Ruminations from a First Year Resident

New Doc Learns the Ropes of Practice Management
Written by Carrie Runde, ND, AANP Board of Directors

In early October I excitedly began a yearlong naturopathic residency at the GW Center for Integrative Medicine (CIM) in Washington, DC. When it opened in 1998, the GW CIM was one of the first complementary and alternative medicine practices in the country to be based at an academic medical center. The CIM is impressive in the diversity of health care providers it employs: there are two nurse practitioners, five holistic medical doctors (two internists, a psychiatrist, a rheumatologist, and a gynecologist), three naturopathic physicians, three acupuncturists, two Reiki practitioners, two psychotherapists, a therapeutic yoga instructor, two massage therapists, a nutritionist, a Trager method practitioner, an IV infusion specialist, and a hypnotherapist! Add the four office staff members and multiple George Washington University allopathic medical students and residents, and you have a crowded house of unique providers.

With so much interesting patient care going on at my workplace, you can imagine that I, like any newly minted doctor, was most excited to start seeing patients. I couldn't wait to apply my naturopathic training autonomously to real patients and witness the outcomes. But, as many new grads learn, seeing patients often happens at a slower pace than we expect. For those that are starting their own private practices, the weeks and months after boards are spent getting a myriad of business logistics squared away before a patient can even walk in the door. For others, the fall is spent creating positions for themselves in places that have never employed naturopathic physicians.

While awaiting the arrival of my medical license, I spent much of October shadowing the providers at CIM and also learning the behind the scenes aspects of private practice. Initially it was a bit daunting having to grasp a whole new system, but I recognized the importance of learning how a busy practice functions. I was able to compare the systems at my residency with the business models that I learned in practice management courses, all the while contemplating how I will run things in my own future practice.

In my time so far at the clinic, I've gained useful exposure to practice management software and electronic medical records. All of the scheduling and billing at GW CIM is done through a program called MindBody. I've benefitted from working with the center's business manager, to learn MindBody's dashboard and bookkeeping abilities, and with the front desk staff, to learn the program's patient scheduling and time of service transactions. The clinic is currently transitioning to electronic charting with Practice Fusion. It will significantly reduce office paper work and administrative tasks, as providers can use it to order and receive labs and message other providers all within the program. However, this program also has limitations, like not being able to integrate with our supplement dispensary or allow for automatic input of data from patient intake forms. I hope to someday have a paperless practice of my own, so learning the ins and outs of an EMR system is invaluable. I am lucky to have entered medicine at a digital turning point and to be learning the ropes as a resident.

Besides the scheduling, billing, and EMR systems, I have also learned the details about working with conventional and specialty labs. From setting up accounts, integrating with EMR, working with local lab reps, learning insurance billing nuances, and calling support staff with clinical questions, there is a great deal more involved than I had realized! As a medical student working in the teaching clinic, most of the business happened behind the scenes. This was in some ways for the good, as we student clinicians had more than enough on our plates. But business is an inevitable part of being in practice and hands-on learning is a perk to being a private practice resident.

While I may not have started seeing my own patients on day one, the non-clinical skills that I have learned are an equally important part of my postgraduate education. I am excited to have an entire year to soak in this experience, learning clinical and business skills. I look forward to sharing more of my observations as a naturopathic resident in future postings!