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How to create your specialized niche in a private practice
Let’s imagine you landed your first job in a private gastroenterology practice or are trying to find the perfect job that allows you to put your energy toward your passions. And, like many GI doctors, you spent additional time in your fellowship training focusing on a specific interest – whether inflammatory bowel disease, advanced endoscopy, motility, hepatology, or maybe the lesser-traveled paths of weight management, geriatrics, or public policy.
Perhaps you haven’t taken an extra year of training, but you have a desire to specialize. What steps should you take to create your own niche in a private practice? How do you go about growing a practice that allows you to utilize your training?
Why specialize? Know your market!
Without a focus, unless you plan to work in an underserved area or to take over a retiring physician’s practice, a generalist position can be challenging because the demand for your skills may not be met with the supply of patients. Much like in any business, the more focused you are, the more you have a differentiator that separates you from your colleagues, increasing your chances of success.
With specialization, however, comes the importance of understanding your patient catchment area. If your focus is highly specialized and serves a less-diagnosed entity, you’ll need a larger catchment area or you won’t have the volume of patients. Also, be mindful about an oversupply of subspecialists in your given area. If you are the third or fourth subspecialist in your group, the only way you will get patients is if you are far superior in talent or personality (sorry – not typical!) or your more senior colleagues are looking to turn over work to you.
Economic considerations for subspecialties
Compensation for subspecializing is often a major factor. Understanding the economics of your specialty are important, as providers can become disappointed and disenchanted when they realize that their desire for income, especially when compared to other colleagues, differs from what their subspecialty can provide.
For instance, in GI, a physician pursuing a procedurally focused subspecialty like advanced endoscopy is likely to be compensated more highly than one who focuses on a more office-based, evaluation and management (E/M) billing-driven specialty, like motility, geriatric gastroenterology, or even hepatology. These office-based specialties are no less important, but the reality is that they create less revenue for a private practice.
Negotiating a fair contract at the beginning is critical, as you may need your income to be supplemented by your higher revenue-producing colleagues and partners for long-term success. Academic centers are often able to provide the supplement through endowments, grants, or better payer reimbursement for E/M codes, compared with a private practice.
Remember, everyone’s in sales
From my vantage point as a partner at Atlanta Gastroenterology Associates, there are several ways new GI physicians can set about a path toward specialization.
One of the first things that you should ask yourself during training is whether you want to spend another year beyond the typical 3 years. Best-case scenario would be figuring out a way to get the necessary training during the 3 years, possibly spending the third year dedicated to the specialty. Another possibility is to simply get on-the-job training during your first few years in practice without the extra year.
Whichever path you choose, building up a specialized niche within a private practice won’t come overnight. You have to create a plan and navigate a course. Here are a few ways to do that:
Take the case, especially the hard ones!
Have the mentality: “I will take care of it.” One of the best ways to specialize is to offer to help with all cases, but especially the most challenging ones. Be open to helping take on any patient. In the beginning, if you develop a reputation that you enjoy caring for all patients, even when the case requires more time and effort, this will translate into future referrals. Naturally, it may be slower in the beginning, as there may not be enough patients to treat within your specialty. Being willing to do everything will expedite the growth of your practice. No consult should be rebuffed, even when it appears unnecessary (i.e., heme-positive stool in an elderly, septic ICU patient – we all have gotten them); think of it as your opportunity to show off your skills and share your interests.
Market yourself.
This is perhaps one of the most important steps you can take. Get out in the community! This includes:
- Attend your hospital grand rounds and offer to be a presenter. There is no better way to show your enthusiasm and knowledge on a topic than to teach it. Many state GI societies have meetings, which provide opportunities to introduce yourself to physicians in other practices that can act as a good referral source if you are a local expert.
- Remember, as a subspecialist, always communicate back with the primary gastroenterologist. In doing so, feel out whether the referring doctor wants you to take over the patient’s management or send the patient back.
- Reach out to foundations, pharmaceutical companies, and advocacy groups in the area. Understand each specialty has an ecosystem beyond just a doctor-patient relationship. Participating in events that support the patient outside of the office will provide goodwill. Further, many patients rely on foundations for referrals.
- Consider research studies. Many pharmaceutical companies have the opportunity for you to register patients in investigational drug studies. By being a part of these studies, you will be included in publications, which will build your brand.
- Many disease processes need a multidisciplinary approach to treating them. Attending multidisciplinary conferences will allow you to lend your expertise. Also, presenting interesting cases and asking for help from more experienced physicians will show humility and leads to more referrals; it won’t be viewed as a weakness.
- Be creative. Develop relationships with providers who are not often considered to be a primary referral source. Motility experts may want to work closely with the local speech pathologists. An IBD specialist should develop a network of specialists for patients with extraintestinal manifestations. Advanced endoscopists and oncologists work closely together.
- Get involved in social media. Engage with other specialists and become part of the online community. Follow the subspecialty organizations or key thought leaders in your space on Twitter, Facebook, and LinkedIn. You should share relevant articles or interesting cases.
There are so many aspects of gastroenterology that present great opportunities to specialize. Following your passions will lead to long-term happiness and prevent burnout. Remember that, even once you’ve built your practice, you must continue to stay involved and nurture what you’ve built. Go to the conferences. Make connections. Continue your education. Your career will thank you.
Dr. Sonenshine joined Atlanta Gastroenterology Associates in 2012. An Atlanta native, he graduated magna cum laude from the University of Georgia in Athens where he received a bachelor’s degree in microbiology and was selected to the Phi Beta Kappa Academic Honor Society. He received his medical degree from the Medical College of Georgia in Augusta, where he was named to the Alpha Omega Alpha Medical Honor Society. He completed both his internship and residency through the Osler Housestaff Training Program at Johns Hopkins Hospital in Baltimore. Following his residency, Dr. Sonenshine completed a fellowship in digestive diseases at Emory University in Atlanta while earning a master of business administration degree from the Terry College of Business at the University of Georgia. He is a partner in United Digestive and the chairman of medicine at Northside Hospital.
Let’s imagine you landed your first job in a private gastroenterology practice or are trying to find the perfect job that allows you to put your energy toward your passions. And, like many GI doctors, you spent additional time in your fellowship training focusing on a specific interest – whether inflammatory bowel disease, advanced endoscopy, motility, hepatology, or maybe the lesser-traveled paths of weight management, geriatrics, or public policy.
Perhaps you haven’t taken an extra year of training, but you have a desire to specialize. What steps should you take to create your own niche in a private practice? How do you go about growing a practice that allows you to utilize your training?
Why specialize? Know your market!
Without a focus, unless you plan to work in an underserved area or to take over a retiring physician’s practice, a generalist position can be challenging because the demand for your skills may not be met with the supply of patients. Much like in any business, the more focused you are, the more you have a differentiator that separates you from your colleagues, increasing your chances of success.
With specialization, however, comes the importance of understanding your patient catchment area. If your focus is highly specialized and serves a less-diagnosed entity, you’ll need a larger catchment area or you won’t have the volume of patients. Also, be mindful about an oversupply of subspecialists in your given area. If you are the third or fourth subspecialist in your group, the only way you will get patients is if you are far superior in talent or personality (sorry – not typical!) or your more senior colleagues are looking to turn over work to you.
Economic considerations for subspecialties
Compensation for subspecializing is often a major factor. Understanding the economics of your specialty are important, as providers can become disappointed and disenchanted when they realize that their desire for income, especially when compared to other colleagues, differs from what their subspecialty can provide.
For instance, in GI, a physician pursuing a procedurally focused subspecialty like advanced endoscopy is likely to be compensated more highly than one who focuses on a more office-based, evaluation and management (E/M) billing-driven specialty, like motility, geriatric gastroenterology, or even hepatology. These office-based specialties are no less important, but the reality is that they create less revenue for a private practice.
Negotiating a fair contract at the beginning is critical, as you may need your income to be supplemented by your higher revenue-producing colleagues and partners for long-term success. Academic centers are often able to provide the supplement through endowments, grants, or better payer reimbursement for E/M codes, compared with a private practice.
Remember, everyone’s in sales
From my vantage point as a partner at Atlanta Gastroenterology Associates, there are several ways new GI physicians can set about a path toward specialization.
One of the first things that you should ask yourself during training is whether you want to spend another year beyond the typical 3 years. Best-case scenario would be figuring out a way to get the necessary training during the 3 years, possibly spending the third year dedicated to the specialty. Another possibility is to simply get on-the-job training during your first few years in practice without the extra year.
Whichever path you choose, building up a specialized niche within a private practice won’t come overnight. You have to create a plan and navigate a course. Here are a few ways to do that:
Take the case, especially the hard ones!
Have the mentality: “I will take care of it.” One of the best ways to specialize is to offer to help with all cases, but especially the most challenging ones. Be open to helping take on any patient. In the beginning, if you develop a reputation that you enjoy caring for all patients, even when the case requires more time and effort, this will translate into future referrals. Naturally, it may be slower in the beginning, as there may not be enough patients to treat within your specialty. Being willing to do everything will expedite the growth of your practice. No consult should be rebuffed, even when it appears unnecessary (i.e., heme-positive stool in an elderly, septic ICU patient – we all have gotten them); think of it as your opportunity to show off your skills and share your interests.
Market yourself.
This is perhaps one of the most important steps you can take. Get out in the community! This includes:
- Attend your hospital grand rounds and offer to be a presenter. There is no better way to show your enthusiasm and knowledge on a topic than to teach it. Many state GI societies have meetings, which provide opportunities to introduce yourself to physicians in other practices that can act as a good referral source if you are a local expert.
- Remember, as a subspecialist, always communicate back with the primary gastroenterologist. In doing so, feel out whether the referring doctor wants you to take over the patient’s management or send the patient back.
- Reach out to foundations, pharmaceutical companies, and advocacy groups in the area. Understand each specialty has an ecosystem beyond just a doctor-patient relationship. Participating in events that support the patient outside of the office will provide goodwill. Further, many patients rely on foundations for referrals.
- Consider research studies. Many pharmaceutical companies have the opportunity for you to register patients in investigational drug studies. By being a part of these studies, you will be included in publications, which will build your brand.
- Many disease processes need a multidisciplinary approach to treating them. Attending multidisciplinary conferences will allow you to lend your expertise. Also, presenting interesting cases and asking for help from more experienced physicians will show humility and leads to more referrals; it won’t be viewed as a weakness.
- Be creative. Develop relationships with providers who are not often considered to be a primary referral source. Motility experts may want to work closely with the local speech pathologists. An IBD specialist should develop a network of specialists for patients with extraintestinal manifestations. Advanced endoscopists and oncologists work closely together.
- Get involved in social media. Engage with other specialists and become part of the online community. Follow the subspecialty organizations or key thought leaders in your space on Twitter, Facebook, and LinkedIn. You should share relevant articles or interesting cases.
There are so many aspects of gastroenterology that present great opportunities to specialize. Following your passions will lead to long-term happiness and prevent burnout. Remember that, even once you’ve built your practice, you must continue to stay involved and nurture what you’ve built. Go to the conferences. Make connections. Continue your education. Your career will thank you.
Dr. Sonenshine joined Atlanta Gastroenterology Associates in 2012. An Atlanta native, he graduated magna cum laude from the University of Georgia in Athens where he received a bachelor’s degree in microbiology and was selected to the Phi Beta Kappa Academic Honor Society. He received his medical degree from the Medical College of Georgia in Augusta, where he was named to the Alpha Omega Alpha Medical Honor Society. He completed both his internship and residency through the Osler Housestaff Training Program at Johns Hopkins Hospital in Baltimore. Following his residency, Dr. Sonenshine completed a fellowship in digestive diseases at Emory University in Atlanta while earning a master of business administration degree from the Terry College of Business at the University of Georgia. He is a partner in United Digestive and the chairman of medicine at Northside Hospital.
Let’s imagine you landed your first job in a private gastroenterology practice or are trying to find the perfect job that allows you to put your energy toward your passions. And, like many GI doctors, you spent additional time in your fellowship training focusing on a specific interest – whether inflammatory bowel disease, advanced endoscopy, motility, hepatology, or maybe the lesser-traveled paths of weight management, geriatrics, or public policy.
Perhaps you haven’t taken an extra year of training, but you have a desire to specialize. What steps should you take to create your own niche in a private practice? How do you go about growing a practice that allows you to utilize your training?
Why specialize? Know your market!
Without a focus, unless you plan to work in an underserved area or to take over a retiring physician’s practice, a generalist position can be challenging because the demand for your skills may not be met with the supply of patients. Much like in any business, the more focused you are, the more you have a differentiator that separates you from your colleagues, increasing your chances of success.
With specialization, however, comes the importance of understanding your patient catchment area. If your focus is highly specialized and serves a less-diagnosed entity, you’ll need a larger catchment area or you won’t have the volume of patients. Also, be mindful about an oversupply of subspecialists in your given area. If you are the third or fourth subspecialist in your group, the only way you will get patients is if you are far superior in talent or personality (sorry – not typical!) or your more senior colleagues are looking to turn over work to you.
Economic considerations for subspecialties
Compensation for subspecializing is often a major factor. Understanding the economics of your specialty are important, as providers can become disappointed and disenchanted when they realize that their desire for income, especially when compared to other colleagues, differs from what their subspecialty can provide.
For instance, in GI, a physician pursuing a procedurally focused subspecialty like advanced endoscopy is likely to be compensated more highly than one who focuses on a more office-based, evaluation and management (E/M) billing-driven specialty, like motility, geriatric gastroenterology, or even hepatology. These office-based specialties are no less important, but the reality is that they create less revenue for a private practice.
Negotiating a fair contract at the beginning is critical, as you may need your income to be supplemented by your higher revenue-producing colleagues and partners for long-term success. Academic centers are often able to provide the supplement through endowments, grants, or better payer reimbursement for E/M codes, compared with a private practice.
Remember, everyone’s in sales
From my vantage point as a partner at Atlanta Gastroenterology Associates, there are several ways new GI physicians can set about a path toward specialization.
One of the first things that you should ask yourself during training is whether you want to spend another year beyond the typical 3 years. Best-case scenario would be figuring out a way to get the necessary training during the 3 years, possibly spending the third year dedicated to the specialty. Another possibility is to simply get on-the-job training during your first few years in practice without the extra year.
Whichever path you choose, building up a specialized niche within a private practice won’t come overnight. You have to create a plan and navigate a course. Here are a few ways to do that:
Take the case, especially the hard ones!
Have the mentality: “I will take care of it.” One of the best ways to specialize is to offer to help with all cases, but especially the most challenging ones. Be open to helping take on any patient. In the beginning, if you develop a reputation that you enjoy caring for all patients, even when the case requires more time and effort, this will translate into future referrals. Naturally, it may be slower in the beginning, as there may not be enough patients to treat within your specialty. Being willing to do everything will expedite the growth of your practice. No consult should be rebuffed, even when it appears unnecessary (i.e., heme-positive stool in an elderly, septic ICU patient – we all have gotten them); think of it as your opportunity to show off your skills and share your interests.
Market yourself.
This is perhaps one of the most important steps you can take. Get out in the community! This includes:
- Attend your hospital grand rounds and offer to be a presenter. There is no better way to show your enthusiasm and knowledge on a topic than to teach it. Many state GI societies have meetings, which provide opportunities to introduce yourself to physicians in other practices that can act as a good referral source if you are a local expert.
- Remember, as a subspecialist, always communicate back with the primary gastroenterologist. In doing so, feel out whether the referring doctor wants you to take over the patient’s management or send the patient back.
- Reach out to foundations, pharmaceutical companies, and advocacy groups in the area. Understand each specialty has an ecosystem beyond just a doctor-patient relationship. Participating in events that support the patient outside of the office will provide goodwill. Further, many patients rely on foundations for referrals.
- Consider research studies. Many pharmaceutical companies have the opportunity for you to register patients in investigational drug studies. By being a part of these studies, you will be included in publications, which will build your brand.
- Many disease processes need a multidisciplinary approach to treating them. Attending multidisciplinary conferences will allow you to lend your expertise. Also, presenting interesting cases and asking for help from more experienced physicians will show humility and leads to more referrals; it won’t be viewed as a weakness.
- Be creative. Develop relationships with providers who are not often considered to be a primary referral source. Motility experts may want to work closely with the local speech pathologists. An IBD specialist should develop a network of specialists for patients with extraintestinal manifestations. Advanced endoscopists and oncologists work closely together.
- Get involved in social media. Engage with other specialists and become part of the online community. Follow the subspecialty organizations or key thought leaders in your space on Twitter, Facebook, and LinkedIn. You should share relevant articles or interesting cases.
There are so many aspects of gastroenterology that present great opportunities to specialize. Following your passions will lead to long-term happiness and prevent burnout. Remember that, even once you’ve built your practice, you must continue to stay involved and nurture what you’ve built. Go to the conferences. Make connections. Continue your education. Your career will thank you.
Dr. Sonenshine joined Atlanta Gastroenterology Associates in 2012. An Atlanta native, he graduated magna cum laude from the University of Georgia in Athens where he received a bachelor’s degree in microbiology and was selected to the Phi Beta Kappa Academic Honor Society. He received his medical degree from the Medical College of Georgia in Augusta, where he was named to the Alpha Omega Alpha Medical Honor Society. He completed both his internship and residency through the Osler Housestaff Training Program at Johns Hopkins Hospital in Baltimore. Following his residency, Dr. Sonenshine completed a fellowship in digestive diseases at Emory University in Atlanta while earning a master of business administration degree from the Terry College of Business at the University of Georgia. He is a partner in United Digestive and the chairman of medicine at Northside Hospital.