“Where Does Your Satisfaction in Your Medical Practice Business Come from?”

"Your answer to this question goes
far beyond your skills, ambition, talents,
knowledge, and objectives you believe are
all inclusive"

Some times in my medical education when I felt satisfied, inspired, and motivated and other times that I couldn't wait to get to the next medical school specialty in our rotation process. It was cyclic in nature, up one season and down the next. I reasoned that most of that intermittent satisfaction was not the result of my circumstances and decisions at the time. It was driven by an issue in my marriage and fueled by an experience that I had while in medical school.

Our marital infertility problem had become evident and the fact that my arrogance about failing the final multiple choice exam in Obstetrics when I had assured myself that I had selected the right answer to every single question on the test, and was the first student of the 144 member class to walk out of the room overjoyed in my confidence. Being notified that I was one of the 5 students that failed the test outright was beyond my comprehension.

In the Dean's office I was informed that I didn't have to pack my bags and leave as I expected, that it wasn't a mistake in the grading system, that I could not take the test over again, but if I made a good grade in the GYN exam next semester, it would be averaged with the OB exam results for a final grade. That removed my panic.

it radicalized me into being a harbinger of advanced competitive challenges. What came next was the notification that the military services would be placing all medical school graduates on notice that they would be drafted into the military in preparation for the Vietnam conflict. The choice of joining a military service bypassed the draft--I joined the Navy, knowing that Vietnam was a land war. It wasn't until the Navy assigned me to the Marines as a Flight Surgeon that I became aware that the Marines had no medical or dental components of their own--all came from the Navy. I had essentially shot myself in the foot without knowing that.

My wife and I adopted Susan during my Navy Internship. We adopted Christopher during my OBG residency (paid for by military funds). We had no money at the end of the residency training, so I became an indentured servant physician at kaiser Permanente for over 2 years.

Up to the time that I made the decision to begin private medical practice I had been under the control of the medical school system, US Navy/Marines, OBG residency, and Kaiser Permanente. Although it was all exciting, new, and interesting, I never felt fulfilled or free to make my own decisions concerning how I practiced medicine. I didn't hate it but didn't love it either. So when I cut the cord at Kaiser, at last it became a new world for me.

Delving into my new private medical practice in 1973 was the most inspiring time in my life. My first year I grossed about $75,000 and knew that it would get better for sure. So my family would be supported financially and not have to worry about going broke or being suddenly fired from a physician job.

What was it that turned me into an independent medical doctor?

Over the next 20 years the most exciting times for me were the times that I "experimented" with my medical talents and skills. For the first time in my career I finally felt free to begin practicing in a way that i believed would benefit my patients and that gave me my greatest satisfaction--just out of my OBG residency, done with Kaiser, and now into determining my own career potential.

Kaiser forbid me to do any infertility work because healthcare insurance paid nothing for infertility treatment at the time. Infertility was not considered any form of disease, but was an unfortunate
outcome of life.

That made it even more of a challenge to me. I researched the literature on infertility, found no medical courses being given on that topic. For the next two years in solo private medical practice I was blessed to get many referrals of patients for infertility. No other private doctors in any specialty were spending significant time with infertility patient management.

The opportunity to focus on infertility when no one else was doing much in that field was a hard-wired challenge I could not deny.

This showed me what an entrepreneurial experience was all about--something that I knew nothing about at the time and what I learned was a foundational part of the practice of medicine later. By having the intestinal fortitude to step out of my self-restricted comfort zone my mind opened up to provide the means to the end of accomplishing my mission. Step by step the process fell into line like magic. The extent of what happened next was far above what I had even imagined.

The thought that I had wandered into the situation in medical practice that would eventually be the most exciting, fulfilling, and productive element of my medical career, like a wave pushes the surfer along with no effort, was astounding and the peak of my satisfaction in medicine then.

The two hospitals that I was on staff of had never established surgical privileges for infertility procedures. I just started scheduling cases, no one said "stop," or, "your not allowed to do that," so I did more and more cases and surgeries. The surgical departments had no instrument trays set up for my infertility surgical procedures as they normally do for most surgery cases. So, I "borrowed" the ear, nose, and throat instruments in the beginning.

I began doing reconstruction tubal-plasties using the ENT instruments and the operating microscope. It expanded into reimplantation of oviducts in the uterus, and more. It was a wonderful feeling to know that what I did was helping a lot of patients that other doctors wouldn't touch. About two years later, in 1975 infertility courses began being offered, which later evolved into microsurgery workshops. Other doctors took the courses and my medical patient infertility referrals dropped off soon after.

When the highest satisfaction in medical practice career shows up...

Physicians commonly believe that once they level off in their medical careers after 20 years or so that the satisfaction they feel just cannot get any better. In my experience in private medical practice, even I thought so.

I was wrong. If the new and never before surgical procedures and medical knowledge continues to stimulate your mind it is extremely difficult to take that one more step up the ladder just when you are planning or thinking about your retirement.

The masterful inactivity of retirement may seem to charm your imagination, but investing your career in just one more effort that matters requires courage. Just the thought that a new approach to old surgical procedures that might be far safer, more easily accomplished, and improve the lives of all your patients is enough to wrestle retirement into second place.

For physicians that never plan to retire until forced to, eventually, their minds are always on the lookout for the ongoing parade of ideas. They rarely are workaholics. These physicians are the type that decided early on that they were committed to use their practicing skills for the benefit of all medical patients as long as they are mentally and physically capable.

The way that I look at retirement, and the reason I never wanted to retire from medicine is because I could never rationalize the cost, time, effort and training to do what a rare few of people choose to do in their life, and then waste a significant time in retirement outside of the medical profession when they could have treated far more medical patients.

This issue of retirement from medical practice is at the forefront of medicine today. For the last 6 decades the attrition of physicians has drastically increased, partly because of the inability to earn enough income to keep their practices open, and the increasing consequences of government restrictions and mandates, among others.

Back on topic...

Suddenly, the new tool for surgery, invented in Germany by Dr. Kurt Semm, and introduced into the United States in the late 1970s, sounded fascinating to me. LAPAROSCOPY.

Have you noticed that income tends to follow along behind self-improvement--and that was what I needed at the time.

I attended Dr. Curt Semm's first course presented in America on laparoscopy. Dr. Semm had developed and taught the laparoscopic techniques all over Europe in late 1970's. My associate had taken the course a few months earlier in Europe so he and I teamed up to start the new kind of surgery at our primary hospital in the Bay Area.

Then we introduced the laparoscopic procedure to other local hospitals. That expanded into advanced laparoscopic procedures. We were the only two OBGs in Northern California doing them early on. I became aware that my surgical abilities were far more than I had anticipated. I loved doing all surgery, but laparoscopy lit up my life. I said, "Thank God I didn't retire a few
years earlier."  

My associate and I began the LAVH (laparoscopic assisted vaginal hysterectomies) procedures and taught it to other doctors. This surgery was safer, easier, and in demand by patients later when patients found out about the advantages of the procedure. We were persistently criticized by the general surgeons for doing laparoscopic surgeries until...

About two years later, a young general surgeon moved into our community, who had been trained in laparoscopy for general surgery cases. By the next year that young surgeon had attracted almost all the patients who needed gall bladder removals within 20 miles around. Then all of the general surgeons, who had criticized us so much, began doing laparoscopic surgery for gall bladders (cholecystectomies).

Comments...

These are several of the factors that I learned and discovered in my private medical practice that enabled me to become a far better physician and of far more value to my medical patients and the medical profession...

1. I never had any idea about my surgical abilities until later in my practice when I decided to
   get out of my comfort zone mentally.
   
2. My satisfaction with medical practice increased gradually with each new change I made in
   my career.
   
3. My satisfaction increased by keeping my mind open to new updates in medical practice business and management because I recognized that medicine was advancing at a rapid rate and there would always be a surprise in store for me every 2-3 years that could use, adapt to, modify to fit my needs, or add to my practice and benefit my patients.
   
4. My satisfaction increased when my confidence increased by adapting to these new and helpful additions to my practice.
   
5. I believe that my mind-set of continuing to learn for the rest of my life made a big difference in my life and practice.
   

The right thing to do at this time is to tell you what destroyed my satisfaction with private medical practice over time...

1. Soon after I started my private medical practice business, I could see that my management of my practice was poor, my money management was poor, my knowledge about business and marketing was ZERO. When I became aware of how much income my call group physicians were earning--about $150,000 a year more than me--it broke my heart. I tried moonlighting jobs and limited real estate investing and ended up in bankruptcy, but continued the practice.
   
2. Medical practice is a real business and I had no business knowledge. Why would a medical school send very intelligent and motivated physicians out into the world without the essential and pertinent knowledge about managing a medical practice business profitably and successfully for the duration of their medical careers? It's like sending a soldier into combat with a rifle and no ammunition.
   
3. What the paragraph above this is saying to physicians graduating form medical school is---
   
   ----Every physician leaving medical school for the last century has been and continues to be set-up (predestined for) to fail financially in private medical practice to some degree, resulting from the lack of a business and marketing knowledge/education.
   
   ----With very few exceptions, every medical school in the United States refuses to accept any obligation or responsibility for providing all medical students with a business education regardless of the wide-spread and increasing numbers of physicians in our nation that are now losing their medical practices for financial reasons.
   
   ----All American physicians practicing in our nation are being forced out of private medical practice because of the government's long time plan to take total control our healthcare that is associated with increasing government mandates and fee restrictions resulting in the gradual disintegration of private medical practice in our country.
   
   ----Worst of all, medical schools and college premed programs maintain a perpetual policy of never advising medical students (or premeds) of the outstanding value of what a business education can offer to physicians, their medical practices, and their careers. The myth that "physicians don't need a business education to practice medicine" is true--if all physicians are employees of the government mandated healthcare facilities or employed elsewhere, where their business requirements are managed by the administration non-medical staff.
   
4. The Democrats have long planned for the takeover of healthcare and have almost succeeded. What they keep quiet about is the fact that once they gain total control of healthcare they will have to gain total control of the medical profession itself--socialized medicine.
   
5. The medical profession has no real allies. The AMA and the AAMC have failed us over and over.
   

NOTE: My recently updated book, 2nd edition, republished July 2021, is the complete discussion and information discussed above. Title = THE WOUNDED PHYSICIAN PROJECT

----Professional Probe----

"Such an interaction parallels my experience in 1973 by starting a focus of my OBG private practice on infertility surgery--no courses that taught that anywhere. Peers thought I was crazy doing surgery
on infertility problems that were considered unrepairable and patients paid with cash only. By repairing oviducts post tubal ligation, obstructed tubes from diseases, adhesion issues, and reimplantation of oviducts via microsurgery under the operating
microscope with successful results, documented my sobriety,

Articles©2013-2022/CGG INVESTMENTS LLC. All rights reserved. #85, 3-16-22