By Amin H. Karim MD
PREFACE:
In many physician professional social media groups, physicians nearing the end of their residency or into early practice often ask senior physicians in the group about their experience in choosing their career; why did they choose private practice v/s joining a large hospital system v/e faculty teaching or research position? Many senior physicians volunteer the answer to the best of their ability and explain their choices. Some members get to read them and most miss it since the groups like WhatsApp have disappearing messages option and the views of the senior physicians are lost forever. Residents outside the groups never get the benefit of the views and this valuable ad hoc proctorship. The same happens with email and FaceBook groups.
In this section of the website, I have tried to record the views of the volunteering senior physicians and surgeons who have been kind enough to allow us to publish their views. We will do this in an orderly fashion first outlining what specialties are covered (the ones most practiced by Pakistani Descent physicians in USA and Canada) and also try to classify the various avenues of career available to the newly trained doctors at this time i.e. 2024-25 and beyond. We will try to keep the comments updated; readers are also invited to post their own comments in the comments section.
COMMON SPECIALITIES IN USA.
These 30 or so medical specialties are the ones mostly chosen by residents from Pakistan. There are many other subspecialties within these groups, which are beyond our scope for now.
These are alphabetically arranged.
Addiction Medicine
Anesthesiology
Colon and Rectal Surgery
Cardiovascular Diseases General.
Cardiovascular Disease Interventional
Critical Care Medicine
Dermatology
Endocrinology
Emergency Medicine
Family Medicine
Gastroenterology
General Surgery
Geriatric Medicine
Hematology
Hospitalist
Infectious Diseases
Internal Medicine (General In and Outpatient)
Nephrology
Neurology
Neurosurgery
Oncology
Orthopedic Surgery
Otolaryngology
Pain Management
Pathology
Pediatrics (General)
Physical Medicine and Rehabilitation
Plastic Surgery
Psychiatry
Pulmonary Diseases
Radiation Oncology
Radiology
Rheumatology
Urology
Wellness Medicine
OTHER (Please define in your comments)
CAREER PATHS AVAILABLE TO TRAIND DOCTORS AS OF 2024:
Private Practice Solo
Private Practice with Uni Specialty Group Self Managed
Private Practice with Uni Specialty Group Managed by a Company
Private Practice with Multispecialty Group Self Managed
Private Practice with Multispecialty Group Managed by a Company
Health Care Administration
Hospital Employment
Academic Employment with a Teaching Institution
Pharmacological Company Employment.
Veterans Administration Employment
Government/Armed Forces
Government/Federal/
State/County/City Employment.
Other (please define in you comments)
PROCTORING COMMENTS FROM PRACTICING AND/OR RETIRED PHYSICIANS
Here are the comments in the order received: For volunteering proctors please use the set up as below and send it to me
AMIN H. KARIM MD
CARDIOVASCULAR DISEASES INTERVENTIONAL
PRIVATE PRACTICE SOLO
I have been in Solo private practice of Cardiology since the late 1980s.
I started immediately after graduation from the fellowship program and have lived and practiced in Houston, Texas since then. Will not go into details of how we did in those years in the last century (although you can read about them on this website under My Journey. The object is to guide the younger generation onwards since the medical world has changed and is fast changing.
I will simply list the PROS AND CONS.
PROS:
1) Number one is INDEPENDENCE. You are your own boss and everyone knows what that means. The buck stops on your desk bringing its own responsibilities.
2) Brings forth all your innate faculties, innovation and resources to learn, plan, implement and see the results. Rejoice in the success and learn from failures!
3) Put your best effort and hard work with resulting satisfaction. This includes marketing, accounting, purchasing and other nitty gritty of running a business.
4) Bring forth your best in manners and behavior towards everyone including patients, employees, referral physicians, colleagues and even relatives. Each one of them are important in the success of your practice in sending referrals and in their comments to others.
5) Last but not the least, the satisfaction of knowing that what you are making is yours and the patients you are making and the name you are making in the community are your “equity” that is only going to build with time. Also you get to claim many expenses in your returns and have your own 401K retirement plan for retirement.
CONS:
As they say there are no free lunches.
1) Number one expressed by many is more time to the practice and less for family. Here you need to plan and adjust according to your needs as time goes.
2) Hassles of billing, insurance, employee retention, regulations like OSHA and HIPPA, Metric s reporting. These have solutions these days as there are companies for everything. Billing and Payroll should always be outsourced as it is not worth doing it yourself. Virtual receptionists are available and your secretary (costing much lower) will be in Pakistan or Philippines.
3) But at this stage, it is becoming increasingly difficult to establish as solo in large cities, unless you are giving an income guarantee (still legal) in outlying area by a new hospital or are willing to go to an area lacking your specialty and still live nearer to the city (eg living in Houston and practicing in Angleton or Baytown).
For the brave and adventurist nothing is impossible. It can still be done for the one who is willing to put in long hours in the beginning.
MUNIR A. SHIKAR MD
Cardiovascular Diseases General
Solo Private Practice
It’s good option if you are young – it takes a lot of time and a lot to learn with a learning curve. Once you are set it’s great. Soon you can pick juniors and make sure you know to reap the harvest of the basic set up that you do. Make sure that you always have an edge above others in any contracts that you make for or with others
Step ladder – solo and soon in couple of years at best partners of single specialty and merge a few years later with larger group with multispecialty group
Pick a specialty of your choice with office and hospital procedures coz that’s the beef of practice
Member: APCNA
ANONYMOUS
Pain Management
Solo Private Practice
I have been in the practice of Pain Management for last decade. It’s non-interventional and includes Addiction Medicine.
Pros: There is a lot of satisfaction in treating pain, even if by a simple trigger point or joint injection. Even removal of joint fluid can add to the comfort and mobility.
Cons: Patient’s tend to be difficult, especially if they have been addicted to narcotic pain medicines or years. Taking them off these can be a challenge.
Then there are professional pain medicine traders who bring in people to make up a story and get a prescription for pain meds. Regulators always watch closely.
Member: APPNA.
ANONYMOUS
Colon and Rectal Surgery
Multispeciality Group Self Managed
Very satisfying and you can do some good for patients. Patients are quite miserable with colorectal problems and they are usually appreciative.
PROS: Good lifestyle, you can work as little or as much as you want. You can do minor surgeries or very major surgeries.
CONS: I cannot think of any. But some people don’t like to deal with poop.
Would choose same again
Member of APPNA.
ABDUL MUNIS
Internal Medicine
Private Practice in Uni Speciality Group Self Managed.
Worked 20 years as hospitalist now working in post acute care for last 4 years
Pros: Less stress time flexibility more time off reasonable income
Chronic pts in nursing home poor nursing family pressure
Would choose a SPECIALTY if given a chance to start all over
Do you what likes you best adjusting for your life style
If you wish to give your views, please click on the link below to go the Google Forms and fill it out. If accepted, we will add to the above
https://forms.gle/b6NLpbUY478vbrAC6
GlobeMedic 