Careers in Family Medicine: Traditional Private Practice

We are continuing our blog series Careers in Family Medicine. Each week, I will highlight a family physician and their career path. Each one will share their pearls. So far, we have highlighted examples of Rural Practice, Value Based Care, Academic Medicine, US Department of State, Multi-specialty group and Leadership, Direct Primary Care, FQHC practices, Hospital Medicine, Tribal Health, Military Medicine, Concierge Practice in an Academic Setting. This week, we take a look at Traditional Private Practice with Dr Debbie Kolb.  

Debbie, can you tell the readers how you decided to go the private practice route?

When I graduated from medical school and my husband and I decided to return to my hometown, I began calling local family physicians to see if they were interested in bringing on a new physician. I was very blessed that an old family friend was interested. My husband was retiring from the Coast Guard and we consulted with a local accountant who crafted an arrangement for my new partner and I to share overhead together, but both remain self-employed with our own professional corporations. We had no written contract- it was all on a handshake. I started in July 2001 (22 years ago!) and our local not-for-profit hospital helped with seed money since I was in an underserved area for primary care. I have been in my original location since I started and have enjoyed caring for generations of families over the years. 

What are your favorite parts of your roles currently? 

My favorite part continues to be interacting with my patients and staff on a daily basis. My wonderful medical assistant recently retired after spending eighteen years with me. We still enjoy catching up regularly. I love that I am able to set my own hours and adjust as needed for family commitments. I try to be mindful of my patients' needs and plan well in advance but I love that I don’t have to “request time off” from an administrator. I enjoy taking trips with my family and combining them with an interesting CME meeting. I love that the flexibility of owning my practice has afforded me the opportunity to advocate for the house of medicine. My husband and I have traveled to our state capital as well as Washington, D.C., to meet with legislators and share our experiences. I love that I have an EHR that prioritizes small practices (Practice Fusion) so that even when I am out of the office, I can take a few minutes to check in and whittle down my tasks. I love that I can tailor my practice to the things that interest me more instead of being told what I must manage.

What have you seen change in private practice over your career? 

I practiced with my original partner for 16 years until he retired at age 78. After that, we were finally able to make the switch from paper charts to the Electronic Health Record- that was big! When I first started out, we were still admitting patients to the hospital but that slowly gave way to the rise of the Hospitalists. It was a trade-off but one that has served me well as it allowed me to adjust my schedule to be at school events and ball games. However, when you are no longer in the hospital, you lose the camaraderie of the physician’s lounge, so it behooves you to make more of an effort to attend events where you can network with your colleagues. I was recruited to serve with our local medical society and have found that to be one of the most rewarding experiences of my career. I believe advocating for physicians in general and family medicine in particular at the state and national level is critically important. As the saying goes, "If you are not at the table, then you are on the menu!"

What key lessons did you learn that you wish you would have known earlier? 

No one will look out for your bottom line like you and your family. I am very blessed that my husband is now my practice administrator and has a very good head for business. He stayed home with our children and as they grew older was able to take a more active role at the office and look out more for my interests and pick up on some things I might not have considered. For example, he reassessed service contracts and supply vendors and observed (before the EHR) all the paper we used in the office. Someone said the paper was “free”. Nothing is free! He looked over the contract that the office had with a local copier company to service the machine and noticed that the “gold level plan” that had been in place since before I arrived included maintenance, toner and paper- at a premium price. We negotiated down for a more economical service plan and bought our own paper at Costco! 

It’s okay when you feel like you can’t do everything all at the same time and do it well. I was very fortunate to have female physician friends who were encouraging and supportive. I remember sharing with one that I felt guilty that I was not able to volunteer as often as I wanted at our community free clinic with three small children at home. I will never forget her saying, "The community free clinic will always be there.” Now that we have an “empty nest” (War Eagle!) it is a new season of life where I can circle back to something else that is important.

What three tips would you tell those who are looking at options for the first job in family medicine? 

1. Prioritize your home life.

2. Know your worth!

3. Start saving early and live a balanced life so that you can have the freedom to cut back your hours or even choose to retire at a younger age!

In what ways have you found Joy in private practice despite the challenges?

My husband often says with private practice comes great risk but also great reward. I feel so blessed to be able to set my own schedule and plan it around my children and family activities. I have wonderful patients who have been with me for over twenty years and say they miss me when I am occasionally out of the office but look forward to hearing about our travels when we return. There are challenges in all jobs. I take care of many people in different vocations who also work weekends and nights and have high-pressure jobs where many lives depend on the decisions they make. The grass is not always “greener” and I think mindfulness and coaching are tremendous strategies for helping one continue to find joy in one's work. I am very fortunate that our local medical community has prioritized self-care for physicians and other healthcare workers with regular programs, book clubs, meetings, and social events.

How do you balance or integrate work with life outside?

I am continuously working on this one! I often ask my patients, “What are you doing for fun?” and I try to remember to prioritize that myself. My husband and I like to always keep a “trip on the books” and travel planning is a nice distraction for my brain. We plan to celebrate our 25th anniversary next month with a Viking cruise in Germany! I am working on regular exercise and prioritizing sleep and have a “hard stop” at 9 p.m. to read a book for pleasure for an hour before bed instead of continuing to work on my charts.

Anything else that you'd like to share? 

I am honored to have been asked to share a little bit about my particular practice. In medical school, I found that I enjoyed meeting new people and doing lots of different things, and family medicine afforded me that opportunity. It has been such a privilege to be part of the lives of my patients.

So many great tips - I'd love to hear your takeaways... Next week the series continues as we highlight Academic Leadership with Dr. Ehab Molokhia. Stay tuned!  Don't miss any in this series; sign-up to have them delivered to your inbox. 

Until then - Have a joy-filled week!  Tonya