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AAOS Now

Published 11/1/2013
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Maureen Leahy

Transitioning from Fellowship to Practice

Tips for establishing an efficient orthopaedic practice

“During fellowship, orthopaedic surgeons are highly focused on learning clinical principles, surgical techniques, and the art of medicine. It’s a lot like drinking from a fire hose,” said Kenneth J. Hunt, MD, of Stanford University, Palo Alto, Calif. “As a result, we often take for granted the efficiencies that our mentors have built in to their practices and what’s involved in achieving them.”

At the 2013 American Orthopaedic Foot & Ankle Society (AOFAS) annual meeting, Dr. Hunt shared what he’s learned since fellowship about developing and running an efficient orthopaedic practice.



New practitioners should focus on getting to know their patients, perfecting their diagnostic skills, and building a patient base.
Courtesy of ThinkStock

Steps for success
The first couple of years in practice can be challenging. In the beginning, Dr. Hunt recommends that orthopaedic surgeons get to know their patients, perfect their diagnostic skills, and start building a patient base.

“I realized early on that I couldn’t see the same volume of patients that my fellowship mentors did,” he said. “I simply didn’t have the efficiencies to handle it, and that’s OK.”

Orthopaedic surgeons just starting out in practice also need to acquaint themselves with the best places and people for referrals. “Get to know where to refer your patients for chronic pain, physiatry, physical therapy (PT), and other services. Make sure that these providers will be attentive to your patients’ needs because that will reflect well on you,” said Dr. Hunt.

Similarly, new practitioners should keep in mind that their best referrals will come from other physicians, according to Dr. Hunt. “Accept all referrals; don’t be too selective, at least until your patient volume picks up. Give talks to local physician or patient groups to increase your visibility in the community,” he said.

Once your practice gets busier, it’s easy to get behind in clinic, Dr. Hunt warned. “Be aware of your clinic list and your schedule, and always have an exit strategy.”

It’s also important to end each clinic visit with a good resolution and plan for the patient, he added. To help educate patients on their conditions and what to expect during treatment, Dr. Hunt recommends obtaining peer-reviewed patient education materials available online from the AOFAS or the AAOS and developing clear written instructions, especially for postoperative protocols.

Establishing efficiencies in the operating room (OR) can also be accomplished in a stepwise manner.

“First of all, don’t expect to do the same number of OR cases that you did in fellowship, especially if you are working in an academic center,” said Dr. Hunt. “Be careful not to overbook and always allow yourself more time than you think you will need.”

In the OR, meticulous preparation is critical. Dr. Hunt recommends writing down the technical steps to each case for later use. He also finds preference cards—similar to those used by his fellowship and residency mentors and modified to his individual preferences—extremely helpful.

Additional take-aways
“They real key to a practice’s success—to having your clinics and ORs flow—is a good support staff,” emphasized Dr. Hunt. “Choose good people and train them on your preferences. Meet with your clinic schedulers and tell them what cases you want to see. Most importantly, educate them regarding which cases are urgent and which can wait a little bit longer. Show staff your appreciation by occasionally bringing in donuts or bagels.”

Finally, Dr. Hunt stressed the importance of balance. “Everyone has either worried or will worry when they start out in practice. Always be conscientious of your patients and look for ways to improve yourself and your practice,” he said. “At the same time, remember to enjoy life, have hobbies, and spend time with people you love because they are a big part of why you do what you do.”

Disclosure information: Dr. Hunt—National Orthopaedic Foot & Ankle Outcomes Research Network.

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org