By performing select procedures in a clinic setting and working with attendings in the private sector, Dr. Singh has garnered an understanding of the necessary steps to provide high-value care to patients while ensuring they’re comfortable and relaxed.
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April 2024Elizabeth Ritter, MD, a resident in the department of otolaryngology–head and neck surgery at University of North Carolina in Chapel Hill, has spent about one-third of her residency at WakeMed Hospital in Raleigh. “This offers a small glimpse into what private practice is like, particularly in regard to its outpatient clinics as well as discussions regarding their experience buying into and operating at a local surgical center,” she said. WakeMed is a hospital-based program, not a true private practice, however.
Learning more about the different aspects of operating a business would be helpful, some residents said. “It would be interesting to incorporate the business and managerial aspects of private practice into our education, which residents often aren’t privy to unless they seek out these fields in their own time,” Dr. Singh said. “I believe these skills would be valuable to all physicians, not only to those in private practice, as our field expands to incorporate third-party investors and larger conglomerates. Understanding this aspect of medicine would equip physicians to be more independent and effective in their patient care delivery.”
Dr. Ritter has learned a lot about private practice operations through job interviews over the last two years; however, she would have liked to have had a better understanding of business operations earlier in residency to help her make more informed decisions. Topics of interest include how to evaluate a contract, negotiation strategies, compensation structure (e.g., salaried vs. relative value units), practice buy-in and buy-out structures, how to evaluate a practice’s health, private equity considerations, and how to market yourself to referring providers.
Hannah Kuhar Morrin, MD, a resident physician in the department of otolaryngology–head and neck surgery at Ohio State University in Columbus, is satisfied with the level of exposure to private practice during her training at a large tertiary care academic medical center. She has had the opportunity to learn about the operational and strategic aspects of private practice, including how to design and build a practice and how to operationalize short and long-term goals with a team of stakeholders.
Many residents do end up pursuing a position in private practice. Dr. Ritter accepted a private practice job mainly to have greater autonomy. “It was very important to have a seat at the table and an opportunity to help make decisions on a daily basis,” she said.
Dr. Singh is planning to join a private practice group after graduation. “My choice is partially because my mother is a happy and successful solo practitioner running a private practice company herself,” she said. “I’ve seen the autonomy, flexibility, and efficiency in private practice groups, regardless of specialty, and I’d like my career to incorporate these same characteristics.”
Dr. Kuhar Morrin would strongly consider private practice. She has a background in healthcare management, has worked at small medical clinics in rural Guatemala and Tanzania during college, and has consulted on hospital operations for a private for-profit American healthcare system. During residency, she seized opportunities to design processes to enhance resident learning and patient care through the development of a clinical and operative anatomy skills training program (a cadaver dissection course for trainees) and an enhanced recovery-after-surgery protocol for head and neck cancer patients.
“The private practice setting would allow me to readily integrate creative thinking, rapidly changing innovative technologies, and relationship-driven patient centered care into a team-based setting,” Dr. Kuhar Morrin said.
A Win-Win
Nariman Dash, MD, chief of surgery in the department of surgery at Mary Washington Healthcare in Fredericksburg, Va., and associate clinical professor in the department of otolaryngology at the University of Virginia in Charlottesville, who’s also the program director for UVA residents during their private practice rotation, said that having residents at his practice has made him a better clinician.
“Residents see patients before a workup has been done, which allows them to identify worrisome signs and symptoms,” Dr. Dash explained. “This differs from academic referral centers, where most patients come in with a likely diagnosis and are there for definitive care. Residents get to see their impact on the community and get quick feedback on the outcome of their treatments or surgeries. They also learn about managing a medical practice by engaging in discussions about issues that arise.”
Karen Appold is a freelance medical writer based in San Diego, Calif.