As a second-year attending, I’m still building my patient base, that’s why when I had the opportunity to take over a retiring doctor’s practice, I jumped at the chance. It’s a family medicine office, and the doctor had been practicing for the past 40 years. Although this seems like a very appealing opportunity, I learned there are caveats. I share these insights for those who may have similar opportunities.
First, do not believe everything you hear. The recruiter for the hospital told me that the previous doctor was seeing 25-30 patients a day. When asked about the other doctors in the office, I was told they were all established and that their schedules were all full. This was not the case. In retrospect, I recommend that you don’t take the recruiter’s word. A better approach is to talk to the physicians, look at their schedules and, if you’re able, spend some time at the clinic to see what you’d be getting yourself into.
This leads me to my next point. Patients are not aligned to a certain office, they are aligned to their doctor. In my case, many patients sought greener pastures at different clinics after their doctor retired. Other patients started seeing the other physicians in my office. In my current scenario, most of my patients are new patients who have never had a doctor or who are leaving a different clinic.
Third, there will be a significant adjustment for the patients seeing a new doctor. Patients are used to a certain level of care. Many of the returning patients were only coming for their yearly physicals and expecting refills even when they weren’t seen for eight or nine months. It takes time to help these patients understand your style of practice. Guidelines and medicines have likely changed compared to a retiring doctor’s heyday. In my case, during a physical, the previous doctor would order chest X-rays, EKGs, blood work, and urine on all his patients. Today, however, without medical necessity, a lot of these tests are not covered by insurance.
Fourth, in most cases you will be practicing in the shadow of the previous doctor. Several times a day, someone tells me that I have big shoes to fill. It can be intimidating. However, during most new doctor-patient encounters, living up to an imaginary bar will allow you to make the best first impression to ensure that the patient stays under your care. This is your opportunity to prove to them that you are worthy and capable of treating them, their family, and their friends.
Fifth, be cautious of how the previous doctor practiced medicine. Especially in family medicine, many older doctors were more independent, rarely referring for things like pain management. You may be walking into a clinic where many of the patients are on controlled medications. With the current climate of medicine, this would not be an ideal situation. You may end up prescribing medication regimens that you know are not comfortable or losing patients that don’t want to change.
Finally, if you are taking over a private doctor’s practice, you may have to buy the practice, which would entail getting a loan unless you have thousands of dollars lying around.
On the flip-side, what are your alternatives? If you join a group or clinic, you will likely be starting from scratch. If the practice is busy enough, you could be busy from the start. However, in most cases, building your practice takes a good amount of time. It can feel very slow. Today, most contracts are based on production (you eat what you kill) after a few years which is not a lot of time if you’re starting from scratch.
Overall, life after residency isn’t all rain clouds and thunder. No matter what practice you walk into, there will be a huge learning curve. You will learn more the first year after residency than your whole residency training combined. You will start making real money and you will benefit from all the years of school and training. I have learned a lot from seeing how the previous doctor practiced and it has made me a better doctor overall.