Book Report: The Doctors Guide to Starting Your Practice Right

It’s the second week in July, and that means there are thousands of freshly minted physicians beginning their first career job.

Launching a career is an exciting, but potentially overwhelming project. There are so many considerations when it comes to the practice, housing, lifestyle, debt management, etc… Wouldn’t it be nice if there were a textbook to guide you through this jungle?

Thanks to Dr. Cory S. Fawcett, there now is. While he titled the book “Starting Your Practice Right,” a better phrasing might have been “Starting your Medical Career Right,” because the book focuses on far more than starting a practice. Perhaps my personal definition of “starting a practice” is too narrow, but this book applies equally well to employed physicians and those joining an established practice.

This is the second book of Dr. Fawcett’s that I’ve reviewed. A couple months ago, we discussed The Doctors Guide to Eliminating Debt, a text that not only discussed avoiding and paying down debts, but was also chock full of valuable lifestyle tips and life lessons.

Having retired from his clinical practice as a general surgeon, Dr. Fawcett now focuses on educating others via his books, website, public speaking, and one-on-one counseling. He was kind enough to send me a copy of his books, and I will be gifting my copy to one lucky commenter (see page end for details).

 

The Doctors Guide to Starting Your Practice Right

 

With 10 chapters in 200 pages, this book can be taken in over the course of a couple evenings, or in about a week reading a chapter or two per day. As I mentioned earlier, this is not a comprehensive guide to opening a medical practice; it’s a much broader book of advice the new physician. From the dedication:

 

“I dedicate this book to the hardworking medical students and resident, their families, and the schools that support them. My hope is you will start your practice right and build the wonderful life you deserve.”

 

The book is not intended strictly for private practice or independent contractors. Those are discussed, as are academic medicine and employed physicians.

In the introduction, Dr. Fawcett mentions a physician earning $450,000 who needed moonlighting income on top of that to make ends meet. She may have formed the basis for Dr. Rolex, a fictional doctor whose career and life path is compared and contrasted to Dr. Timex throughout the book.

 

Location Considerations in Your First Job

 

Before you begin your job search, Dr. Fawcett recommends taking a number of factors into account. He knew roughly where he wanted to be, and the recruiter he was working with couldn’t find him work there.

Taking matters into his own hands, Dr. Fawcett personally contacted all of the hospitals in his desired geographic location. That led to six interviews, and he was able to land his dream job. That’s a great lesson — many of the best jobs are not posted publicly; networking can do wonders for you, particularly if you have a specific spot on the map in mind.

What other considerations are there?

  • Housing: Consider renting and don’t buy all the house the bank will allow.
  • City versus Rural: He discusses the pros and cons of each. You probably know which you prefer. Geographic arbitrage can come into play here.
  • Friends and Family: Proximity to a support structure can be extremely valuable.
  • The cost of moving: Your first job will probably not be your last. He recounts a physician who added up $175,000 in total costs of moving for a job change!

 

Lifestyle Considerations in Your Career

 

fawcett starting your practice right

fawcett starting your practice right

This is an area that I focus on quite a bit. We make a lot of value choices in life, and if you are like Dr. Rolex (or my Dr. D), and prefer leasing new cars, frequent fine dining, extravagant vacations and an oversized home, you’re going to have a tougher time working towards a comfortable retirement, or any retirement for that matter.

If, on the other hand, you model my Dr. Timex (or my Dr. A or Dr. B), the physician who paid cash for her vehicle, lives close to a great public school, and takes family friendly vacations from their quality but not overstated home, you will have a much better opportunity to build real wealth over the course of your career.

You won’t be surprised to hear that Dr. Timex becomes a multimillionaire with the ability to retire early, and Dr. Rolex struggles to become a millionaire by the time she reaches retirement age. It’s obvious, yet lifestyle inflation remains a major roadblock between physicians and financial independence.

 

Finding the Right Job

 

In addition to outlining the pros and cons of the various types of jobs available to physicians, Dr. Fawcett gives you ideas on how find the best job. He found his by cold calling, but there are a number of other ways.


There are online job searches that aggregate the results from numerous physician and other job search sites. I happen to host what’s probably the best one for docs right here on my Jobs page — it even defaults to your location – check out what’s available in your specialty.

Your residency program may keep an alumni directory. National journals often advertise positions (usually academic) and national meetings offer great networking opportunities. Working as a locum tenens physician led to numerous job offers for me.

Dr. Fawcett has a number of good interview tips — you want to be on your best behavior, of course, but the interview is usually more of an effort to recruit you, and you need to get as much information as possible on the practice and the area if you’re not familiar.

The right job can turn out to be the wrong job if the contract is not written in a fair manner. It’s important to get what you were promised in writing, and although I haven’t personally had a contract reviewed, I would recommend a professional contract review, as the good Dr. Fawcett does. Contract Diagnostics is a national firm that works with attorneys to review physician contracts exclusively (and is a paid advertiser on this site). A local attorney with physician contract experience may be another good option.

 

Before You Start Your First Job

 

There are practical considerations. Dr. Fawcett outlines what should be obvious (but delays have postponed numerous physician’s starts in my experience). Get your state license. Get your hospital credentials, and give the administration ample time to get you licensed with the appropriate insurers.

If your start does become delayed by a snafu, the author might not think that’s such a bad thing. He actually took three months off in between residency and his first job. Of course, he finished in the days of q2 call and was feeling a bit burned out.

 

starting your practice right

 

When I finished my residency, which was rather arduous but I imagine relatively benign compared to his surgical residency, I was ready to work from day one. I had locums lined up starting Monday, July 3rd. Whichever option you choose, just realize that the opportunity to take a month or three off might not exist again for decades.

Additional considerations he highlights are getting yourself and your family properly insured, which is not to be confused with overly insured, but remember, as a doctor, you have a target on your back.

He goes into additional advice that touched on earlier — the expected doctor lifestyle can easily stand in the way between you and accumulating any real wealth. Remember that when you’re interviewing and the assigned realtor takes you around to all the high-commission homes. If you’ve already got massive student loan debt, you might want to wander the middle-class neighborhoods. To borrow a quote from the book:

 

“You gotta make it a priority to make your priorities a priority.” – Richie Norton

Establishing Yourself in Your First Job

 

Dr. Fawcett stresses finding work life balance early on, being sure to find adequate time for family, exercise, sleep, vacation, and more.

I agree that these non-job aspects of life are vitally important, but I think the author makes it sound all too easy to make these choices. As a young doc trying to make partner, or a new employee in an established health system, you probably won’t have the autonomy you might wish for or the ability to say “No” as much as you prefer.

For example, Dr. Fawcett says “Plan your life and fit work into it, instead of focusing on your work and fitting your life around it.” And “You run your practice. Don’t let it run you.”

I like the advice, but for most of us, it may not be the most practical. Nevertheless, he’s right about getting your priorities established; you may have to wait until you’re a little better established in order to throw your weight around, though.

In the closing chapters, we learn some personal finance tips on managing a budget, managing debt, and of course we revisit Drs. Timex and Rolex. Which one do you suppose does a better job with her budget and debts?

 

Planning for a Physician Retirement

 

In what I imagine is largely a teaser for his third book in the series, Dr. Fawcett touches on retirement planning and future considerations. While many young docs are focused on the present and the job they just landed, the fact is the best time to plan for a comfortable and perhaps early retirement (like his and mine) is in the beginning of your career.

He touches on finding an accountant, competent financial advisor (not a commissioned salesman! — and remember, you can DIY), funding your retirement accounts, and planning for your childrens’ education.

All are important, and I imagine will be expounded upon in an upcoming volume. I think this is a great book for a medical student or resident, and will help them get their career started on the right.

 


You’re still not using Personal Capital? Track all your accounts in one place like I do.


 

Don’t want to shell out the $7 (Kindle) or $19 (paperback)? [prices at time of this post’s publication] You can have my copy.

After all, this will help one of you more than me. I’m winding down my medical career. Comment below and I will randomly select one of you (via Google’s random number generator) to receive the book, and will ship it to you post-haste. Best of luck!

 

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39 comments

  • OMMD

    I think the best advice given is that most of us do not last long in our first job. I chalk it up to how little we actually learn in our training about the business and practice of medicine.

    • OMMD,
      You are right about this being very important. Choosing well with the first job is a major contributor to your future financial situation. It is expensive to move to a new job so take the time to decide what you really want and go get it. Investing in this decision is money and time well spent.

  • Mark C.

    Virtually nothing is taught in Med School about Personal Finance. This book sounds like an interesting read.

    • Mark C.,
      You are right. That was the reason I wrote this book. I’ve included many things you need to get right but no one bothers to cover during your training. There just isn’t enough time during your training to do it all. This will be a very inexpensive supplement to your education.

  • Not a physician, but this all seems like great advice!

  • SG

    Thanks for the review, I would be interested in a copy. Started my practice 2 years ago, still have so much to learn.

    • SG,
      I just ended my practice and I still had much to learn. It is a never ending process. Even if you have already started, there is often things you can do to improve how you do it. This book is aimed directly at the person who is just exiting their training, but it also will serve anyone who wants to improve their current medical practice. We are never too old to learn.

    • Congrats, SG. You won the book!

      I’ll contact you for a mailing address.

      Cheers!
      -PoF

      • SG

        I wanted to Thank POF for the generous gift and Dr. Fawcett as well. The book is extremely thoughtful and well written. I intend to pass it onto a medical student/resident that rotates with me as it is written primarily for them. Certainly anyone who visits this forum will not necessarily learn anything new in this book, but it is still worth a read. I think the most interesting aspect of this book is Dr. Fawcett’s disdain for debt. I couldn’t agree more. I think the one aspect of the book that I have trouble agreeing with is practice ownership equity. I am in my second year in a small private practice and I struggle with going into more debt to buy in. Especially if FIRE is a goal you would have to consider paying off the buy in and possibly a buy out in the near future of a senior partner. If you know you want to work for 20+ years certainly it is less daunting. However if you want to have the ability to retire after 10-12 years then is it worth the opportunity cost and risk of buying out another partner? Additionally who is going to buy your small practice if the majority of residents coming out elect for employee based? So you have equity tied up in an investment that may not sell, that is dependent on you to create income. It is a hard decision for sure.

        • SG,
          There are good points and bad points to every decision. The idea of my book on starting your practice right is for the reader to think about the plusses and minuses of these decision and move forward with confidence after weighing the options. Ownership is not the choice for everyone. But if you are an “Owner” personality, and you pick “Employment” you are likely to regret it. The reverse is also true. My hope is that every resident will read this book before becoming an attending. If they do, they are much more likely to make the right choice the first time. Making the right choice will be a lot cheaper in the long run. Your happiness factor will also be higher.

  • Rick

    Just graduated, starting first week of August-Would love a copy.

  • MRD

    Hey, I would love to read this book!

  • Great advice! As someone who is just going through the process (start date August 1st), I feel that the non-medical part is just as important. The whole relocation and getting into a new routine is just as important as the job itself.

    Add in the fact that most of us have to study through boards in this critical transitional period. So that extra month or two before our set start date would give us a breather to start our new process.

  • CS

    Would love a copy of this book!

  • Jeniel

    If i don’t get this book from FIRE, I’ll buy it, sounds like a great read.

    – Dr. Casio

  • I am always amazed how industrious some docs are. The fact that Dr. Fawcett has been able to write 2 books is no small feat (with a third presumably on the way).

    Biggest advice I have is not to buy a house. Not at least for 2-3 years until you know the practice setting, town, and work-life balance are right for you.

    You may also be expecting certain things (like raises) that never come by year 2 or 3 leading to frustration in an otherwise happy work setting (this is where the contract becomes important).

    So hold off on home buying. In this case, do as I say and not as I did.

    • Dads Dollars Debts,
      That is great advice and I spend considerable time on supporting the decision to rent for the first few years. Selling a house after two years if you move to a new job is an extra burden you don’t need in addition to the expense it will cause you. It is rare to make a profit on a house you only owned for 2 years.

  • Roger

    Wish this resource had been available to me when I started practicing in 1985. I just turned 60 and love what I do, but maybe I would have changed my approach to preparing for retirement better if it had!

    • Roger,
      I hear that so often, “I wish I had this information earlier.” So now it is out there and hopefully fewer doctors will be saying that in the future. My goal would be for every resident and medical student to get this book and get a good start on their long and happy career. If we are lucky, it will become required reading during training.

      I don’t want anyone 10 years from now wishing they had heard this earlier.

  • E

    Just starting pgy-2. This book sounds very helpful. It would be great to have the resources with answers all in one spot for questions that I know are coming my way now & next few years …. insurance/asset protection, contract review/negotiation, practice set up etc. Thanks for your thorough review!

    • E,
      The ideal time to read this book is one year before you finish your residency. That is when you are beginning to look for your first job. Picking that first job right is so important to your future wealth and well being.

      Best of luck to you.

  • Ann

    The best job hunting advice I got in residency was from one of my favorite attendings, who told me “there are 3 main components to a job: vocation, location, and compensation. Whichever is most important to you, you can get that one on your first job if you are willing to give up the other two. If you are lucky, you might get 2, but it is really rare to get all 3, especially on your first job.” It really helped me narrow down what was most important to me–which was vocation. Even without focusing on the highest compensation, I am on track to be FI within my first 10 years of practice, although I don’t know if/when I will RE, as I enjoy my job for the most part (but still would rather be prepared for a change in tide). I would like to start a financial curriculum for the residents I work with and may have to add this to the library for them.

    • Ann,
      Good advice. But I would hope people aren’t looking at it as their “first” job. This implies they plan to leave. I would hope to encourage people to make it their only job. It is very expensive to trade jobs and move again. Treat it like a wedding, you only want to do it once.

      It is great that you want to start a financial curriculum for the residents. This book and my book on eliminating debt would be a great help for them. If you contact me through my website, we may be able to get you the books for your residents at a bulk purchase discount.

      Best of luck to you.

  • John

    Maybe this is stating the obvious, but what I have noticed is that one of the most important factors in choosing a job is whether the spouse (if you are married) is happy with the location. I almost chose a first job in Texas, and I am almost certain that if I had, I would eventually have moved because my spouse would have been miserable. Thankfully, I have had only one job my entire career, which is unusual. I attribute that to the fact that my wife is very happy with the locale.

    • John,
      That is great advice. In the section on interviewing, I stressed the importance of the spouse being on the interview and their impression is as important as yours. “If momma ain’t happy, ain’t no one happy.”

  • DoubleMDs

    Will try to add this to the library for our resident staff. Think it sounds terrific.

    • DoubleMD’s,

      Some programs are buying the books for all their residents for Christmas. They can get a bulk discount if they get them from me directly. Both the starting your practice and the eliminating debt are good for residents. You can give one book each Christmas.

  • rr

    sounds like a good book to check-out. Send me a copy if I come up as the lucky winner from the google random number generator.

  • Dr P

    I agree with John. Make sure the job is a good fit for both you and your spouse. I almost took a job out of residency that was much farther away from family than either of us really wanted (especially my wife); I can’t imagine that would have turned out well.

    • Dr P,

      When I looked for a job, our families lived 4 hours apart. I only looked at places between the two families. It is great to be close to family. Saves a lot of time and money around the holidays. My story of finding that job is in the book. Make sure the spouse is happy!

  • Jason Faucheux

    Very true. This is good advice we all need to hear as physicians.

  • Lane

    Put this one on my to do list

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