What young physicians need to know

From negotiating their first contract to considering alternative career paths, six physician leaders joined Becker's to discuss what advice they would give to new physicians:

Question: What's something that all young physicians need to know?

Editor's note: These answers were edited lightly for brevity and clarity.  

Stephen Almond, MD. Pediatric and Transplant Surgeon with Children's Physician Services of South Texas (Corpus Christi): Young physicians need to know the ins and outs of contracting. They need to know and understand debt, financing and money management. Finally, young physicians do not know how to do billing and coding. 

Frank Hromas, MD. General Family Medicine Physician in Amarillo, Texas: Physicians are honored by their patients with the title of "doctor." The honor is not granted based on credentials. It must be earned every single day.

Matt Mazurek, MD. Assistant Clinical Professor of Anesthesiology at St. Raphael's Campus of Yale New Haven (Conn.) Hospital: Being a physician has never been easy, and it is a fantastic career with built-in purpose and meaning. Young physicians are entering practice in a volatile and uncertain climate with a lot of potential for continued disruption and are entering a new era, too, as employees. It's important to know one's value in this environment and also know all of the details of an employment contract. If there are details discussed in the interview regarding compensation, call schedules, etc., it is critical to ask that these expectations are included in the contract. It's a mistake to believe verbal promises will be honored. Also, many physicians today leave their first job after residency within three to five years, so having an exit strategy from the beginning is important. This includes building up a cash reserve, waiting to purchase a home, etc. Remember, too, this is a marathon, not a sprint, so take care of yourself.

Harry Severance, MD. Adjunct Assistant Professor at Duke University School of Medicine (Durham, N.C.): One critical element, beyond clinical knowledge, that young physicians should now know and become involved in is the economic/political side of healthcare —  evolving economic business conditions and political decision-making realities driving healthcare and how these will affect the future of healthcare platforms and thus their careers. 

This is critical information whether one plans on becoming an employed physician, desires to open/manage their own private practice or envisions a role in physician leadership. Most physicians, for too long, have abrogated the business and political side of healthcare to others – trusting that these others would do the right thing for patients and the healthcare system — (I'll just see the patients and you manage the shop). This abrogation has led to marginalization of physicians as healthcare decision-makers and leaders, while significantly contributing to disintegrating conditions within healthcare workplaces, leading to worsening patient outcomes, increasing worker departures from healthcare as well as other cascading workplace problems. 

Also, during this time we have seen an exponential explosion in the number of healthcare administrators/managers. These increasingly large cliques of manager/administrators now more frequently view physicians as an oppositional force. We have seen accelerating consolidations within healthcare systems, with many hospitals and healthcare facilities now part of megasystems dominated by corporate or private equity interests, who have increasingly imported senior decision-makers and managing board members from other successful non-medical business sectors. But, said leader-imports increasingly have no clinical background. As physicians have abrogated their roles in business leadership positions, these boards now have little to no input from practicing clinicians and do not seek such input. Healthcare is increasingly being run as a business for business's sake, with profit as a sentinel driving force. 

Thus, young physicians, if they want to experience an enjoyable and long/prosperous healthcare work career, must become familiar with the economic and political realities of the healthcare workplace, inculcate that knowledge base into their practicing skill set, and actively strive to improve these conditions — no longer abrogating these issues to others!

Mark Soberman, MD. Senior Safety Officer at Ethicon Global Surgery (Raritan, N.J.): There are multiple career paths in medicine. Of course, you can be a clinician, researcher or teacher. But you can also use your medical knowledge (perhaps after some additional education) to go into pharma/med tech, hospital or healthcare administration or even finance/investment banking. Don't underestimate the value of your medical degree or limit your options.

Edwin Smolevitz, MD. Former Internal Medicine Physician in Lincolnwood, Ill.: I would encourage young physicians to pay attention to the business of medicine. Not necessarily to make a better income but to understand insurance issues/deductibles/costs to patients. I would also encourage them to develop their skills in active listening. (Good for patients.) I think private equity is becoming more involved in many areas. In general I view this as good for the investors, usually good for more senior doctors, and often more costly to patients and insurers.

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