Editor’s Note: This is a candid account about the dark side of orthopaedic practice life, especially for women. There are lessons here for us all.
I had a wonderful experience as a medical student, orthopaedic resident, and fellow. I was fortunate to have great teachers, role models, and mentors. The fact that life in practice has been very negative came as a major shock for which I was unprepared. In each instance, as described below, instead of working through the difficulties, I chose to avoid conflict and move on looking for something better. I did not want a negative story associated with my name. Here is what happened.
After fellowship, I began my career in a small private practice with respected and fair-minded partners. Because of a family illness I voluntarily left the practice to move closer to home where I was needed. In truth, I also missed academia, so this gave me an opportunity to get back to that venue.
I was hired by the wonderful chairperson of the program where I had trained. I became the first woman on the faculty. I was treated well, loved the teaching, and was generally very happy. I earned a “teacher of the year” award. I was “in the middle of the pack” with my production.
My chair’s retirement enabled another individual to rise to head of the department. Things changed drastically for me. My surgical block time was taken away while I was out on an approved maternity leave. Instead of operating in the hospital setting, I was sent off to work at a surgery center which provided varying levels of skilled help. It came to my attention that a new male staff member, whom I happened to be mentoring at the time, had signed on for 40% more money than I was receiving. I met with my chair about this, and he said, “Doesn’t your husband make a lot of money?”
A trusted advisor referred me to an employment attorney. Even though I had a solid case, I did not want to sue and experience all the associated spectacle and controversy. After a great deal of thought, I decided to seek a new job in another part of the country where my husband had an employment opportunity.
I joined a “privademic” practice where members “eat what they kill.” It took some time to build a patient base in that environment. I was involved with teaching several of their orthopaedic fellows and that pleased me. Despite the positives, it became apparent that the practice was involved in fraudulent billing in their surgery center business. The group was sued by an insurance company. Thankfully, I was not a partner, so I did not go down with the ship financially. Subsequently, the practice disbanded.
It was time again for me to build another practice, this time I chose to go back to academia. It is startling to me that this last move has led me to the most dysfunctional workplace of all. Not apparent from the outside, there appears to be no master plan for the direction of the department. More surgeons are being hired without building out more working space to accommodate them. Distribution of resources is far from equal among the staff surgeons. I have two days per month of OR block time while my chair has four per week! I have two rooms in the clinic for patient visits while many others have four. Most of the women on staff are paid considerably less than the men. To justify their lower compensation, the argument can be made that they produce less but under these circumstances, who wouldn’t with less patient throughput and less access to the OR? I have a busy practice and make 50% of what my male partners make!
I am now middle aged and have a professorship. I am a single parent of two children. If I could relive my professional career, would I do it in the same way? Yes, there is no question that I would choose orthopaedic surgery as my specialty and no, I would not make the same employment decisions.
So, what have I learned from all of this?
- There is a huge financial cost to changing jobs. Time spent winding down a surgical practice and then building up a new one is accompanied by loss of income and retirement savings. A toll is taken on family members. Moving is expensive.
- “The grass isn’t greener.” Each job comes with its own drawbacks and benefits, even if they are not apparent from the outset.
- It is good to start as an employed physician rather than buying into a practice (if offered) before you understand how the practice conducts its financial affairs.
- It is important to Iearn “the business of medicine.” An MBA degree is not a necessity, but a trusted accountant is.
- Choose a “physician friendly” area as a place to practice. Investigate, ask questions of hospital staff and the community, spend time there beyond the interview.
- You should never underestimate working with people who are your champions!
- I am not ashamed of my work history as not all of the adverse practice experiences were under my control. Sometimes things just happen, and you get caught up in it. If you are unfortunate enough to have this happen a number of times, however, it is advisible to explain so others can better understand the circumstances. Some of these occurrences may be unheard of in their professional worlds.
- Stand up for yourself and negotiate your way through difficulties, if possible. It may help to preserve your quality of life and financial wellbeing.
- I trust that telling others about my negative career experiences may help prevent them from encountering similar adversity.
