My name is Reed Litchfield, I'm an endocrinologist from Henderson, Nevada, and I'm really pleased to spend the next ten minutes with you. This is probably the hardest talk I ever have been asked to give, to teach you everything you need to know about small group endocrine practice in ten minutes, with four slides. So normally we spend an hour with this at the Baylor College of Medicine program that maybe some of you have attended or will attend this year, later this year. But I'm going to do my best, obviously we won't be able to cover all of the bases, and my contact information is at the back, you can reach out to me if you have specific questions related to your individual situation over the next six months or so as you transition into being a practicing endocrinologist as opposed to finishing your fellowship. So my first slide tries to emphasize the opportunity for those going to small group practice to embrace the small part of small group practice. Depending on what your aspirations are for your career, if you have an interest in owning a practice as opposed to simply being an employee of a practice, I think small group practice really does provide a faster track to being on that partnership track than does working for a big corporation. Some would view this as a burden, others would view that as an opportunity, and whether you see it as a burden or whether you see it as an opportunity really helps you to make the decision as to whether or not this is something that's for you or not. There's plenty of you here that foresee your practice of endocrinology falling under the paradigm of an employee, and that's just fine. But for those that are in that opportunity mode, that's kind of the position I come from, so I tend to see the world through those types of glasses. If you have an interest in ownership in a practice, then small group is a great way to learn the ropes and kind of have somebody hold your hand through that process of beginning to learn. Use the first part of your first job to begin to learn the nuts and bolts of practice management. That will require that you learn the process of what it takes to run an endocrine practice, knowing about everything from employee operations to negotiating contracts to how the money's come in and out of the practice. Most endocrinologists that are partners in a small group are exhausted, and they're just looking for help. So as you're recruited to various practices, if you come to that practice and aren't crazy and show interest in assisting with the administrative process of that practice, I think in most cases you'll be really welcomed, and there's often a place for you in the management of that practice. So offer to become involved, offer to assist with non-clinical administrative responsibilities in the practice, A, so you can learn them, B, so that you can help out, and C, so that you can let your aspirations for the future be known to the group that you're joining. Learning about payers and contracting is an important part of this. Early in the course of your new job, take the time to just make yourself familiar with who the contracts are with, which companies you'll be providing endocrine care to. If you can have the opportunity to systematically review the explanation of benefits with the partners that are doing the business analysis, that's very instructive for you, and it helps you to know if A, you're billing properly, B, you're getting paid according to your contract, and C, what parts of the practice that you're spending time in are less profitable versus more profitable. If you've never had a chance to be trained on how to properly code and bill and collect, now's a good time to do it. It ultimately will affect your bottom line and your revenue stream. ACE has courses, there are other online resources out there to help you to ensure that when you do something, you should be appropriately paid for it. You also want to be careful not to bill for things that you don't do, for services you don't perform. But I would submit that every time you do something, you should be paid for it. So fellowship's going to be ending, where your free service is going to end as well. You should be reimbursed for the stuff that you do. Reputation management is an important part of every practice, whether you're in a small group or a large group. In a small group, just remember there's more opportunity to stand out and there's less opportunity to hide. It is very important that you work on how you're perceived in your community. Start within your own in-house reputation. How your colleagues, physicians, physician assistants, nurse practitioners view you. How the administration and management of the practice views you. And don't underestimate the importance of how you treat your medical assistant or your receptionist. That goes a long way to determining what you'll be perceived as and whether you're going to be given a second contract after that first two years of practice. External reputation is very important. Obviously, get out, meet the doctors who will be sending you their patients. Just remember that a large part of your perception in the community by non-endocrinologists has to do with the correspondence that goes from you to the referring doctor. Make sure they're getting those notes. Take pride in those notes and make sure that they appropriately reflect on who you are and what your capacities are. And then don't forget your patients. The single most important source of new patients to a practice is what the other patients you already have say, what they say to their family and their friends. I think the single most stressful part of practicing endocrinology is the electronic health record. And it is a big stress and a big source of burnout and a major determinant of your ability to be productive. So as you enter into your practice, especially if it's a small group, there's fewer doctors, you have more say in how that electronic health record is going to be integrated into the practice. So take some time to get to learn it. Learn how to import old notes, what the default settings are, and I would strongly recommend that all of you spend some time developing your own custom templates. Disease state based. So you've got a template for a type 1 on a pump, a type 1 on MDI, hypothyroid, a thyroid cancer, osteoporosis, and as many as these templates that you can have will increase your efficiency in practice and ultimately make a major impact on your productivity. I've got just a few more minutes and we're going to spend a few minutes speaking about working with advanced practice providers or APPs. This is the reality of endocrinology practice today. And there's just not enough doctors and there's way too many patients and it's just the reality of it. Whether you're in a small group practice or even an academic practice, there will be part of your work. Especially in a small group practice where you're one of the partners, APPs do represent a potential to increase your bottom line. You really do need to choose them carefully and train them well in order for them to be productive and cost effective. If you are going to be supervising a PA or a nurse practitioner, you should try to practice with them in a collaborative type of way so that they can independently see patients that you will collaborate and supervise with them. And that will absolutely increase your revenue. It's probably more lucrative to an endocrinologist to have a physician assistant or a nurse practitioner than it is to have a new partner. Just the way the dollars and cents add up. Make sure that if you're going to be doing this, you do incident two billing. And be prepared to, it takes a lot of groundwork to prepare your practice to bring in an APP. You have to teach the patients and train them. You have to be able to train the staff. You have to be very attentive to things like the words that you're using. The words really do matter. If you're referring to your nurse practitioner as a mid-level, it implies that they're getting mid-level care. Or the physician extender. We don't use those words. Those are not helpful terms. They're your colleagues. They're not your chattel or your property either. So don't be referring to them as your PA or your NP. It sends the wrong message to patients especially. What patient wants to come, if they could see you or come back and see the mid-level, what are they going to want to do? They're going to want to just see you. And that makes it problematic for you to pay the salary of these people that are on part of your team. And what we really need to do to be effective and efficient is create an atmosphere where endocrine care is provided in a team setting. With a supervising physician that is meaningfully involved, who takes time to supervise and train the rest of the team and ensure that high-level care is being administered. Just remember, it is not reasonable for you to act as a supervising physician to an APP if your schedule is full and you're busy seeing all of your own patients. You've got to scale it back so that you can have time to spend meaningful supervisory time and training time with these other members of your team. So we could talk for another hour. We just don't have time. Small group practice is a wonderful opportunity for you to have a little bit more control of your destiny because you're one of a fewer number of players. There are greater opportunities for you to rise up into the management level of that corporation, and to be able to have a little bit more say in how the practice is going to run and work. It will, of course, necessitate that you take on non-clinical administrative responsibilities to help that practice be functional and profitable. So I think it's a great model for practice, and we'll have time for questions a little bit later. So thank you for your attention.

small group endocrine practice

practice management

coding and billing

reputational management

collaborative practice