Consultant orthopaedic surgeon Mr Peter James, group medical director at Circle Health Group, shares the advice he wishes he had been given when starting his private practice journey.
It can be daunting for clinicians to contemplate private practice for the first time, but once you are established, it quickly becomes one of the best decisions you ever made.
After decades in private practice, and many years of supporting colleagues as the biggest private operator’s medical director, here is the advice I wish I’d had when I began my private practice.
The most important things to strive for are the three ‘A’s: affordability, availability and affability. These will be the mainstays of your success and you have real autonomy to deliver all three.
In the independent sector, you have a rare opportunity to be ‘master of your fate and captain of your soul’ in the words of the poem Invictus. But the corollary of this is that you must be mindful of the fact there is no middle-grade support and the buck stops with you.
As such, the first and most practical piece of advice I can give to new joiners is to start simple. Select straightforward cases with predictable outcomes to enable you to establish a track record; avoid complexity and risk until you are secure and well-established in your specialty.
Develop a team
It is crucial to remember that being autonomous does not mean being isolationist. Developing a team you know and trust is paramount in every industry, but it is mission-critical in high-risk fields such as surgery in healthcare.
Finding a regular anaesthetist you can partner with will help you to grow in confidence and skill, and taking the time out of your busy schedule to get to know theatre and ward staff personally will prove invaluable in the long term.
You should make a point of getting to know the resident medical officer (RMO) or resident doctor well: you will need to have each other’s back and work collaboratively and flexibly to make your practice a success.
In an independent sector setting, the RMO is your principal support, colleague and back-up, so invest in that relationship.
You will also need to invest in a network of colleagues and nurture those relationships. As in many industries, networking can bring beneficial, new contacts to help you along your way.
From holiday cover to advice on complications, to informal referrals, your colleagues can be incredible sources of support, so do not allow the daily juggle to prevent you from investing in those relationships.
The caricature of surgeons with a ‘God complex’ is rarely true in practice, but it can be the case that highly educated and specialised professionals are sometimes reluctant to ask for help.
Avoid this mistake at all costs. Study after study has shown that the most effective organisations in healthcare have flat, non-hierarchical structures that prioritise learning lessons when things go wrong.
‘Stop the line’
There is simply no escaping the fact that the most effective way to minimise errors is to tap into the skills and observations of every single person in a team.
That is why Virginia Mason – a US hospital renowned for its trailblazing work on patient safety – instituted a ‘stop the line’ approach borrowed from Toyota production lines.
In its factories, every single worker on the production line has the right to bring the factory floor to a halt if they spot a defect.
The same approach in operating theatres can dramatically improve patient safety, with every member of the surgical team encouraged and empowered to speak up if they spot a mistake.
Of course, as a consultant you are in a leadership role. But as intensive care consultant George Findlay, a well respected NHS leader, puts it: we must be leaders with ‘big eyes, big ears and a small mouth’.
Know your hospital
One thing that I wish someone had told me earlier is the importance of getting to know your hospital well. Find out:
- What services and acuity of services are offered?
- What central support services does it offer? From procurement to PR, there are a wealth of central services who are willing and able to support you
- Crucially, what are its clinical governance policies and processes? This can seem like red tape, but it is actually about protecting you and your patients, so take the time to read up, ask questions and become fluent.
Clinical governance
Our robust clinical governance processes at Circle have led to some of the best clinical outcomes and patient satisfaction stats in the sector – recognised when we were awarded LaingBuisson’s Private Hospital Group of the Year for four consecutive years.
Embracing clinical governance procedures diligently can help boost your clinical outcomes and reputation among colleagues and patients.
From a personal perspective, the importance of maintaining appropriate levels of indemnity cover and being honest at all times with declarations will protect you from regulatory and financial challenge.
Less is more
Another top tip is to limit the number of hospitals you work at in order to become established in one place rather than spreading yourself thinly over two.
Contrary to popular belief, working at two hospitals does not make you twice as busy; it often just means you spend more time commuting and are less well known in both organisations.
When I decided to commit to one hospital in Nottingham earlier in my career rather than split my time between two, my practice took off and I found myself much busier than before.
Remember the importance of the personal touch in every interaction: patients paying for healthcare want to feel seen and heard, so spending extended time connecting with your patients in outpatients is critical when starting out.
Finally, hindsight is a wonderful thing, but I would advise my younger self not to rush when starting out.
Concentrate on quality above all else; never cut corners. Aim for consistency, excellence and organic growth, accepting that anything worth having in life requires patience, persistence and sheer grit.
And another thing…
In this digital age, no one can afford to ignore marketing. Word-of-mouth recommendations are still invaluable, but it is now rare to meet a patient who has not first looked their doctor up online.
Seek out the hospital marketing manager and ally your efforts to promote your services with their work to pitch the hospital.
You do not have to dance on TikTok to get noticed, but you will need to become familiar with search engine optimisation (SEO) and put consistent effort into your own personal web presence.
Nothing is more powerful for your practice than a large number of positive patient reviews, so be diligent in requesting these and uploading them promptly across a range of platforms.
