Editor's Note
Entering the World of Practice
In June 1977, I left the womb. After 29 years of gestation through high school, college, medical school, and residency, I hit the cold air of life and practice. In a few months, I had collected a house, a mortgage, a daughter, and five partners. Managing it all was daunting.
Not that medical school and residency weren’t intimidating at times. The uncertainty of not knowing enough for a test in medical school morphed into the paranoia that not knowing enough could kill someone during residency. Twenty-four-hour learning evolved into 24-hour learning and doing. And always coloring my insecurity was the purple haze of sleep deprivation, that dull-headache, leave-me-alone feeling caused by 80-hour work weeks and caffeine-induced wakefulness.
Yet for all their perils, medical school and residency were basically safe, cozy havens of supervised education with all of the rest of life put on hold. As I stepped into the world of medical practice in 1977, even more scary than house, family, and having to use my accumulated medical knowledge on patients were the details of running a practice. I joined an established private practice, in business since 1960, with wise partners who had a workable billing system, compensation formula, and retirement plan. I should have been able to show up and start healing the sick. But I quickly found out I had to master all those business concepts with no Harrison’s textbook of billing or compensation formulas to help me out. I yearned for the clarity of hypothyroidism, crisp metabolic pathways that explained disease and treatment.
At the time I was starting practice, all of medicine in Minnesota was learning about a new way of doing business. In the early ’70s, a Minnesotan named Paul Ellwood concocted a creation dubbed the health maintenance organization. It was taking hold in his home state, causing Minnesota physicians to scurry to find their place in this new model. Responding to the threat posed by HMOs, Hennepin County physicians formed Physicians Health Plan (PHP), the forerunner of Medica. I remember attending an organizational meeting for PHP and getting vertiginous as terms such as “withholds” and “per patient per month” swam in my head.
Today, the players are different. HMOs have become managed care. The Park Nicollets and HealthPartners have largely supplanted small, independent groups as desirable employers for most graduating residents, although a few still choose to hang out a shingle. But the birthing process for new doctors is still traumatic. As medical students, they still worry. As emerging residents, they still struggle to comprehend the business of medicine.
As I was finishing residency, I found a midwife. Tom Hoban, who for years was the executive secretary of the Hennepin County Medical Society and seemed to know every doctor in the metro area, kindly sat down with me and pinpointed which groups were looking for doctors and what I would need to think about as I stepped into the medical community in the Twin Cities. Although no substitute for sage advice from a wily veteran, this month’s Minnesota Medicine offers similar guidance to those starting out. Maybe it’s not a textbook, but we hope it will ease a few “births.”
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org