Careers in Family Medicine: Traditional Private Practice

We’re continuing our Careers in Family Medicine series, where each week a family physician shares their career journey and insights.

This week, we highlight Traditional Private Practice through the career of Dr. Debbie Kolb. Enjoy our conversation below.

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 saw my first patient July 1, 2001 and our local not-for-profit hospital helped with seed money since (at the time) I was in an underserved area for primary care. I have been in my original location since I started and enjoyed caring for generations of families over the years. 

What were your favorite parts of your role? 

My favorite part was interacting with my patients and staff on a daily basis. My wonderful medical assistant retired after spending eighteen years with me. We still enjoy catching up regularly. I loved that I was able to set my own hours and adjust as needed for family commitments. I tried to be mindful of my patients' needs and plan well in advance but I loved that I didn’t have to “request time off” from an administrator. I enjoyed taking trips with my family and combining them with an interesting CME meeting. I loved that the flexibility of owning my practice afforded me the opportunity to advocate for the house of medicine. My husband and I regularly traveled to our state capital as well as Washington, D.C., to meet with legislators and share our experiences. I loved that I had an EHR that prioritized small practices (Practice Fusion) so that even when I was out of the office, I could take a few minutes to check in and whittle down my tasks. I loved that I could tailor my practice to the things that interested 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 an 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 on the Executive Board of 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!”

The advent of the EHR was certainly a game changer. I tried to provide the very best care of the patient and learn as much as I could about coding to the “highest order of specificity” so that I would have my excellent clinical care noted and compensated. I tried to ethically… [comply with insurer expectations]… while submitting a ‘clean claim’ with the information the insurance companies required so rejections did not slow things down and we could make payroll!

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 eventually became 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. One of the staff told him 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 causes that are important to me.

What 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!

4. Learn the nuances of coding effectively so you will be paid for your work.

In what ways did 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 I was able to set my own schedule and plan it around my children and family activities. I had wonderful patients who had been with me for over twenty years and said they missed me when I was occasionally out of the office but looked forward to hearing about our travels when we returned. Mindset is critical. There are challenges in all jobs. I took care of many people in different vocations who also worked weekends and nights and had high-pressure jobs where many lives depended on the decisions they made. 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 like “Live Well,” book clubs, meetings, and social events.

How did you balance or integrate work with life outside?

I often asked my patients, “What are you doing for fun?” and I tried to remember to prioritize that myself. My husband and I liked to always keep a “trip on the books” and travel planning was a nice distraction for my brain. We celebrated our 25th anniversary two years ago with a Viking cruise in Germany and are planning a cruise up the coast of New England and Canada to see the fall colors this October! I committed to regular exercise and prioritizing sleep and had 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. I miss seeing them since my retirement but am excited for our next chapter!

Thank you, Dr. Kolb, for sharing your experience and insight into the rewards and realities of traditional private practice.

Debbie recently retired after twenty-four years in private practice and updated her post. She and her husband now enjoy travel and spending more time with family and just purchased a Mercedes Sprinter Camper Van! They are planning their inaugural trip to Lake Tahoe this fall. 

Next week, the series continues with Academic Leadership featuring Dr. Ehab Molokhia. Stay tuned!

Until then, have a joy-filled week!
Tonya