By Sonya Paisley Agnew, MD

While it is widely understood that your first few years of practice will represent the steepest learning curve of your medical education, I was very surprised to realize how much the business aspects and the political machinery of medicine had in my early career as a surgical attending.

As I moved through training, I learned how to operate, who to operate on, and how to be a caring and compassionate surgeon. I learned some of the fiscal components of running a practice but I was not prepared for the role that established policies and workplace politics would play in medicine.  I assumed that political deftness and business acumen was unnecessary, even unsavory, in that it tends to prioritize the personal interests of those involved rather than the patient.  I believed that workplace politics detracted from the sole mission of a physician:  to provide excellent medical care.  I focused on developing my knowledge and surgical skills, and was confident that a positive attitude and kindness were assets that would lead to a successful and protected career.

With this mindset, I was considerably naïve as I entered practice in a competitive market.  Though I was correct in my belief that workplace politics can interfere with the goal of providing good care, I was wrong to ignore the importance of maintaining a healthy interpersonal exchange with all of my colleagues.  As I later learned, awareness of this concept is absolutely necessary.

Had I known then what I know now, I might have stepped more cautiously when it came to what I’ll broadly refer to as “contract and practice negotiation”.

Based on my experience, I recommend keeping the following in mind:

1. Prior to accepting a position, consider consulting with an attorney who specializes in physician contracts. Without legal advice or practical experience you will not fully understand your rights as an employee and those afforded to you by obtaining hospital privileges.
2. Seek out former partners to familiarize yourself with red flags or any obstacles you may face before you commit to a practice.
3. Be aware that your arrival in a new position may have an impact on the status of your colleagues’ practice and consider the possibility that you may be viewed as competition.
4. Learn the appropriate channels through which you can address concerns about patient safety, equipment issues, ethical behavior, etc. at your institution.
5. Remember that your mentors, former co-residents and co-fellows will become a significant source of support as your career evolves.

I have no regrets that during my training I focused on learning what truly is our sole mission as surgeons: providing the best care to patients.  While it is true that the business side of medicine often clashes with its idealistic side, I now understand the importance of understanding the former so that I am able to continue to practice the latter.

I am extremely grateful to have had the opportunity to learn from some of the greatest surgeons in the world. In particular, I would like to thank Dr. Nicholas Vedder, who was instrumental in helping me navigate my way through the quagmire of my first year in practice.

Sonya Paisley Agnew, M.D.
Assistant Professor, Division of Plastic and Reconstructive Surgery and Department of Orthopaedic Surgery and Rehabilitation
Loyola University Medical Center, Maywood, IL
Section Chief,  Plastic Surgery, Hines VAMC