By Lawrence T. Donovan, DO

I can recall vividly a conversation that I had with my dad in 1978 after my first year of medical school when he was passing on some very sage advice. My dad was a pathologist who practiced at three small, rural hospitals in Iowa and Minnesota, traveling 45,000 miles per year making his rounds. He said, “If I was a young man, I believe that I would go into dermatology. No nights, no weekends, and best of all, no hospitals.”

In those days, hospitals were your friends. There was a symbiotic-like relationship in which we needed each other to co-exist. For years this relationship was cultivated on both sides. We, as surgeons, wanted to perform the latest and greatest procedures utilizing cutting-edge technology. The hospitals were more than happy to accommodate–as long as they were profitable.

After graduating from medical school, I joined the U.S. Army and completed my orthopaedic and hand surgery training. While in the Army, I learned the valuable meaning of camaraderie, and learning how to depend on your fellow residents to do more with less. Early on in my training, due to the lack of incentives, we would have to admit our patients a week ahead of their scheduled surgery just to get their history and physical completed. We would invent ways to try and “sneak” our patients into the operating room just to get their case done.

After my Army career I moved to northwest Iowa to join a single orthopaedic surgeon. Here, we were the big fish in the small pond. As the largest revenue producers for the hospital, we could do just about anything that we wanted. We could add cases at almost any time, day or night. After fifteen years of traveling 20,000 miles annually for clinics and surgery, and being on call every other night, I became run down. My wife said, “It’s time for a change.” Being a good soldier, I followed her orders and we moved to a large metropolitan area.

At age 52, I was concerned about who would hire an aging surgeon, but I soon discovered that the possibilities were wide open.

I joined a six-person hand surgery group that, within eight months of my joining, merged with a large orthopaedic group. Currently, we have 27 partners, approximately 50 physicians (nine hand surgeons), and more than 800 employees. We have three large clinics, two of which have large, freestanding surgery centers capable of performing complex orthopaedic procedures, and the ability to admit patients for postoperative care if necessary.

Each of these practice scenarios have taught me many things. In the Army, we did everything with very little technical support and virtually no control over our environment.

In my two-man practice, we were very efficient (except for call and travel) and were able to control every facet of our practice. The tradeoff was not being able to control my traveling and call schedule, which became increasingly demanding, both physically and mentally.

In my current practice, I enjoy a great deal of freedom from call (1-8 hand only), rarely do I have to operate in the middle of the night. The tradeoff is a large group of physicians who sometimes, I believe, couldn’t agree on what color to paint an exam room. One other problem in such a large group is that we try to standardize the way we practice (at least to some degree) and that sometimes requires compromise.

If I had to make a choice, I would vote to continue with my current practice over the other two, with no regrets. Unfortunately, I lost my wife to a rare form of cancer in 2010. Even up until the very end, her favorite saying that I have often repeated to my children (I would say kids, but my wife would remind me that goats have kids and people have children), “Live life, love life.”

Do what makes you happy, and allows you to practice and live the way that you have always dreamed of.