I graduated from residency in Boston last year and eagerly anticipated starting life in private practice in the greater Chicagoland suburbs. After years of education, training and constantly being on the move, at times living out of a suitcase, it was time to finally settle down and begin my career. The transition to private practice life was a welcome breath of fresh air away from the rigors and demands of residency. Things seemed to be going well. There was, of course, frustration with hospital credentialing and the length of time needed to onboard with insurance plans, but I was well aware of the prolonged nature of this process.
I can’t recall when I first started reading about the strange new virus originating from Wuhan, China, but it hit home for me when I heard the first reports of it in the United States emerged from the state of Washington. I’m originally from the Seattle suburbs and the thought of this scary virus being anywhere close to my family made me feel anxious and obviously worried. In fact, the nursing home with the first reported deaths from COVID-19 in the U.S is literally 10 minutes from where I grew up. Things started to progress more quickly than I think any of us imagined.
Once the shutdown became imminent in March, life in private practice changed quite drastically for me. Having been up and running for a little over seven months, I was still trying to establish myself in the community and develop a patient following. My patient load became almost non-existent as cancellations mounted and it was not entirely clear when things would normalize again. Although my practice remained open and took precautions in order to continue seeing patients, my schedule of patients did not improve. I began discussions with my employer about goals and the direction in which I wanted to take my career.
To make a long story short, I ultimately decided to resign and take my chances with unemployment in order to eventually find a more suitable practice that would fulfill my career goals. I prepared myself to be unemployed for a minimum of six months, if not longer. Who in their right mind would be hiring when so many people had already been furloughed and practices needed small business loans to keep afloat?
During the time leading up to my resignation, I quietly began reaching out to medical/sales reps to see if they knew anyone looking to hire an associate. Given that reps work with so many different doctors and hospital systems, I felt this was the logical thing to do. Perhaps I would get lucky even though my expectations were zero.
One Saturday morning, I awoke and saw a text message from one of my medical rep colleagues: “Are you available for a conference call this morning?” I wasn’t sure what this was about but I instantly replied, “Of course.” It turns out that his boss is close friends with a podiatrist who has one of the largest practices in Illinois. I spoke to his boss and explained my situation. He implored me to call his friend since he is always on the lookout for new doctors and is rapidly expanding his practice. (In fact, he bet me a steak dinner over the outcome.) Well, I made the phone call. One week later, I signed a contract to join that practice.
Now I am back at square one in a new practice. It amazes me that even though I was previously on insurance plans, the whole process has to start over. I am also convinced that a “credentialing abyss” exists. I don’t think there is anyone that can ever provide an estimate of when this process will be complete despite my staff being on top of the paperwork and helping me every step of the way.
Then there is getting onto hospital staff all over again. Due to prior contractual obligations, I had to rescind staff privileges at my hospitals and surgery centers upon my departure from the practice. The entire process takes months to do over again at new hospitals and the sheer volume of paperwork required is mind-boggling. Even different hospitals in the same health system require a separate, unique application.
Since beginning at my new practice, I have been fortunate to work with an outstanding marketing director. We speak multiple times a week and strategize ideas on how to market to patients, hospitals and health care providers. The concept of “boots on ground” implies going to various primary care/vascular/physical therapy offices directly. There I would introduce who I am and request a lunch conducted via Zoom with the provider(s) in order to discuss how we can mutually benefit and provide the best care possible to our patients. All of these ventures take enormous time and effort, but they are ultimately necessary in order to build a successful practice within a practice.
Sometimes I sit back for a moment and forget about the size of this practice. We have 15 doctors with nine offices and 50-plus employees. Then I think how lucky I am that I get to be part of this venture, and it was all because of a random text message one Saturday morning from a medical rep.
I think the lesson I would like to impart on others that may just be starting practice or who may be in a similar situation is to always try and make as many connections as possible. Whether it is a medical rep that wants to bring lunch to the office and discuss new products or getting invited to an educational dinner, take every opportunity you can and meet these people. Treat them well and listen to what they have to say. At the end of the day, you never know what life situation you will be in and just how helpful these wonderful people can be.
Dr. Khademi is an Associate of the American College of Foot and Ankle Surgeons and is in private practice in Downers Grove and Fox Lake, Illinois.