What They Don't Teach in Medical School

January 23, 2017
Daniel Hoffman, MD

When you get out of residency, you have to make a few career defining decisions. You also have a lot of questions that will need to be answered.

After spending four years in medical school, a rotating internship, and three years of residency, I was well grounded in the profession of medicine. However I quickly realized that the eight years of education were total lacking in two very important areas. First the economics of practicing and second preparing for the end of your career.

There were a lot of questions to be answered: Do I start my own practice or join a group? If I join a group, how do I determine if the salary, benefits and opportunity for partnership are fair? What happens if the members of the group do not like me or the way I practice or if I do not like them and the office policies? Should I get an attorney and if so what does he know about the practice of medicine to be able to see if what I sign is reasonable? Can I be fired or quit, and if so what happens then?

If I do decide to open a practice on my own, what bank should I go to form the capital and what will be the terms of the loan? Should I rent or should I buy office space - and where? If I need to remodel the space, how much area do I need for reception area; exam rooms and bathrooms? Where do I buy or rent the equipment for the office and exam rooms? Most importantly where do I get supporting staff? How many staff do I need? What benefits and salary am I going to have to pay?


When I went into practice, I quickly learned that everything was by trial and error. I was not residency trained in intern medicine or family practice, so none of the groups wanted me. I looked around the community and found a small shopping center at the north end of town and rented space. I borrowed from the bank close to the office and put in a small reception area, bathroom, three exam rooms, and a little room for my desk. Over the years as other tenants moved out, I took over their space until I had and office with seven exam rooms; kitchen; private office; two storerooms; a large reception area, work area for the staff, and four bathrooms. Just goes to show what 30 plus years and hard work can do for you