Melissa Young, MD: In house or not, that is the question

As an endocrinologist, I do fingerstick blood glucose readings in the office. I use the same glucometer a patient might use at home, courtesy of one of the companies that leaves me sample meters and strips. I charge for the service, and am paid anywhere from nothing to about $10. Not a substantial amount, won’t change my bank account by much, and I’d probably do it even if wasn’t reimbursed since it takes a couple of seconds and it doesn’t cost me anything.

Enter medical supply company reps hawking their Hba1c machines. They are fairly easy to use, they don’t take up a lot of staff or physician time, and allegedly they are decently reimbursed by most albeit not all payers. The machine is free, but the consumables are not. So after expenses, net reimbursement is about $5.

So the question is, is it worth it?
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Yes, I need the Hba1c in my clinical decision making, and yes, having the result in front of me while the patient is in the exam room sure beats calling them back with lab results. But I have a pretty good system in place, and although it doesn’t always work, the majority of the time, it does.

I have patients get their labs done before their visit. Like I said, not all of them do (“Really? Was I supposed to go to the lab?”, “Oh, yeah, I think you did tell me that.”), but most of them do. Besides, I have them get other labs, too – lipids, met panels, urine microalbumins – so if they come without an a1c I’d need to call them with their other labs anyway.

The rep’s argument was that I could order all those other labs to be done prior to the appointments, but plan on doing the Hba1c in the office, as an income generator. Really? For $5 a pop?

And just when he was beginning to sway me, he brought up other tests I could do, now or in the future. It started to feel too much like “business” than service, and that me uneasy.

In the end, I figured I’d give it a shot on a trial basis. I’ll have to see a) what it does to our work flow, b) whether or not it will actually get reimbursed as he claims, and c) how my patients feel about it.

Melissa Young, MD: The weather has been frightful

My practice is in New Jersey, basically central New Jersey, although people who live closer to New York consider us South Jersey, and people who live closer to Atlantic City think we’re North Jersey. We are also fairly close to the shore. This generally makes for a mild winter with one, maybe two, snowfalls that result in an accumulation of a couple of inches. And winters have gone by when I would wonder whether my children would ever experience the joys of building a snowman or sledding down a hill.

Well, I wonder no more. We have had more snow this winter than we have had in years. Oh, we had a worse storm a few years ago, but that was it for entire winter. This year, although the storms have not been particularly bad individually, they just keep coming, and putting new snow on top of old snow.

Now, why am I writing about the weather in a Physicians Practice blog? Because these storms come in the middle of workweeks. On days when the office schedule is full. Prior to the last storm, a couple of patients called the day before to cancel. The weatherman said the snow would start in the morning but it wouldn’t be bad until the afternoon, so I said we’d stay open for the morning and close early.
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But the snow started that night, and as I looked at the accumulation starting, I decided to cancel the morning appointments, too. I didn’t want patients or my staff driving through the snow or slipping on our walkways. I was unfortunately not able to get hold of everyone, so I went in just in case people would come.

One patient came. An 85-year-old woman brought in by her 60-or-so-year-old daughter. The daughter had knocked on the rear door, generally reserved for employees only, because they had parked right outside it. When I opened the door, she went back to the car to get the patient. I cringed as I watched her slowly make her way over, carefully stepping over mounds of snow. Mind you, I had actually spoken to the daughter earlier that day, and tried desperately to discourage her from coming, but apparently this was the only day she could bring her. When I was done with her visit, I walked them to the back door again, and held my breath as they walked to the car. I stood outside the door in my white coat until I could see she was safely seated inside the car.

The day after the storm, more people cancelled, either because they hadn’t been plowed out yet, they had no one to watch the kids who had a snow day, or they were just afraid of driving through what was left of the snow on the roads.

So two days of lost productivity. Tolerable, I suppose. But guess what? We just had another storm. I think this time people have just said, “whatever,” and decided life must go on, because aside from one 85-year-old woman, everybody else showed up yesterday, and she only cancelled because her ride cancelled on her.

Now granted, yesterday the roads were passable and the parking lots plowed. Not so today. One patient had already called yesterday to cancel, and another called early this morning. So I head to the office, and I guess I was the only one insane enough to do so because the parking lot was empty. Which was just as well because it wasn’t plowed. Nor were the walkways shoveled. And quite honestly, the town had done a pretty bad job at plowing our road. So I text my staff and tell them not to come in, and I get on the phone to start canceling patients. They all said they were about to call and cancel anyway.

So aside from yet another lost day of productivity, I am also faced with the problem of where to reschedule all these people. I didn’t want to push them out a month, so I ended up squeezing them in next week during times I generally go to the hospital to do rounds or at the end of my “short day.”

So what do you do when Mother Nature doesn’t cooperate?

Melissa Young, MD: The second physician

I was talking a couple of weeks ago to an internist. She had been in solo practice for a couple of years, and then she hired a former co-resident as a second physician. He left the practice after less than two years, and she has since hired a second “second physician.” I told her that I am currently in the process of finding someone for my practice.

During the course of the conversation, I couldn’t help but think back to when I was first hired at my old practice. When I was the second person. It’s a tough transition — for the new person, for the senior partner, for the staff, and for the patients. Even for new patients.

I still remember the sting of being told by patients that they had really wanted an appointment with Dr. Senior, but they couldn’t get in to see him soon enough, so they got me instead. Ouch. Well, most of them decided I wasn’t so bad after all, and actually were glad to see me in follow-up, or at least weren’t upset that they weren’t seeing their first choice.
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Well, what could I expect? My senior partner had been in practice in the community for over 12 years when I came around. All the local docs knew him. They spoke very highly of him to their patients. Who was this newcomer? Is she any good? It took years before I was recognized as my own person, someone worthy of sending patients to, someone to refer family to.

The staff had done things the same way for years. My partner’s way. He was the boss. He set the tone of the office. Sure, there were things I did my way, but it was often met with resistance. “Are you sure? Dr. Senior doesn’t do it that way.” And when we hired a third partner, he was met with the same reluctance to change things. “This is the way we do things around here; it’s how we’ve always done it.”

So when I bring a new physician on board, I plan to have new patients scheduled with her. I’m sure many of them will have been referred to me by their PCP’s, or that they will have heard about me from family and friends. Will they give my staff a hard time about scheduled with “the new doctor?” To make matters worse, she’ll be straight out of fellowship, just like I was.

I’m sure she’ll have her own unique way of doing things. Will my staff be flexible enough to handle it? Will I? Will she?

I hope for her sake that the transition will be minimally painful. I’d hate to have to look for a second “second” and start yet another transition.

Trendspotter: Where Hospitalist Communications Fall Short

By Ken Terry


One of the persistent problems in our healthcare system is the communication gap between inpatient and outpatient care. The increasing use of electronic health records hasn’t really resolved this problem, because, unless ambulatory-care physicians are using the same EHR that their hospital is, comprehensive information about a patient’s inpatient care is still hard to obtain in a timely manner. Discharge summaries are supposed to contain this data, but they often arrive too late to be helpful; and even if a primary-care doctor receives this document soon after a patient’s discharge, it may be missing key information.

A recent study in the Journal of General Internal Medicine found that tests pending at discharge were mentioned in only a quarter of discharge summaries and that only 13 percent of the summaries stated what those tests were. “We already know that outpatient providers aren’t very good at following up on pending tests documented in the discharge summary,” commented Dr. Martin Were of the Regenstrief Institute, the study’s author, in an article about the study’s findings. “Imagine how much worse the follow-up is when pending tests aren’t even documented.” Were added that the growing use of hospitalists and the tendency to discharge sick patients faster make the situation even more alarming.

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The discontinuity of care between hospitalists and outpatient physicians has been mentioned in a number of studies. Internist Robert Wachter of the University of California San Francisco, one of the hospital movement’s leaders, told me a few years ago that good hospitalists believe it is essential to contact referring doctors when one of their patients is discharged. “They ‘get’ that sending the patient back to the primary-care physician without the right information and without a phone call is a bad thing to do, both for the patient and in terms of the program’s credibility,” he said. But he admitted that some hospitalists in some programs are not very good about calling outpatient physicians; they might have a nurse or house doctor do it.

Even if the hospitalist does call the primary care doctor, he or she might not mention a pending test. The hospitalist might think it’s more important to focus on the most relevant issues in a brief call. There are also reasons why pending tests might not be documented in a discharge summary, Were points out. For example, multiple consultants order tests at different stages during a hospitalization. To find out which were pending, the hospitalist might have to pull information from several different hospital systems. Of course, that would not be the case in a hospital with a computerized physician order entry system—but only about 15 percent of hospitals have CPOE.

Even if hospitalists are aware of all pending tests, Were notes, they must distinguish between which are important enough to include in a discharge summary. Outpatient physicians will be annoyed if they are prompted to follow up unnecessarily on tests such as kidney function or CBC tests if the results had been normal throughout a patient’s hospitalization.

Another major issue is confusion over who has responsibility for following up on pending tests in the hospital, Were notes. Even if a primary-care physician knows about a pending test, he or she may feel that the inpatient physician should follow up. Hospitalists, on the other hand, may believe that, after a patient is discharged, the outpatient physician is responsible for all aspects of that patient’s care. But if a pending test is not documented, Were believes, it should be the responsibility of the hospitalist to follow up on it.

Blogger Kevin Pho observes, “Some hospitals have post-discharge clinics where hospitalists do the follow-up themselves, but that’s not commonplace. We clearly have a ways to go in bridging the communication gap between hospitalist and outpatient physician.”

This is an area that deserves much more attention, especially given the shockingly high readmission rate of Medicare patients. Part of the solution is to give hospitalists better tools and incentives for communicating all key inpatient data to primary care physicians, whether on the phone or in the discharge summary. In addition, as we build electronic health record systems in hospitals and physician offices, national health IT policy should prioritize the creation of electronic connectivity between inpatient and outpatient care settings.

Podcast: Michael Howe, former CEO, CVS MinuteClinic

What can you learn about your practice from the retail industry? It's a question I recently discussed with Michael Howe, former CEO of CVS MinuteClinic, which has in many ways redefined the care-delivery model.

For our February podcast, Mr. Howe chatted about how he thinks care delivery will continue to evolve, how different generations have different expectations of their physicians, and what physicians can learn from other industries outside of healthcare.

Listen to the podcast here, and join the conversation below.

Melissa Young, MD: Getting ready for doctor No. 2

I verbally offered a position to another physician. She has verbally accepted. Now to formalize the agreement.

By the way, she called me the other day because her husband is in a panic that she is declining other offers without having seen a contract from me. Let me say here, that I know this person. I’ve known her for the last five years. We joke that I have taught her everything she knows. I know her family. I visited her in the hospital when she had a baby. We have visited each other’s houses. She is confident that I will not bail on her or be unfair.

So I spent some time this past week preparing a skeleton contract.
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I spent an hour or so with a lawyer discussing other contract stipulations. Aside from the obvious salary, benefits, and vacation time, there was discussion about termination – with or without cause – ownership of records, revenue other than that from patient care, etc. Points I really had not given a lot of thought to. It did seem rather boilerplate, and sounded familiar, having had a similar contract when I was an employed physician.

I want to be fair to her. But I also want to be a smart businessperson. How much can I spend on her as far as CME? How much PTO can I really afford for her to have? How much am I willing to share of what comes in, and how much should she contribute to the practice? What counts as expenses directly related to her employment?

I’m not sure if it would have made a difference if I were hiring a stranger. Would I be less generous? Or would I be worried that the other person would balk at my proposal, and therefore would I be more lenient, say with the restrictive covenant?

The lawyer was quite helpful, going down a checklist, telling me if I seem overly nice or too stringent. She will have the written contract to me in a couple of days, and after I review it, and amend it if needed, I will send it off to my potential future partner. Will she have a lawyer review it? I don’t know. I know every advice column says you should. I have yet to meet a doc who has. Will she just sign on the dotted line, or will we go back and forth with changes?

I also had a conversation today with a solo doc who is now on her second “second physician.” That transition from solo to group is tough, not just on the senior partner, but also on the patients and the staff.

I remember being that second doc. More on that next week.

New Tip of the Week on Career Development

For our next round of Tips of the Week, we have contributions from Michelle Mudge-Riley, a doctor who now consults for physicians about developing their careers or transitioning into nonclinical jobs.

We first heard from Michelle in 2006 with her series for the journal called "The Ex-Doctor's Diary." Check out a few of her essays here, here, here, here, and here.

I also spoke with her for a podcast, where we discussed some of the chief complaints from practicing physicians and ways to find new ways to practice that will enhance their life and career.

Look for more tips from Michelle this month and join the conversation in the comments here.

Red Flags rule update

The House unanimously passed a bill last week that would exempt small practices from the FTC’s new Red Flags identity theft rule, which goes into effect Nov. 1, HealthLeaders Media reports.
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Practices (and other entities) with 20 or fewer employees would not be covered under the requirement, which requires entities considered creditors — pretty much most medical practices — to develop policies for preventing, identifying and responding to identity theft.

Now the bill moves to the Senate.

The bill also exempts an entity that knows all of its customers individually, only performs services in or around the customers’ homes, or has not experienced incidents of identity theft and identity theft is rare for businesses of that type. It’s up to the FTC to determine what entity meets that requirement.

Considering that enforcement of the rule has been pushed back a few times, most recently from Aug. 1 to Nov. 1, and the deadline is just days away, chances are your practice has already developed a Red Flags policy. A show of hands in an audience during the MGMA annual conference earlier this month revealed a vast majority of practices there already had plans in place.

Surely that isn’t a wasted effort, as protecting patients from identity theft is good business. But perhaps the smaller practices may be able to breathe a little easier (particularly those still scrambling to get a policy in place) if the exemption passes.

MD plus MBA

You know those days when you feel like you need a business degree to run your practice?

You’re not alone, and in fact, more physicians are pursuing post-graduate business degrees, according to a new report from Cejka Search and the American College of Physician Executives.
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One-third of physician executives have an advanced business degree — an MBA, master’s of medical management, master’s of public health, or master’s of health administration.

Most of the physician execs have an MBA and are filling the roles of medical director, chief medical officers, division chiefs, and department chairs.

Cejka Search officials say physicians are getting more education to advance their careers, and that it’s a requirement for those positions. Rather than rely on experience alone to learn these business skills, many physicians are learning practice management in the classroom. Physician executives in those management positions with advanced degrees also earn more than those without (11 percent more with an MBA, for example).

As we’ve noted before in coverage on docs getting MBAs, the extra time and money for school isn’t for everyone. You have to decide why you need an advanced degree. Although the day to day running of your practice may feel like it requires the degree, it’s clearly more suited for those considering a career in healthcare leadership.

Melissa Young, MD: Solo doesn't mean all by myself

I am going to take a break from talking about my EMR choice for now to talk about something I learned along the way about solo practice. See, I had resigned myself to the idea that from now on, it would be all me, all the time. That I would have to plan all the little details of every little thing that went into the practice.

And I supposed I could continue to think that and to act that way. Or I could accept the fact that there are people and organizations that can make things a little easier, or at least a little less expensive.

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For example, I had created and budgeted for a marketing plan. Now, first of all, a mentor from SCORE (an organization of retired business people who counsel entrepreneurs) questioned my need to advertise since most of my patients would come from referrals. And I later realized that the local hospital I was applying for privileges at would be more than happy to arrange ways for me to network. And the physicians who found out that I was coming were eager to ask for and hand out my cards.

I also had planned on coming up with patient education material, completely forgetting that while drug companies cannot spare me a pen or sticky note, they can provide me with ample copies of educational pamphlets, books, and Web sites.

I have found that the hospital has an excellent diabetes education center, so I don’t have to personally teach the patients how to use a glucometer or how to inject insulin (although I will probably continue to show them the basics).

At my old practice, my staff scheduled patients’ radiology tests. I was worried that I would be spending time on this task, but when I called the hospital to find out who the contact person was, I also found out that all I had to do was fax a request with a note saying, “Please contact patient with schedule.”

And thankfully, I have an administrative assistant who is bright and able to work independently. Even when I was still a fellow, I was told that your staff can make you or break you. The office has only been open for two weeks (she’s actually been around for four weeks, helping me get things ready), but she has been able to handle the unexpected tasks that come with starting up a practice.

And lastly, I am blessed with a very supportive husband who has helped with everything from billing to hanging diplomas.

I suppose I could do it all if I had to. And I really thought I did. But now I realize that I don’t have to do it all. Sure, I am still physician/employer/janitor/manager, not to mention wife/mother/friend/daughter/sister. But help is out there — and even better, sometimes it’s free.

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.

Melissa Young, MD: The Search for the Perfect EMR, Part 3

The search is over.

Well, sort of. I mean, I’m done searching. But perfect? No. I wouldn’t say that. There are days I have plenty else to say (none of which can be published uncensored), but perfect? No.

Don’t get me wrong. I still think that among the different EMRs I looked at, I made the right choice with e-MDs. It was right for my budget — I wasn’t going to “settle” for one just because it was cheap (or free even) if it didn’t have the features I wanted, but I also didn’t have unlimited funds. (I did have other start-up expenses, you know, like exam tables and a new bathroom and such.) It had a decent number of endocrine templates, although I still made a lot of my own. It was fairly easy to make these templates, although there was a lot of trial and error. And my VAR has been pretty responsive to my cries for help (I’ve even got their cell phone numbers).

But perfect it is not.
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Going back to the templates — yes, easy enough to create, if you know what questions you usually ask, and what answers you expect, and just how you want that to look when it’s printed as a sentence. But it takes time. Time that most practicing physicians don’t have. I had the luxury of starting to create these while I was on “vacation” from my prior practice. And there are nuances you don’t expect until you try to create a note. Little things like where the period goes, and what conjunction to use, and do you let the user type in the answer or is it all multiple choice.

I have also discovered that a lot of labs and tests I order aren’t on existing templates, so I’ve had to add those on, too. I guess that’s the problem with being a specialist in a field where there are so few of us. I guess nobody else who seriously uses the system has bothered to add these things before.

And there are things you don’t discover until you’ve gone live with patients. Like there’s no good way to quickly enter the dozen of supplements they take when the patient brings a list of brand names but has no idea what the active ingredients are.

And there have been technical bumps in the road, too. I think I have to put my VAR’s tech support on speed dial. They usually address my issues quickly, and they do a lot remotely. I hate calling for help, but I know my limits. I’m a decent end user of technology, but I am not a tech person. So hallelujah for remote access.

Before you think that all I have are complaints, let me make this disclaimer: I am very critical of things. I think all doctors are, or should be. We are taught to look for what is wrong with things.

I believe in my EMR. I believe that once I have worked out the bugs that it will make my staff and me more efficient. It will certainly save me space that would be taken up by paper files. It saves my secretary from pulling a chart to put a lab result in it or to give to me if a patient calls with a question. From the comfort of her desk, she can put the patient on hold, call over her shoulder, “John wants to know if you said increase his basal rate to 1.0.” And I, in the middle of reviewing someone else’s labs (that have automatically been faxed into the EMR), can pull up my note on John and tell her to say, “Yes, that is precisely what I said.”

I hope to save on paper — both making me green and saving me green. No more printed faxes. No more cover sheets. No more print outs of lab results that just say “pending.” It will remind me, when I am overworked and the patients merge into one giant faceless patient, that it is time for Mrs. Smith’s DXA, that Bob needs a flu shot, and that Mr. Doe owes the practice $50 in no-show fees. (Hmm, perhaps a topic for another post.)

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.

Are you getting a flu shot?

Do you plan to get the flu shot? How about the H1N1 vaccine?

Considering the hype around getting the vaccine distributed and readying your practice for the flu onslaught, it surprised me that most health care workers likely won’t be getting vaccinated themselves.

So should it mandatory?
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Historically only 40 percent of healthcare workers get vaccinated from the seasonal flu. Why? Perhaps it’s many of the same reasons the general public hesitates. Maybe they are skeptical the vaccine will work, or they are convinced they won’t get sick.

Now, many hospitals and healthcare organizations are mandating the flu vaccine. New York State is requiring it, and large hospital chains like the Hospital Corp. of America, MedStar Health, and the UC Davis Health System are mandating it, according to NPR. Here's a pretty strongly-worded opinion in favor of mandatory vaccinations for healthcare workers.

Opponents of the requirement say it’s infringing on their rights.

But what is the hesitation? Wouldn’t it make sense to keep yourself flu-free and avoid spreading it to patients? Should it be required?

And are you planning on getting the flu shot? Why or why not?

Are you happy being a doctor?

Are you happy with your job?

It’s one of the questions we posed to physicians in a recent survey in which we tried to get a handle on just who is the modern American physician. It turns out, for the most part, you are pretty content — even considering the headaches of long hours and declining reimbursements, for starters.
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We found that more than 80 percent of respondents agree or strongly agree with the statement that they like being a physician. Nearly half of you reported being “happier and better adjusted than most people.” When asked to rate happiness on a scale of 1 to 10, 78 percent of you ranked yourselves at seven or above.

Similarly, a survey by the think tank Center for Studying Health System Change, found that 39 percent of docs were “very satisfied” with their careers and 43 percent said “somewhat satisfied.” Hey that’s not so bad given the current state of affairs.

To be clear, frustrations abound. I am working on a story for the November issue based on our annual Physician Compensation Survey. Perhaps not surprisingly, many physicians are struggling with flat or declining practice income and looking for ways to bring in more money. (More on that soon.)

But it seems that the overall satisfaction level often gets overshadowed as the country slogs through the healthcare reform debate, and physicians scramble to keep up with new regulations, all while trying to keep the practice humming. It can be easy to forget why you got into medicine in the first place. Yet, when asked to reflect, you all are a fairly happy bunch.

A wealth of fascinating information emerged from our Great American Physician survey. Read the full story on the survey, and check out October’s The List column where we compiled 10 things doctors want to tell their families. (One example of a statement to a spouse: “I will be late today. I have to finish some paperwork.”)

Melissa Young, MD: A medical waste permit?

So as I said in my previous post, I probably know more about running a practice than most physicians I know. I have read books about starting a new business and starting a new practice. I read about personnel management, financial risk management and marketing. I learned about captives, the accrual method and HCPCS. I talked to physician friends. I read blogs. I asked questions on physician bulletin boards. I scoured the Web.

And yet, I still found surprises along the way. One week, I started asking fellow MDs who they used for medical waste pick-up. A couple of docs gave me the names of the companies they use. Two had me ask their office managers. But it was the administrative assistant of one of them who asked me if I had applied for my waste permit.

My what?!?!
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This wasn’t in the books! This wasn’t in the four dozen articles I had read. And no one else had mentioned this before. I figured she must be wrong. If I needed this permit, surely someone else would have mentioned this along the way. So I asked my doctor friends. None of them had any idea what I was talking about. They were going to “check with the office.” Turns out, yes, I do need a medical waste generator permit. And yes, I do need to pay the government for the privilege of generating said waste.

Just like I have to pay for the privilege to perform a waived test. I had always figured that when you say something is a CLIA waived test that you didn’t need to apply for anything. But, nooooo…You need to apply for a waiver. And they don’t even tell you ahead of time how much you have to pay. You need to tell them what test you plan to do and how often, then they tell you what the fee is. This is another tidbit of information I discovered on my own.

What other little surprises await? I guess we’ll find out.

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.

Melissa Young, MD: Why I'm going solo

I am embarking on a new adventure. Or what some are describing as a suicide mission. You see, for the last eight years, I have been an employed physician at a community hospital that is an affiliate of a major university hospital, and I am going into solo private practice. No, there was no major falling out, no catastrophe, nothing obvious that set this into motion. Why then, you may ask (everyone else has), am I leaving the security of employment for the uncertainty of a new practice?

Is it the need for autonomy? Is it to be five minutes from my kids’ school instead of 25? Is it because I am tired of being pulled in three directions every day? Is it temporary insanity? It is probably a combination of all of these, as well as some other annoyances I’d like to avoid and some dreams I’d like to pursue.
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Being employed definitely has its advantages. For the last eight years I have enjoyed a decent salary, good benefits, paid vacation time, and conference time. I have not known nor cared to know how much it costs to keep a roof over my head, a secretary at the desk, or paper in the copier. As part of a faculty practice, I was surrounded by peers I could bounce ideas off, curbside about patients, and complain to about the administration ( uh, I’m talking about the government, I would never complain about the hospital administration). Teaching residents and students kept my mind fresh, and I had ample opportunity to receive CME credits.

So why, oh why, am I leaving? Part of it is purely personal. My new office will be closer to home and closer to my kids’ school. And part of it is because I think it’s time for me to start calling the shots. I want to be able to choose what EHR I want to use (a subject for another post), to fire a staff member I think is incompetent, inconsiderate to patients, or just downright freaky, and to have hours during lunch or after five so that patients who work can come in. And also because, while I wanted to do a little bit of everything when I started, over the years I have been asked (a little more adamantly each time) to 1) see more patients, 2) set aside more dedicated time for teaching, 3) and commit to doing research. And while multitasking is one of those talents every doc must have to some degree, there are only so many hours in a day.

It was not an easy decision. It took more than two years of research and soul-searching. I read books, blogs, and e-newsletters. I attended practice management conferences, webinars and telephone conferences. I talked to family and friends in and outside of medicine. And while I am somewhere between excited and terrified, I think I probably know more about running a practice than most docs I know.

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.

Life after clinical practice?

Have you ever considered a career outside of clinical practice? Ever wondered what kinds of jobs are out there for doctors wanting to leave medicine?

That’s the topic of this month’s podcast.
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I spoke with Michelle Mudge-Riley, a doctor who now works as director of wellness and medical management at a brokerage firm. She is also a consultant for physicians looking to enhance their careers or transition out of medicine and into other jobs.

She wrote a series of essays on her experiences for Physicians Practice in 2006 called the Ex-Doctor’s Diary. The five stories explored job satisfaction, knowing what you don’t know, embracing uncertainty, lessons in leadership, and whether physicians who leave medicine are still physicians.

Listen to our conversation and join the discussion below.