American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Advice on Strategic Resource Negotiation when Starting a Surgical Practice

Have situational awareness.

Regardless of your practice setting, as a young surgeon finishing training, you must develop realistic expectations and have situational awareness. On average, it takes three years for a practice to become profitable. In my opinion, your initial ask should be kept to a minimum. Your chair and/or employer are looking at your passion and demeanor; being humble in what you ask for becomes paramount. Remember they all want you to succeed.

Also, it is important to keep in mind that every person and situation is different and you may want to consult additional colleagues, lawyers, or even a professional negotiator for their assistance and expertise on this topic.

Create a budget. Minimize requests. First deliver and then ask.

In order for you to better understand your chair and hospital administration’s response when requesting resources, it is imperative that you develop a budget. Implement realistic projections that will enable others to better understand your true needs to develop a successful practice.

Your office and hospital consultations, as well as compensation for surgeries performed, will be your primary sources of income. It is not unusual for physicians to expect to have personal office space, as well as a full-time nurse, secretary, and surgical assistant support. This support, plus your license, medical malpractice insurance, office space rental, and time away from work (for vacation and/or conferences) constitute expenses that will have a major impact on annual profit and loss calculations.

It is important to show restraint and understanding for the current healthcare environment and try to minimize your requests for new and expensive equipment. You may want to consider sharing your overhead, such as secretary and nurse support, until your practice pace becomes robust. Use the available clinic and operating room equipment as much as possible. It is best to wait until your practice has begun to turn a profit to ask for better and additional equipment.

Be a strategic marketer.

Market yourself from the inside out. Do not expect mailings and billboards to make your practice thrive. In my opinion, these efforts are expensive and of little benefit. Your best marketing tool is to engage with peers, office staff, and other caregivers. Be available, reachable, and likeable. Take good care of your patients and try to get excellent Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAPS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey feedback. Respect other caregivers, regardless of their rank or experience. These actions will circle back to you via a positive impact on your practice. Most of your initial referrals will come through the emergency room and senior partners. In addition, an excellent strategy to market your practice is to publish whenever possible and to participate as faculty or attend conferences. At these events you should actively network with peers that may become potential referring sources.