LAS VEGAS – Three rheumatologists shared three different career routes that fellows may choose to embark on over the course of their careers.
Dr. Michael Schweitz, who has been in practice for over 30 years, presented insights into the world of private practice, as well as tips for interviewing and contract negotiation. Dr. Orrin Troum discussed taking the clinical research track, and Dr. James S. Louie explored the option of working for a pharmaceutical company. They shared their perspectives during Rheumatology Fellows Day at Perspectives in Rheumatic Diseases 2013.
Amy Pfeiffer/IMNG Medical Media
From left: Session moderator Dr. Daniel Furst discusses possible career options for rheumatology fellows with Dr. Michael Schweitz and Dr. James S. Louie.
PRIVATE PRACTICE
According to Dr. Schweitz, there are pros and cons of going into private practice that must be weighed. Having a private practice or being a partner in a group practice may bring more financial gain, but with that comes more responsibility, management, and liability, noted Dr. Schweitz, who has a private practice in West Palm Beach, Fla. Some physicians prefer to join a group practice as an employee.
Interviewing. When interviewing at practices, he recommended that physicians meet with all of the partners in the group to get a sense of what they are like, as well as a sense of the culture of the practice. He recommended that fellows spend a day at a practice before accepting a position, and watch how physicians interact with the staff and patients.
One of the interview tips that he offered is to make the prime focus of the interview about the practice, not about salary, vacation, or how long it takes to become partner. "Ask operational questions. Financials will work themselves out over time," he explained.
After a position has been offered, it is important to have a lawyer look at the contract. Try to find a medical business attorney, he said.
Building a practice. The best way to build a practice is by doing a good job so that patients will recommend the practice. "Your biggest source of referrals will be your patients. They will fill your schedule," he said.
When referrals come in from other physicians, call the referring physician and let him or her know that the patient was seen and what course of action was decided upon. Stress the "we," he said, so the referring physician does not feel left out of the treatment process.
Another way to build a practice is to get involved with the community. For example, give lectures at community centers, churches, and health fairs. But starting a private practice is hard, he stressed, and may not even be feasible with the current plethora of medical regulations. In an audience poll of the fellows at his lecture, no one said that they planned to start their own practice.
CLINICAL RESEARCH
Dr. Troum said that he believes that one of the most rewarding parts of doing clinical research is providing patients with medication that they would not otherwise be able to obtain. He said that it has also expanded his expertise and enriched his experience as a rheumatologist.
There are no cures for most rheumatic diseases, and some of the most common conditions among Medicare populations are arthritis (57%) and osteoporosis (16%), said Dr. Troum, clinical professor of medicine at the University of Southern California, Los Angeles. Most rheumatologists are already performing assessments required by studies every day when they are seeing patients, so participating in clinical trials should not be that difficult, he said.
However, he would never ask his patients to participate in a study that he wouldn’t participate in himself, and chooses not to participate in phase I studies, he added.
Undertaking a trial. When deciding to embark on a clinical trial, there are many regulations that need to be followed. First and foremost, patients must be advised that the drugs they are being treated with are for investigational purposes and that all requirements regarding informed consent are met, he explained. Patients must be informed of the potential dangers of the therapy, as well as the benefits. There are also reporting requirements to the sponsor (adverse events, serious adverse events, and unexpected problems).
It has to be also be ensured that all associates, colleagues, and employees assisting the study are informed and trained. Be sure to understand the investigator’s brochure and consider the risks and side effects. Good clinical practice is a requirement, and includes study design, conduct, performance monitoring, auditing, recording, analysis, and reporting to ensure a credible and accurate report.