Reflections One Year Into Practice

By Kiran Dhillon, MD, CCFP

It’s amazing how quickly the first year in practice can fly by! Adjusting from residency to independent practice comes with a few challenges at the start, but just as with any life or career transition, a bit of time and experience will help you find your feet. Here are a few tips and suggestions that I’ve come up with after reflecting on my first twelve months in practice.

1. Start low and go slow.

Not just a useful slogan for titrating medication, but also a good mantra for your first few months of practice! When I started practice, I locumed for a month and then started accepting my own patients. From the beginning, I had a full day clinic every day with some hospitalist work, seniors home visits, and teaching roles on the side. I love every aspect of work that I did, but at times (for me at least, I know there are many doctors who juggle much more!) it was a bit too much altogether to do right at the start. Looking back, I wish I had started 3 or 4 days a week and then built up from there. It’s always easier to add in more work hours than to cut back. Starting slow and building up will allow you to figure out what the right work/life balance is for you.

2. Saying no means saying yes to something else.

When you’re starting out, there will be many opportunities that present themselves, and just try and remember that you don’t need to say yes to everything. In fact, think of saying no as saying yes to other important things in your life – family, working out, hobbies etc. It’s true that variety in your work can be helpful to prevent burnout and keep you interested and engaged, but it’s important to strike a good balance. Opportunities will always be coming up, and saying no to something now doesn’t mean you can’t say yes to it in the future after you’ve had a chance to settle in to staff life and the additional responsibilities that come with it.

3. Make time for paperwork.

… And make sure that time isn’t in the evenings or on weekends! This can be as simple as giving yourself a couple hours every 1-2 weeks just to catch up on paperwork and forms that will undoubtedly start to pile up.

4. Be INTERdependent, not independent.

Many of us will be fortunate enough to work in a setting with other physician colleagues as well as allied health professionals. So you never really are alone. If you have a clinical question, walk over to one of your colleagues and ask them what they think. Also, if there is something one of your allied health colleagues can do for you, make use of their skills.  In a team-based care model, the family physician doesn’t have to do tasks that can be delegated to other members of the healthcare team.

5. Set clear expectations.

One thing I wish I had done in retrospect was prepare something like a ‘welcome letter’ that I could give to patients at their initial appointment with me. Although I generally go over what patients should expect from my practice at these appointments, it can be a lot for patients to remember, and putting things in writing is always helpful. A few suggestions on things to discuss with patients and/or include in the welcome letter are:

• Information on late and no-show policies.
• The minimum amount of time you need to complete forms/paperwork, as well as if and how much you charge for notes and paperwork.
• Helpful reminders like encouraging patients to bring their medications in to each appointment. Another idea is to include a green sleeve with information on advance care planning so that they can look through it and speak to you about it at another appointment.
• Information about benzodiazepines and opioid prescribing. The letter that I’ve put together states that if they use these medications they will have to sign a contract and may be subject to random urine drug tests. I also include a line that states I may want to work with them on reducing or discontinuing these medications if I feel alternative options are more appropriate.
• Something I’ve recently thought about including is a line about ordering bloodwork and investigations. I’ve had so many patients come in requesting bloodwork that has been advised by an alternative health practitioner. Being clear from the outset that you only order tests that you feel are clinically indicated can be helpful so that patients aren’t surprised when you don’t order all the tests asked for. On a similar note, you could clarify to patients about how you will follow up with them on tests (for example, if you don’t call for normal results, if they will be called in to discuss abnormal results, etc.).
  • If you take on learners, you could also include that you have male and female learners in the office. Explain that you would be very grateful for your patients to allow learners to see them so that the students/residents can learn and develop their skills.

6. Don’t feel bad about taking time off.

I often feel guilty when my patients start saying “it’s getting so hard to come in and see you!” but the truth is, you don’t need to feel guilty about it. Taking time to recharge will make you a better physician for your patients in the long-run as it prevents burnout. Try and schedule your time off in advance though, to avoid needing to rebook patients.

7. Get to know your staff and colleagues.  

I am guilty of often staying in my office during my lunch break to catch up on tasks and charting, but taking some time to socialize with others in your office will add enjoyment to your day, and just make your overall work environment more positive.

8. Engage in CPD.

This is just another way to stay mentally engaged in your work, as CPD allows you to learn new things and connect with colleagues who are passionate about Family Medicine.

9. Take on students.

I love having students with me. It gives me someone (who isn’t a patient) to talk to throughout the day,  and it also reminds me of how cool our job is, because students find everything interesting!

There you have it! While these suggestions may not be useful for everyone or every practice setting, I hope there is something in the above will be helpful to those of you who are just starting out in your practice. Time and experience are the ultimate teachers, but hopefully some of these tips will give you a bit of a head start towards feeling comfortable and content with your work.