Mind the Costs–Don’t Underestimate That Red in the Ledger

For Clinicians and Clinicians-to-be.



I spoke to my son’s allergist the other day. He’s sixty-four, runs his own practice and was calling me back at 7pm at the end of a fifty patient day. Having collaborated with him for over 25 years, I asked him if MACRA was going to finally drive him out of his clinic. With strong emotion in his voice, he answered me. “I’m sixty-four,” he said “and I’ve been practicing for 35 years . . ”




You, however, are not sixty-four. You have not been practicing for 35 years. You’re just starting out.


And here’s something that you may “know” but not yet fully understand.


Life wears on you.


And practicing medicine makes it wear that much faster. You see the pain of the world.


If you practice medicine in an ill-suited environment, it’ll wear that much more quickly still.


You can make a mistake in your choice of practice. You can settle in exchange for a paycheck.


But it won’t be free.


It’ll cost you joy time.


Joy time.


That time in your career when practicing medicine is a complete joy. It’s wonderful, it’s exciting, it’s why you’ve struggled to become a clinician.


It’s also finite.


And an ill-suited practice will run you out of joy time before you know it.


You’ll burn out faster, you’ll become cynical faster. You’ll disengage. I’m seeing it everywhere in our profession.


The lost time will vary from person to person, from situation to situation—but a loss there will be.


So as you make your practice decisions, don’t miss that red in the ledger.


You’re still young, you can afford to make some mistakes—but you’re not that young, and the costs of mistakes are not always apparent.  So be intentional, be cautious.


It may be worth it to settle for a practice with less pay, less certainty in exchange for doing what you love, out of love, for longer than you otherwise would.




My son’s allergist told me he didn’t care about MACRA, about MIPS, he’s just going to ignore them.  That emotion I heard in his voice was JOY. Yes, Joy. He LOVES his practice and his patients.  He created his own clinic from scratch right out of training—and has been there ever since.  He doesn’t need the money or to get away from his spouse, he simply created his ideal medical practice out of the gate and as a result, all these years later, he’s still fulfilled by what he does.And, he’s not about to let anyone tell him how he can and can’t practice.


He’s still practicing in joy time.


I can think of no greater blessing than to wish that happens to you.










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Last week’s tip here.


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