Practical  Resident's Review: OPA Dialogue


The following article is based on Dr. Mamta Gautam's presentation, entitled, "Successful Psychiatric Practice: Everything You Need to Know to Have One", to the Resident Section on Saturday February 1, 2003 at the OPA 83rd Annual Meeting, and is primarily based on Dr. Gautam's personal experience, that of her colleagues, and information offered to residents on practice management by MD Management.

Congratulations! You are near the end of the residency! But, then what? Do you know the four phases for determining what your practice will be like?

  • Thinking About a Practice
  • Setting Up a Practice
  • Starting a Practice
  • Maintaining a Practice

1) Thinking About a Practice - Remember Medicine is a Business!

  • Consider your area of focus - general or specialized?
  • Consider the age group - children, adults, geriatrics?
  • Consider the structure of your practice - private practice (home office, mini-office, sublet office space, private office (owned or leased) - solo or group - and/or hospital based - inpatient/outpatient, academic involvement (blended financial arrangements, need to negotiate income, benefits, office space, support, etc), research, teaching or administrative.

2) Setting Up a Practice

  • Consider - size of town or city, type of patient population, family needs (cultural, social, school), facilities for hospital admission, research, labs, ambulance, consultants available. Could you five here for 20 years?
  • Resources for Opportunities - Program Director's Office, PAIRO - Practice Opportunities Listing, Provincial and National specialty meetings, job fairs, or try a community as a locum if unsure.
  • Set up an Advisory team (real estate broker, accountant, financial planner, lawyer, insurance broker, bank manager)
  • Look for office space - consider location and layout - arrange financing, negotiate a lease, hire a lawyer, get office insurance, review accounting needs
  • Get all necessary papers -Get a billing number from Ministry of Health, ensure you pay CPSO for your license.

3) Starting a Practice

  • Furnishings - ensure that office is background, not an interruption, to therapy; furnishings reflect your style; consider lifestyle of your patients; carefully consider your choices of art, colour, furniture style, plants and magazines.
  • Office Equipment - furniture, art, phones, answering machines, fax, copier, computer, shredder, security systems (determine what you will buy and what you will lease and use a separate business credit card)
  • Office Staff - receptionist (needs careful training by you), answering machines (be professional, include information on when you are available, when you check messages, emergency contact), answering service (real person), bookkeeper (can be cost-effective), full-time vs. part-time, know job descriptions, advertising, interviews, hiring, contracts, payroll, employer #, benefits, deductions, taxes, letting staff go. Staff need AIR (appreciation, information, remuneration).
  • Office forms - office policy brochure, new patient intake forms, Forms I + 14, letters for consultations, referrals, end therapy.

4) Maintaining a Practice

  • Scheduling patients - determine timing and length of sessions, discuss cancellation policy, schedule new patients when others are around, schedule time for paperwork, meetings and time off
  • Time management - code mail, touch paper once (patient related/immediate, patient related/less urgent, office operations, educational material, junk mail, patient info sheets, test results), schedule time to call back, call pharmacy.
  • Office files - keep accurate, complete, legible records; include date and length of visit, start and stop times, highlight session content and MSE
  • Medication records - visible, accurate, updated.
  • Keep files in locked cabinet, limit access, ensure confidentiality
  • Billing OHIP - self or billing service; cards, computer, modem; shop around for billing program; keep accurate records and reconcile payments; know billing rules and codes.
  • Billing Patients - clearly outline policy to patients in advance and document; use a brochure; determine if and what to charge for missed appointments, sick notes, pharmacy calls, wrong OHIP numbers; charge lawyers and insurance companies reasonable rates based on OMA hourly rates; consider block billing.

Remember to avoid isolation - plan time to meet with colleagues, organize journal clubs, attend rounds, meetings and conferences - and - balance your life - take care of yourself, indulge in exercise, nutrition, hobbies and interests, make time for families and friends, set and maintain limits at work, watch for burnout, take holidays and live within your means.

Mamta Gautam, MD, FRCP, is a psychiatrist in private practice in Ottawa, and an Assistant Professor in the Department of Psychiatry, University of Ottawa. She is a specialist in Physicians Health and Well-being. Hailed as "The Doctor's Doctor; physicians make up her entire patient population. Dr. Gautam is the founding Director of the University of Ottawa Faculty Wellness Program. She is on the faculty of several medical leadership programs, including the Foundation for Medical Excellence Leadership Course, the University of Ottawa Medical Leadership Course, and the CMA Leadership Workshop of Medical Women. She has created videos on Physician Stress and authored several articles and book chapters on this topic. Dr. Gautam is an internationally known speaker and has given over 250 keynote presentations and workshops in the area of physician's stress and mental health, and issues specific to women physicians and physician's spouses. She serves as a consultant to multiple local, national and international advisory committees on physician's well-being.

Dr. Gautam was a member of the OPA Council from 2000-2003.

Krishna Balachandra
Ontario Psychiatric Association Dialogue March 2003