Fall 2015 (Volume 25, Number 3)

Tangri's Ten Tips on Starting a Rheumatology Practice

By Vikram Tangri, MD, FRCPC

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1. Get a lawyer and incorporate.
Early on, it may seem like an onerous undertaking, but incorporation is a must and it is always best to start out early. You will save plenty in the longer term. Your lawyer can help you navigate incorporation and also help with signing of leasehold agreements later. The Ontario Medical Association (OMA) has resources which may be helpful, and other provincial medical associations may also be helpful in this regard.

2. Get an accountant.
They will become your new best friend. Remember that the more you have your accountant take care of, the more your expenses will climb. Accountants, along with lawyers, work on billable hours so it is probably best to have them help you early on during incorporation, and then yearly to do your corporate taxes and year-end statements.

3. Choose a location.
This is one of the most difficult choices of all—deciding on where to begin your practice. Lifestyle and family considerations are obviously important, but also think about the size of your community and catchment area for referrals. These factors will play a role on how quickly your practice becomes a "full-time" practice.

4. Decide on whether you wish to locum or not.
Locums can be a key way to start bringing in income. Consider whether you are prepared to do internal medicine (IM) locums or rheumatology locum work. IM work may be easier to find and many hospitals will require some degree of IM work to maintain privileges; however, IM work requires at times tedious night shifts at times! Rheumatology locums can provide a taste of what is to come.

5. Academic vs. community.
This is a big question mark hanging over the heads of many residents during their training years. Staying in a large academic centre typically involves additional education/training, but also provides for an easier transition to practice, with hospitals/departments often helping set up your practice. An academic centre allows more education and research opportunities, but a community practice can offer a significant role for teaching (you may get affiliation with a University as an Adjunct Professor) and community-based research.

6. Partnership.
Do you want a partner? The answer is generally yes! Sharing an office with another physician will split costs in half, and also provide some much-needed social interaction during your work days. On the other hand, you need to have an effective understanding with a partner, since decisions will have to be made collaboratively.

7. Take inventory.
Wherever you work now, go into the office and mentally follow patients’ steps from when they register for an appointment to the physician assessment. Note all equipment, supplies, and staffing needed along the way. The initial costs to set up an office are not minimal. Remember to get business cards/appointment cards!

8. Record keeping.
If you have the chance, try to use and understand various electronic medical record systems (EMRs). Get comfortable before choosing one; weigh your options carefully. Remember that templates are great—creating a sheet that easily records important patient information in a single page format will save you time!

9. Develop policies.
Most rheumatologists (for good reason) post a sign indicating there are mandatory fees to be paid (e.g., for missed/skipped appointments). Decide on these early, and have it posted in your waiting room.

10. Enjoy!
With all the headaches of starting up a practice behind you, it is time to reap the rewards.

Vikram Tangri, MD, FRCPC
Rheumatology,
Department of Medicine,
Royal Victoria Regional Health Centre
Adjunct Professor,
University of Toronto
Barrie, Ontario