AMA STEPS Forward® Series Announcement: [00:00] Hello, and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at STEPSForward.org
Taylor Johnson: [00:22] Hello, and welcome back to the AMA STEPS Forward® Private Practice: Attending to Business podcast, a 10-episode series exploring the business side of private practice. In this series, we talk about how to navigate business operations and practice efficiency solutions to create and support a thriving and sustainable medical practice business. I'm your host Taylor Johnson, manager of physician practice development at the American Medical Association, and I'm joined by my colleague and cohost Meghan Kwiatkoski, Program Manager of private practice sustainability, also at the AMA. Collectively, we have two decades of experience in private physician practice, and we continue to support physician practices in our current work at the AMA. Before we start, I want to emphasize that this episode is for general informational purposes and should not be relied on as medical, legal, or other professional advice. listeners are always encouraged to consult a professional advisor for any such advice.
Meghan Kwiatkowski: [01:21] Here we are at episode four already. In today's episode, we are going to discuss the factors involved for a resident who wants to move into private practice. But before we do that, we have some new listeners joining us. So let's do a quick intro for them. Taylor, can you start us off with a little background on yourself?
Johnson: [01:40] Yes, so I completed my undergraduate degree from Loyola University Chicago in health systems management, and I recently completed my MBA from Pepperdine University with a concentration of entrepreneurship. And my experience is in health care administration with small to medium sized practices working on the business and operations side of those offices. And Meghan, can you give our listeners a quick background on yourself?
Kwiatkowski: [02:13] Of course, I did come to working in health care by a bit of a wandering path. My undergrad degree is in psychology and my master's degree is in organizational psychology, which is the psychology of business. But I also have several certifications that are health care quality improvement relevant that I've earned as a result of my experience and exposure to the work. And those have been really great for foundational knowledge, and I've used them in support of the work that we do here. All that to say is that I have been working in different facets of health care for coming up on 15 years. I was in an ambulatory surgical center, a surgical oncology practice, and then I was working specifically and most recently in quality improvement and technical assistance payment for small to medium sized private practices. I also worked on a federally funded grant, and that focused on practice transformation and assessing practices' readiness to implement facets of value-based care.
Johnson: [03:19] Wow, you have done a lot. So today, we're talking about how residents get interested in private practice. And so can you tell us, how do you most residents become interested in private practice? Where does that start for them?
Kwiatkowski: [03:37] Of course. Just based on their training, resident physicians typically are not exposed to private practices. They're either coming from an academic setting or an employed setting. But they now are at an inflection point where they have to consider what type of practice setting is best for them moving forward. The options that they have are solo practice, solo private practice where they're the sole decision maker, they have high levels of autonomy and management responsibility, entrepreneurial and financial risks. They could join a group of private practice physicians that will have them collaborating with their other partners. They'll have some lower levels of autonomy, but definitely still have the ability to make their own decisions. They'll have lower levels of management and financial risk. But again, as I mentioned, definitely you still have overall responsibility in each of those areas.
Johnson: [04:37] Also, they could be an employed physician, they could work at a health system or a hospital, and there the employer sets the rules and the requirements of their employment. There are lower levels, much lower levels of autonomy and financial or entrepreneurial risk. And then also there's the option of being employed at an academic organization which is similar to the physician at a health system, but there's definitely a higher focus on research and teaching and things like that. Really, I would say most residents that I have ever worked with, they only become interested in the private practice setting, when they realize that being in a private practice setting really does allow them that autonomy over the treatment plans with their patients, as well as more control over their schedule.
[05:28] And I would just add to that, that the physicians in an employed setting, whether they're in a health system or an academic setting, they don't have much exposure to the business or operational side of medicine, because it's all handled for them. So that's something that they aren't exposed to until or unless they enter a private practice. So that, you know, when they're considering private practice, that might be a little daunting for them, right?
Kwiatkowski: [05:58] Yeah, absolutely. I mean, they don't know what they don't know, as the saying goes. To that note, how can residents dip their toes into private practice? You know, where should they start, or where should they look to get exposure to this model?
Johnson: [06:13] I think a good place to start would be networking. So they can reach out to physicians at their academic center to find out if there are any shadowing opportunities at private practices in the specialty that they would like to go into in their community. So it may not be that specific physician that they're initially reaching out to that they would shadow, but that physician most likely has connections in the community that they could leverage. And there are also several great resources online that outline the private practice model. So researching the model, by listening to interviews or reading articles, will really give residents a foundation to understand private practice. So even before they go in to shadow those physicians, they can look at some of these resources online and decide if they even want to go shadow. You know, they may, maybe they look at one of these resources, and they decide, you know, that's really not for me.
Kwiatkowski: [07:19] So before accepting your current position with the American Medical Association, you managed and helped open a private practice with a physician in your community from the ground up. You were talking a little bit about resources, and I'd love for you to sort of touch on where you found helpful resources. Also, can you talk about some of the key challenges that you experienced in setting up and running that practice along the way? And also, how did you overcome them? And why is it important for residents to sort of understand and have a grasp on this information?
Johnson: [07:56] Yeah, so I think I mentioned this in a previous episode, but the biggest challenge that I faced when the practice first opened was navigating the different insurance payers. This was a new practice. So we had to credential the practice and the physicians at the same time. We have a resource that we just put out, the Private Practice Playbook, and that really kind of walks through the credentialing process. If any residents want to know what that is, we'll link that in the description. But the practice itself has to be credentialed with the insurances, and then the physicians have to be credentialed with the insurances. And so if you are only credentialed one or the other, most likely your claims are going to be denied. So insurance credentialing was one of the most important pieces in practice operations, because almost all of our patients were insured. So we had very little self-pay, and we were not a direct payer or a concierge practice. So if we didn't complete each step in the credentialing process correctly, it would have been financially detrimental to the practice because the physicians would not have been paid for their services.
[07:56] So I opened the practice with one physician that was the sole owner and then about a year into it, we just got so busy that we had to add another physician. And so now this physician was not a resident they were practicing at another office prior to joining our practice, but the credentialing process was still very much the same as if they were a new brand new physician straight out of residency because we had to credential them on all of our specific insurance plans. Which the practice that they were at previously, they did not credential them with the insurances that we used. You know, before you can even start seeing patients after you're hired into a new practice, you need to make sure that all of your credentialing is in order so that you are paid for your services. You have to have patience when you're dealing with the insurance companies. The AMA has a lot of great resources for physicians with little exposure to insurances or other administrative topics when you're being onboarded into a new practice, and we will link those in the description below. But there is a series on transitioning practice. The residents section at the AMA has great resources on transitioning out of residency, and navigating all of those different things to becoming a physician in practice.
[10:47] What are recommendations that you have for residents who may have decided to go into private practice? Specifically, can you list some of the key skills needed to succeed in this model?
Kwiatkowski: [11:03] Yeah, of course. So I would say first off, you want to start off by evaluating yourself. I mean, you may have decided that you would like to go into private practice, but I think, you know, the self-reflection here is, is key. Are you a self starter? Are you self-motivated? Are you determined, efficient? All these things are particularly important when starting your own private practice. But that being said, if you are interested in joining a private practice maybe to start your career, you're not quite ready to build your own practice from the ground up, you can look to find a medical group to join. The group will be established, they'll offer support around the business side of medicine, and it will be a place that you can learn, grow, and you can ask questions that will help you then potentially in the future, start your own private practice.
[11:57] And then finally, I would say it's really important that a resident who is anticipating either starting their own private practice from the get go or joining an established practice, they really want to be sure that they know what it takes to run a business. Practicing medicine is only half of the workflow when you own a practice or work in a practice, and so that is a really key piece of practice. The name of this podcast series is Attending to Business, and we…that's really what we're focusing on here is the business side of medicine. That is the last piece of advice that I would give to residents who are interested in private practice for sure.
Johnson: [12:42] I think those last two things that you said are crucial. If you've evaluated yourself, and you're still a little bit uneasy about running it alone, that's a great idea to you know, maybe join a medical group and kind of dip your toes in to get some help and answer some questions and really see what it's like to be practicing in a private practice and not just shadowing. And then, you know, that gives you the opportunity to sit down and look at the business side and make sure that that's something that you think you could do if it was your own private practice. So Meghan, do you have any final thoughts or comments that you'd like to share with the listeners today?
Kwiatkowski: [13:30] Yeah, I mean, I think when you're considering entering into private practice, it can seem daunting. But there are so many resources out there from physician organizations like the American Medical Association and others, to help residents succeed on this path if that is truly what you decide you want to do. So just don't be scared—jump in and there are places that will help you, people that will help you, and the best way to start is to begin the journey.
Johnson: [14:01] Well said, I could not agree more. The tools and resources mentioned in today's episode are linked in the podcast description and available on the AMA website. CME is also available for this episode on the AMA's Ed Hub, and linked in the podcast description. I'm Taylor Johnson and this has been Private Practice: Attending to Business. Thank you for listening.
AMA STEPS Forward® Series Announcement: [14:24] Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA's STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, STEPSForward.org.
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