Going (or Going Back) into Practice: What to Expect

Starting a practice, taking a new position, or transitioning to a different practice type or location is a daunting proposition, and one that our professional training doesn’t necessarily prepare us for. Many practice management decisions we have to make are outside our expertise and comfort zone. Some preparation, organization, and perseverance can go a long way to reduce anxiety and foster a successful quest. Whether you plan to go into private practice, group practice, or academic medicine, these 10 steps will help you navigate your practice transition and build a rewarding career in otolaryngology.

Top 10 To-Do List for Going into Practice 2022

1. Plan Ahead

Think about your professional goals, values, and vision: What would you like your career to look like in five years, in 10 years? Determine your comfort level with risk, and then examine each practice type to determine the real risk involved. Starting a solo practice might seem riskier than taking employment with a health system, but there are risk factors associated with an employed or tenure track position as well. Create a timeline for your transition and start planning early in the process. Make a list of checkpoints and deadlines to help move the process along. You may not always be able to follow the plan exactly but envisioning what the search should look like is very helpful.

 2. Find a Mentor

Look for shadowing opportunities in a practice setting that you think you might enjoy. Talk to colleagues from residency who are in practice and find out their likes and dislikes. A mentor can help you set and achieve goals, hold you accountable and provide trusted answers, act as a sounding board, and give practical advice and insight that will improve your chances of finding the right fit for you.

 3. Assemble an Idea Book

Collect examples of best practices in your current position: Forms, policies, and procedures; instruments lists and clinical supplies; patient surveys and welcome letters; marketing materials, patient education, and communication tools; and coding and billing resources.

 4. Find the Right Community

Research professional demographics: Is the region saturated with your specialty because it is near a training center? Or, is it an underserved area with a paucity of specialists? Study the major health systems in the area and speak to providers in that system if possible to gauge their job satisfaction level. What are the predominant referral networks for specialists, and how would your practice fit in? Compare the regional cost of living versus salary and benefit packages in the area. Several organizations release yearly salary and benefits comparisons to get a general idea of compensation in a particular state or region. Talk to colleagues who have settled in your region of interest and ask how they feel about earnings versus expenses. Will your partner and/or family be happy here? The best practice opportunity is often a blend of professional opportunity and optimized personal life.

 5. Find the Right Practice Type

Do you hope for an academic appointment after a fellowship? Are you excited to practice comprehensive otolaryngology as a community provider? A hybrid of both? Employed by a health system or owner/partner in a private practice? Do you prefer a large or small group? Full-time or part-time? Some physicians in transition choose a temporary locum tenens assignment to test drive a location or practice.

 6. Find Your Practice

Once you’ve done your background work, start asking more specific questions: What is the salary or productivity plan? What is the call and hospital rounds arrangement? Is there a signing bonus or a buy-in contract? What is the governance structure or tenure track plan? How much flexibility does the schedule allow? What is the reputation of the clinic or department in the community and within your specialty? Does the corporate culture align with your goals and values?

 7. Assemble Your Team

Get as much input as possible from your partner and family. A healthcare attorney can be very helpful to review contracts, productivity plans, noncompete clauses, and other legal matters. A recruiter or locum agency, if appropriate, can be very helpful in some cases. A realtor who knows the local housing market is very important, as is a financial planner and/or an accountant.

 8. Get Involved

Once you have settled on a practice, get involved with physicians locally and nationally. The AAO-HNS has the Young Physicians Section, Women In Otolaryngology Section, and the brand-new Private Practice Study Group. In addition, there are many Academy committees and Board of Governors committees to join. Become active with your state otolaryngology-head and neck surgery society, the American Medical Association, your state medical society, your medical school and residency alumni organization, your hospital’s medical staff committees, your clinic, or department governance boards. Attend meetings and network!

 9. Learn Basic Practice Management

Even if you have an administrator, clinic manager, financial officer, or department chair, it pays to understand how your business office functions. Correct coding requires more than just a passing knowledge of CPT and ICD-10 codes. Financial management, performance metrics and dashboards, marketing and reputation management, quality and patient safety reporting, and alternative payment models are the future of clinical practice. If you’re not at the table, you may be on the menu!

 10. Build a Winning Team

Get to know your office and operating room staff well, benefit from their experience and knowledge, and build mutual trust and respect. Offer and take honest, constructive feedback to strengthen relationships and streamline best practices. Catch them in the act of doing good work, and reward excellence. Pay attention to their needs, listen attentively, and model flexibility and courtesy. Promote teamwork and synergy and make it your job to find and fix any dissatisfiers. Your staff and support team can make your practice a paradise, or, well, you know…

There are many options for Otolaryngologists, and one of them is just right for you. Make your plan, gather your team, and enjoy a fulfilling and rewarding career in your new practice!