When we go into medical school or our first residency, we’re a little naïve on the business of medicine and ignorance is bliss. We’re so excited about finally practicing; so focused on achieving our calling.
But maintaining that mindset as you practice is not practical. Three to four years in, it strikes you that being a doctor isn’t only about practicing medicine and saving lives but there’s also the business side of it. Your life situation evolves and your priorities change — for most people it coincides with the composition of your family changing because maybe you get married or maybe you have kids or something else entirely, but something will change your life and your priorities. What I wish I knew about being a doctor was the importance of understanding the business of medicine and of maintaining flexibility.
The perception of doctors as rich persists but most of us graduate medical school with a mortgage’s worth of loans but no house to show for it. Entering 15 years of practice, I still have a third to pay off. It’s important to have a long-term view when managing your debt because finances will play into your decisions, such as whether to go into a larger medical group or into private practice or even where to live and practice geographically. Be responsible with your finances and don’t bite off more than you can chew.
My class didn’t learn anything about coding in medical school. We touched on it in residency but it was very rudimentary. Know how insurance will look at billing and at your chart notes when it comes to determining your coding. This may be used to determine how much you’re paid or what your bonus will look like.
Don’t take contract negotiations for granted. It’s easy to think you’re just a cog in the machine but take them seriously and set it up the way you want to practice. It’ll be way easier to get things at the beginning than to go in and try to change them later.
Think broadly and don’t pigeonhole yourself too early. When thinking about your specialty, remain as open as possible for as long as possible. We all had this idea of what kind of doctor we wanted to be but there are pros and cons to every specialty. My family was already growing when this decision came up; it was important to me that I do a very predictable schedule and not be on call 24/7.
When you’re practicing, maintain your privileges even if you don’t think you’ll need them. In medical school, everyone was champing at the bit to get into the next phase of life and be practicing but think really hard about what it is you want to be doing day in and day out for 30 or 40 years.
Staying broad in your specialty gives you more time to see what everything is about, while maintaining privileges will allow you to change up your routine every once in a while. Getting out of my routines and temporarily changing my settings makes me a much better doctor. As with contract negotiations above, it’s going to be easier to maintain your privileges than it would be to get them back.
Who you are at 30 isn’t going to be who you are at 60, but you might not even be that same person at 32 years old. Keep this in mind when you start your career. Understand the long-term financial aspects and the business of medicine and stay as flexible as you can be. You’ll get so many fewer headaches. Your family will thank you, your patients will thank you, and you’ll thank yourself.
Email Thomas Valdez, MD
