Challenges and Experiences of Young Medical Specialists in Establishing Private Clinical Practice

Abstract

Background: The field of medicine is constantly changing. Notable changes occur in the patterns of clinical practice, business of medicine, shift in demographics/generation of the health care workforce, emergence of sub-specialization; and advances in research and technology. These changes can affect the way young physicians establish their practice and this is an area not addressed by the medical education and training.

Purpose: There is little data in the literature regarding the experience of young physicians in establishing clinical practice. This study was undertaken to answer the central question: Among physicians in the field of Internal Medicine with or without subspecialty who graduated from training in 2013 to 2018, what were the issues and challenges that they faced as they established their clinical practice in the urban or mixed setting? 

Methodology: Qualitative research-case study; Key informant interview was conducted among junior Internal Medicine consultants who satisfied the inclusion criteria.  Data analysis used thematic analysis consisting of reading, writing notes, describing, and classifying transcripts according to categories and themes. 

Results: After a comprehensive analysis of narratives, five emergent themes surfaced: “Tough Days” (Period of figuring out the system; Need for Self-introduction; Few patients and Feelings of frustration and depression); “Torn and Divided” (Unpredictable work schedule and workload; Lack of time for issues outside career); “Temporary Debt” (Large start-up cost; Expensive maintenance); “Difficult but Tolerable” (Family support; Call-a-colleague; Debt of gratitude to mentors) and lastly “Dreams and To-do’s”.

Conclusions: Our respondents have experienced substantial challenges in starting clinical practice. Learning the ways of the healthcare business, effectively promoting oneself to the community, dealing with the emotional turmoil of having few patients, coming up with a strategic schedule and area of practice, and looking for funds and paying it back, were the challenges and experiences of these young medical specialists as they establish their careers in the urban and/or rural setting.

 

Key words: clinical practice, challenges, start-up, establishing practice

  1. Lund A. Medicine in the New Millennium: Looking Back at the Future. BC Medical Journal. 2000 June;42:255–8. 
  2. Types of medical practices [Internet]. American College of Physicians. Available from: https://www. acponline.org/about-acp/about-internal-medicine/ career-paths/residency-career-counseling/guidance/ types-of-medical-practices 
  3. Asghari S, Aubrey-Bassler K, Godwin M, Rourke J, Mathews M, Barnes P, et al. Factors influencing choice to practice in rural and remote communities throughout a physician’s career cycle [Internet]. Cfpc.ca. [cited 2022 Oct 2]. Available from: https://www.cfpc.ca/CFPC/media/Resources/ Rural-Practice/CJRM-RuralPractice2017.pdf 
  4. Castillo-Carandang N. Physicians Choice of Geographical Area of Practice and Medical Specialty: A cross sectional Survey of Graduates of the University of the Philippines College of Medicine. Acta medica Philippina. 1998;34(2–3):75–92. 
  5. Barondess JA. The future of generalism. Ann Intern Med [Internet]. 1993 [cited 2022 Oct 2];119(2):153–60. Available from: https://pubmed.ncbi.nlm.nih.gov/8512164/ 
  6. Primer on starting and establishing a private medical practice in the Philippines [Internet]. Tripod.com. [cited 2022 Oct 2]. Available from: http://privatemedpract_phil. tripod.com/ 
  7. Eighteenth congress of the republic of the Philippines [Internet]. Org.ph. [cited 2022 Oct 2]. Available from: https:// philippinecollegeofradiology.org.ph/wppcr/wp-content/ uploads/Physicians-Act-of-2020.pdf 
  8. Kevin. Pros and cons of private practice versus hospital owned [Internet]. Kevinmd.com. 2011 [cited 2022 Oct 2]. Available from: https://www.kevinmd.com/2011/05/ pros-cons-private-hospital-owned-practice.html 
  9. Solo versus group practice [Internet]. CRSTEurope. [cited 2022 Oct 2]. Available from: https://crstodayeurope. com/articles/2012-may/solo-versus-group-practice/ 
  10. Mizell J, Thrush C, Steelman S. The Business of Medi cine: A Course to Address the Deficit in Financial Knowledge of Fourth-Year Medical Students. The Journal of medical practice management: MPM [inter net]. 2019 May [cited 2022 Sep 22];34(6):344. Available from:https://www.researchgate.net/publication/338083232_The_Business_of_Medicine_A_ Course_to_Address_the_Deficit_in_Financial_Knowledge_ of_Fourth-Year_Medical_Students 
  11. Kieves NR, Roark AW, Sparks TK. Business education in veterinary schools: the potential role of the Veterinary Business Management Association. J Vet Med Educ [Inter net]. 2007 Winter;34(5):678–82. Available from: http:// dx.doi.org/10.3138/jvme.34.5.678 
  12. Dayrit MM, Lagrada LP, Picazo OF, Pons MC, Villaverde MC. The Philippines health system review. In: Health Systems in Transition. World Health Organization. Regional Office for South-East Asia; 2018. 
  13. Manivasakan S, Parija SC. Knowledge on practice management and financial literacy: Need of the hour. Journal of Scientific Dentistry [Internet]. 2019;9(1):1–1. Available from:http://dx.doi.org/10.5005/jp-journals-10083-0919 
  14. Rabinowitz HK, Paynter NP. The rural vs urban practice decision. JAMA [Internet]. 2002 [cited 2022 Oct 2];287(1):113. Available from: https://jamanetwork.com/ journals/jama/fullarticle/1844613

 

Articles related to the one you are viewing

There are currently no results to show, please try again later

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.