Transitioning from residency to independent practice is no easy task - you’re suddenly dealing with more paperwork, more patient volume, and overall just more responsibility, To help out, we interviewed a handful of new doctors, all who have 1-5 years of practice experience, and asked them a few questions about what you can expect and what they wish someone had told them when they were first starting out. We then spoke to more seasoned doctors and asked them for specific physician advice and tips to improve productivity. While some of this advice you may have heard before, some of it you might find surprising. We suggest reading everything over once and then strategize on how to implement the ones you found the most useful. What you’ll find:
- New Doctors Reveal their Best Tips and Advice when Starting Out
- Physician Advice for Productivity
New Doctors Reveal their Best Tips and Advice when Starting Out
1. What was/is the biggest challenge/struggle as a new doctor?“Time management has certainly been the biggest challenge as a new doctor. This is both in clinic (trying to provide good care on a 10-15 minute booking schedule) and outside of clinic (paperwork, labs/results, volunteer/committee work, etc). Dr. Arlo Green (GP)
“Setting up a new practice with respect to the business side of things, mostly admin and billing.” Dr. Deborah Kahan (Psychiatry)“Self doubt, imposter syndrome. Time and continued learning were big for this. Locuming also helped, but ideally at the same places to get the hang of things, each new location will have different EMR's etc., so you don't want to spend more time and energy on that as well.” Dr. Nicole Del Bel (GP)
“Changing from the role of a resident to an attending is probably the biggest. It did take some time to build confidence and experience. Suddenly you are the last person to sign off a prescription or report and nobody else will necessarily review it. I seek out advice and tips from other colleagues who have more experience than I do. And also be patient. Confidence does come with time and experience.” Dr. Derek Chang (GP)“Big jump from residency in terms of patient volume, responsibility, billing knowledge, time management. Talk to colleagues and mentors for advice and tips.” Dr. Daniel Wong (GP)
2. What has been the most frustrating part?“Paperwork, notes, labs, etc. - all the extra work outside of direct patient care that takes a considerable amount of time (and is not compensated for, at least not directly). And with how connected we are (eg. at home EMR access, cell phones), it can be a challenge to carve out personal time.” Dr. Arlo Green (GP)
“The biggest hurdle was probably managing time, especially with the boluses of referrals that can come all at once, and then trying to finish and get home in time to get some sleep to start the next day all over again.” Dr. Terence Yung (Internal Medicine)“Not having a supervisor to run things past anymore.” Dr. Deborah Kahan (Psychiatry)
3. Was there anything that you found surprising?“The amount of opportunity there is. No shortage of work, both formal opportunities and the ability to create your own path. And maybe not surprising, but definitely reassuring: the amount of support offered by colleagues (from fellow doctors, allied health, administration, etc.) who genuinely want to help each other and patients.” Dr. Arlo Green (GP)
“While this may vary between centres, independent practice feels like a more collegial experience than residency. While authority and hierarchy often dominate too many interactions in residency and in large centres, collegiality, service, and assisting and enhancing patient care remain more central to independent practice.” Dr. Michael J Diamant (Internal Medicine)“I'm more confident than I thought, the work is really enjoyable.” Dr. Deborah Kahan (Psychiatry)
“Most surprised by the level of peer support in division – just because you’re out of training doesn’t mean you can’t still learn from those you work with who have far more experience.” Dr. Daniel Blum (Internal Medicine)(Working as a locum) “I love the variety and miss the people I work with and the patients I care for when I am away.” Dr. Nicole Del Bel (GP)
“Besides clinical skills, there are many other skills to learn as a physician (management, coordinating, leadership...).” Dr. Derek Chang (GP)“Time really flies by so enjoy the journey.” Dr. Daniel Wong (GP)
4. What were you least prepared for?“The Administrative responsibilities.” Dr. Deborah Kahan (Psychiatry)
“The amount of outside the office work has been somewhat of an adjustment. As a trainee/resident, much of the behind the scenes work was completed by others (i.e. your preceptor); as an independent new physician, it is your responsibility to follow up on all lab work, faxes from pharmacies, calls from community supports and nurses, etc. etc.” Dr. Arlo Green (GP)“Ensuring consults were booked in appropriate timeframe was a challenge – had to work closely with clericals to ensure nothing fell through the cracks. Still have to do this.” Dr. Daniel Blum (Internal Medicine)
“The financial and practice-building aspects of work remains the most opaque. Residency programs prepare physicians well for content and decision-making, but billing, as well as designing and managing a practice, remain poorly taught and rarely discussed.” Dr. Michael J Diamant (Internal Medicine)“I found billing to be slightly confusing at the beginning and can leave a lot of money on the table. I found that having a mentor is helpful. Find tutorials that may be helpful.” Dr. Amy Chen (GP)
5. What advice would you give to new doctors?“Go to business/admin seminars if they are offered.” Dr. Deborah Kahan (Psychiatry)
“Make choices mindfully, especially in the amount of work you take on initially. From clinic/hospital work to leadership roles to educational opportunities, there will be many demands on your time and you will feel like saying "yes" to everything. It is okay to say "no" to some of these opportunities as you have to make decisions to guide your career in the path you want to take as well as protect some of your own personal time.” Dr. Arlo Green (GP)“Locum where you want to work, take your time determining a good fit. Ensure you like your team. There is no end to the ability to do more work so learn to say no and make sure you know your priorities and your ideal balance. Check in with the divisions in your area, check with mentoring doctors, also check with any residency programs for any resources for new physicians in the area. Send out an email/fax if you are a specialist (they can help with this) if you are a GP don't send out an accepting patients list until you feel settled. You can get full in seconds. Make sure you learn the billing codes for your area. “ Dr. Nicole Del Bel (GP)
“Independent practice remains a self-directed learning experience. Re-evaluating your own decisions, documentation, workflow, billings, and patient communication remains central to continued growth as a physician.” Dr. Michael J Diamant (Internal Medicine)“Your colleagues in the group are your biggest resource. Treat them well, keep them close. They have the real life experience that can save you time, effort and even money. And so, it's especially important to join a group that is supportive. To do that you need to locum a bit first. Don't get committed to a group that may be toxic.” Dr. Terence Yung - Internal Medicine
“Stay on top of your paperwork and billing. Set your work schedule up to work for you. Find people that you like to work with.” Dr. Amy Chen - General Practitioner
Physician Advice for ProductivityWe asked a handful of seasoned physicians from 3 top specialties; General Practice, Psychiatry and Internal Medicine, to share their best productivity tips. We then took those tips and listed them below. Keep in mind that these tips are not specific to any speciality but in general are good things to keep in mind as you start building your independent practice. Most of the physician advice was directly related to billing or workplace productivity.
Physician Advice to Improve Your Billing Productivity
More Billing Tips:“Keep a record of the times you are seeing patients as both hospital and outpatient follow up visits now require that you report the time. Also, if using an EMR (e.g. InputHealth) integrate Dr. Bill into the EMR and do the billing on the spot.” Dr. Fidel Vila (Psychiatry)
“Use a billing sheet that has Patient’s name, PHN, and birthdate on it. I record their admitting diagnosis. Then I record the time I see the patient, discuss them with the team, family meetings and phone calls. Not only does doing this as it happens mean it’s more accurate, I remember to actually bill for my time and it saves me time trying to remember what I did during my day (so saves time and will make you more money!). I add patient stickers as I go through my day so I don’t have to hunt for information later on. Using label snap on my phone through Dr. Bill makes entering billing really easy.” Dr. Anna Nazif (GP)“When using Dr. Bill, log onto your account on a computer and look at rejections - it helps to understand what you are missing, billing incorrectly or when you need to provide more details in order to get paid for the work you did.” Dr. Melissa Gillis (GP)
If you need an easy way to reference billing codes try bookmarking our searchable databases: BC (MSP) Ontario (OHIP) Alberta (AHCIP)
Physician Advice to Improve Teamwork & Workplace Productivity
- Make sure you have good office policy, one that patients can understand and easily follow or read while in the waiting room. Start using a “reason for visit” or simple “questionnaire” form with a quick checklist that patients can fill out when they arrive.This way both doctors and staff can quickly see the reason for their visit and whether certain forms, notes or prescription refills need to be given; rather than have the patient request these things when you are heading out the door at the end of the visit.Dr. Yuchen Wu (General Practice) recommends keeping a clear poster for non-insured services, both in the waiting area and exam rooms, to educate patients (sick notes, letters, forms etc.) “This is going to save you time explaining such costs to patients.”
- Get into the habit of offloading tasks, either of low value or simply ones you don’t like. This will help improve your overall productivity as you’ll have more time to focus on the things you do need to handle. This is often something that doctors struggle with, as it’s not taught in medical school, but it is a necessity if you’re running a small business.For example, have medical office assistants (or nurses) take blood pressure measurement, visual acuity checks, weight, urine dips, phone calls, etc. Ideally, they can be doing this before you even see the patient and can even assist in answering basic questions and filling out paperwork. If you don’t already have someone who can help, spend the time to hire someone and make sure they’re trained well. Then, don’t forget to appreciate their help. Creating an environment where employees consider themselves valuable contributors will help everyone stay friendlier and more productive. Remember, staff will make or break the functionality of an office (and therefore you).
Dr. Eric Cadesky (GP) reminds us “You have trained too long and worked too hard to spend time doing things you don't like that others can do.”
- Be a team player: in any situation, whoever you’re working with, make sure you are part of a team. Several doctors we interviewed stressed the importance of having a “group” and the benefits of communication.
“We are always trying to improve our communication. Having a 5-minute staff huddle before the day begins and a monthly staff meeting helps head-off time-consuming or avoidable problems.” Dr. Deborah Hocking (GP)
- Develop a ranking system so that if a new task comes up you can decide if it ranks in your top 10% of things to complete that day. This will allow for more success and improved productivity but focusing on what’s essential to each day.
“You need to be good enough but not perfect. Be safe, be aware and do your best.” Dr. Smita N. Naidoo (Psychiatry)
- Dr. Lacresha Hall (Psychiatry) says “Learn to feel comfortable saying no to patients and colleagues. It is not necessary to over work yourself.” The leading trend in burnout is due to an ineffectiveness of completing tasks and too much paperwork, so why take on more? Know the limits of your practice and what you’re willing to do and the results you can deliver. Don’t say you can do something if you’re already dreading doing it. You’re not being measured by the large lists of things you didn’t do but instead by the ones you did do, so each day make a list and focus on your top priorities, then say no to anything else.
“Creating solid relationships and having open and frequent communication with GP and specialist colleagues has a direct effect on how effectively you provide care to your patients, and therefore, productivity. When we create a culture whereby we are interdependent and feel obligated to support each other, it makes us as individuals and the entire system run more effectively. ” Dr. Susan Horsfall (GP)There was also a lot of physician advice around joining a network, study club or suggest meeting with colleagues outside of work once a month. Making sure you have someone, or a group of people, to bounce ideas off or discuss challenging cases is a crucial step in productivity as it increases accountability and motivation. Studies have shown that people are more likely to do something if they have someone to share or report back to.
The Takeaway:Following each of these tips and implementing the advice above is a sure way to streamline your practice and make sure you start your career in a productive and positive mindset. And while Dr. Bill can’t help you implement all of the physician advice mentioned, we can definitely take care of your billing. Using our software you add a claim in 3 seconds, get detailed remittance reports and rejection management.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.