I think I'll give us another minute. We're having more people joining us. Oh, yeah. Very good. Oh no, Dr. Nahir is on here. He may want to put it on mute. Okay, so I think we can go ahead and get started. So, welcome to the AUX webinar series. I'm Dr. Kimi Minhaji, moderator for today's webinar. Today's webinar is Transitioning into Private Practice by Dr. Ryan Stratford. Dr. Stratford will present for 45 minutes and then the last 15 minutes of the webinar will be dedicated to Q&A. So Dr. Stratford is an MD, MBA, FACOG, is a fellowship trained urogynecologist who's board certified in FPMRS. While attending medical school, he took time off to study business and obtained an MBA from the University of Chicago Booth School of Business. His interest in business was longstanding and drove him to his undergraduate studies with a major in finance. He worked with pioneers in urogynecology, such as Dr. Charlie Nager, Dr. Carl Ruber, and Dr. Sean Menefee, while completing his residency at UCSD. After completing fellowship training at Scott and White with Dr. Bob Schall, he started a practice exclusive to urogynecology in Phoenix, Arizona. After over 18 years of practice, Dr. Stratford has observed the ebbs and flows of running a practice, recruiting physicians, and growing in an ever-changing third-party payer environment. He has learned to seek out growth opportunities and career development available in private practice that has affiliation with an academic institution and residency training. Dr. Stratford served on the board of directors for Oggs as treasurer for three years and learned about the key emphasis of the leaders of Oggs who seek to best represent all urogynecologists. He offers unique perspectives to the creation and leadership of a company practicing urogynecology. He says that his greatest achievements are outside of work, and he loves to spend time with his wife and five children, two in college, two in high school, and one in elementary school. So before we begin tonight, I'd like to review some housekeeping items. This webinar is being recorded and live streamed. Please use the Q&A feature of the Zoom webinar to ask any of the speakers questions and use the chat feature if you have any tech issues. Oggs staff will be monitoring the chat and can assist. Okay, Dr. Stratford, it's all yours. All right, let me pull my slides up and we'll get started. Thank you for such a kind introduction. I hope that I can provide a little bit of help. I have had some experience, but it's been a little while since I made this transition myself. So I think there's some things that I could look back on, and now I've had opportunities to help with other physicians transitioning that might provide some help. So we'll walk through this and then hopefully you'll have some questions that I can be of help for. I'll try not to take too much of your time and make it interesting. I don't have any disclosures except for one. I do some expert witness work for Gynecare in defense of the mid-uterus sling, but have otherwise no other disclosures. So I'm going to kind of talk a little bit about all these transitions from the perspective of a fairly well-known business mind named Stephen Covey. He wrote a book called The Seven Habits of Highly Effective People. And here's what he said. He believed that all of our actions are the result of past conditioning and that we must change our habits and who we are in order to succeed with making large changes in our lives. So we need to make adjustments that will change not only, I know it doesn't seem like a big deal to move from fellowship into practice, but it actually is a really significant change. And it's something that can be, there's going to be bumps in the road anyway, but it can be a lot harder, a lot easier depending upon how you decide to make changes. So developing habits will help that. And we'll talk a little bit about it. This is the book that he wrote. I think it's interesting. You may want to pick it up. It's a quick read, but he talks about seven different habits. They kind of follow in line and transition from one to the next. I'm not going to follow that, but I'm going to use some of the ideas to talk about things that I think are important. So one of the things he mentions, which I guess research has now shown it takes longer than 21 days, but he said in 21 days, if you do the same thing over and over again, it'll become a habit. And there's certain things you want to develop habits that you may not be familiar with as you leave fellowship and start practice. So let's talk a little bit about some of those things. So I'll have seven different suggestions that kind of tag along with these habits. So suggestion number one is you need to understand billing. Steve Covey said, seek first to understand, then to be understood. And in his words, because most people listen with the intent to reply, not to understand. You listen to yourself as you prepare in your mind what you're going to say, the questions you're going to ask, et cetera. You filter everything you hear through your life experiences, your frame of reference. You check what you hear against your autobiography and see how it measures up. Consequently, you decide prematurely what the other person means before they finish communicating. You may think you understand billing. You may think, OK, I work extra hard. If this requires an additional amount of my effort, then it'll equate to an additional amount of payment or reimbursement for the work that I did. But that's not true in a third party payer system. And we need to understand how that works. There's a lot of ways to do that. Most of you have probably been shielded to some extent from administrative tasks because as fellows, you may be taught or asked to do some form of billing. But your experience with understanding how that works is probably relatively superficial. If it's not, that's fantastic. And I just encourage you to try to learn as much as you can. And there's a lot of ways to do that. OGS has resources that can help. There's a whole committee that works on this. There's also resources from other organizations like AUA. ACOG has billing seminars that you can participate in. I did that when I first came out because I didn't have a whole lot of other people to talk to. So there's a lot of resources. But you've got to be careful because if you just kind of go off of what you think you know, you may actually run into some problems. We know that if you overbill, that it's considered fraud and that it definitely has implications that are very significant. And you also don't want to underbill because if you're consistently doing that, then it'll affect productivity or at least what is measured as productivity. So the only thing I'd suggest is finding a solution for this that works for you. There's not a perfect way to do that, but there are a lot of resources now and you need to spend some time learning. And like Steve Covey said, you first need to understand before you seek to be understood. So understand why billing is the way it is and why the requirements are to use multiple different CPT codes or ICD-10 codes in order to justify a specific CPT code. And understand how surgery billing is reimbursed the way it is through most healthcare systems and also through Medicare. The one that you bill first is you're able to bill for the full amount and then each subsequent code, they'll discount by 50%. There's a lot of things you need to learn about that. If you haven't learned that, I'd suggest doing that. It's far more than I can talk to you about in just this simple presentation, but there's a lot of resources. And every time we have an AUGS meeting too, there's a lot of information and there's a seminar on that. You can learn as much as you'd like. You can also learn from your colleagues. So that's the first suggestion. The second is to put first things first. And the first thing that you're going to be asked to do is to produce. So what are first things? First things are those things you find of most worth. If you put first things first, you're organizing and managing your time and events according to the personal priorities you established. In private practice, and it's true in academic medicine and every form of medicine, it's all about productivity. Because that's going to be a large proportion of your measure. And that productivity can also, especially in academics, refer to what you produce in research. But at a minimum, they're going to look at what you produce as a provider. And I would say that most of the people who I've talked to have some form of interaction with using RVUs. RVUs is relative value units of work, and they have different ways of that being allocated. It does have to do with how you bill, which is why it's important that you understand the billing process. Another way they may look at it is just by how much revenue you generate. You can track that in most systems. It's relatively easy. The reason they don't do that in every scenario is because revenue will favorably treat the income you receive from insurers that you may have a better contract with, which you have no control over. Whereas RVUs sort of levels the playing field and gives you equal value for the, let's say, for a specific CPT code, regardless of what the reimbursement would be. Because it may be low, for instance, for a UnitedHealthcare versus a Cigna versus a Blue Cross or another one. Another way that they'll look at your productivity is your contribution to overhead. When you work in a business, there's a couple ways to be successful. We'll talk about that in just a minute. But a big part of what you do is reduce costs. You drive costs down by the activities that you do if you're careful with utilization of resources. And so being thoughtful about what resources you're using and how well you're putting them into practice is important. You may not control all that at first, but understanding it's important. So you need to know what other people in private practice are doing. And you can talk with your colleagues what their productivity measures are and what their expectations are. Typically, you'll have an assessment, hopefully more often than once a year, but you'll be assessed based on your productivity. And you need to know what that is before you start the job. And I would recommend having at least some touch points, at least quarterly, with either your chairman or the managing partner, whoever it is that is running this portion of the practice that oversees your production, so that you have an idea of what you need to produce on a regular basis. And then you want to have some way to track that yourself. I mentioned that there's a few things that are more productive as it relates to just generating revenue. In urogynecology, you kind of have a unique setting. I assume most of you coming out of fellowship are going to be in a practice that is predominantly urogynecology. Some of you may have some amalgam, and you're going to do some ongoing obstetrics, or you may do general gynecology. So there are other variables that play into this. But over many years of practicing just in urogynecology, the key things that drive revenue, if you wanted to just pick a couple, if you said, okay, I wanted to know what's going to increase my bottom line, what will generate the highest amount of revenue. Surgery is top on the list, even, it doesn't matter where you practice, regionally in the United States. The number of new patients you see is number two. And additional amount of care that you provide on follow-ups that you see patients for, whether it be for just in-office care or other things, that's lower down in terms of the amount of volume of revenue that you produce. Because you have to see a significantly higher number of patients as a follow-up visit than you would in new patients. And the reason why new patients drive that bottom line is because they continue to produce more revenue through your practice, whether it's for follow-up visits or whether it's for surgery or other things. But the numbers that drive your production, essentially, in a urogynecology practice, probably about, if I looked at the numbers, I think it was around, it's close to almost 70%, 60-70% of all the revenue you generate will come from the number of new patients you see in surgery. Now, those two are correlated, but if you just want to have an idea, how am I doing, without knowing the actual numbers you're generating, because they may not give you, disclose all that information initially in your practice, depending on how they want to give you information, you can know that pretty well if you just follow those two numbers. You also need to remember that it's like a bathtub. You're filling it up while the drain's on. During COVID, this was a real clear example of this. I remember someone talking to other colleagues and people who were not in the field of medicine, and they lost work opportunities, and they're saying, what kind of sector am I working in that would be able to sustain itself over time if there wasn't? And what drives that? Is it manufacturing with supply, or is it some other field where you're just providing a service? But as physicians in urogynecology, we're strictly consultants. So if at any point you turn off that fill into your bathtub, the drain just keeps going. So essentially what that means is that you have to have ongoing new patients coming to your practice. If you don't, then in a short period of time, within three or four months, you won't have a lot of work to do. It's not like you were in a primary care practice where you develop relationships with people that will keep coming back to see you over years. It adds because they go back to see their providers or taking care of the rest of their health. So that's important to remember. We'll talk more about that in a minute. So my next suggestion is to think win-win. I love this habit that Steve Covey talks about because you can find this in almost every business situation. You just need to align the incentives. It's not like you have to compete with other people if you just work together. Win-win sees life as a cooperative arena, not a competitive one. Win-win is a frame of mind and heart that constantly seeks mutual benefit in all human interactions. Win-win means agreements or solutions are mutually beneficial and satisfying. To go for win-win, you not only have to be empathetic, but you also have to be confident. You not only have to be considerate and sensitive, but you also have to be brave. That balance between courage and consideration is the essence of real maturity and is the fundamental to win-win. Where I see a win-win is in your professional relationships. I would place as a high priority developing the habit of interacting with other people in your community. Your own partners or those you work with in your practice are top on your list. But on top of that, it's the other doctors and people you interact with. It's the anesthesiologists, it's the nurses in the OR, the nurses on the floor in the hospital, the other doctors that you interact with or you send patients to and how you communicate with them. Your job depends on your relationships with other people. And it's not just the doctors you work with, it's the patients you work with. How you treat them and how they speak about you to other people will drive the success of your practice. Referring physicians need to know who you are. When I started my practice, it was a fair number of years ago. I'd have to count if it's over 18 or 19 years ago. At that time, I think Mickey Cram was the only person, maybe one or two others, that had a private practice in urogynecology. Almost everyone else was jumping into academics and there weren't a lot of other people who had jumped out into private practice. So I spoke with him and I spoke with a couple other people, but everyone in my community hadn't even heard of urogynecology. I went out and visited with every OBGYN, every urologist, every primary care doctor, every colorectal surgeon that was within about a 30-mile radius of where I am, just so that I get a chance to meet them. Now, that's not what you have to do today, generally, and that's not actually the most productive thing to do. But there are times you'll interact with people. You'll be at the hospital. You get involved with the meetings you may have with either your group or other doctors. You want to definitely get to know people. It's worth your time and effort. Go to the societal meetings. Go to any sort of interaction you can have where you get to know people. They need to know what training you've had and what that means. I mean, you can speak to it. They won't have any idea the difference between what fellowship you went to. But the fact that you're fellowship trained will be significant. And then you've got to communicate with them. After you interact with them, you may not be best friends. That's fine. But if you take care of a patient of theirs, how you interact with them matters. It used to be, I remember I'd send letters and I'd get all these primary care doctors so grateful that thanks for sending that letter. That helped me out. And I'd give them a summary that I'd dictate to them that was separate from my note in my own chart. But now, actually, I send a lot of texts to different surgeons that I interact with. And we'll talk about patients that are complicated that way. And I'm impressed at how quick they are to respond. It's created for me a real support system of people that I can lean on for help. But I definitely encourage you to create relationships. The next suggestion I have is to develop yourself. You've got to plan for this. You can't just let it happen. And there's something about synergy that really matters. So I'm going to talk about that just for a minute. To put it simply, synergy means two heads are better than one. Synergize is the habit of creative cooperation. When people begin to interact together genuinely and they're open to each other's influence, they begin to gain new insight. The capability of inventing new approaches is increased exponentially because of differences. So part of developing yourself is learning how to manage this new autonomy. And the other part is to find a mentor or two mentors or three mentors. And take the parts of that relationship in watching what they do and how they learn and how they've developed to help you. And there are so many people so happy to help anyone who's eager to learn and to try to be the best they can be. And you'll find someone wherever your new job is. It's so important to have someone that you can go to not only for questions, but that you can ask about what they've done to make adjustments and how they've developed in their career. You need to be someone that you admire, someone you trust. There may be characteristics that you see in them. They have nothing to do with their skill set in the operating room, but the way that they treat other people, the way that they interact with patients. And you want to be better in the way that they do that. And you want to be an amalgam of all these wonderful traits that you learn from other people. The other part about this is the autonomy. It's a whole different thing. I don't know that this is something that anyone thinks through, but you really haven't had complete control of your time for probably almost a decade. I know that seems crazy, but when you come out at a fellowship, it's going to feel really strange. You decide what you do with your time. And some of that, you may just feel like, well, I've got to do what I've always done. I've got to go to every meeting that I can. I need to show up because my attendings would want me to do this or do that. Now it's your choice. And so getting back to that other recommendation about productivity, you need to decide, where is my time being better spent? I don't think that it's a good idea to let go of your education and quit going to any scientific meetings, because that's where you interact with people that will save you. But you also need to be careful that if you're going to all these other meetings and you're trying to adjust to that alone, it may be not as value-added as sitting down and spending some time reading the literature or doing some other way to educate yourself and then spending more time with patients or being more productive in other ways. You need to figure that out. But I would highly encourage you to, as you start to get your feet wet, determine, okay, how can I best utilize my time? And one of the best ways to do that is have a mentor. I think that that will help you tremendously. So that's my other suggestion. The next one, this is a fun one to talk about. Be proactive. There's a lot of ways you can be proactive. And I think what we think is, okay, it's like if you're an eager resident or fellow, I'm going to get in there and do every case. I'm going to take really good care of my patients. I'm going to make them feel really good. And that's fantastic. All those are good things. But in private practice, and I submit that really in any practice, you need to create a reputation for yourself in the way that we now communicate. And that is through social media. And I know this sounds like, why am I going to have to do this? It will drive your success when you get back to that bathtub idea. It's about your reputation that drives your organicology practices, what people think about your ability to help them. And you got to remember, they don't know anything about whether you went to whatever university or whatever medical school or what fellowship training. They don't know what that means. What they know is how someone else thinks about you. And so developing this relationship is really important. Let's talk just a little bit about being proactive. Proactive is about taking responsibility and realizing that you are response able. Don't blame circumstances, conditions, or conditioning for your behavior. You know you can choose your own behavior. Reactive people, on the other hand, are often affected by their physical environment. They find external sources to blame for their behavior. But proactive people focus their efforts on their circle of influence rather than their circle of concern. What influence can I have? Well, you can't change the world and you can't force everyone out there to think you're the best doctor in the world. And truthfully, there's a lot of good doctors in your community probably too. But you're uniquely qualified and you will resonate with thousands of patients and you're the perfect person for a lot of them. And you have to believe that. You got to be confident. but then you got to talk with them. You got to, you got to find ways to communicate those things to them. And believe it or not, people rely a lot on what they get through social media and online. Um, this in my practice, I think I pulled this up just about, this is about a year old or maybe two years old. I think a lot of you as fellows may think that most of you, maybe you know this because wherever you did your, your fellowship training, you've learned this, but the majority of your, your consults will not come from OBGYNs and that may shock some of you, but they're not the majority of those who will be referring to you by far in a way, the highest single category is going to be either primary care or patients themselves. And if you were to just look at on, in our practice, the number of people who either find out about us or want to come see a, a urogynecologist from either the internet or from another person who spoke with them, it's essentially almost, you know, 48 over, you know, getting close to it's, it's over, you know, 40% of all those who come to see us, that's a fairly high number. The other thing that I learned is that a lot of other subspecialists send patients to us quite a bit. And, and they're usually complicated cases. And as you work with those cases and those doctors, they've developed more confidence in you and you, and you want to work with them. I don't know. I did a lot of cases early on and I still do. Anytime someone wants to do a combined case, I'm happy to do that. I think working together, you learn from each other and sometimes you can assist and learn other surgical techniques when you work with other doctors as well. And I think that's always, for me, that's been a very big boost to me. And, and, and feeling like I'm not just out on an Island. Um, one question I'd suggest that you ask every patient you see is how did you find out about us? How did you, what brought you here? It, you can, if you let someone else figure that out, you'll never know. And I'm telling you, it'll open your eyes. And when you start tracking that you'll, you'll understand, okay, where do I need to spend my resources and trying to help people to learn about us and help people to want to come see me? There's a, there's a few, a few research does the Pew research center does about every two years, a revamping of all this data, but it's really interesting to look at the number of people that spend time on social media. So if you look in the, this, this now goes out to about 2019, nearing 2020, and it's, it's nearing 80% of adults who have at least one social media site. That's a lot. I don't know if that resonates with all of you. This is all ages. And even by gender it's, it's, it's fairly close, but as you can see, women are a little bit more often engaging with social media than men. You know, just over 75 to close to 80%. Um, I think people have talked with me at different times saying, well, yeah, but if you're out in a, you know, suburban area versus if you're in, um, you know, rural, rural, or if you're in an urban area, downtown, different cultures and different races, we'll, we'll use social media differently. As it turns out, not so much, they're very similar, very similar. Um, I also found this interesting. Uh, there's certainly, as I watch, uh, I work a lot with, with, uh, young, single adults and youth and I, and we'll see what they spend their time on. And it is different, but overall the majority of adults will spend time on Facebook and YouTube. Those are the two highest. So if you're trying to have the biggest impact, you'll have a much more significant impact in, in engaging in those two social media outlets than any other, this also shows how many people use their site with what level of frequency. So daily isn't that dark blue. You can see Facebook is the one that's most commonly used, but they are all relatively high rates of daily over 50%, almost all of them, except for Twitter. That's that's a lot like every day. And I know that for some of you, that seems really mundane and obvious, especially since you're not, I might be a little dating myself, but I'm the internet just came out when I was in medical school. So this is, you know, this is newer for me than it would be for you, but it is important to remember that most of your patients, even those who are octagarians they're, they're using the internet as well. So you can post things you can, you're, you're where, where you work. They may do that for you, but you want to be a part of that. You want, you can create your own reputation online. And interestingly, most of those reputation generators, we're not gonna spend a lot of time on this, but those that require a login, they'll usually be more relied upon. So like Google or I'm trying to think of a couple of the other ones that just my mind's slipping in, but unlike like health grades or vitals or some of these other ones that people still rely on, you can't go in there and put multiple different evaluations in and all of them are sort of becoming more like that. But the trust factor level is higher with those that you have to log into. So we'll move on to another topic. And if you have questions after we can talk about it, another suggestion I have, and this is about personal life, but begin with the end in mind, where do you want to be in five years? What do you want to be in 10 years? What does life want? What do you want life to look like? And you got to create long-term financial plan for that. Um, if you don't make a conscious effort to visualize who you are and what you want in life, then you empower other people and circumstances to shape you and your life by default. So develop a personal mission statement and Sean Covey's book. He talked, this is a big part of most, almost every business now. It was, it was really cache for probably about two decades, but every, almost every business now has a mission statement and the more pithy it is, the better it's usually one sentence, but it defines what that business is about. I'll give you an example. Um, many of you probably don't know this, uh, unless you saw that movie on McDonald's, uh, but when McDonald's was actually generated, so that the revenue that was being generated was predominantly done by the original owners because they would lease the land and purchase the land where all the, um, all the other, uh, McDonald's franchises were being, um, built all over the world. And that's how they actually generated most of the revenue, but you know what their business model was, believe it or not, initially it was to make hamburgers that were tasty and have a simple menu and all that, but their, their primary focus for a, for a number of years was just to have clean bathrooms. That was their primary focus. They would purposely strategically put McDonald's in places where along back when they had, you know, route 66 and people would want to stop along the road. If they had clean bathrooms, they knew people would come in and stop and they might buy something on their way in or they just rushed in to use the restroom. That was fine. That's not their current business model, but it worked and it's because it was simple, we have clean bathrooms. And so every franchise had to agree to specifics about how they kept the bathroom clean, otherwise they couldn't become a franchise and it made them very successful. The point is, is when you have a specific plan about what you want to be, if you can define what that is, and it's got to do some introspective thinking and, and you know, sometimes it takes time. You don't have to figure it all out at once, but what do you want to be? What do you want to look like? You know, do you want to be, do you want to, do you want to change the way we think, because you want to come up with a new invention or idea that manages prolapse in a way that we couldn't before? Or do you want to be someone that, you know, you've trained people in a way that will leave a legacy throughout your life. Do you want to be what kind of person you want to be in your community? What kind of person you want to be with your family, all those things matter. And if you can define that, you're going to be successful. And that runs into how you are with finances. A lot of people don't think about long-term goals because you really haven't had much time to think about it and you haven't had a lot of money. And so you're thinking, okay, all of a sudden there's all these dollars coming in that I didn't know what to do with. It's a lot easier to spend money than it is to make it for me in my life right now, it's actually changed, but that's because of my personality. I think I've become a lot better at making them than spending. I struggle to spend money, but the point is if you have a goal about what you want, it's, it's a lot easier to do it. So you need to say to yourself, I mean, this sounds crazy, but when I started private practice and I started practice all by myself, I didn't have anyone else to join and I just hung up a shingle and had to hire people and get a business and build out an office. And I had a goal about when I was going to retire. I already knew what my age would be when I retired and I had to break it down by how much money I would need to support my family off the interest that I would have from a nest egg that I'd build. And how would I get there? Well, I'd have to earn so much per year and I calculated the time value of money and what it would do to get me there. And at least I knew what I was shooting for. Now, I don't know if I'm going to quite make what I had originally planned for, but the good news is, is that it's been exciting to run that road because I had an idea about what I wanted. You also need to know about what it's going to require to support. If you have children, you know, many of you probably have an idea about this, but education's expensive, raising children's expensive, and you need to have some budgetary plan about what you need to do before you start spending money other ways. Housing's one of the biggest investments you'll make. This is just, this is entirely not Ogg's sort of sanction, but my own personal advice is to reduce debt. Debt is a constant driver. You'll never be able to get out of debt. It doesn't matter if you're in a pandemic, if everything in your life goes to shambles, you're still going to owe your debt. So reducing that will save a lot of consternation in your life and trying to at least manage it. There are certain places that you can't completely avoid it, but in places you can, that's what I'd recommend. So begin with the end in mind. And if you haven't thought through that yet, now's the time. Before you start your new job, start thinking about this and calculate it back and be thoughtful about it. And you'll make adjustments as you go. But if you don't have a plan, I promise you it's, I mean, the old adage, at least from where I, I've heard this from other business people, so I don't know if this is true and it's entirely unfair to sort of label. But they also see doctors as being folks that as soon as they get money, they go crazy. Like they get out of fellowship and what do they do when they first get their first job? They buy the nicest car they can find, they get the nicest home they can get, and they start spending money on things they never spent before. And then all of a sudden they find out, whoa, this is not quite meeting up with what my income is. I know that's a generic and not a fair thing to label anyone with, but that's a normal human response, suddenly having access to resources. But if you have a plan and you continue to budget, life can be great. It takes discipline, but I'd encourage that. And then the last thing I'd recommend, and this is probably of all the suggestions I make, maybe the most important of all of them, there are things you probably would have figured out. This is one that you won't figure out. And I want you to be really, really, really thoughtful about what I'm about to tell you. You've got to sharpen the saw. You're in it for the long haul. This is not a three month rotation or you're just so used to these short term goals where you extend yourself, you work really hard to accomplish something and you jump to the next one, you jump the next one. You've been living in that mode for a long time, for almost a decade. And now you're not. This is a marathon. This is not a short sprint. In order to survive a marathon, you have to sharpen the saw. You got to take time to do things that enhance and help you. You're your greatest asset. You got to take care of it. And that doesn't mean that you squander your time in doing things that are frivolous. You need to be thoughtful about it, but you need to find out what refreshes you. What helps you physically, emotionally, and socially, mentally, and spiritually. And you got to make time for that. One of my favorite analogies of this, I think I may have heard this in a church talk or something, but it was an idea. Maybe it was talked about in one of my elementary school classes. But if you see this picture at the bottom here, there's these two jars and believe it or not, and even though this is showing two different pictures, you can fit all the material into one jar, but you have to put the rock, heavy rocks in first, then the sand easily fits in around the edges and around in the gaps. But if you put the sand in first, you can't fit the rocks in. Of course, the concept there is the things that matter most, the big rocks in your life, if you put them in first, you schedule that into your plan, then everything else will fit in. But if all you do is, you know, I'm just going to put my head down and work, work as hard as I can and forget about my family, forget about everything else that will help me from burning out and just go forward, you're not going to fit everything in and you're going to find that things didn't work out the way you thought. What I would suggest, whatever works for you, you need to figure that out, but you've got to pace yourself. My the first partner that I had that came out of fellowship, I think it was about, I don't know, four months into it, and she came and sat down and said to me, hey, Ryan, and she started crying. She said, I'm, I'm not sleeping very well at night. I'm struggling. I said, what's wrong with what's happening. And she said, you know, I just, I didn't realize the weight that I would feel when I was the only attending in the room when I operate all the time and I go home at night and I, you know, things went well in the surgery that day. There was a couple of things I thought, you know, I hope that the goal is okay. I hope that there's no spontaneous bleeding overnight or something happens. And I, it just mulls around in my head and I've been working through it and working through it. Now it's like, I'm not even sleeping. I just have this pressure. I didn't know this existed like this. And this is someone who is extremely, an exceptionally good surgeon. I was like, wow, first of all, it shows what kind of care that this, this doctor really has for her patients. But the second part of that is just, yeah, it's, it's a lot. So if you're in this pressure cooker and you're not letting the steam off, things aren't going to go well. So you've got to find a way to do that and it won't happen by itself. You're going to be given time off what paid time off in some way, shape or form. Don't wait to do all that. When you get to the end of the year and think, yeah, if I have time, maybe at the holidays, we'll use it. I would suggest you break it up and you take regular intervals of time off, get away for an extended weekend or for a period of time and let go of everything you do at work and let everything else just diffuse and enjoy what makes you happy. You've got to take time to do that. Force yourself to do that. I promise that's the rocks. If you don't put those rocks in, they won't fit in later and you'll get burned out and you won't be happy and you won't be successful. The last suggestion I'd have is that we all are used to short term. I mean, everything, if you want information, you Google, right? You get anything you want the second you want it. That sense of being able to get what I want right away is definitely ingrained in our culture. If you go back about a generation or two before me, it was not. Everyone believed you had to wait to gain anything of value. And most people work for one employer their entire careers. That won't happen for you. And that's fine. But if you know that that's how you operate, you've got to change your paradigm when you start a new job. Settle in, it takes time. Don't feel feel bad if in the first three or six months you still feel like, I don't know if I really like my job. I don't know if this is what I really thought it was going to be. You did all these things to prepare and yet you're still not feeling comfortable. That's normal. So you've got to realize it takes time and that time slowly. It's like a rock going down the hill. It just chips off little pieces and it smooths you out in the process of learning. And just just let that happen. Don't be too upset when things aren't going exactly as you like. And I'd suggest don't make any real significant decisions about your career, about your life in the first three to six months of a job, because you're going to feel uncomfortable a lot. It's just the way it is. And that's normal. So if you do all these other things we suggested, finding mentors and developing relationships, taking time to sharpen the saw, if you do all those things, you'll find that it's not going to be over so overwhelming that you can't continue forward. But just know that this is this is the way it is. And in those relationships with your fellows that you know that are going off in other practices and good friends that you've made at Oggs, you need to foster those because you're going to need to make a phone call at some point and say, hey, what's going on over there in Ohio? What what's your job like? And comparing notes and trying to figure things out. And that's good. You need to air that out. So and that's one of the reasons why we have a society, I'd suggest leaning on that a little bit, take advantage of it. Those are my suggestions. I know this is not a life coaching class, but as it relates to business, this is what matters. The truth is, is all everything else. You're going to figure that out. But these these basic ideas are what really matter. So I'm up for questions. Thank you so much for that. So we have about 15 minutes for questions. So audience members, you can submit your questions in the Q&A section below. See if we have anything coming up. I'm looking here at the number of of attendees and trying to get an idea, it'd be helpful for me if I knew a little more about what your upcoming positions will be like and if there's specific questions you have about that. So we actually have a few questions coming in. Is there anything that you wish you could have answered in the Q&A session? Is there anything that you wish you would have done differently starting out in your practice? Yeah, I think I would have done a better job of connecting with people in the community. I work with Bob Scholl and he was a pretty big proponent of the be involved with the community, get involved in your local medical society or your county medical society. And I did I jumped in. I was the president of our local medical society of our county medical society about four years out. And I did some things there that were helpful. But I think really developing relationships is more about getting to know people. And I would suggest working really hard on getting to know the people you work with. And you don't you know, I remember someone once complained that, you know, if you're not going to academics, you're not going to have chances to teach. I do get to teach residents. That wasn't the case for the first eight years of my practice. But you teach everyone you work with. You teach the scrub techs. You teach the MAs you work with in your office. And if you are that way, if you engage with people and try to develop relationships and try to help the ways that you can help, that I think will always, always reap more than what you sow. I mean, it's not too hard to put in that effort and have a huge, huge benefit. Like when you're stuck in the operating room and you've invested in the people you work with and you say, this is an emergency, I need help, you'll be amazed at the number of people that scramble and will do anything to help you because they like you. They want you to be successful. So I learned that slowly at first. I just kind of did what I did as a fellow and try to get to know people best I could. But, you know, just to kind of fit in rather than just really engaging personally with people, getting to know them, I'd suggest that be what I would have done differently. Perfect. And what are important things to look for in a potential partner mentor as a junior attending? That's that's a good question. We all have to find who we resonate with. And the truth is, is when I interview people to to join our practice, it has nothing to do with their qualifications. I can find all that out by talking to other people. How do they do in the operating room? How do they interact with patients? I just want to know if I can get along with them very well. And do I trust them? It's all about trust in business. Every business begins with a contract. And the reason for a contract has nothing to do with how the business is going to perform. It has to do with how you're going to what's the exit strategy? How's it going to break up? It's all based on how we're going to break up and we don't get along. The only the only relationship I suggest you do not do that in is your marriage. Everything else. It's probably a good idea to have some plan for how things will break up because it defines your relationship. And you want to make sure that you when you go through that process of doing contracting, you find out how much you trust each other because you start having to ask questions. So if this happens. This is what you're going to do. And it's like, well, do you really think I'm going to do that? Well, no, but we just want to have it in place. And you talk it out and you start thinking through things. And you've got to you've got to trust the person that you that you have as your mentor. And you may trust them for different reasons, like you may trust them more, but you don't maybe trust them as a business person. But generally speaking, it's someone who you think has integrity and the values that you want to have. That's what I'd focus on. And then everything else will work out. They may not even be a urogynecologist. It's true. And do you actively manage your pair mix? I'm sorry, my what? Make pair mix. Oh, yeah. So it's hard to do that. You can do that legally as long as you make it a practice wide policy. You can't just selectively say, well, I don't like to see patients that are from Blue Cross because they're all ugly. I mean, whatever the reason is, you can't selectively not treat patients based on something they have no control where they have some control over. But you can't do it based on their insurance. But if you have a policy in your practice and this is where you talk with the rest of your group, you can do that. So you can say, we only have this many open slots for Medicare versus all the rest of the other insurers. And let's say that, you know, you have 20 new patient slots in a week and you're gonna give up a third of them to Medicare and the rest of them, you won't. And so in that setting, someone, this generally is the case with Medicare as an example, that Medicare patient may have to wait longer to get in to be seen than someone who's privately insured. That you don't always have to do this, but you can control that. You can't control who refers to you as well, except by developing your own relationship. And I would focus all your efforts, like direct to marketing. Spend your time developing relationships with those that you interact with. But as far as getting referrals, I would spend less time going out and asking people to send patients to you and going out and just making a reputation for yourself online and talking to your patients and being the best physician you can to those patients, because they will be your best referral source. I had a lady come see me that flew from Jamaica. And I was like, why did you fly here? I have great friends in Florida. She said, oh, because my friend said that you're the one I need to come see. I said, but I'm in Arizona. So I know, I know. I said, do you have family here? No, but my friend lives here, so I can stay with her. And she flew over to see me once and flew home and then flew back for surgery. And I tried to convince her not to, and I have good friends that are every bit as qualified as I am to do good work. But that, for what we treat in particular, it's a very private thing. And if they have a trust relationship with someone who recommends you, that's powerful. It matters to them. So I would be, I'd focus on that, direct marketing. I'm going to combine two questions that are similar to what we were just discussing. So did you find that meeting with primary care doctors personally helped with generating referrals? And then when it comes to specifically marketing with social media, do you do that directly to patients? And if so, how? Yeah, so social media is where to spend your time. I know I'll say it over and over and over again, spend your time there. Meeting primary care physicians is awesome to get to know a face with a name because you want to have a relationship. You want to know who they really are. But as far as referrals, I'll tell you exactly what will happen. You can track this. You'll go meet with someone, like you do a lunch with someone and get to know them. You'll see a bump in referrals that'll last. You'll see it in about week two. And then at about one month out, it'll start to trail in about two months out. It'll be back to exactly where it was. There's very little longevity associated with just going out and meet and greet. I've done it. I've done it over many years. I've looked at this in multiple different angles. I'm not suggesting not do that, but do it for the right reason. Do it for you. Get to know that person. Get a face with them and just get to know them. And then when you write a letter to them or you text them or you call them, you know who you're talking to. And it matters. It matters a lot. So that's the reason I would do that. I would do that for the benefit of getting to know the people in your community, for you. And then as time goes on, it'll drive that. What'll drive it is if you communicate with them, if you talk with them after you see patients. Like instead of just, well, they'll get my note and that's good enough, right? Call them, especially if it's a complicated case, especially if they send you someone that's complicated, because you know that they're trusting you. Like the first time someone sent me a fistula complication from a surgery, I called her right away and said, look, this is what's going on. This is what we're going to do. We'll take care of her. And the point is you're not just trying to cover their back, but you're letting them know that, you know, you're doing the best work you can, both because it's their patient and it's your patient. Right, true. And then on social media, how do you like, what are your tactics? Is it Instagram, Twitter? So the reason I showed you what I showed you is Facebook's probably where the money is if you wanted to start somewhere. There's other places, Instagram's great. Twitter's even lower down, especially with our patient population, but it's there, especially if you're working, if you want to kind of start kind of a clinic for third and fourth degree lacerations and helping people recover from that. So it depends on the target audience. But the truth is, is how you do that, I don't know if you guys have paid any attention. I mean, even like if you go to someone's Instagram page, you can see that they'll color coordinate the posts that they have, so that it looks like it's its own artwork. And so people are more attracted to look it up. There's little details about that. Learning about that. Don't spend all your time on it, but I would spend your time on that over other things. The one thing that I'd say that matters a lot as far as reputation is looking, Google yourself, find out what people are saying and respond to it. Be engaged in that and make sure that's a part of what you're doing. And you need to have mechanisms to help you. Don't do it all yourself. They have great SEO, search engine optimization, ways for people to see you and to know that you're there. And then if you organically, it's all about organics. If you organically have people that are rating you and your ratings are really high, I'd say at least half of those that go on the internet, that's the reason they came to see me, which is weird, right? It's not really fair. You don't have control over who says what on there, but you can. You can ask people after they see you, like I usually will float the idea out there after we've completed treatment of something and say, hey, if you'd be willing to post something. And we have a system that does it and ask people to all the time. And I probably get somewhere between five and 10 a week of someone who goes on to rate me in some way or the other. And I respond to them and I thank them and I engage with them and spend your time on that. I think there's some value in that. And it's who you are. And the truth is, even though it seems unfair over time, who you really are kind of comes out. And if you're kind to people, it matters. And then they talk to each other. And that's being a good doctor, taking care of people. And then, sorry, I'm gonna try to go through these questions. We have a few of them coming in. How did you learn the financial portion of running a clinic? I know you kind of briefly mentioned this at the beginning. I think this was missed for this person. So I would talk to the people in your practice. The best way to learn, they know how to do this. This is not rocket science for them. This is what they do day in and day out. So talk to those people, sit down with the manager or if it's a senior partner, just say, can you walk me through how this looks? Can you help me understand the nuts and bolts so that I know when how I'm being evaluated matters, but also so I know how I can help the bottom line. I wanna be a part of making this successful. Help me understand how that happens here. Because how it happens at an academic institution that may share resources with the OBGYN department that gets money in because they send patients to the NICU who also draws resources in. There's a whole different, it's a web, but if you know where you land and then what they're gonna evaluate you on, right? Because at some point you may create ancillary care for other parts of your system. And they see that as value, but then when they go to evaluate you, all they do is look at your RVUs. Well, that may not seem real fair. And so you wanna say, okay, I wanna help the whole system, but tell me how you evaluate me too so I know how I'm creating value that you see. And then you wanna talk about that and say, okay, I find that helpful, I'll follow that pattern, but are there ways that I could also generate value that would help the system in other ways? And if I do that, can I be evaluated based on that as well? I hope that wasn't too vague, but I'd talk to the people that you're working for. I like that, that's great. Then can you talk about your experience hiring a fellow when you were a solo practitioner? How were they compensated the first few years? What things do you think set someone up for success when transitioning to private practice? So break that down for me a little bit. I guess the question I'm trying to gather here is you wanna know what the key things are for success or- And when you're hiring a brand new, I guess, graduate fellow. Fellow. Yeah, how you were trying to compensate them the first few years. So I think that almost everyone's risk-averse. Unfortunately, you chose a profession because you are. You wouldn't have chosen medicine if you were not. I have a little bit more tolerance for risk because I was interested in business. And I think that that's something that I've learned over the years that is different. And what I mean by that is almost everyone wants to have an income that they know they're gonna get paid. They have a paycheck coming in. And so I structure it as a salaried position for the first few years. It's kind of an opportunity for us to determine whether that person enjoys working with me. And if I enjoy working with them, and if we wanted to work together, where we partner on trying to align our incentives to make a practice successful. So I don't want anyone to join my practice that doesn't wanna become my partner. So that's the whole goal is that I wanna work together. Can I do that? Can I have a lot of people just salaried and working for me? Yeah, but that's not what I would prefer. I'd prefer that we're equally yoked. We're working together to solve something. But to get to that point, you gotta figure each other out. You gotta spend some time together. You don't just run off and get married to someone if you haven't dated him for a while. And there's some truth to that when you've joined a practice and it may not be the right relationship. And you may decide this is not the people I wanna be partnering with. That's fine. Take some time. Don't make that in the first three to six months, but you may need to make an adjustment from there. But that's what you should be after to some extent. And do you have any advice for a Urugine joining an OB-GYN group without any other Urugines in that group? Yeah, that's complicated because you have different incentives. And so you gotta look at this in a completely different perspective. You're not gonna think the same way. They're gonna generate revenue in a much different way. And as long as you understand what they do to generate revenue and what drives their productivity and know how yours fits in, you can find a lot of things to align. But if you don't understand them and all you do is say, well, you're so focused on all these other things that don't really matter or that don't help me out, you're never gonna get along. The only way I see that work in a multispecialty group is people have to be willing to sacrifice what their actual revenue generation is for the greater good. And it's hard to do that, it's altruistic. But you have to have some piece, not the whole piece, but some piece of all that you generate has to be dedicated to the greater good. So if you have someone that says, I love adolescent GYN, but adolescent GYN doesn't generate nearly as much revenue as if I go off and just deliver a bunch of babies. But if I do less deliveries, I can't do to see as many of these patients that you're all sending to me. And it's not fair because now I'm making a lot less money than you are. And I'm working just as hard. And so you have to say, okay, if we wanna create a group that can take good care of patients at all these different multifaceted ways, then we have to have some piece of what we do that goes into support everyone in that. And if you set up a system that does that, you're all aligned, it's gonna be awesome. But you gotta have that. And if you don't have it, then talk about it because you already know what the end's gonna be. You're not gonna be happy. That's true. Then what are some efficiency tips for clinic billing that you've learned over the years? Be honest. It's not worth getting audited. I thankfully have never been audited, but it's not, that to me, I'd stay as far away from that as you can, but not at the expense of being thoughtful and appropriate in your billing. Now, I'm using generalizations because you really need to dig in and learn this. And to do that, you need to take some billing courses and you need to understand it really well. Because just this last year, it changed. So this whole factor of what you get to add into your time includes the time if you're calling other doctors or you're typing your note out. That didn't used to be a part of the time evaluation if you're billing your office visit. So it's a constantly changing target too. Listen in. It's boring, right? You go to, you're like, I don't want to listen to the coding seminars. It's the most boring thing I've ever done. It's hard for me too, but it's part of your life. And you realize it'd be, from my perspective, much better if I could just charge the people that I take care of. I mean, I walk out of the same surgery and I was in there for four hours or two hours because I was sweating to death over the complications. I mean, I'd probably charge that person a little bit more, but I don't get to do that. It's the same CPT code. So it's a third-party payer system. It is what it is. You can't change that right now. You can get involved if you want to get involved in that process, but it's a long one, but you can adapt to what the situation is and be thoughtful about how you do it and spend your time appropriately. Don't practice at the lowest level of what you can do. You shouldn't be doing what you can hire someone else to do. No one else can do the surgeries that you do. You've been trained to do that. No one else can do that. So that's where you should be spending your time, most of it, and everything that leads to that. If you're doing a lot of pessary fittings and taking care of pelvic pain and things, if you enjoy that and that's what you want to be really good at, then that's what you should do and decide what you like and go after it. But at the highest level of your training, you should be practicing, not at the middle or the lowest. And then when you started off, how did you find backup coverage for vacations and privileges? Thankfully, you picked a good field. There's not a lot of... All of you coming out of fellowship are probably on call for a ton of other things, and that's not private practice. You take care of people and you take good care of them, you're not going to have that much call. There's just not that much. So when I started, I was my only person. I worked with another doctor in the community who eventually joined me for a while. He was the end of his career and he did basically all the urogyne for his big group of OBGYNs. And so we'd cover each other's patients and that worked pretty well. But you got to have coverage. You can't just leave town without coverage. But I had relationships with OBGYNs in the community that I could trust, that I could leave them with. But it's not that hard. It is just not that hard. Call really changes in private practice. Then how long does it take to build a full private practice in urogyne? And do you encourage or discourage doing benign GYN in a startup private practice? So the challenge with benign GYN is not whether you can do it well. You could probably be successful at it. The problem is that you'll alienate your referral sources a little bit. A patient comes to see you for something incontinence, then you, hey, can I just come here for my pap smears? Yeah, why don't you just start coming to see me? And the work gets out. And suddenly no one starts sending you any patients at all because of that. So that can become a pretty significant issue. So I would suggest not trying to expand your level of care to a lot of other resources at the beginning, if you want to do just urogyne. Later on, you can, but you have to slowly adapt that. And that may be something you really enjoy. And if it is, then you need to look at that in a different perspective and maybe look for a job that offers that. So I would avoid doing that. Makes sense. And did you give up doing certain types of surgeries or procedures when you went into private practice? I didn't do a lot. I mean, no, I did everything that I needed to do. In fellowship, I carried it over. Just one second. I did everything that I did in fellowship because it was all that my fellowship train, Dr. Scholl would do. So he wasn't doing general gynecology. But I think that if you did, I did cover labor and delivery while I was a fellow, but I think that if you choose not to do some of those things, then it's best to not start doing them. If you have been doing them and you want to just do urogyne, I would suggest focusing just on urogynecologic procedures. The truth is, is people start to trust you in different ways. And they'll ask you to do complicated GYN cases sometimes. There's no one out there. I mean, apart from all your training, I know many of you are probably well-trained in laparoscopic techniques and doing a lot of other things. But the truth is, is that there's no one else out there that does vaginal surgery like urogynecologists. And so once they discover you can do things vaginally that they couldn't accomplish vaginally, then they lean on you for other things. Anything that's benign in the pelvis. And I interact a lot with oncologists, urogynecology a lot, not because a lot of patients have similar urogynecologic, urogynecologic problems that have cancer, but because they'll just say, hey, this is a complicated case. Doctor doesn't want to do it. I don't have time. Would you take care of this? Because they know that you'll do good work. And so in time that can develop, but I would suggest not making that your primary focus because you'll alienate your referral sources. And then how do you deal with bad evaluations on social media? That's a whole topic. So I'll give you the real quick rundown. Number one, call the person, talk to them personally. And the best way to handle it is if they'll take it off, if they'll choose to remove it or make a comment. That is number one. That's the hardest one to do. You have to have some guts to do that. And you gotta be kind and humble and talk with them. Number two, and I'd suggest you do that. If you send your office manager, and they may be a screening tool, but they'll respond differently to you. Number two, if they don't, and they're really struggling with it in a very kind way, and this is very, be very careful here. Don't get into any kind of debate online. It'll only hurt you, but in a very kind way, diffuse the situation and make it clear that you're speaking from a broad perspective. If it's too focused and you can't divulge information that's personal about their specific problems, but make it broad that this is how we normally do things. I'm really sorry that this occurred and blah, blah, blah, because you are, you didn't intend for someone to be that upset. And sometimes they have preconceived notions and things happen. I mean, it's going to happen. No one's perfect for everyone. That's how I handle it. Second, there are other steps you can take if it becomes more egregious. Thankfully, most of these sites will allow you to eliminate one or two evaluations and you can appeal to them, whether it's Google or some of the other ones, if it's something, and they have a good way of kind of determining, hey, this is not really, this is something that's going off the handle here and it really shouldn't be online. And so you can appeal to them. That's the next step. And then the final one, obviously, if you wanted to take it to court, you could, but once you do that, you've opened Pandora's box. And so I would avoid that at all costs unless they're really taking you down. Sounds exciting. And this is our last question of the evening. For someone who is just starting on the job search, do you have any recommendations for finding opportunities? Yeah, I think Oggs has, I mean, a lot of people advertise through the Oggs site. You can start there. I think the best way is to network. You talk, you talk to all your friends and colleagues and say, hey, you know, talk about where you want to go and where you'd like to work. What kind of people do you want to work with? Sometimes that's a lot more important than even the location for a while. At least, you know, I think everyone, my experience when I was hiring people, at least until about five years ago, one, two, and three priority, when they made their final decision of where to go was location, location, location. It's just because you spent your whole life working wherever you're told to work, right? You want to get to the best medical school. You want to go to the best residency. You want to go to the best doctor. And so you didn't really, you knew it was a short time period and you would live wherever you'd have to live. But when you now get to decide, I'll tell you what, that becomes really important to everybody. And it's, you know, am I close to my family? Do I have a support group around? Is it the weather, the experience, things I can do outside of work? All of those things actually matter to people a lot. And they make their decision one, two, and three. Now it's one and two. Three is now job opportunity, but it's not the job, honestly. People are, you think it is, but it is the job once you have the right location, right? But that ends up being the top thing that people look for. So when you're thinking you're outside of where you want to go, what's happened is there's been a reduction of number of job opportunities at any given location. And so, you know, it's because there's been a higher supply. There's still demand, don't worry, but there's been a higher supply. And so now people are having to base on other factors. What started happening about five years ago is that people started using their number one factor is their incoming salary. And hospitals learned that. So most hospital systems would offer a really big, but you get only a one-year guarantee. And that one-year guarantee would be pretty hefty. But they also knew that in year two, you weren't going to produce nearly enough in those two years to supply for the income that they offered you in year one. They already know that. But they know that you produce other ancillary care that they can support it, but they also know they can show you you're not producing enough. And they're going to then decrease your income. That was almost, it repeated itself in most markets. And, but people got real excited about this, you know, first-year income being really high. So be careful, be thoughtful about that. I wouldn't make that your top priority. You need to know how they're going to evaluate you. And you need to know how you're going to be compensated. But look at other things that we talked about in this kind of seminar. I think that if you do those things, you'll end up being a lot happier. Because believe it or not, if you want to make money, don't do it in medicine. Because it changes your perspective. It makes you look, you can potentially get in trouble a lot more easily. The way to make money is outside of medicine, but you have such a comfortable income, you can do that. So that's my recommendation to everyone who comes to me in business. Like, oh, well, how do you make a lot of money? I said, not in medicine. Be thoughtful, be productive, be efficient. Yes. But if you want to make money, there's much better ways to do that. And then you're not going to be struggling with ulterior motives about how you do things in practice. I'm not suggesting that you don't, you have to do it that way, but that's my recommendation. That's great advice. Thank you so much. On behalf of the OGS committee, and I'd like to thank Dr. Stratford and everyone for joining us today. For a full list of upcoming webinars, please visit the OGS website to sign up. Thank you so much. This was a great talk. Yeah, thanks for coming, everyone. Hope it was helpful. Have a good day. Have a good night.

Transitioning into Private Practice

Dr. Ryan Stratford

billing process

productivity optimization

building professional relationships

social media utilization

self-care

surgery

work-life balance

networking