Guest Editorial: This weeks issue of RI offers us some helpful hints, all the way from the Great White North. Esteemed colleague, Matt A. Heilala, DPM, FACFAS, of Anchorage, Alaska, provides us with his top ten list of of the most important tips for residents to carry on to their practice.
Top 10 Tips after Ten Years in Practice!
It’s hard to believe that it has been ten years since residency. The many months of preparation and training were met with a new and exciting challenge that practice would present. Among the many opportunities and pitfalls that a new practitioner will face, I will attempt to choose a mere ten aspects to highlight.
1. Know who you are and how you fit into your community
Self realization of your strengths and weaknesses professionally and personally is critical. Am I truly well trained and confident in my skills clinically and surgically, or do I have many weaknesses which will limit my scope of practice beyond those with better training or skills? Ironically, for most, the answer to both is a resounding YES. Staying within your comfort zone, while not limiting yourself needlessly, is the continual battle we face, especially in the early years of practice. You are not alone in this mental battle.
2. Slow and Steady Wins the Race, Proceed with Temperance
This intrinsic “self realization” is critical in creating safe guard rails for your path forward but as important to your success as your surroundings. Learn quickly who your patient and professional community are. Others' perceptions of you as a “podiatrist” might effect how you proceed in practice. If the community has the “old world” view of our profession, it may be prudent to proceed with greater caution and temperance, while at the same time taking every opportunity to display your “new world” knowledge and talent. Avoid the “Vine, vidi, vici” (I came, I saw, I conquered) attitude on a timeline. Instead, stay consistent, continually making progress until one day, you look up to find your work has led to success.
3. Make Alliances
Professional friendships and alliances go a long way toward building a practice and strong credibility in any community. Demonstrating that you are a friendly person with good intentions to patients and other professionals will be more protective of your future than any malpractice carrier or consultant could ever be. When things go awry, as they occasionally will, it is nice to know that your reputation as a solid individual will precede any review by patient and other professionals alike. I can’t count how many times my strong personal relationships with many in competing professions have “protected me” from potential conflict and needless accusation so common in this litigious world of ours. It also does wonders for your referral base…
4. Understand the “Rule of 1/3rds”
When things do go awry or poorly, understand that it might not be your fault or even the fault of the patients. Since we do exist in a blame based society, it is important to establish, very early, that there are at least three primary contributors to the outcome of any treatment; “I the Surgeon”, by the techniques I choose and how well or poorly I perform those procedures and the instructions I give. “You the Patient”, whether you follow my instructions and proceed reasonably and with caution and finally , the last third (in no particular order) is “God, Nature, Heredity and Genetics” All three of these together give us an outcome only predicted by statistics and probabilities. I find most patients appreciate this discussion and can very consistently repeat this back to me many months after the surgery, often volunteering any shortcomings in “their 1/3”. On a humorous note, I had a patient tell me that her very prominent orthopedic surgeon had a similar discussion with her, but his concept was that it was a 50/50 formula, “I the surgeon” and “You the Patient”. My response was that it is understandable as this Surgeon sees himself as both God and Surgeon.
5. Early bird gets the worm
My most productive times are early in the morning, before the frenetic day begins. Being alert and ready for the day to begin is the advantage of the farmer's schedule of early to bed and early to rise. Most of my best ideas and decision making happens during the lucid calm of my early mornings, by myself, at my office. This might not be the same for others, but something that has worked well for me.
6. Delegate
Time is sacred. You will never get it back. Use your limited time efficiently. Delegate those tasks that do not require your hard earned talents and those that are least productive, to supporting characters. Remember that you are the leader in managing your practice and patients. Sifting through the minutia and accomplishing the daily mission requires the support of others and your ability to effectively delegate.
7. Do not suffer Fools Gladly
Your ability to delegate is only as good as your support is competent. Recognizing the capabilities of a new employee should happen within the first several days. Hoping for “improvement” in baseline character and personality traits will only drag down the function and morale of a staff and reflect poorly on your practice as a whole. Whether in an ownership arrangement or associateship, incompetence must be rooted out early.
8. Even Keels are better than bipolar spark plugs
On the topic of cohorts, staff and peers, an individual of consistent performance and predictable nature is far superior to the ups and downs of the one day manic dynamo and the next day moody depressive. Persons that meet this standard lend beautifully to the directive mentioned in #2, Slow and Steady Wins the Race.
9. Enter into partnerships and associations with great caution and “business is not about family and friends”
This harkens back to the “self Realization” philosophy I referenced in the first tip. Do I have an intrinsic need to be the “master of my own professional destiny” or am I content to be, at least partially, subordinate in what appears to be a proven path of success in an existing practice as an associate? Early in practice, I found myself as an associate in a practice that was full of personal and professional strife. With this as my backdrop, I decided that I needed to be my own master of professional destiny. Success or failure would be due to my own actions and decisions and not that of a dubious associateship. On the other hand, if I wasn’t very confident that I “had the goods” and could stand out, then I would be at risk of a foundering practice with all the work, liability and expense entailed in being an owner. Coming to this decision is complex yet critically important and should ideally be arrived at early in practice as to avoid the regret of “wasting all those years” either in an unfulfilling associateship or in a failing grind as an owner, only due to stubborn ego or hubris. Often the ultimate decision is arrived at only after trying both “on for size” and learning more about how “we fit into” our world of life and practice. In the right circumstance, success can be found, long term, in either. A must read on this topic is “How to Join, Buy or Merge a Physician’s Practice” by Yvonne Foxx and Brett A. Levine, which you can purchase from Amazon online. One axiom that must likewise be understood in this vain, is if a business arrangement makes sense only because it is with a friend or family member and it doesn’t stand alone as a sound business agreement, then rest assured, in the end, you will have neither a friend nor a business.
10. Invest in the Future
The reinvestment of what you reap back into your practice is insurance for the future. Resisting the temptation to take the spoils of the year’s hard work and spend it on personal items alone is a recipe for future failure. Keeping a modern practice with updated equipment and technology is “priming the pump” for a long term healthy practice. This continual reinvestment must also be in the form of continued education and training as a clinician and surgeon. We must constantly be expanding our diagnostic capability and broaden our treatment options as innovations occur. We must end our careers with many more new tools in the box than what we started with decades prior.
I hope this practice tip segment was helpful for the new and seasoned practitioner alike. If not enlightening, perhaps a stimulus for introspection in hopes of arriving at a more balanced place in a world of chaos and uncertainty.
