Enter Private Practice Research Articles

Professional Education and Private Practice: Is There a Disconnect?

This article summarizes results of a national study conducted to evaluate the private practice career intentions of MSW graduate student members of the National Association of Social Workers (NASW) (n = 271), the extent to which these students are being prepared for private practice by the graduate schools, and the views of the graduate deans (n = 104) and macro practice (n = 152) and clinical (n = 278) members of NASW about private practice and social work education. An analysis of mailed questionnaire responses from these stakeholding groups suggests a striking disconnect between practice and education. Although a majority of graduate students plan to enter private practice, most on a full-time basis, graduate schools do not teach content specific to private practice careers, and many faculty even discourage the discussion of private practice career aspirations. On the other hand, a majority of NASW members, whether clinical or macro social workers, expected graduate schools to begin educating students for private practice. It is proposed that the labor force transition from the public to the private sector has resulted in the bifurcation of social work education. Implications for social work practice are discussed; short- and long-term initiatives for matching social work education to social work practice are proposed.

Attitudes of Ohio Dentists and Dental Hygienists on the Use of Automated External Defibrillators

The American Heart Association reports that approximately 220,000 people die each year of sudden cardiac arrest. In ventricular fibrillation (VF), the most common abnormal heart rhythm that causes cardiac arrest, the heart's electrical impulses suddenly become chaotic, often without warning. Death will follow within minutes if the victim is not treated appropriately, and the only known treatment is defibrillation. An automated external defibrillator (AED) can restore a victim's normal heart rhythm by providing defibrillation. The purpose of this study was to gather data from dentists and dental hygienists in Ohio on their use of and attitudes toward using AEDs in dental offices. Six percent of Ohio dentists and dental hygienists were randomly selected to receive a twenty-three question survey related to their use of and attitudes toward their use of AEDs in dental offices. Thirty-three percent (244) of the surveys were returned; 41 percent of the respondents were dentists, and 59 percent were dental hygienists. Six percent said they have had to administer nitroglycerin to a patient during a dental visit; 5 percent have performed CPR on a patient in the dental office; and 78 percent said their last CPR training course included training on an AED. Eleven percent said there was an AED at their dental office. With the increased likelihood of dealing with a cardiac emergency in the dental office setting and the willingness of dental professionals to use an AED, all dental offices should consider obtaining an AED. Dental educators should become familiar with current protocols for handling cardiac medical emergencies in the dental office and prepare dental and dental hygiene students with the skills necessary to manage patients with cardiac emergencies. Graduating dental students entering private practice may want to consider the AED as part of their medical emergency office protocol.

Entering Private Practice: A Handbook for Psychiatrists

Back to table of contents Previous article Next article Book ForumFull AccessEntering Private Practice: A Handbook for PsychiatristsMARYAM RAZAVI M.D.,ROGER PEELE M.D.,MARYAM RAZAVI M.D.Search for more papers by this author,ROGER PEELE M.D.Search for more papers by this author,Published Online:1 Mar 2007https://doi.org/10.1176/ajp.2007.164.3.532AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This is a valuable book for those contemplating psychiatric private practice, especially for those who have been shielded from the business aspects of psychiatric practice. The book guides one through the checklists and areas to consider along the way. It is filled with sample lists, forms, and questionnaires to use as a reference tool. Key areas such as office setup and design, marketing, and record keeping are covered. Furthermore, informative sections on collaboration with primary care physicians and use of websites for referral base are discussed. The book also tackles material on the most common legal issues encountered in private practice and ways to maneuver through, as well as a discussion of ethical issues in private practice, with clear vignettes that illustrate dilemmas encountered in everyday practice.The few pages on addressing the challenges of managed care are slim however, especially in view of the author"s vast knowledge about the workings of managed care. For example, how to appeal an adverse managed care decision is barely mentioned.After reading the many things suggested in this book to achieve an adequate private practice, one may feel overwhelmed. The editor reassures, however, that “I myself have been able to continue an active private practice, teach residents, volunteer for a free clinic, write, and be actively involved in organized psychiatry and medicine”(p. 5). Dr. Lazarus forgot to add that he has also been very busy with a family, has time to train to compete in triathlons, and his achievements in organized medicine at the AMA are without parallel for a psychiatrist. Let"s hope his next book tells us how he does it all.For many a patient, private practice offers the best potential for ideal care and treatment. This book helps the practitioner achieve the ideal.Washington, D.C.Rockville, Md. FiguresReferencesCited byDetailsCited ByNone Volume 164Issue 3 March, 2007Pages 532-532THE AMERICAN JOURNAL OF PSYCHIATRY March 2007 Volume 164 Number 3 Metrics PDF download History Published online 1 March 2007 Published in print 1 March 2007

Pediatric cardiology: The “state of the heart”!

Althouse and Stockman provide valuable insight into workforce issues in the field of pediatric cardiology. This subspecialty is popular among trainees, ranking as the fourth most-selected subspecialty. However, a serious problem for pediatric cardiology is its aging population of practitioners; the mean age is 50 years. This with the fact that an increasing number of young trainees are seeking part-time employment presents additional challenges. Two seemingly opposing forces are at work in shaping the future of pediatric cardiology. An increasing number of trainees are interested in a private practice setting or a more clinically focused job in academic medicine (29%). The current fellowship structure, however, is tailored for the young researcher, and the third year of the training program is devoted to research in the field. Some have suggested the need for a fourth year of training for fellows to learn more specialized clinical areas and research methodology. This discourages private practice as a career. At the same time, there are fewer young research scientists entering the field—this will ultimately result in less basic science and translational research being conducted in pediatric cardiology. Althouse and Stockman do not address these issues of increasing private practice as well as specialization in clinical medicine and research within the field of pediatric cardiology, due largely to limitations of available data. One issue that is unique to pediatric cardiology is its close tie to cardiovascular surgery. Advances in the field have often combined advances in surgery and medical care. This may be one reason why there are few pediatric cardiologists in rural areas. This also raises issues about regionalization of healthcare services and the ultimate influence that may have on the projection of workforce needs. The training centers of the future must solve these dilemmas and ensure that more individuals enter private practice where the demand exists and that fellows train in more specialized clinical areas such as interventional cardiology and electrophysiology as needed. Pediatric cardiology fellowship programs must also continue to train bright young minds so that they will pursue the basic research that will keep pediatric cardiology viable. More sophisticated data will be needed to assess true workforce trends and needs for the future.

Satisfaction and gender issues in otolaryngology residency

To evaluate the otolaryngology residency experience with attention to operative experience, career guidance, and gender. Otolaryngology residents were anonymously surveyed by mail about their residency experience. The 22-item survey was scored on a 5-point ordinal Likert scale. Responses were analyzed with respect to gender and postgraduate year (PGY) level. Complete surveys were returned by 261 otolaryngology residents (24% female). PGY level correlated with confidence that surgical skills were appropriate (P = 0.003), establishment of solid career network (P = 0.003), and confidence that surgical abilities are adequate for practice (P = 0.028). Female residents reported less confidence that surgical skills were appropriate (P = 0.050) and that surgical abilities were adequate for postresidency practice (P = 0.035). Women were encouraged to enter private practice more often (P = 0.012), were less likely to have a solid career network ( P = 0.025), and were less confident about being able to run their own practice (P = 0.036) Significant differences exist for several questions regarding surgical confidence and career issues, even after correction for PGY level.

Salary differences in academic versus private practice dermatology: Do they explain the large numbers of new residency graduates entering private practice over academic dermatology?

Salary differences in academic versus private practice dermatology: Do they explain the large numbers of new residency graduates entering private practice over academic dermatology?

Private Practice or Not: Economic Considerations for the Physician Assistant

The decision of the Physician Assistant whether to enter private practice or an alternate career path can be greatly aided by economic considerations. The potential income both now and in the future for each alternative needs to be assessed. Trends in operating costs and gross revenues for relevant private practices must be researched. Characteristics of the practices, such as, age, size, specialty and location have impact, as well. Issues of fee collection and reimbursements require investigation. The purpose of this article is to review the role that economics plays in the decision-making process for the Physician Assistant (PA) in terms of the type of practice to pursue. Critical to the decision of a new Mid-Level Professional whether or not to enter into employment in a private practice or hospital / clinical based assignment, is research into the long term economic consequences. A third practice model to add to the mix is the physician / physician assistant owned practice partnership. This entails consideration of the following: Potential salary presently available and its likely 1. growth in the future Any investment costs accounting for loss of future 2. interest Potential revenue, now and in the future from 3. private practice Operating costs attributable to private practice both 4. now and in the future Problems related to reimbursement and collection 5. of fees Type of practice e.g. size, age, specialty, or multi6. specialty Location of practice 7. Participation in managed care, HMO's, etc 8. Income disbursement from the practice or 9. organization In general, assessing potential salary and prospects for the future can be guided by Bureau of Labor Statistics publications that provide current salary ranges and employment prospects for the future. Among such publications are the Occupational Outlook Handbook and Occupational Outlook Online (http://www.occupationaloutlook-handbook.net). For physician assistants, median annual earnings in 2002 were $64,670 with the middle 50% earning between $49,640 and $77,280. These earnings are affected by factors such as specialty, practice setting, geographical location and years of experience. Physician assistants are expected to be in very high demand over the period extending to 2012, even more so than other professions. To the above data, one would need to make some estimates of the fringe benefits which would be in addition to salary. Perhaps a percentage estimate typical for these professions could be used. If a PA is entering a private practice as a partner, as many are beginning to do, one then would need to determine whether a capital investment would be required, and if so, what the amount would be. To this, one would needs to add an estimate of the lost interest earnings over time using a low risk long term interest rate. Next, an estimate of the revenues and costs associated with private practice must be made. While it may not be possible to obtain precise information related specifically to the PA, one can utilize private practice Private Practice or Not: Economic Considerations for the Physician Assistant 2 of 5 data to elicit trends in both revenues and costs that most likely would have effect on their practices and salaries. For the following analysis, we will primarily utilize data from office based private practices of primary care physicians. This is viewed as being the most akin to the PA profession. For ease of comparison, it has been determined that only data from various surveys conducted by Medical Economics over the past ten years related to office-based MD's and DO's in office-based private practice will be utilized in the following analysis. A limitation is that this may not be the most exact or best data available. In fact, professional organizations may possess more specific data necessary for the final decision making process. While there is no reason to believe the exact same population was sampled and responded to each of the surveys, the nature of the list gives some confidence that it is representative. It should be noted that the subsequent revenue and cost data is presented on a per physician basis. Tables 1 and 2 present data related to the revenue side of the picture. Median net earnings for 1995 and 1999 are presented in Table 1 and total compensation for 2002 and 2003 in Table 2 . While these are not strictly comparable, for eliciting a trend they serve the purpose. The data for 1995 and 1999 show either almost no growth or even a loss in year earnings when inflation is accounted for (consumer price index is utilized as a measure of inflation over the period). The total compensation picture for 2002 to 2003 is mixed across the various specialties but pretty much flat. Figure 1 Table 1: Median Net Earnings ($)

The scope of private practice nursing in an Australian sample.

The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.

Cardiology's workforce shortage: implications for patient care and research.

The common wisdom at the end of the 20th century was that the United States was training too many specialists, including cardiologists.1 By 2001, however, there was increasing evidence that the supply of cardiologists was not meeting the growing demand. That year, as president-elect of the American College of Cardiology (ACC), I appointed a task force to evaluate cardiology workforce. The task force undertook a 2-year process of literature review, hypothesis generation, research design, data acquisition, and analysis. This intense effort included a Bethesda Conference at which consensus was achieved on a report that will be published in the Journal of the American College of Cardiology . Based on various types of information and data, the ACC task force concluded that the United States is facing a shortage of cardiologists. This will reduce access to specialty care of proven benefit and will undermine our nation’s vital cardiovascular research effort. The Bethesda Conference report includes 8 working group documents that recommend several short- and intermediate-term strategies to help narrow the growing demand-supply gap for cardiologists (see Table 1). Some recommendations can be implemented at a local practice or institution level. Others will require a series of complex and coordinated actions at a national level. Hopefully, the report will catalyze actions by academic medical centers, regulatory organizations, federal policymakers, professional societies, and others that influence the output of cardiovascular specialists. View this table: TABLE 1. Working Groups of the ACC Task Force on Workforce Several things continue to drive demand for cardiologists. Elsewhere, I have argued that various scientific, social, and demographic “demand catalysts” outweigh factors that might decrease demand for cardiologists during the next decade2 (see Table 2). Although the relative influence of each demand factor will change over time, one thing is certain: the cardiovascular disease burden in the United States …

Academic Physicians Just Don’t Get It!

To the Editor.—As a practicing pediatrician for 25 years, I would like to respond to Drs Moreno and Bergman’s commentary on “Resident Stress.” Residency training should prepare one to enter private practice, and, I fear, if residency training is softened too much, it will rob physicians in training of much valuable experience.Dr Moreno notes: “Residents will always struggle with setting a balance between their personal and professional lives.” This struggle does not diminish or disappear when one enters practice.They add: “The adage that patient needs invariably take precedence over family needs” is in fact the nature of what we do. As physicians we accept a commitment to those who entrust their care to us, and we and our spouses need to come to grips with this reality early in our training.In regard to pagers, paperwork, dealing with insurance companies, coordinating patient care with specialists, etc, as a practicing physician, I deal with these things every day. Is it wrong that physicians in training are learning to handle these things?And in regard to “shift” work: it’s nice work if you can get it. In practice, you get up; make hospital rounds; see patients in the office for 8 hours; do paperwork; make follow-up phone calls after hours; if on call, answer your pager at all hours, finding the strength to ask the right questions and give sound advice at 2 AM; go to a delivery or the emergency department in the middle of the night (sometimes more than once); get up at 6 AM to make rounds; and return to the office to see patients for another 8 hours.There is a value to testing your skills and endurance for long hours under the supervision of senior residents and attendings in preparation for the real life of private practice.I am afraid that most of today’s residents are in for a real shock when they enter private practice. One doesn’t train for a marathon by running around the block.In Reply.—Dr Brennan’s astute comments raise the important concern that decreased resident work hours may leave the graduating resident unprepared for the demands of a busy private practice. Because residents in training now grow accustomed to working no more than 24- to 30-hour stretches, these same residents may find themselves unprepared to take jobs in which they are regularly expected to work 36-hour shifts.In considering these concerns, I find myself turning to evidence-based medicine. There is a vast amount of medical literature that documents increased risks for motor vehicle accidents,1–3 depression,4,5 pregnancy complications,6,7 medical errors,8,9 and decreased empathy towards patients10 associated with prolonged work hours. This extensive evidence contributed to the present resident work-hour rules. When considering these data, one has to ask: “Is it healthy for me or my patients if I work 36 hours in a row on a regular basis? Am I offering patients the same standard of care at hour 35 as I was at hour 3?” If we are concerned that regularly working 36-hour shifts is harmful for residents as well as patients under their care, should we consider whether this is an issue for the pediatric profession as a whole? Perhaps the enlightenment that has finally reached residency programs should be extended into the practice setting. Dr Brennan may be right that long work hours during residency can prepare one for heroic work hours in a private practice, but one wonders why he is not advocating for improved hours in the practice setting.In Reply.—Thank you for forwarding Dr Moreno’s response. Once again, my point is proven: academic physicians just don’t get it.Private practice is a business. Our revenue to run this business is: 1) generated by the number of patient visits; 2) limited by outside sources (insurers); and 3) generated during “normal business hours.” Hiring a physician to cover our “shift” is not economically feasible; Besides, patients expect personal care from their personal physician.The economic reality of the business of medical care delivery does not afford us the luxury of “improved hours.” And I don’t think the American public would accept any adaptation of the Canadian health care system.Thank you for your time. No response is necessary.

Private duty nursing: the last days in Central Queensland

Private duty nursing plummeted from being the pinnacle of a nurse's career in 1900 to being almost non-existent by the 1970s. This paper explores the nature of private duty nursing in the 1960s and 1970s and seeks to identify factors contributing to the demise of this avenue of work. Three former nurses from Rockhampton, Queensland, were interviewed as part of an oral history project. The interviews were transcribed verbatim and analysed within an historical context. The main factors identified as impacting on private duty nursing by the 1970s were the opening up of opportunities for married nurses to gain part-time employment in hospitals, the increasing level of technology associated with high dependency patients, and improved wages and conditions of hospital nurses. While many of the factors relating to the decline of private duty nursing are no longer relevant, other issues that emerged from this study, such as professional isolation, working environments and the ability of the patient to pay for nursing services, warrant consideration by contemporary nurses entering private practice.

Private practice: benefits, barriers and strategies of providing fieldwork placements.

Occupational therapists are entering private practice in ever increasing numbers. In order to gain the skills to practice in this area, students should have the opportunity to experience private practice fieldwork placements. However, the number offered in private practice settings continues to be limited. The purpose of this exploratory qualitative study was to identify the benefits, the barriers, and the strategies associated with providing fieldwork opportunities in private practice. Data were obtained through semi-structured interviews with six occupational therapists in private practice. Results indicated that participating in fieldwork education affords benefits to the profession of occupational therapy, to the clinician, and to the facility. Potential barriers included student characteristics, cost, time, travel and legalities. Involvement from the university and the private setting were considered necessary for providing and implementing strategies. The findings have implications for increasing private practice placements for future students in occupational therapy and other health care professions offering clinical placements as a component of their formal education.

The choice: Lewellys F. Barker and the full-time plan.

In 1914, Lewellys F. Barker, William Osler's successor as Professor of Medicine and physician-in-chief at Johns Hopkins University School of Medicine, resigned to enter private practice rather than accept the terms of a full-time plan, whereby professors in clinical departments would be salaried like other professors in the university. Barker had been an early proponent of the full-time plan. His decision reflected not only a personal desire for a larger income but also contradictions inherent in the Flexnerian ideal of clinical medicine as a research-oriented university discipline devoid of financial incentives to see patients. In private practice, Barker maintained a high profile as a teacher, writer, supporter of the Johns Hopkins medical institutions, and public figure. The issues raised by his difficult decision remain relevant and have not been satisfactorily resolved.

Meeting the Demand for Future Dental School Faculty: Trends, Challenges, and Responses

This report presents data from ADEA's 2001-02 survey of vacant budgeted faculty positions and examines challenges likely to exacerbate faculty shortages in the immediate future. The fifty-four dental schools responding to the survey reported 344 vacant budgeted positions, a decrease of 4 percent from 2000 to 2001. Seventy-nine percent of these vacancies are for full-time positions. Approximately one out of four dental schools has ten or more vacancies. Of just over 1,000 faculty separations during 2001-02, 53 percent were reported to be individuals leaving to enter private practice. There is no indication of a near-term reversal of the decade-long trend toward increasing budgeted vacancies, and the current economic environment along with other factors delineated in this report makes the challenge to recruit and retain dental faculty more difficult. ADEA and other stakeholders are currently pursuing a number of strategies to meet the demand for future dental school faculty.

Dental School Vacant Budgeted Faculty Positions: Academic Year 2000 ‐ 2001

The 1999 Report of the AADS President's Task Force on the Future of Dental School Faculty (1) drew attention to the situation dental schools are experiencing in attracting and retaining faculty. A year 2000 ADEA Association Report on faculty shortages indicated the number of vacant budgeted positions was approaching 400 (2). The year 2000 - 2001 ADEA survey of vacant budgeted positions indicates a further four percent increase in vacant budgeted positions. Over 73 percent of the vacancies were in the clinical sciences. Of identified full time faculty separations in the 2000-2001 ADEA Survey of Dental Educators (3), almost 34 percent were due to retirements; 33 percent were faculty moves to other schools; and a little over 18 percent were moves to enter private practice. Almost three percent of identified faculty separations were from deaths. It is anticipated that, with a further "graying" of an already aged dental school faculty, retirements will further exacerbate the problem of faculty vacancies and the ability to attract and retain new faculty. There is needed urgency in implementing strategies and recommendations provided in the 1999 President's Report and the 2000 Association Report.

Desired training characteristics of a potential oral and maxillofacial surgery practice associate: A New Jersey survey response

Residency training in oral and maxillofacial surgery has undergone many changes over the past 30 years. Training programs have evolved from 3 years in length to a minimal of 4 years with some integrated MD or PhD programs being 6 years or greater. The motivation toward longer training and completing medical school originally came from the desire to expand the medical knowledge of the practicing oral and maxillofacial surgery practitioner and, in some cases to circumvent hospital policies allowing only physicians to perform patient admitting histories and physical examinations. Decreased private practice workload and diminished insurance reimbursement also contributed to the expanded scope of the specialty with practitioners wanting to perform more elective procedures. Currently, 38% of oral and maxillofacial surgeon training programs offer integrated MD programs with 43% of the trainees enrolled in such programs.1 The expanded scope of practice has forced some states to critically evaluate their dental practice acts to include all procedures that residents are currently being trained to perform. Restrictive dental practice acts in some states are creating controversy between surgeons with single and dual degrees, allowing only dual-degree surgeons to practice certain expanded scope procedures under the auspices of their medical licensure.2 Residency training in oral and maxillofacial surgery is governed by the Commission on Dental Accreditation. Accreditation standards for advanced specialty education programs in oral and maxillofacial surgery have been revised as of January 2000, requiring a minimum of 75 major cases and 100 general anesthesia/deep sedation cases per graduating resident. Major cases must include a minimum of 10 cases in the trauma, pathology, dentofacial deformity, and reconstructive and aesthetic surgery categories. However, most residents in major teaching institutions will be involved in a great number of major surgical cases covering the entire scope of the specialty. On completion of an accredited residency program, it is important for graduates planning on entering private practice to understand what surgeons/ employers desire when hiring a potential associate. This survey was developed to answer that question as it pertains to the private oral and maxillofacial surgery practitioners in the state of New Jersey.

Dental school faculty shortages increase: an update on future dental school faculty

The 1999 publication of the American Association of Dental Schools (AADS) President s Task Force on Future Dental School Faculty revealed a crisis in the shortages of dental school faculty. Stakeholders from around the nation have used the AADS Task Force report to address the crisis. In addressing one of the AADS Task Force recommendations, the American Dental Education Association (ADEA), formerly AADS, gathered additional data through a new survey of dental school deans to elucidate the current state of faculty shortages. Based on this research, ADEA projects that the number of unfilled budgeted faculty positions in U.S. dental schools now approaches 400. Survey respondents identified retirement as the leading reason for full-time faculty separations, while separation to enter private practice was the second most frequent reason for leaving the institution. Offering a salary competitive with that of private practice was identified as the most critical factor in recruiting future faculty. A number of short and long-range strategies to recruit and retain faculty are presented. Ultimately, the dental school faculty shortage places in jeopardy the general and oral health of the public.

Entering an Ethical and Successful Oral and Maxillofacial Surgical Practice

Summary This article presents the options and methodologies available for an oral and maxillofacial surgeon to enter private practice: self start-up, purchase of a practice, and associateship. It is entirely possible that, over a practice career, an oral and maxillofacial surgeon could become involved in all three alternatives. Each oral and maxillofacial surgeon and each oral and maxillofacial surgical practice and practice situation are unique. The material is presented as general guides and guidelines to assist an oral and maxillofacial surgeon in getting starting, entering a successful and ethical practice, and covering the major areas and points. Regardless of the type and to enter practice, an oral and maxillofacial surgeon has to make only two decisions: a professional decision and a personal decision. However, they are major and significant career-shaping and lifemolding decisions. They require a tremendous amount of thought, consideration, effort, and expense. They also demand a great deal of patience, perseverance, and time, particularly if the oral and maxillofacial surgeon is a novice and not in the immediate area. On the average, you should allow 6 to 12 months to enter private practice. You must put together your professional advisory team. Speak with other professionals in the community and interview as many as necessary (see Display Box 4). Be as specific as possible as to what you believe you have to do, what you expect them to do with you, and what charges you can anticipate. Many of these talented individuals are empathetic to your novice position and overwhelming responsibilities and are considerate with fees and charges in addition to being extremely helpful. Build relationships. There are many ways to keep certain costs down,5 Purchase astutely. Do not be sold. A wise oral and maxillofacial surgeon once said that “almost everything is negotiable.” In virtually all arrangements you should get several, or at least more than one, bid, quote, or price. This includes loans, leases, insurance, equipment, computers, supplies, professional services, wages, and construction. You must shop the market. At all times, you must be totally professional and highly ethical, even if it hurts or seems impractical. You have been impeccably trained and are superbly talented. You will spend approximately one third of your life in your practice. You have a vision of how you want to spend it. If you keep your eye on the vision, yours will be a highly ethical, extremely productive, totally rewarding, rapidly passing career in a glorious, exciting, challenging field.

Increasing recruitment contacts between generalist residents at the Medical College of Georgia and rural and underserved communities.

To increase the number of residents choosing to practice in rural and underserved areas, the Medical College of Georgia in 1994 created the Office of Recruitment and Retention (ORR) for generalist physicians as part of its participation in The Robert Wood Johnson Foundation's Generalist Physician Initiative. Its major purpose is to increase the contact between generalist residents and practice opportunities, especially those in rural and underserved areas. The office has helped residents better understand the resources available in rural settings and has helped these communities better understand the needs of graduates in generalist residency programs. It became a point of contact for residents and communities. It also organized on-campus "practice opportunity fairs" that permitted community representatives to meet formally with generalist residents to provide information on practice opportunities and community resources. The office organized practice management sessions and provided legal consultation to residents desiring to enter private practice in rural settings. This program has already been instrumental in furthering contact between generalist residents and the rural communities they selected as clinical practice sites during training. Although it is too early to know the impact of these activities, communities increasingly use the office to recruit generalist physicians, and residents use it to identify appropriate practice sites.

Clinicians' Reasons for Rejecting Private Practice

Much attention has been focused on the attractions of independent social work practice and the motivations of individuals who choose to enter private practice on either a part-time or full-time basis. The author presents the findings of a study of a national sample of social workers eligible by their training and experience to engage in private practice but who for various reasons chose not to do so. Their reasons for not entering private practice are examined in light of previous research on the attractions of private practice as well as current challenges of private practice. The implications of these findings for structuring rewarding work experiences in agency contexts are discussed.