Rambling onwards

Twitter and CME
December 8, 2011
Patients: please take your medications!
March 26, 2012

Hi everyone, realized I haven’t blogged for a while, so I thought I would do so.  Hope you all are well.

For me it has been more of the same.  Busy trying to keep up with the demands of a busy practice and busy family.  It has been a lot of fun!  My little girl is very generous sharing things…even cold germs which I have had several of in the past two months!  But this makes working long hours even more challenging than it already is.

As usual there are new trials coming out and even a new medication.  Xarelto is a new anticoagulant for patients with atrial fibrillation.  It offers the chance for some patients to stop taking warfarin and having the blood tests!  It is, of course, not appropriate for everyone.  But it is a great option for a lot of patients, as is Pradax, which I discussed last year.

On an unrelated note, an article I read caught my eye: an article on CNN Money entitled Doctors Going Broke. http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm  Basically this article describes a number of financial pressures American doctors are facing that are making private practice a less and less viable option for many physicians.  Instead they are becoming hospital employees.

Most of my colleagues and I here in Canada do not face the same problem with declining Medicare reimbursement and so forth.  But certainly we are not made to appreciate, in training, that running a practice is a business!  Billing numbers may look impressive but you have to be careful to run a profit while covering all your expenses.  Drastic cuts like those described in the article can have a big impact on your bottom line.  I wonder if we in Canada are next with our budgetary problems and aging population?

I think the decline of private practice in the US is particularly unfortunate.  It is actually a stated goal of the Obama administration to force more doctors to become hospital employees.  It might be possible to do well as a salaried hospital employee.  However you lose much of your independence that you have worked so long to obtain – when you work, and more importantly, freedom to practice according to your best judgement.  Hospitals have rules and protocols.  Most of the time these are for the best, but there have been numerous examples where things were poorly done, doctors or nurses blew the whistle and changes were made.  When you work in private practice, you consult for the hospitals, so usually you still have your own practice even if the hospital takes away your privileges.  When you are a hospital employee you do not have this same freedom.  There are many protocols for treating disease in hospital – most of the time these are appropriate, but sometimes, with expert judgement, these should be disregarded.  Knowing when to do so is a hallmark of a wise physician.  One could imagine employee physicians being more pressured to conform to protocols – it already is a problem in some institutions

I very much enjoy the independence that comes with private practice, and could not imagine doing things any other way!

I’m interested to hear what you think!  Should doctors be trained in the basics of running a business?  Are these changes inevitable in a weakened economy?  Is private practice a good thing?  Drop me a line and let me know!


  1. Erin says:

    Should doctors be trained in the basics of running a business? God, yes! As a relatively new clinic owner (built from empty space, sole owner) I can honestly say I put it off for over 5 years mostly because I had no idea where to start, and the whole process was so intimidating. Now that it's up and running, though, I don't regret a thing. Like you say, independence is everything. Now, for myself, I'm fortunate that my dad is also a small business person, and has offered a lot in terms of advice in how to run the business side of it. I feel for physicians going out and starting clinics who aren't lucky enough to have such guidance.

  2. Great comments Erin. I was also very fortunate, I knew a cardiologist in private practice in my last year of training, who taught me a lot about running a practice. Otherwise I would have no idea.

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