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For those of you in private practice orthopedics

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  • For those of you in private practice orthopedics

    What does your schedule/routine look like? How is your lifestyle? What can one expect if they were to pursue this?

  • #2
    It can be pretty much anything you want. My group has a wide variety.

    The slowest guy in my group (slow by choice), works 4 days a week, 9a-3p each day. He does not take call. He takes 12-16 weeks of vacation a year. Clinic 2 days a week.

    The busiest guy in my group is a trauma guy who takes 15 days/month of Level 1 call. He works 2 weekends a month, which consists of actually doing cases till 3pm Sat and Sunday. He very rarely has to go in at night but he works 630a-5p most days. Once or twice a month he's stuck at the hospital till 9pm and once a week or so he's done at 10am. Clinic 1 day a week.

    My lifestyle is great. I like my work, and although I work hard, the amount of money I make for the hours I work is hard to beat.

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    • #3
      I'm in a bigger group so lots of variety.
      Older guys slowing down are working 4 days a week, doing pretty much only OP surgeries. No call.
      Most of our mid career guys are not really taking call any longer and do elective surgery 2 days a week, clinic 2-2.5 days a week in addition but see a ton of patients when they do clinic. They have scribes and PAs to help with that load. We take call roughly one weekend every other month for our practice.
      I take ER call and have to go in at night maybe once every other month, the rest is admitted for surgery the next day or taken care of by the ER guys.
      In terms of lifestyle it is all dependent on how much you want to work. If you're ok making "orthopedic minimum wage" and have a steady elective practice, I doubt lifestyle can really be beat. You can easily work 4 days and take no call

      One thing I've really come to realize in private practice is that it is the lifestyle you make it out to be. You can work relatively little and make a good living and you can work very hard and make a very very very good living

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      • #4
        Originally posted by abds View Post
        It can be pretty much anything you want. My group has a wide variety.

        The slowest guy in my group (slow by choice), works 4 days a week, 9a-3p each day. He does not take call. He takes 12-16 weeks of vacation a year. Clinic 2 days a week.

        The busiest guy in my group is a trauma guy who takes 15 days/month of Level 1 call. He works 2 weekends a month, which consists of actually doing cases till 3pm Sat and Sunday. He very rarely has to go in at night but he works 630a-5p most days. Once or twice a month he's stuck at the hospital till 9pm and once a week or so he's done at 10am. Clinic 1 day a week.

        My lifestyle is great. I like my work, and although I work hard, the amount of money I make for the hours I work is hard to beat.
        At what career stage is the slow guy vs the trauma guy? I would assume trauma is inherently busier with the amount of call required (one reason I decided not to do a trauma fellowship), but I would imagine the slow guy is older and the trauma guy is younger?

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        • #5
          Originally posted by DrRab View Post
          I'm in a bigger group so lots of variety.
          Older guys slowing down are working 4 days a week, doing pretty much only OP surgeries. No call.
          Most of our mid career guys are not really taking call any longer and do elective surgery 2 days a week, clinic 2-2.5 days a week in addition but see a ton of patients when they do clinic. They have scribes and PAs to help with that load. We take call roughly one weekend every other month for our practice.
          I take ER call and have to go in at night maybe once every other month, the rest is admitted for surgery the next day or taken care of by the ER guys.
          In terms of lifestyle it is all dependent on how much you want to work. If you're ok making "orthopedic minimum wage" and have a steady elective practice, I doubt lifestyle can really be beat. You can easily work 4 days and take no call

          One thing I've really come to realize in private practice is that it is the lifestyle you make it out to be. You can work relatively little and make a good living and you can work very hard and make a very very very good living
          How long does it take to get to the "make your own schedule" stage of your career in orthopedic private practice? Are there opportunities out there to have that much control over your schedule fresh out of fellowship? If so, and you decided to have a slower practice, does that generally impact your prospects of making partner, buying into the practice, buying into real estate, etc?



          Do you guys see orthopedic private practice surviving healthcare reform? I have an older attending who told me the other day he doesn't know why anyone would go into private practice these days due to the amount of overhead. This was during a discussion where one of my former chiefs whose been doing private practice trauma for 1 year hates his job and is trying to get out. It seems that large orthopedic groups seem to be doing okay. The ones I have my eye on joining in 3 years generally have 15-20+ physicians in their practice.

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          • #6
            Our group has a total of 6 orthos (4 general or sports, 1 spine, and me the hand guy). The guy that works the most takes call at 3 hospitals a night 10 nights a month and the oldest partners takes no call and works 3.5 days. Even the guy that works a ton is coaching his sons' soccer teams and is around a lot, considering all the call.

            I operate 2 days per week, do clinic 2.5 days per week. I'm trying to figure out how to trim the clinic down because i don't have space and i'm not sure I want to hire a PA. I take 7 nights of ortho call per month and rarely go in. Anyone can call me for hand call whenever they want. So I go in about 3-4 times per month for hand stuff. Hard to count what going in for call looks like in terms of hours, but I work less than 40 hours per week most week.

            The hardest thing is the building of a practice so all your practice isn't based on your call. Fortunately I walked into a full practice from a retiring surgeon.

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            • #7
              Originally posted by DynamicHipScrew View Post

              How long does it take to get to the "make your own schedule" stage of your career in orthopedic private practice? Are there opportunities out there to have that much control over your schedule fresh out of fellowship? If so, and you decided to have a slower practice, does that generally impact your prospects of making partner, buying into the practice, buying into real estate, etc?



              Do you guys see orthopedic private practice surviving healthcare reform? I have an older attending who told me the other day he doesn't know why anyone would go into private practice these days due to the amount of overhead. This was during a discussion where one of my former chiefs whose been doing private practice trauma for 1 year hates his job and is trying to get out. It seems that large orthopedic groups seem to be doing okay. The ones I have my eye on joining in 3 years generally have 15-20+ physicians in their practice.
              The reality of it is that it depends on a lot of factors... In my group, I could make my own schedule starting day 1, but that would also mean that slacking off and not being available would make it take a very long time to become partner and to mature your practice. I don't know of any fresh out ortho surgeon who starts off with a slower practice on purpose. You have to realize that in the PP model, the partners are usually floating your salary until you are able to stand on your own 2 feet OR there is a hospital support agreement in place that usually only lasts 1-2 years (and comes with lots of strings attached). Yes, absolutely it would impact your ability to make partner if your not working your butt off from the start. If you want to work a very limited amount straight out of training, I can't really think of any options other than maybe the VA or locums gigs. Maybe there are employed positions where they would let you work part time? I haven't heard of that.

              My 2 cents is that once your out of training, you want to get busy and start operating sooner rather than later. Not because you'll make more money, but because you will grown and improve as a surgeon. I learned more from my first 6 months of practice than I did in residency and fellowship.

              As for health care reform, who knows what will happen with that and what impact it will have on small and medium sized groups. There are upsides and downsides to both. I have plenty of friends griping about working at Kaiser and plenty of friends unhappy in PP. Overhead can vary a lot even within the same geographic regions. Even employed based practices have overhead and that likely translates to lower salaries.

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              • #8
                “The hardest thing is the building of a practice so all your practice isn't based on your call. Fortunately I walked into a full practice from a retiring surgeon.”

                This! There were posts in the past about distribution of call/referrals.
                Part is the transition from resident/fellow, part is building brand. But when pay is production based, getting up to volumes seems to be the critical factor. Thoughts on time frame it takes to reach the point of having the option of limiting production.

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                • #9
                  It also helps if your practice owns PT, MRI, and ASC. Passive income is the best income.

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                  • #10
                    Originally posted by DrRab View Post


                    My 2 cents is that once your out of training, you want to get busy and start operating sooner rather than later. Not because you'll make more money, but because you will grown and improve as a surgeon. I learned more from my first 6 months of practice than I did in residency and fellowship.

                    .


                    I agree with this statement 100%. I've told multiple people how much I learned in my first 6 months in private practice. Most of us came from academic training programs, and then go out in to the "real world". I came from very busy residency and fellowship programs, and I still learned so much more on how to be a doc those first 6 months

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                    • #11
                      I take 10 days of level 2 trauma call per month. I’m salaried and make my the call schedule every month with my two partners who also take 10 days each.

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                      • #12
                        I’m not private practice ortho, but did build up a robust practice in an employed model as a hand surgeon. My philosophy was working hard out of the gate (taking more call, specifically) in order to get my name out there and build up my practice as quickly as possible. Within about 18 months I had a full clinic and OR schedule (surgeries scheduled 2-3 weeks out for truly elective cases, but still with room for trauma/stuff that couldn’t wait; 2 days of surgery per week and 2.5 days of clinic), and it seemed like a breeze because it was easier than anything I had done as a resident or fellow. Things changed and I backed off but it was way easier to do that than to start slow (and get used to that) and then try to ramp things up.

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                        • #13
                          I'm in private practice ortho in a large group. Our compensation is tied directly to our production and there is an economies of scale such that the more you produce you have a relative decrease in your % of overhead. Newer, non-established surgeons get a fixed break in part of the overhead for a couple yeas as they build their practice. We all have the ability to invest in ASCs, commercial real estate for our group, and some other ventures for additional revenue (if we want). We work as much or as little as we want to provided that (1) we work at least enough to cover our overhead and pay ourselves and (2) we have some call obligation. Many times call can be "sold" to others if we don't want it. We're expected to network and market ourselves, but the group does have some corporate marketing for the group as a whole. If I want a PA and it makes sense (i.e. their surgical collections will cover their costs or add efficiency to make my life easier) then I can have a PA. If I want a scribe I can have a scribe (but I pay for it directly). If I need a second assistant to follow me around to every clinic to field phone calls or help rooming patients I can have that, if I pay for it. If I only want to see degenerative spine conditions I can have our schedulers only fill my clinic with that kind of stuff. If I want to fix ankle fractures because I'm bored I can have them add that to my clinic as well. I personally have 4 half-days of clinic per week and operate 4-5 half-days per week. If I need to start late or finish early for an appointment I tell my assistant to block of whatever part of the day I need blocked off so I can do whatever else it is that I need to do. I only work a half day on Friday. I have clinic in three different cities and I routinely operate in two different hospitals and a surgery center that are all different cities. I have almost no interaction with any administrative people at all - I just show up, work and go home. It was a little hard to get used to coming out of of an academic residency and fellowship program, but I'm pretty happy with the set-up.

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                          • #14
                            Good info in this thread. Appreciate the real world advice. It can be difficult to get a grasp on how things work in the "real world" outside of an academic institute.

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                            • #15
                              I would say that 90% (maybe 95%) of orthopaedic surgeons in private practice (and even employed ones) make pretty good money and have a great lifestyle.

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