It may not feel like an auspicious time to begin your career as a physician. But as Dr. Adam Stewart writes, there’s still much to learn. Here’s what he wishes he knew when he began practicing.

What a feeling! It’s wonderful and exciting, and invokes a feeling of accomplishment and pride. If you’ve just finished all of your many years of formal medical training and you’re ready to start your own independent medical practice, congratulations.

But it can also be a little overwhelming. A little chaotic. A little daunting. Especially these days, in the midst of a global pandemic. You may be wondering where to start. What should you focus on?

I am frequently asked for tips and trouble-shooting advice related to running a medical practice. Here are three things you may wish to consider as you begin your journey as a business owner. They can be applied now, during the pandemic, or in the years beyond. These are some best practices I wish I had known from the start, but the list also includes some things that have proven helpful for me through my first 10 years in practice.

Your business is all about people

As the saying goes, “Culture eats strategy for breakfast.” Work to ensure the colleagues, staff, financial and business advisors you work with are of the utmost quality and integrity. When you surround yourself with good people you will make your job that much easier.

Draw from the expertise of veteran physicians. Their clinical knowledge can illustrate how things may not be as clear as was taught in school. Learn, too, from the workflows of those who run successful practices. But don’t be afraid to pave your own path. Break down barriers and status quos. Your fresh perspectives and passion may be just what is needed.

Hire exceptional staff and treat them well. Be supportive rather than punitive with your staff. When addressing mistakes, avoid placing personal blame or fault. Instead, focus on the system and procedures that lead to the problem so as to avoid repeating it. Foster a work environment that is positive and enjoyable.

That being said, should significant issues with staff or colleagues arise, it’s important to address them clearly and directly.

Remember that nurturing and retaining exceptional staff is a priority. So is having low employee turn-over, particularly when you consider the cost of recruiting and re-training a vital staff member. There are books, courses and degrees that focus on these sorts of things, so I won’t belabour them further. But know how vital these notions are.

Formalize office policies and stick to them

It took me a few years into practice to realize the importance of this but I wish I had done this right from day one.

In your day–to–day practice, you and your staff will encounter recurrent issues that merit creating an official office policy. Some examples may include:

• Patients who are late or miss appointments
• Patients who exhibit disruptive behaviour or are rude to your staff
• Patients who forget their health cards
• Fees for prescriptions without a visit
• Fees for uninsured medical services
• The prescription of opioid, benzodiazepine, cannabinoid and sleep medications

In my opinion, it is essential to avoid positively rewarding negative behaviours. That only encourages and enables conduct to continue. Creating and enforcing your practice’s policies up front helps align expectations for the patient and physician. That way, patients who feel you will not meet their expectations can opt to seek a different clinic or physician, saving you both the frustration of venturing too far into an unproductive relationship.

I visited a clinic last year where some young physicians were just starting out. They had already formalized clear and firm policies on these matters so that every new patient who was coming in to register had clear expectations. I was envious and happy for them because, in their first year, they were already at a point that took me several years to reach.

Maintain your work-life balance

This sounds cliché, but sometimes clichés speak essential truths. The matter of physician burnout is increasingly topical these days, and for good reason: It’s always easier to speed up than to slow down.  

I am realizing this now 10 years into practice. It is very challenging to shrink the size of your practice once it grows to a large size. Consider that 1% to 2% of a typical family practice will die each year, as unfortunate as that is. In a practice size of 1,500 patients, that equates to a loss of 15 to 30 patients per year. Some additional patients will move away, but so too will new babies be born by existing patients. By those figures, if a doctor with 1,500 patients wishes to shrink to 1,300, it could take more than six years!

When you grow your practice, you may wish to do so at a controlled rate, only accepting a certain number of new patients and new “welcome visits” per week. This will allow you to keep the growth controlled and to get a feel for how busy you are, before accepting hundreds of patients en masse.

I also suggest blocking off entire weeks of your schedule periodically throughout the year (e.g. one week every 2-3 months). You don’t need to predetermine what you will do with that time, whether it’s for vacation or ‘stay-cation,’ a Continuing Medical Education (CME) course, or just catching up on other work. It is too easy for patients to get booked into your schedule and then several months pass by without you ever getting a break. Even if you don’t take that specific week off, that free week can serve as a buffer into which you can shift and reschedule patients from a different week that you end up taking off.

Make your personal health and well-being a priority. Last year, after some introspection, I decided to make sleep, exercise, and meditation priorities part of my daily schedule. Whereas these are often the things we sacrifice to accommodate overflowing demands, I started to make these areas untouchable. It changed my life for the better.

Along these lines, be sure to pursue and maintain your passions outside of medicine, whether it’s reading, playing an instrument, learning a new language, sports, further education, and so forth. I am now trying to find ways to take back the time to do these things, to carve “protected time” back into my schedule.

Too often, we forget another common truism, “Happiness is a journey, not a destination.” Maintain balance and enjoy the ride.

Adam Stewart is a family physician with a practice based in Madoc, Ontario. In 2017 he was named by the Canadian Medical Association as one of "17 physicians who have helped shape the future of health care." More information on his practice can be found at www.stewartmedicine.com.