Fall 2015 (Volume 25, Number 3)

Preparing for Transitioning Into Practice

By Thanu Ruban, MD, FRCPC

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With only two years of rheumatology training ahead, senior rheumatology residents need to be as proactive about career planning as they are about learning the ropes in their chosen field. Career planning requires dedicating time and resources to ensure you are set following graduation. In this article, I highlight my own personal journey into practice as well as impart helpful advice for current trainees.

The first thing one needs to decide upon when choosing the type of rheumatology practice to pursue is whether academic or community practitioner is the correct direction for oneself. This is a conversation that may start with mentors while in medical school and internal medicine training; this will take more concrete form during subspecialty training. For myself, I was drawn to both spheres of practice: the pull of academia would allow one to explore research questions as well as teach and inspire junior trainees, while community practice would allow for more independence and focus on clinical practice. I found the following most helpful in deciding on my career plans: networking with other rheumatologists and taking part in community practice electives during my training. I was fortunate enough to work with community practitioners, who showed me that there was plenty of opportunity to work with trainees with the increase in distributed medical education, as well as to take part in clinical research and advocacy work while in private practice.

Networking is a critical step in the process of deciding your career plan. During my first year of rheumatology training at the University of Toronto, I had the opportunity to attend the Ontario Rheumatology Association (ORA) Annual General Meeting (AGM), where I spoke with multiple practitioners about the job market and perceived underserviced areas. Following this meeting, I contacted several rheumatologists in areas where I was interested in working, and discussed clinical opportunities as well as hospital affiliations. During my second year of rheumatology training, I was able to do community rotations at several of these sites that gave me a chance to see how private practice was conducted, the role of allied health professionals in rheumatology practice, and the available research opportunities for the community rheumatologist. Learning about office technology and staffing issues was also very helpful. These opportunities gave me a brief glimpse into what my future practice might entail.

With the support of the local rheumatologists, I decided on setting up practice in Markham, Ontario, a rapidly expanding city within the greater Toronto area. I contacted the hospital Chief of Medicine to discuss terms of a hospital affiliation. It was helpful to have some perspective from the current rheumatologists in the area when it came to negotiating clinic opportunities in the hospital and call duties; I also started doing internal medicine call coverage following my internal medicine certification and found this was a great way to get to know the hospital and its medical and support staff. Being exposed to this welcoming environment while doing internal medicine call was another positive factor that influenced my decision-making at that juncture in my career.

Following my rheumatology training and while studying for the rheumatology Royal College exam, I had the opportunity to do a clinical locum to cover a maternity leave. This was a great way to be immersed into practice without the worry of starting up one’s own clinic right away. I worked with a group of supportive rheumatologists, which made transitioning from training to practice all the easier. I would highly recommend exploring locum opportunities as well as working with seasoned rheumatologists when starting out in the field.

For those currently in rheumatology training and those who are planning to pursue a career in rheumatology, here are some helpful pointers for the post-fellowship job search:

1. Be engaged:
Become a member of your regional professional rheumatology association and attend their annual meetings. This is a great networking opportunity, allowing you to get up-to-date job market information. You may find that there are specific programs directed to help you with career planning; for example, the ORA has a great initiative (www.rheumcareers.ca) that assists current rheumatology trainees in exploring job opportunities in underserviced areas in Ontario. This program allows trainees to visit an area that they might not be familiar with and learn more about what the community has to offer.

2. Take part in community electives:
Contact a local rheumatologist in the region where you are interested in working. Doing community rotations during fellowship allows you to get a feel of the type of practice you would like, including solo vs. group practice, Electronic Medical Record (EMR) use, and involvement of allied health professionals within the practice.

3. Know your business:
There are many resources available to graduating residents who are setting up their practice. The Canadian Medical Association (CMA) administers all-day practice management seminars,¹ with discussions around contract negotiations, financial wellness and evaluating practice options. Be sure to also check out the CMA’s document Setting Up Your Medical or Clinical Office.² For those in Ontario, the Ontario Medical Association (OMA) has a similar document,³ which is a great resource for transition to practice.

Setting up practice following subspecialty training may seem like a daunting task, especially with clinical duties, research endeavours, and the looming Royal College exam; however, there is plenty of support available to help you build the ideal practice. The key is get out there, explore resources, and make the best of your opportunities.

Suggested Readings

1. Canadian Medical Association. Seminars for Medical Residents. Complete listing available at: www.cma.ca/En/Pages/seminars-family.aspx.

2. Canadian Medical Association. Module 14: Setting Up Your Medical or Clinical Office. Available at: www.cma.ca/Assets/assets-library/document/en/practice-management-and-wellness/MEDED-12-00307_PMC_Module_14_e.pdf.

3. Ontario Medical Association. Starting a Practice: A Guide for New Physicians. Available at: www.oma.org/Resources/Documents/1_StartingPractice.pdf.

Thanu Ruban, MD, FRCPC
Rheumatologist,
Sunnybrook Health Sciences Centre
Toronto, Ontario
Markham Stouffville Hospital
Markham, Ontario