in the program. I think the first disclosure I'd make though is I don't really consider myself to be particularly wise or have any sort of answers on how to build a practice. There's like not really an instruction manual for this. Looking back at my first five years, I actually had it pretty easy. I had great partners, I had a great support system, and so I hope that I can at least give you some wisdom based on some of the mistakes that I've made because Dr. Byrd told me when I was in fellowship with him is that mistakes are just a name you give to your experience, just a name you give to your mistakes. So I did, so quick background for me, I did residency at UVA and when I when I came out in my chief year, I wanted to work at UVA but they really needed a hip doc and honestly I'd never even seen a hip scope before and I had no formal hip experience coming in for my fellowship. And so I actually ended up interviewing some other place, UVA ended up being my dream job, and so even with the hip stipulation, I decided I wanted to come to UVA and work. So UVA arranged for me to have a fellowship with Dr. Byrd, which I did, and I joined the department back in 2013. And again, I joined a department with a very well-established sports medicine practice, so with Dr. Miller and Dr. Dedeck, Dr. Brockmeyer and Carson. So ten years later, now I'm doing mostly hip, probably 60% hip. I'm the primary hip specialist at UVA for the past, you know, ten years or so. I do take general call, I work with fellows and residents, which actually is very gratifying to me, and I'm one of the orthopedic team positions for UVA. I'm also married and I think it's really important to know about the work-life balance because when you're building a practice, you're also building a family at the same time, and if you neglect that part of your life, I think it'd be really a big mistake you can make. So let's rewind back to the first five years. So when you're joining a practice, a lot of people in this room are just getting out or still in training. It really is the first time in your entire experience you're really putting down real roots, you know. All throughout your medical school and training and whatnot, you basically are on these chapters of your life, and so when you start your practice, it's the first time really putting down real roots. You might have moved to a new city, a new part of the country, and you're transitioning from being dependent on somebody else to being autonomous, and these are big steps you're going to be making. So you got to build a foundation. When you build a foundation, you're building a practice, you're building a reputation, you're building a family, and you're building really an identity. Also at the same time, you're trying to prepare for part two. I know part two is coming up for a lot of people in this room this week. So there's a few realities, okay, and the biggest reality is one, there's no instruction manual for doing this. You will come into your practice as a complete unknown. Your partners will be established, you will be unknown. You will not be nearly as busy as your fellowship or residency attendings were. You will not be nearly as efficient either, and you'll not have a team that you're used to. You know, you come from a fellowship that has this great team, and all these patients are getting taken great care of. When you start, you're not going to have that team. You have to build that team, and despite doing good surgery, you are going to have a few bad outcomes, which is really hard for a lot of us to tolerate, and so it's important to know that all of us have bad outcomes, even with good surgery. So when you get started, I would say be patient. You're trying to build, this is the Empire State Building, it started with a foundation. So you got to be patient, be available. I would say do not limit your scope of practice. You know, you want to be the path of least resistance. If somebody needs to get seen, make sure they can get seen. You might see some low back pain, you might see some stuff you don't want to see, but you will evolve into a much better practice. You got to figure out where you fit in. You got to fill the gaps in your partner's practices, and learn about your community. Take call. If you take call, I think it's a really good opportunity to meet patients, to get cases, and your best referral sources will end up being other patients and physical therapists, and so make sure you make yourself available to those people. Use your time wisely. When you get started, you want to have all this free time, use it wisely, make a plan. So you want to build a team. The people around you are really going to define who you are and how you practice, and go out of your way to meet everybody, even remotely associated with your practice. I think the nicer you are, the more people you'll start to learn about you. You want to build your team identity, and you want to empower your team. Make sure they feel valued, and ultimately make it fun. You know, take them out for happy hours. Make it a cool place to be a part of your team. A couple mistakes that I made, poor charting. So you'll learn about insurance and how you get like surgeries approved, and if you're not charting properly, you might have a hard time getting this approved. You'll get bogged down on peer-to-peers and those types of things. If you start pushing indications, I think you'll also have some mistakes that I've made, or a failure to recognize futility in your treatment. So if you're treating somebody, sometimes the most important thing is just to know when your limitations are. You also can't assume your OR has everything you need. It's one thing I thought going in that they just have everything they needed, and sometimes you turn around, ask for an instrument, and they might not have it. So it's important to kind of know what's on your pans and how to make sure your pans have everything you need. Don't settle on the operating room. You want to leave that operating room happy, and sometimes you bite off a little bit more than you can chew. So there will be dark days, okay? So you won't be busy enough. You'll be discouraged because I'm just not seeing as many patients as I thought I would see. And also, shoot, my partners, are they better than me? Like, why am I having these inferior outcomes, you know? I promise you everybody in this room has gone through some times where they thought they weren't doing a good enough job. Just work through those dark days. You'll have complications. You'll have poor outcomes. You'll have these albatross patients you just can't shake. For whatever reason, you can't shake those. There might even be bad patient reviews. These are going to be dark days all of us have shared. You'll have a work-life balance you're trying to overcome. And finally, there's a lot of paperwork you're attending, so it really is hard to know about all that paperwork. A few things that help for me, having a niche is really nice. So as you're in your training process, try to figure out a niche you can develop in order to have for your own. I did learn to compartmentalize. So what that means is you don't want to take your work home with you. If you had a bad outcome in clinic that day, don't take it home to your family because you got to figure out a way to keep that separate from your life at home. I really was, I call all my patients a post-operative day one. That to me has been really helpful to maintain a relationship with those patients. I answer questions and for whatever reason, it's really given me a lot of patient satisfaction scores. Get involved in AOSSM. It can't be, this is the best society. It's a massive family and all of us are here to help. Also keep in touch with your mentors and your classmates. You know, that's really important if you keep in touch with those people. They can guide you through some of these dark times. Teach. The more you teach, the more you learn. And finally, when in doubt, I said yes. To the trainees in the room, I just kind of put all these up at one time. Pay attention to the little things in the OR. Make videos. Take notes of post-op timelines, like what are normal times for people to be doing after rotator cuff repair. Listen to how your attendings talk to patients, especially those who aren't doing as well as they might expect. Collect your attending surgery cards. It can be very helpful. Sometimes try dictating a case instead of using a smart phrase. The reason being is that if you can dictate a case from start to finish, then perhaps when you're doing that case, those steps will start to come to you. Learn about coding and billing and learn about insurance. Those are things I did not learn about when I was a residency and that was a big mistake. And your time will come a lot sooner than you think. So ultimately, the good news, you're not alone. We've all been through this together. We've all traveled this road together. You're part of a much bigger family. It gets better every year. And at the end of the day, your orthopedic surgeon is pretty freaking cool, I think. So enjoy the ride. Thanks.

orthopedic surgeon

building a medical practice

patient availability

work-life balance

finding a niche