We're going to have Brian Stay as well as Kelly. We're going to bring up Joe Lamplot. He's at Emory University. Gabby O'Day, who is now at HSS up in New York, and then Catherine Logan, who's local, more or less, in Denver at Colorado Sports Medicine and Orthopedics. So thank you for being here for this panel. Did we ever, by the way, do we ever fix the microphone situation? Are they working? They should be? Okay, so. Is this working? Are we good? Perfect. Yeah. Yeah, I think so. Great. All right, so good. So building a practice. So let's maybe, kind of like we did, like challenges for the OR. Not everyone has to answer this one, but do people just want to kind of maybe talk about some of the challenges, or a challenge in particular you've had in building a practice? Because I think we all kind of think, hey, I did this great fellowship. I do an awesome ACL. You know, the person who does the most ACLs in the community didn't even do a fellowship. He's been doing it for 40 years. That's old school. Like, all the patients are gonna start flocking to me. And then you get like two months in, you're like, where are all the ACL patients? So any, you know, any challenges that you specifically faced or were surprised by, and then how'd you avoid them? Or how'd you conquer them? There we go. Can you guys hear me? Okay, I think it's just this one. All right, that's better. So I'd say probably one of the biggest challenges is understanding that you are an unknown entity. So particularly in like the world of social media, you know, you've got zero stars because you've got no ratings. So patients don't know anything about you. So probably one of the biggest challenges is, and not even just patients, other doctors in your community, one of the biggest challenges at first is putting your name out there to other physicians in the area, letting them, you know, know who you are, put a face to a name. Because in many cases, that's where your patients are gonna be coming from. Some of your primary, people who are primary care doctors in the region. And they, if they have some level of familiarity with you, you know, then they're more inclined to send patients your way. And then when you do have those patients, you need to encourage them to, you know, write you a good review online, you know, particularly if you've seen them, even if it's something as simple, like you saw them for like impingement and eventually you released them, if they had a good experience, you know, tell them, hey, you know, you know, give me a rating on the website. So you can kind of build up those five-star reviews and people are more likely to come to you if they say, hey, this person's been kind of vetted by other people and they have a good reputation. But that's certainly a challenge on the front end is being that unknown entity. So you have to give people that, you have to feed people that information. Absolutely. What about Kelly? I know we've talked a little bit about not to put you on the spot. How do you do all this without stepping on your partner's toes? Because, you know, a lot of your partners are gonna already be seeing the patients you wanna be seeing. They may or may not view you as a threat depending on how busy they are. How do you kind of navigate, you know, for lack of a better word, marketing yourself, publicizing about yourself without, you know, being a bad partner? I think it's very important to know your environment and know what type of environment you're going into. One way to do so, obviously, is by talking to your older partners or your more senior partners just to kind of get a lay of the land, especially if you're not from there, or even if you are from there, but it's been, you know, almost 20 years since you've been back. And really, observation is key. It's almost like, you know, sending in the first military unit just to observe and report, basically, to kind of see what's going on in that environment and then, to your point, Beamer, and exactly what Gabby said, too, like, going out in the community, making yourself known, I mean, there's no other way for me to say this besides just hustle. Go door-to-door, meet primary care places, go to physical therapy places, give lots of talks, and then you kind of also gauge, you know, oh, okay, who do you send your patients to or whatnot, right? And if that's their territory, then that's their territory. You're just coming to, like, you know, introduce yourself, but I think the biggest thing in terms of not stepping on toes, which is difficult to do when you're in an environment where there's a ton of orthopedic surgeons, and, you know, the other thing is, especially if you don't look like the rest of them, then it's gonna be very difficult to not step on toes as a new surgeon who comes into an area, but one thing that does go really far is your engagement with the community, and eventually, that takes time. One of my mentors, Dr. Fu, used to always say that, like, just be good to your patients, and they will come, and that is so true. Like, just continue to deliver good care to your patients. Don't worry about other things. Focus on them, and your reputation truly will build, but initially, like, I hit the ground running and just hustled. Absolutely. Like, and I mean, every weekend, if I wasn't in the OR or if I wasn't in clinic, I was out kind of, not marketing, and I would joke around, like, bringing, you know, giving out propaganda, but just getting to know the lay of the land, seeing where you could help out, volunteering, you know, making yourself available. Another one of my mentors, Dr. Jim Bradley, had said the three A's, affable, able, and available. You know, it's good to be well-liked. Of course, you wanna be able to do things, so you wanna be a good surgeon, too, and a good clinician, but also, number one is to be available, so when somebody calls you or they know they can call you, you have doctors, nurses, everybody who's calling you because you are so available and you're so nice. That's gonna continue to bring your patients in, and you can't help that if one of the established guys, you know, that was their patient or whatnot. Like, you honestly can't help that if they're sending them to you, but as a courtesy, I would say, hey, I saw one of your patients. What would you like me to do? Sure, yeah. And for the most part, a good senior partner will be like, you know, oh, take care of him. You got this, but you do have partners that are like, oh, oh, you need to send it back to me, and I do, and you know, it is what it is. Obviously, if the patient's okay with that, you know, but. Absolutely, so you gotta play nice in the sandbox, for sure. So real quick, before we get too far along, I just wanna have one kind of number answer from everyone on the panel. In your first couple months of practice, about how many patients would you average in a day at clinic? I think my first couple months was probably eight to 10. Do you wanna give a number, just kind of like, how many you see in a day when you first started out? These are like, you know, first couple months, just like a number going down the row. Yeah, so I've started two. Two, all right. I've started, no, I've started two different practices. So I've started two different practices now, so it's different. So I was in a hospital-based system that kind of had some feed-in, and there was some ramp-up. So I was seeing about, you know, 15 to 20, and now I see about 10. 10, yeah, that's a new number. But be mindful, those are 10 new patients. 10 new patients in any day is difficult, very difficult. So it's not really the number, it's the type of patients that you're seeing and the amount of time that you're allocated. So don't be worried about seeing five, 10 patients. They're all new. Down the line, you'll be seeing five, 10 new patients in a practice of 40, 50, and it's still the same. So yeah, so how many, just give me a number, Kelly. How many would you average your first couple of months in clinic? I would say five. Five, what about you, Brian? It's probably like 10 to 12. 10 to 12, Catherine? Same, like 10, 12. 10 to 12, Joe, yeah, so 10 to 12. So the point being, you're seeing 10 to 12, which means you do have more time in terms of how you use that time wisely. So maybe, Brian, do you wanna speak to like some things of how you use that extra time and to strategically build your practice or enjoy other areas of life? Yeah, I mean, I think just that expectation, don't expect that you're gonna be seeing 40, 50 patients to start. How you can use that time. So for me, research was a big thing for that. So I think the biggest thing, like I said, no one cares who you are. No one knows who Brian Lau is. No one cares in the clinical world, but also- I care, Brian. I care who you are. Yeah, in the research world, no one cares. No one cares about your case series. It's gonna take years to build your case series. No one cares what you did for your first couple. But what you can do is set the foundation. So you have all this time between cases. You're doing as many cases. You have all these things. So PROs is something that, you know, it's obviously gonna be there for years to come. So really think about how are you gonna do your PROs in clinic? You have a staff, maybe it's not your own staff, but you have lots of time. So you can go over those PROs with those patients. Figure out how are you gonna do that. And so when you are busy, your staff knows what to do because you've done it from the very beginning. Make it a priority, make it important so your staff knows that that's what you're looking at it. Review of the patient. You're like, oh, where's the PROs? Because what's this? So then your staff starts knowing what you want and why you want it. So then when you get busy, they already know how to do it. Because when you start having 40 patients in clinic and then you're trying to put PROs in, it's like impossible, right? So start early. And then the other thing in terms of that is like between cases, like your case laws you did as a resident, I still do them, not through a formal means, but you keep track of all your patients. You think about what happened afterwards. So it's like a debrief. So you can, that's how you next time you do an ACL, you're like, that wasn't quite right. Like really be critical to yourself. And that's how the next time you're gonna be more efficient, you're gonna be better. But as you do that, you also now are building your case list. So now after several years, you have thousands of patients on this Excel sheet. And we've all done chart reviews. So I listed out how I wanna do it. So I'm like, how many ACLs have I done? So I know exactly how many ACLs I've done. It helps for research, but also helps when you talk to your, when you're trying to renegotiate. Well, I know 20% of my practice is pediatrics. So, or I know this number of ACLs I'm doing. So it helps you later down the line when you're renegotiating. You know, when you go to the community, people ask you like, what are you doing mostly now? And you can say it, you know how many labor rooms you're doing and stuff. So take the time to really do really well with your own personal documentation. So that later down the road, you've learned from all the cases that you've done, you take the extra time to do it. You have your PROs, you have your Excel sheet of all your cases. So it's easy to go back and look at those. And that's how you build that series so that at year two, three, four, now you've got a whole list and you've started from day one, as opposed to like, oh, now I'm two years in practice. I'm going to go try it back and find out what I did for those, all those patients. So that's something you can do early on to not just build your clinical practice, but build the research stuff. And I think the biggest thing for me is with the debriefs when I'm with myself, like no one's there, no one's talking to me about it, but like you're thinking how you're going to improve it. You're researching. That's where the research questions come from. Oh, no one's actually, like there's nothing on this. I'm going to do a systematic review on this or I'm going to do that. And you have the time to do it. You're seeing 10 patients in clinic. So that's what was really been fruitful for me and kind of launched the research to the other part of a practice that if you're interested in that. Absolutely. All right, so Catherine and Joe, you've all been kind of patient. We'd love to hear your pearls. I know Catherine, you've had some pretty interesting experiences with building some new entities with your practice and we'd love to hear any wisdom or insight you have in kind of building things and building a practice that kind of mirrors what you want it to be. Sure. I think I'll touch on two things, like what I did in that extra time and then also building one of the unique people that maybe I should have had more fear, but I started a new practice. But I would first sort of say the one thing I did early on when I had that extra time and I was only seeing eight to 10 sort of folks a day is at least once, oftentimes twice a week, I went to a physical therapy clinic and actually saw my own patients there. So there's a big map in my office where it's like Denver Metro and I pinned all the physical therapy clinics that I've visited. And at this point, there's probably about 45, 50 that I've been in. Every physical therapist I give my cell phone to and I might sort of ping one and say, hey, I have time Friday afternoon. Are any of my patients there by chance? And they'd be like, yep, you have someone, you know, post-op ACL. And so I'd go in and I just sort of say, hey, how are you guys doing? And the patient's obviously, you know, a little surprised and excited. And, you know, always when I was walking out, I could hear like another patient saying to them, was that your surgeon? Does your surgeon visit you? You know, so I think that was really impactful and having every physical therapist have my cell phone, I think at least in my market, they're referring more surgical cases than primary cares. Primary cares are often sending you the impingements and, you know, nothing wrong with that. But, you know, at least in Denver, since it's direct access, the ACLs are generally like calling their physical therapist. So that's been super, super helpful. I know this isn't a deep dive into starting a private practice, but I'm always happy to talk to anybody after if they have any sort of questions about that. But the short sort of summary is I started out hospital employed. I think in our next section, when we're talking about choosing a job, you know, there's certain things that you're looking for. For me, I really wanted to stay in Denver after doing fellowship and bail. And, you know, there's only so many options. So I got my foot in the door in the market being employed, but for many reasons, that was not a great fit for me. So I think, you know, being a little brave, making sure you've got some good, strong people around you. But the most important thing you're doing is really selecting your team and making sure that you're leading that team. And I think, you know, I echo a lot of things that Kelly was saying about, you know, treating everything like being an athlete. Like you're, you know, you're there to be a leader. You have to really think about the team around you, how you're supporting them. And, you know, anyway, I can go into a lot on that. So I'm happy to answer any questions, but I won't spend too deep of a dive on that. Absolutely. And I think giving your cell phone number to the PTs is huge because it's so easy. You know, they just want to know that they're sending their patients somewhere where they're going to get a high level of care and then get them in right away. So PTs look good when they're, oh, I got a guy or I got a girl. They'll get you in right away. And so I'll give my number to the PTs as well. And they'll just text me, you know, hey, I got a patient, this and that. Here's the contact info. It seems burdensome, but it's really not. I just immediately forward the text to my admin assistant and then they call the patient, get them registered. And they kind of know like, hey, like I leave a couple spots on my schedule for these kinds of situations. And the PTs love it. You know, it makes you look really good because you get them in right away, as opposed to just calling up a clinic and being told they have to wait three weeks. And so it's definitely that available, you know, aspect where, and it also helps on the post-op side of things where if there are complications or if a patient's having a hard time getting their motion back, they can text you about it. You can get them into clinic sooner. You can kind of hedge off any problem. So it really, really helps because if it's becoming a problem, it's going to be your problem eventually. And you'll build a good reputation of being proactive, which is good. So what about you, Joe? I know you've had, you know, your ups and downs with building a practice. You're at a satellite at Emory in a more rural area. So give me maybe some, or give the audience some, you know, just challenges and strategies you've employed to try to overcome that. So I have a lot to say on this. I'll speak quick, and I'll give you a lot of practical things that you can do. So first of all, where is everybody right now? Who's in training, residency or fellowship? So a lot of people in training. Who's in practice? Is anybody in practice now? Okay. So in terms of where I work, I started a new practice in a new community where my organization had no footprint, i.e. there were no existing referral patterns. So one of the things I learned, I listened to Pat Denard from Oregon give a talk on this topic. And he said, before you take a job, you have to understand where your patients come from. Okay. I didn't really know that. I didn't really ask that question. So when I started, I kind of had to figure that out for myself. So in terms of my practice, patients come from a call center. They come from my non-op partners. They come from schools in the community that I take care of. You have to accept anyone. So I don't do hip scopes, but I see hips. I don't do foot surgery, but I see feet. You gotta take those patients all the way through until they need to see somebody for a hip scope or see somebody for a flat foot reconstruction. You guys can see them. You can triage them. You can send them to PT, send them for injections and send them to a partner to have surgery. And your impact on that patient, their family, their friends is gonna spread through the community. So you have to see everybody. Number two, in terms of marketing, you have to meet all the PCPs in your community. I met everybody within a 15 mile radius of my practice, PCPs and PTs. And at first I didn't really go with much. I didn't go with any food or anything along those lines. And I kind of figured out if you go in with a tray of chicken nuggets from Chick-fil-A, a tray of salad and a tray of fruit, they will send you more patients. Like no shit. Especially in Atlanta, if you got the Chick-fil-A. So what I did early on, seeing 10 patients per day, people wanna see you early and late. So keep your office open from 7.30 until 10. And then from 2.30 until 4.30. You can, in the middle of the day, you can make your visits to these clinics, bring food, more people will show up. And you guys will see the same thing when reps and other people come to your clinic to meet you. When they bring even small things, you're a little bit more interested. So that's worked for me. Urgent cares are another thing. Urgent cares will send you tons and tons of patients. Lots of patients from the PCPs and the urgent cares won't be surgical, but they'll turn into surgeries, family members, et cetera. So it's all about getting patients in the door. You need to give talks to PCPs. So PCPs in your organizations, PCPs outside your organization. Give talks to them about cuff tears, about shoulder arthritis, about meniscus tears, et cetera. And tell them the right x-rays to get. So for example, you guys will see lots of PCPs get two views of the shoulder with internal and external rotation, which are completely useless. They'll get non-weight bearing views of the knees. So give them a half hour succinct talk about how you approach all these conditions and they will send you patients with those conditions. So that's one thing I've done. Teams, so high school teams, if you can get involved with colleges, the ATCs will send you patients and those are the patients that you want. You guys want young athletes with sports injuries. You need to get into these schools. So in Atlanta, it's a little complicated because there's contracts and so on and so forth. But if you're in an area where the schools are not spoken for, go meet the ATCs, give them your phone number and be accessible and they'll send you patients. Patients want easy access. So if you have a centralized call center that's inefficient like mine, you have to have ways for them to reach your secretary quickly. So all of my referral sources have my secretary's direct line. She's available 7.30 to 4.30 every day. They don't have to wait. They're not on the phone for 10 minutes waiting for a call center. And if that's the case, they're gonna hang up, they're gonna call Northside, they're gonna go see Kelly. Okay, so you just have to make things easy and I've tried to do that. So these are just practical things that I've done. And in terms of marketing materials, when you make your visits to PCPs and PT clinics, have marketing materials. If your organization won't make them for you, you make them yourself. I made mine myself. If you guys want them, you can have them. You can swap out my face for yours. But it's something that's improved access. So again, building from ground zero into a practice, these are the things that I've done. Absolutely, no, those are all great. And I think one thing I've learned too is just going to the PTs isn't always enough because they've had referral patterns that they have been using for years. I have found that I have to send them a few patients before they start sending some back. So even if your system, a lot of hospitals now have their own PT associated with it, like we do at HSS Florida. We have our own HSS Florida PT, but I have patients that kind of come from all over. And so I don't encourage all of my patients, I don't say, hey, drive 30 minutes to come here. Instead, I'll identify a good therapist there, send a patient, let them know you're sending the patient, call the clinic, call the PT, say, hey, I'm sending a patient your way. Can you have whoever works with them, give me a call to update, talk to the therapist. Every opportunity is a chance. And what I found is I had to start sending therapists a few patients, and then they saw my work. They saw how the patients did. They saw how involved and accessible I was. And then they started sending them back. So just because you go and talk to a PT doesn't always guarantee they're gonna send people your way. So it's kind of a two-way street. If a PT sends you somebody and you do surgery, you absolutely have to send it back to track those kind of things. And ultimately, even if you get, I'm not in a private group, but if you get ancillaries from your PT, you will make more by doing surgeries from these referring PTs and sending them back than you will by hoarding all these patients with your own PT. So make sure you take care of your referring doctors and therapists. Absolutely, yeah, you'll definitely. I would echo what you were saying. Make sure you let the PTs and people know that you're sending it back to them. Send them a note, take the extra time you had the time, because they'll see it. They're probably a full clinic. They don't always remember exactly who, where, what, but you let them know, like, hey, I saw this patient. I'm sending it back to you. Do that for the PCPs who send you patients. Just let them remember that you're actually remembering that they sent you something and you're acknowledging it and giving it back to them. Absolutely. I think the biggest thing, like what Kelly was saying, the three A's, actually the least important of that is how well you are in the OR. Like, they don't know, right? They only care that you're a good doctor, you're available, you're nice to them, you're talking to them. They don't actually know what you're doing in the OR, like the PCPs, PTs. So the most important thing is just making sure they know who you are, you're available, you're nice to them, you send them back their patients, and then eventually, when you get the skills, you'll be really good too. But at first, admittedly, you won't be, right? It's all of us are like that. So just be available, let them know what you're giving the patients back to them. For sure, and I think you have to accept a lot of referrals you don't want until you get the ones you do. So I have a trauma partner who, he'll send me some really good cases, but for every good case he sends me, I probably have to see like three to four, you know, 85-year-old with a partial rotator cuff that you're never gonna touch with surgery, you're just gonna inject. But you know, I like seeing those patients, they're nice, they're kind. I wanna give good care to everyone. So you kinda have to take the good with the bad and you can't complain about the bad. And as soon as you say, no, I don't see 85-year-olds with shoulder pain, like until you, like as soon as you start saying that, then you're done. You're never gonna see another referral from that person. So, you know, you might get to a point where your surgical volume's enough where you can start being more selective, but until that actually happens, you're kind of at the mercy of the referral center way if you wanna grow it. Yeah, I would echo two specific points. One about the availability. In particular, even when you're starting to get ramped up, make sure to, you know, allocate some times for either same day or next day appointments and let the primary care providers and the PT people know that, that you always make accommodations for somebody who has something that needs to be seen urgently. That's where you're gonna get your ACLs, that's where you're gonna get your traumatic cuffs and people who had a fall, that maybe it's nothing or maybe it's a workup, but you'll definitely get a lot of patients from that standpoint just being available because you have the earliest access and they're not having to wait three, four weeks, three months for some of your other partners. The other thing I would echo is you kind of have to curate and cultivate your primary care providers and what they're providing you. So the important thing about sending the notes back to them about, hey, I saw this patient, see my note attached, is I'll briefly kind of tell them, here's my plan, but I'll also have the full note and explain, in particular, why I'm not gonna operate on this patient. So that way, you know, they know, okay, she doesn't scope 85-year-old knees. All right, well, now I understand who to send there. Or, okay, this person's got a cuff, but I probably shouldn't have injected him last week before I sent it to them. You know, that way they kind of know what are the parameters that they need to kind of, you know, be able to look into or to sort of tee up those patients for you. And just a nice note, kind of letting them know, hey, I saw this patient and this is why I'm doing what, is actually very educational to them as well. Absolutely, and I think being, almost being slow to operate when you start out, I mean, you obviously have your clear operative indications of things that need surgery right away, but for those, you know, partial thickness cuffs, those meniscus tears, you know, you'll actually get a better reputation, I think, if you try some PT or other things first, because I think a lot of patients, they come into a surgeon's office and they're a little fearful. They just think they're gonna get cut on and they're afraid and it's a scary thing for them. And I've had a lot of patients where they get very relieved, say, oh, there are other options or things we can try. And some of them convert to surgeries. The ones that truly need it, it's kind of like letting them ripen on the vine, so to speak, that, you know, some of them will ripen and declare themselves as needing surgery and some won't. And the ones that need surgery, you'll be grateful for, and they'll be grateful that they're still with you. And the ones who don't will be very happy that you were able to treat them in a way that they didn't need surgery, and that'll be equally as good of word of mouth. And so that's important too. So we have to kind of wrap up this panel. Unfortunately, any like burning last words, Kelly looks like, I'll give you like 15 seconds, Kelly. We didn't talk about this at all, but the other thing is call. So I took a lot of call too, to like build my practice. And I still take a lot of call to build my practice. Early on for like the first year, year and a half, when you get a call from the ED, go in. It sucks, but go in, because that's how the physicians there, the nurses there, everybody gets to know you and they get very comfortable calling you. So even when you're not on call, they'll even curbside you and say, hey doc, I'm not so sure about this, you know, and ask me and I'm like, yeah, just go ahead and ask the person on call, make sure you get this, this and this. And that ultimately will lead to more referrals because they know that you care about patients and you're not out to just steal patients. You're like, look, send it to so-and-so who's on call, but here are things I can do to help you take care of the patient. But to go in and actually see those patients, even if you're not gonna operate on them, just exactly what Joe said, it's gonna turn into three or four surgeries down the road. Somebody's grandma, somebody needs a replacement, their shoulder, somebody's kid needs an ACL. So all that stuff really does come through to fruition. For sure, and I think a lot of the ER docs, if you get to know them well, if someone else is on call, you know, who doesn't come in to see the patient, they might be like, hey, so-and-so's on call, but Dr. Middleton, like, she's really, really good, so maybe you should see her. So the other thing about call, and I'll get to Joe in one sec. The other thing about call is it may or may not be a good way to build a sports practice. So where I'm at in terms of call, it's a lot of geriatric hip fractures, which is fine, but it does nothing to build a sports practice. So if you really want to kind of build like a more specialized sports practice, it may be a good way to get busier, but it may not be a good way to actually, like, you know, groom a sports practice. So I have personally found, at least in my demographics, that the grandmas I take care of on call don't really have sons and daughters and granddaughters that are like, you know, injuring themselves and coming my way. Yeah, I'm in Florida, so that's probably why. So it's unique to every market. Some markets it's a great way to establish your practice, some it's not. So to Joe's point, you kind of have to know your market and how strategic it is or isn't in terms of building a sports practice, which, again, it's not wrong to get busy from trauma, but it just depends on your goals and where you're going. Final word to Joe. Yeah, the first two years, in my opinion, are about filling your clinic with people. It's not necessarily about filling your clinic with surgeries, those come, but get as many people in as possible and never say no to a referral, even if it's a low back. Absolutely, good word. So in summary, some take-home points. Use your extra time wisely. Don't feel obligated to just sit in your office if there's no patients there to see you in the afternoon. Go out and network, build a research infrastructure like Brian talked about, or spend a little extra time with your family. Get home a little earlier, spend some time with your friends, family, because once you do get busier, you won't have that luxury. So, you know, invest in the things that you want to early on. See every patient early on, don't deny a referral. Every referral equals an opportunity for word of mouth. Stay humble, it takes three to five years at a minimum to start gaining momentum in some of these referral patterns so you gotta be persistent. You gotta send some referrals before you get some back. Pursue coverage opportunities. They may or may not give you a lot of cases, so I help cover the New York Mets. I don't get a ton of cases from them, but I cover a local NAIA college, I get a lot of cases from them. High school can be the same thing. So coverage is great, it can definitely build up your reputation in the community, but it may or may not increase your clinical volume, but it's still a very good thing to pursue, so you gotta be strategic with that. And then trauma call may help you get busy, which is good. It may or may not help develop a sports practice or a niche that you really want to have, which, you know, isn't necessarily a bad thing, you just have to be aware of that as you're trying to groom your practice over time. Any burning questions from the audience on this topic? As you guys were thinking, the only thing we didn't talk about was family. I think the best advice that I got from a mentor was that you're busy in a different way, it's not like your hours are as bad as a residency, but you're doing all these other things trying to build your practice. Always have a vacation planned with your family. So you're on vacation, plan the next one. Just so that your family knows that you're thinking about them, just always have that there, so there's always something your family's looking forward to. And that's been, I think, you know, really important. We didn't spend a whole lot of time talking about family, but it's, they're gonna take a lot of sacrifice. They think that you're done a fellowship, you're gonna have all this time to hang out with them, but you're actually a lot busier doing other things when you're starting your practice. That's a great point, great point. Awesome.

building a medical practice

challenges

establishing reputation

physician

building relationships

patient care