Transitioning from residency to independent practice is no easy task - you’re suddenly dealing with more clinical responsibility along with all the new realities of running your own business.
Learning how others have survived their first year of practice is a great way to avoid some of the common stressors. That's why we interviewed physicians who have transitioned to independent practice in the last 8 years as well as physicians who have been practicing a decade or longer.
We asked them 5 questions about what they wish someone had told them when they were first starting out and what productivity tips they've learned along the way.
1. What was the biggest challenge or 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 are some frustrating things about being a new physician?
- “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)
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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 Productivity
We asked a handful of seasoned physicians from 3 top specialties; General Practice, Psychiatry and Internal Medicine, to share their best productivity tips:
Billing Productivity
A lot of doctors say that having the ability to bill right away on their phone, with easy access to codes and reminders, is priceless. This is especially true for rounding physicians and those who practice out of multiple locations who are constantly on the move.
Dr. Erin Smith (Psychiatry) highly recommends billing for each patient either on the spot or by the end of the day, but no later, to reduce billing pileup.
Many physicians feel more confident about the completeness of their claims when billing is done in the moment and the patient encounter is fresh in their mind. It also means billing becomes part of the workday and not a task to take home and complete on personal time.
Dr. Melissa Gillis (GP) suggests that you separate your billings into groups. “I use the "month," but you can use anything to help you organize, it helps with finding patients later. Then delete groups when you no longer need them to keep your folders manageable. Also, use the notes section for MSP notes, but also for yourself - a few words might help you remember a complicated billing.”
More Billing Tips Straight From Physicians
“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:
Teamwork & Workplace Productivity Tips
As you transition into your role in independent practice, you’ll either be in charge of a team or working closely with one, so it’s important to get started off on the right foot. Having a positive work atmosphere is essential in order to thrive and have a successful first year.
- Physicians we spoke with, especially those in clinic environments, spoke about the importance of having a 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.”
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.”
Dr. Cadesky's advice is sound as new-to-practice physicians in particular can struggle with delegating. Here are some tips:
- Get into the habit of offloading tasks that can be be performed by other, even if you have to start small. This will help improve your overall productivity as you’ll have more time to focus on clinical care and high priority tasks. For example, have medical office assistants (or nurses) take blood pressure measurement, visual acuity checks, weight, urine dips, phone calls, etc. There's a lot that can be accomplished before you even see the patient and this increases the value of your patient face-to-to face time.
- Never forget to express your appreciation for the work of your colleagues and direct reports. Fostering an environment where everyone feels valued improves work culture and helps people be more productive. Remember, staff can make or break the functionality of an office (and therefore you!).
- Some physicians suggested developing 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.
- Dr. Lacresha Hall (Psychiatry) says “Learn to feel comfortable saying no to patients and colleagues. It is not necessary to over work yourself.” Burnout is real and something to stay on top of with robust prevention techniques throughout your career.
Many physicians talked about the importance of being a team player and the benefits of regular communication touchpoints:
- “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 entbire system run more effectively. ”
Dr. Susan Horsfall (GP) - “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) - 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:
Advice from those who've walked this path before is always helpful. Of course you'll gather your own tips and tricks along the way - don't forget to pay those tips forward one day!
While we can’t help you implement every piece of physician advice, we can certainly help you optimize your billing! With Dr.Bill, you can submit claims in 16 seconds. Get in touch with us if you'd like a demo!
