What I’ve learned in private practice

06 Mar 2019

By Emily Murphy

Full disclosure: I am a private practice surgeon in the truest sense of the term, I am a partner in a six-person group who provides care at a 545-bed hospital almost exclusively. Further disclosure, this was the job I always hoped I would have (in my hometown, with the opportunity to teach medical and physician’s assistant students, with a solid core of senior partners), so I am probably more than a little biased. But two years into practice, I have learned some things that are specific to my experience, but likely translate pretty broadly.


  1.       Introduce yourself to everyone (as “Dr. So-and-so”)

Playground rules apply to surgery too. Play nice in the sandbox. Interact pleasantly with others. Establish that you are Dr. So-and-so. And if it feels uncomfortable to call yourself doctor among peers, say your name and explain that you are a new surgeon with your group. It is easy to overcompensate for the personality traits that can be associated with “the female surgeon” and fall into the role of the sycophant, embracing those cool-mom-tropes of relaxed rules and neglected hierarchy. Don’t do it. Especially in the operating room, the surgeon is the boss. Sure, ask about people’s kids, pets or interests, establish whatever rapport fits with the relationship you hope to have, but your job is to keep a patient safe, and nothing should impede that. And similarly, you decide how you fit in the social nuances of the politicking of medicine.


  1.       Say “yes” (until it is time to say “no”)

Wouldn’t it be nice if patients showed up in your office fully worked up with the appropriate medical clearance and preoperative testing? If you have a particularly specialized practice that can be a harder ask than it might seem. The relationship between referring physician and surgeon should be pretty simple, at least from the referring physician’s perspective. First, a surgeon should have an office staff that is nice to patients. Second, a surgeon should be a competent proceduralist who provides timely care and communication. Third, a surgeon should make a referring physician’s life easier, not harder. Things we do to “help” sometimes don’t. Complex flow charts of the nuances of work up of disease processes with esoteric imaging and labs can make more work for those referring. Be available to patients and providers. Squeeze a case on at the end of a day or call someone directly with results. Little things make a big difference. Don’t jeopardize patient safety. It is never wrong to advocate for those who cannot advocate for themselves.


  1.       Know what your time is worth

Sometimes more money does mean more problems. I once calculated my resident salary to an hourly figure. I shouldn’t have done this. It made me sad. Like many young surgeons, the amount invested in my brain is far greater than the money invested in my bank. It can be tempting to pick up call and other cast offs from senior partners. There are always bills for a wedding or a car or a house, and I have felt this huge sense of being behind my peers (both medical and non-medical). But the money doesn’t matter if there’s not an outlet for it. Figure out what is fair by deciding what is important to you. If you want eight weeks of vacation and will settle for less money, state this. There are many resources that report average salaries, but that doesn’t give the complete picture of the job.


  1.       Eat what you kill (but maybe don’t be an apex predator in the first few years)

To “build” or “grow” a practice, one must start from one point and meet milestones to achieve another. The first months (and sometimes even years) of practice can have some pretty painful lulls. Watching partners with over-full clinics complain about how busy they are can be disheartening. But remember, everyone starts at pretty much the same point—excited for a lipoma consult. Most of us strive to be the best of the best, but remember a career is a marathon, not a sprint. And finding ways to diversify can help assuage burnout.


  1.       Look for mentorship opportunities (see your world through someone else’s eyes)

Personal and professional development takes external perspective. Often young surgeons think of mentorship as something they receive, but mentorship is a two-way-street. It’s easy to forget how much we have accomplished by the time we complete surgical training. We can get a little jaded about all of our struggles and forget the incredibly important work that we do. We literally help people and their families in ways that they cannot help themselves. The saying that when you teach, you learn twice is certainly also true. And investing in the development of those around us (whether it is teaching a surgical technologist about a case so he can better assist you or encouraging an ICU nurse to pursue a CRNA or letting a medical student throw her first stitch) provides some grounding among all of the things that we cannot control.


  1.       Have bad days

There are days when a hospitalist calls one too many times or a family member asks one too many questions, but the worst days are those with a complication. They can be devastating, not only to patients, but also to surgeons. Most of us went into medicine to help people, to fix them or make them better. Unfortunately, sometimes people get sick and sometimes they die. But unlike a patient or family that can grieve in the moment, we often have more patients and sometimes more bad news in the next room. We don’t always have the luxury of feeling things in the moment. And in practice I can’t stop at the gyro place around the corner for an eat-your-feelings session of falafel and baklava after work with my best friend, because we now live more than 1200 miles apart. We still run through cases on the phone, but it’s not the same without the humus.

While there a struggles every day, not every day is a struggle. Most of the time, I think I have the best job in the whole world (and not just because I’m in private practice). It’s not the easiest. Or the cleanest. Or the most sophisticated. The hours aren’t great. And the stress is high. My senior partners don’t meet for cheap ethnic food, but they do provide a sounding board. But being a surgeon more often than not really helps people. Sometimes I even get to save a life.


Emily E. K. Murphy, MD is a private practice surgeon in Sioux Falls, SD. She is a Clinical Assistant Professor in the Department of Surgery at Sanford School of Medicine at the University of South Dakota. She completed her medical education at Sanford School of Medicine at the University of South Dakota. She was a general surgery resident at Christiana Care in Newark, Delaware. She has also completed a fellowship in endocrine surgery at the Medical College of Wisconsin in Milwaukee, Wisconsin.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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