The private practice hidden curriculum

I've worked in several different hospitals and practice models during my clinical career. One was a 7-year stint as a double board certified solo private practice otolaryngologist (ear, nose and throat surgeon)/ facial plastic surgeon.

As you know by now, most doctors are employed physicians. Less than half are in independent practice and even fewer are solo practitioners.

But what hasn't changed is the reluctance of medical schools, residency, and fellowship training programs to teach their trainees the business of medicine, including private practice entrepreneurship. Here's what I learned the hard way:

1. Internal financial controls. Without them, your employees will steal from you like one did from me. Learn how to read basic financial statements.
2. Sales and marketing but learning to do it following the appropriate code of conduct and the rules of your state board of medical examiners. I had to sue the attorney general of Colorado to print "facial plastic surgeon" in the Yellow Pages (ask someone what they were if you are younger than 30)
3. Keeping your enemies close, some of whom are colleagues who become envious of your professional success.
4. Trusting investment advisors when you don't know what you don't know but your ego won't let you admit it until you have to pay up and recapture when the tax laws change.
5. Stop calling it "medical practice management"
6. Hiring too fast and firing too slow
7. Spending way too much money on furniture and equipment when you get started
8. Thinking that finding and paying for office space is like renting a condominium or working at WeWork
9. Spending some time each day on marketing and building your referral network instead of just doing
10. Learning to improve or compensate for a lousy bedside manner
11. How to sell your practice, recover money patients and insurers still owe you and all the stuff you bought when you realize private practice does not fill your cup
12. Patients don't care how you think until they think you care.

Like many doctors, I thought that getting an MBA would make me a "better businessperson". It didn't.

There are two courses in the hidden curriculum. One course in the hidden curriculum includes all the things you need to know to be successful and happy that they don't teach you in school, like how to learn independently. The other are the things you unintentionally learn about the culture.

Is it worth saving private practice??I believe it is essential.

Fortunately, times are changing. Just don't let school get in the way of your business of medicine education. You can be successful in private practice or as an employee despite your MBA.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship