Colleagues share best advice

May 1, 2006

As young people go through medical school and residency, they runinto a lot of intelligent people - some may even be brilliant- and those people can heavily influence these youngphysicians-to-be. Sometimes all it takes is a passing word orphrase; other times it may be straightforward advice. And theadvice may not even come during training - instead, it may befamily or friends who have an impact on the way a doctor eventuallydecides to run his or her practice.

On Call asked dermatologists around the country to share some of the wisdom they have gained over the years. We asked them about the best piece of professional advice they ever received and how it impacted their professional lives. Some doctors recalled the advice, but admitted not following it - or they noted it hadn't worked quite as well as they had hoped.

'Work for yourself'

"I followed that to the extent that I am in solo, private practice and own my own building.

"Unfortunately, the nature of medical practice these days - at least if you do anything other than cosmetic dermatology - means that nobody is really completely their own boss. What we can do and not do is basically dictated by insurance companies and Medicare."

In practice for 23 years, Dr. Ramsdell says having his own business does give him some control.

"I can take off for vacation, I have pretty much control of my schedule - but I truly resent the intrusion into my decision-making process by the insurance companies and Medicare."

He says insurance company control not only impacts reimbursements and the procedures a doctor can do, it impacts the whole shape of the practice.

"I have a large cosmetic practice as well as a large medical practice, and I do Mohs surgery - and I want to be the kind of dermatologist who can do all of that in my own business. I enjoy medical dermatology, skin cancer reconstruction, but in an attempt to be able to work for yourself and not for Medicare or the insurance companies, I think more and more doctors are looking to cosmetic dermatology as a way to stay independent."

Dr. Ramsdell is happy that he at least has that option - one that other specialists or family practitioners don't have.

"For me that was good advice and a good decision, and I would do it again - but it doesn't mean I'm not frustrated like everybody else."

In San Antonio, 10-year practitioner Robert L. Ochs, M.D., received similar advice - but didn't quite follow it.

"An attending during my residency told me never to be afraid of going into a solo private practice. So," he laughs, "When I finished my residency I joined a group."

But he realized the wisdom of the advice and left to start his own group.

"I like making my own decisions and being responsible for them. That's just my personality - so it was a good idea not to be afraid to go into practice for myself."

'Keep looking'

James F. Pehoushek, M.D., in Glendale, Ariz., says the advice he remembers didn't come from a particular person; it was written above the chalkboard in the conference room during residency.

"The one thing I remember - and I don't know if it was said by a dermatologist or not - but the quote said, 'More is missed by not looking, than by not knowing.' And that's true."