We’ve already discussed the differences regarding private practice and academics, but the ultimate question any medical student and resident asks themselves is which one is the right one for them- in truth, there is no single best answer. There is no best advice. What may be ideal for one person, may be hellish for another. Ultimately you need to know yourself best. So, what did I do? The simple answer is that I went into private practice… however, I’d actually define it as “Privademics”. I’ve tried to build my practice based on lessons that I felt played off my strengths. With each of these lessons, there is both a ‘private’ and ‘academic’ aspect to each that I have to incorporate simultaneously.

Lesson #1: Be patient.

Once I realized that the true ‘academic’ practice was not ideal for myself, I had to find a private practice job that had the opportunity for me to grow and develop it into the ideal situation. Once in practice, it takes time to build a full clinical schedule.

It is generally believed that a practitioner does not reach their maximal efficiency until at least five years, if not 8-10 years. As a young practitioner, I work hard to use this time early on to build a practice through outreach to patients, physicians, and physical therapists. On the research side, I have used this time to develop research protocols and organize patient databases. It will, of course, take years to develop a large enough patient database for clinical studies, so early academic endeavors can focus on writing book chapters, publishing review articles, or bench-work type research if the appropriate facilities are available.

Lesson #2: Hit the ground running.

Upon completion of your fellowship, it is natural to want to take time off and ease into practice. After all, you had just spent all of your adult life working towards being done with training. While it is important to take time off and enjoy the fruits of your labor, once you get started in practice, I don’t recommend ‘taking it slow’.

Even if joining a practice in which patients are being ‘held’ until your arrival, it still takes time to build up a full clinic volume. Rather than using the downtime to relax, make use of it.

• Start working on protocols
• Focus on mastering the foundation research projects
• Implement clinical scoring systems into your practice
• Develop a system for tracking patients
• Pursue educational opportunities, such as workshops or seminars in obtaining research funding or writing grants

When I first started practice, I realized that there was an extensive amount of ‘behind the scenes’ items that I had not considered. Naturally, it will take time to get both the clinical and academic side of your practice running on all cylinders.

Lesson #3: Be Persistent.

The process of finding the right position is tedious and brutal. Throughout the interview process, it is important to keep one thought in mind: not only are they interviewing you, but you should be interviewing them. I practiced this in all my interviews and was prepared to ask as many questions as possible to ensure that the position was conducive to helping me develop the ‘privademics’ practice I desired.

Some of the things I was hoping to get a good grasp on were:

• Patient Referral Process (especially since I wanted to focus primarily on foot & ankle)
• Opportunities for involvement in hospital and professional society committees
• Potential funding for research
• Other avenues for developing these programs in time

Through this process, I discovered that my original plan for execution to develop a successful ‘privademic’ practice was far from effective. I’ve been through multiple iterations of both my clinical practice but also numerous research projects before finding the right balance.

Lesson #4: Use your resources.

Even though I may not be in a true academic setting, it is still possible to use academic resources to build a practice and develop research. One of the ways I prioritize learning is by maintaining close relationships with my mentors. Not only have they been critical for giving advice on complex clinical cases, but there are opportunities to collaborate with them on research projects and other academics such as book chapters, webinars, and review papers.

I have also found a lot of great opportunities and discourse by maintaining my involvement in my professional foot and ankle society. It’s not really enough to just be a ‘member’ however, you’ll want to consider joining a committee as many of these societies will have committees focusing on many avenues of academics and private practice. I have been a part of both the membership committee and research committee, with the latter exposing me to numerous critical educational tools, such as grant writing workshops.

Lesson #5: Diversify.

Medicine has evolved into so much more than simply patient care. While this is the foundation of what we do and our number one priority, being a doctor can be so much more than this. As an attending physician in ‘privademics’, I have had the opportunity to mentor both college and medical students as well as orthopedic residents.

We live in such an advanced technological era that there are ample opportunities to incorporate technology into your practice. I’ve had the tremendous privilege of being featured on a local radio station speaking about foot and ankle conditions.

While it can be time-consuming and an extra commitment, I have enjoyed working with a team of orthopaedic surgeons providing online mentorship through Instagram (@OrthoMentor), and I have also developed my own professional Instagram page in which I share interesting cases in foot and ankle surgery (@FootAnkleDoc). Amazingly this has connected me with orthopaedic surgeons across the world and I’ve learned so much from these colleagues.

Lesson #6: Adapt.

There isn’t one best way of doing things and this is especially true in setting up a clinical practice. Through my practice, I have adapted both my clinical approach to patient care as well as my surgical techniques. I left fellowship thinking I would do every surgery the same way as my mentors, yet I have quickly found that this is not the case. Innovation is a wonderful tool.

While I may not be at a point where I can be the ‘first’ person to do a surgery (and assume the inherent risk that comes along with this), I have found that being up to date in research and willing to try new procedures allows me to provide patients with ‘cutting edge technology’ and potentially improved surgical options.

Academically, being ahead of the curve has afforded me numerous benefits. It has provided me with an opportunity to work with the industry on developing improved surgical techniques/instruments/equipment. It’s also granted me exposure to some of the most well known and respected orthopaedic foot and ankle surgeons, development of research studies reporting on new procedures, and one innovative new technique has even landed me on the nationally televised show The Doctors (with my appearance airing this upcoming September).

Lesson #7: Have fun!

This one is simple in theory but perhaps the most complex- you have to love what you do in order to continue to do it. Working in private practice and academics takes a lot of effort, time and diligence – you need to love it. Put yourself in a position in which you are happy doing what you want to do. If you find yourself unhappy, reflect on the why this may be the case and work on adjusting your private and academic practice in order to find your happy medium. I’ve had to frequently implement lessons 1-6 in order to reach lesson 7 and I’ll likely continue to have to do so as my practice continues to grow with me.

And remember, many doctors don’t stay at their first job. There is a reason for this. We are constantly learning about ourselves and our ideal job, so it is only natural to change jobs if we do not initially have the perfect fit. No matter what, it will all work out.

“If at first, you don’t succeed, try again.” – William Hickson