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Transitioning into Private Practice

Hey! The transition from student to private practice professional can be a real jolt, what with all the new and added expectations. Actually, it is often overwhelming.

So, what makes being in private practice daunting for new and recent grads?

To get the ball rolling, here is a quote from one of our Strive & Thrive in Private Practice participants;

"When I first started I found it difficult to combine a meaningful assessment, whilst thinking to myself the direction I was going to take with the treatment and then being able to effectively communicate with the patient without seeming like I wasn't confident. I guess it was all pretty overwhelming"

Understandable when university undergraduate courses for health professionals have their clinical practice component steeped in a hospital tradition. Fair enough, that was where most graduates headed to after completion of their degree. Well, they did 20+ years ago. Not so in recent time. A much larger number of graduates are heading directly into private practice and the expectations and skill sets required are significantly different. What happens? Stress, overwhelm, confusion, and dissatisfaction.

Here are three of the more common challenges voiced by new graduates on our Strive & Thrive in Private Practice course and some suggested solutions.

Problem 1.

"I find it hard with differential diagnosis. Sometimes I second guess my diagnosis as I find there are so many possibilities the problem could be sometimes, and being a new graduate, I always feel like I may be treating or managing the patient incorrectly."

Suggested Solution

Step 1. Differential diagnosis = A work in progress

In a nutshell, this new grad is expressing a lack of confidence. Being honest is essential to develop as a practitioner, but remember, a differential diagnosis is just that, a work in progress. Apart from a direct blunt trauma (e.g. thigh contusion), our diagnoses are 'in the grey zone'; non-specific chronic low back pain, myofascial pain syndrome, anterior talofibular ligament grade 2 (ligament grading system not validated), subacromial impingement syndrome, medial tibial stress syndrome or lateral elbow epicondylphagia.

The reality is that for most musculoskeletal problems;

  • Have no gold standard test (so no diagnosis)
  • There are multiple contributing factors
  • Develop over time (a time continuum)
  • Are attached to a person (treat the person, plus the injury)
  • Can be clinically managed several ways

Accept reality. There are often several theoretical ways to achieve a successful outcome (with some more appropriate than others).

However, don't forget also to take each individual as such. Important learning can be gained by exploring each option conceptually and then putting the best option into clinical practice. For example, you have identified a person has tight quads and low back pain. They can't lie prone as it increases their LBP and when in side lying, they can't reach their foot, so you teach them RF stretching in standing.

Step 2. Be open to peer review

To grow requires learning, and to learn you need to have the confidence to step outside of your know comfort zone, which can be perceived as threating. As expressed by another participant "Asking for help. I didn't want it to look like I didn't know what I was doing in front of the people who have employed me." This sensation makes sense and is completely reasonable. However, staying with it will severely limit your growth. It is natural to be dependent on others before you gain independence. It is important that you surround yourself or have access to senior clinicians that you respect, plus to whom you're comfortable explaining your clinical reasoning and decisions.

Problem 2.

"Being efficient - In the beginning, I was not able to get a subjective and objective assessment plus some treatment in a standard 30-minute initial consult."

Suggested Solution

Do you provide appointments or solutions?

To develop as a clinician, you must manage your time well. This is a key skill and for this reason, we allocate a whole module to Time Management Essentials (see our free 34 minute video here [http://aapeducation.teachable.com/p/strive-thrive-in-private-practice], scroll and expand 'Course Curriculum') in our online Strive & Thrive in Private Practice course.

Let's examine a common mindset about 'perceived value and time.'

Time is finite and if you 'spend' extra time with one client you will need to 'borrow' from another. Given the assumption all are paying the same fee, is that fair?

If you thought no, you are only valuing your service based on time. However, if you can solve the person's problem in 20 minutes, due to your skill and experience, should you sit around for the obligatory extra 10 minutes, to pad out the appointment to the allotted 30 minutes? No way. Clients come to have their problem solved, not spend a set time with us. Appointment time frames are created by us, to facilitate organisation of bookings, based on an average client's treatment requirement. If you solve their problem in 20 minutes, they are happy and you have gained a valuable 10 minutes.

Consider yourself a problem solver, not a time filler.

Problem 3.

"Forming an accurate diagnosis independently. During prac at Uni we had time to discuss our subjective and objective findings with a supervisor" and "Trying to make appropriate clinical decisions on the spot without being able to go away and ruminate".

Suggested Solution

Step 1. Educate as you go.

In both of these statements, there is a wish to be able to step away from the F2F client situation and either consult with our internal voice or an external mentor. Well 2 + 3 = 5, Yes?

In the same way, you can explain out loud to your client, that based upon their answer to your first question "How can I help you today?" all the important details you have learnt from;

  • The subjective examination (2)
  • Why you are conducting the objective tests that you have decided to perform (+3)
  • How this leads to your chosen intervention (=5)

In explaining this, you may think the client will think less of you. Not so in my experience. In telling clients an examination finding is normal may seem pointless to you, but it helps to ease client anxiety, as they learn how much of them is 'normal'. Explaining/teaching (2+3) helps to clarify your thoughts and priortise examination needs. Plus, your client will better understand the logic of the information you are collecting and by involving your client in the process, they will better understand and comply with your treatment or recommendations.

Step 2. Focus on short-term improvement

Another option is to focus on treating the symptoms for the first 1 or 2 consultations. Often there is a significant acute component, and so local symptom-based treatment and education is appropriate. After this time, they will know you better and you will also have a clearer idea of their lifestyle and possible contributing habits/factors and you will be in a better situation to address the underlying causes of the presenting problem.

Step 3. Time Creation Tip

After each treatment, I would also suggest you leave a note in your file about what you would do (test or discuss) next time they visit. It may seem an extra 'thing' to do at the time of the appointment and therefore be avoided. However; it is a great time-saving habit for when you open up the file next time, as you won't need to re-read all your information to 'get up to speed' and decide what to do next. A little investment in time now, produces significant returns next time you see your client.

Want to learn more?

Jump link to the Strive & Thrive in Private Practice online course here.

 

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