Words of Wisdom: Reflections on Starting Off in Private Practice

Steven H. Dayan, MD, FACS is a facial plastic surgeon practicing in Chicago, IL. He is Co-Chief Medical Editor for Modern Aesthetics® magazine.

Recently, I had a fellow in my office at the tail end of his fellowship. He had made the decision to go off into private practice on his own far from his family and friends. As he prepared for a new life in a new city and a new existence, he sought any pearls of wisdom I could provide. Many remember this time period with multiple stressors including board exams, a new job, strange unfamiliar responsibilities, possibly a young family or the possibility of starting one imminently. And for all these reasons, decisions made in this short span of time seem to have vast importance.

I get visceral pangs of excitement, nausea, and anxiety when I think back on that time in my life. Mostly I reminisce positively. Even though I may not have realized it at the time, the moment was fertile with endless potential. Our first true opportunity, a virtual tabula rasa to create whatever we desired. Nothing is impossible, and all is at stake. I certainly made my fair share of mistakes…none of which I can say I truly regret, but there were many potholes I probably could have avoided. I neglected to tell the young fellow how to steer clear of such. Instead of giving him the practicalities, I fell in line and reflexively spit out the standard idealist mantras that we already all know and that can be found all over the self-help section of any local bookstore.

“Love what you do,” “always do the right thing,” “treat patients not diseases,” “don't cheat, steal, or lie,” “marry for love” and “always call your mother.”

However, I skipped the tips that probably matter most: the somewhat salty, certainly cynical, nitty-gritty pearls to survive and thrive in practice. After he left, I gave it more thought and came up with a better list.

Never fully trust your professional advisors. (Accountants, Lawyers, Money Mangers, CFO's, Business manager, etc.)

Nobody will ever care about your finances as much as you do. While we all likely hire top-notch professionals, most of us recognize that there are times, perhaps rare but nonetheless possible, when our accountant or lawyer may overlook a fact that is critical to our existence or situation. Keep your eyes on your books. I recommend having a third set of eyes look them over because if you are in practice long enough eventually someone will try to steal from you. Red lights should go off if someone you recently met tries to convince you to partake in a “great” deal that is sure to deliver fantastic returns.

Hire the best talent available regardless of the empty position. 

Strong talent always finds a meaningful purpose. Often times such hires take me in a direction other than what I expected but regardless, that person was passionate and productive and my practice always was the better for it. The corollary, though, is that truly talented people will likely eventually want to grow beyond your realm, and that is OK too. Their next stop may also prove valuable to you.

“I told you so” gets you nowhere.

This goes under the philosophy of not letting your ego get in the way of good medical judgement or a prudent business decision. Having a healthy ego is probably a necessary character trait for a surgeon, but learning to dampen it will bode well for professional and personal growth. Success rides on an ability to control appetite and emotions. Few will fancy angry outbursts, as anger always leads to destruction. Learn to compromise. The greatest leaders and most productive pioneers all commanded this strength. 

An absent leader is an oxymoron.

A captain must be at the helm directing the ship and forging the route. He/she must lead by example as his/her actions and behaviors are being watched, as are yours. Beware complacency for it leads to death. Uncertainty heeds discontent, but consistency breeds comfort.

Your enemy today maybe your best friend tomorrow and vice versa.

Measure your words and actions carefully, as you may one day be surprised by who backs you in crisis. We all take different routes for different reasons. Taking pride and appreciating those differences quells discord, tempers competition, and often leads to symbiotic relationships.

You have to make a meaningful difference to be relevant.

Don't confuse being busy with being productive or making a difference. It is easy to be flashy and to spark interest. To make a meaningful and lasting impact, however, you will need to find a creative insight that has yet to be expounded. Once you do don't be surprised if others think you are pushing the envelope. While that may be good, always know where boundaries lie.

The best resources from which to create something special is nothing.

It is easy to want the latest and greatest toy, but often it doesn't turn out to be as great as anticipated. When you start with nothing, you get awfully creative at finding a new and better way to reach the same place as everyone else. If, however, a purchase is a necessity, then always get three quotes before deciding.

Those who boast they will send you patients often don't. 

Beware of the bearer of gifts and fear the flatterers. They quite often expect something of greater value in return.

Be aggressive in thought but cautious in action and speech.

Think big, but plan actions one or two steps ahead. Reflexive behavior and rash decisions often lead to a quick demise. Nothing good comes fast or easy. Allow things to develop, including the latest trends. Don't be in such a hurry to be the first to adopt a new technology or procedure. Those in the front of the charge usually take the most arrows.

Listen, listen, and then listen some more.

Whether in consultation with a patient, in a review with an employee or in a tiff at home, you are more likely to make the correct diagnosis and choose the best course of action if you master the skill and art of listening.