty practice associated with Mountain View Hospital in Madras, Oregon.  This hospital is a critical access hospital (25 beds or less) in a rural town (Madras has about 6500 people).  I split my days between Madras and a slightly larger town, Prineville, Oregon (pop. approx 10,000 with a local population of about 20,000), which also has a critical access hospital (Pioneer Memorial Hospital).  Both hospitals have granted me full privileges and scope of practice.  The local economies have been steadily growing over the past decade with more growth projected in the future (Oregon was not hit as hard with the collapse of the real estate and economy bubble).

One question that deserves answering is: how did I find this opportunity?  While I was a resident, I was in contact with the rural health office in multiple Western states.  The opportunity did not present itself at the time, so I kept in touch with these folks.  My rule is to never burn a bridge, and with some luck, the opportunity came up in Oregon.  Mountain View Hospital was organizing a provider-based clinic while revamping a previously poor community image.  The new hospital CEO hired a professional practice management company who eventually recruited me.  After two visits (paid for by the hospital) and some negotiation, we came to a fair contract, and I moved my family across the country.  Now, here we are in Oregon! 

Changing jobs is by no means easy and carries a significant risk, but when approached carefully, can result in a successful and lucrative career change.  Hopefully my experiences can shed light on what you might expect under these circumstances.  For anyone interested in any specific details, please feel free to write in.  I’ll answer as honestly as I can.  Best wishes.

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]