Um, so one question here is, um, uh, I'm joining a well-established group and have heard that I can expect to start off a bit slowly, but then it ramps up. How long does it take to develop a busy practice months, years, and thanks very much. So anybody want to, um, Sheila, do you maybe want to mention like how long do you feel like it took before you were busy? Yeah. Um, that's a great question. I think, I think one of the part, the part of the question you have to understand first is what is the practice structure? Like, you know, what's, how are they filtering patients into the practice? So oftentimes when you're first starting out, but one of the best ways to build up your patient platform is by taking a lot of call, right. To get those patients that hopefully don't have a cardiologist, but you're taking care of them in the hospital. It's a bummer when they do, but if taking care of patients in the hospital that don't have a cardiologist, very easy referral, you're going to be fresh out of fellowship, bright eyed, bushy tailed, really excited. Um, take the time to meet the family that goes a very long way. Um, take the extra effort to call the family. If they're not at the bedside, um, doing, you know, obviously doing on-call cases and STEMI or STEMI, again, meeting the family after the case, before the case, getting involved, this is really going to help establish a strong reputation of compassion as well as being, you know, the great doctor that you are. And, and then the other thing is to think about, you know, how did other physicians in the practice build their practice? So one of the things that I, um, we, we had a couple of practice locations when I started and I noticed that it was very difficult to crack our flagship, which was Clark, which was the first building, you know, my father bought and built and his, his patients loved me, you know, but they also really loved him. And, um, but we had another practice in East Orange and Essex County, and that was a recent buy. It was easier to just establish care there, you know? And, and so if there are locations that need to be built, build them because that's, that's going to be your little bit of like your booty. It's going to be your ability to build something up. And obviously you do need to put the time and the effort in, um, and figure out when there are no, no shows why. So for me, I had to do a lot of infrastructure, recorrection on a lot of administrative work to also improve the inflow. But I have to say the pandemic really was a blessing because it allowed us to centralize our work into the Clark location. And I got to help my father understand that if you build a flagship, people will come. So there's this old world thought that you need to really spread out, especially in private practice to get patients from different zip codes. But, um, the concept of branding also really works. And we had launched a website in 2020. So for, it's also very important to recognize how the practice that you're joining is going to market you. And that's a very valid question. Ask them, do they have financial support for marketing? Are there brochures? Do they have a marketer? Um, is there a website? How are you, you know, are you going to get on the website, give them your bio work on it, um, and then refer the patients that you meet to that website. Um, so we launched our website right before the pandemic and it took, it takes about six months for search engine optimization to actually occur. And you can imagine like his address has been living for 35 years. So we had to do a lot of correction, but it eventually crawled really well. And it's, it's done really well and helped a lot of, you know, women cardiologists get more second opinion cases than any, you know, the male cardiologists. And so I have been found so much because of that website. And I have to say that that really has helped similar to what you said, Nadia, you know, if you started off slow now, it's a matter of, Oh my gosh, where do I fill in the time, um, to see these patients. And so it happens you're, you're, you know, you trust that you are well-trained, you're an excellent doctor and the practice and the patient volume is absolutely going to come, but take it slow, definitely take it slow, be methodical and have a little bit of a strategic approach, um, with, with, you know, building your practice. Yeah. That's great advice. Um, Regina, um, what, what do you think, how long did it take you? You've started now in two different programs. So I think it probably took me about six to seven months to feel like my clinic was busy and filled up. Um, I definitely agree with Sheila. The marketing is really important, especially in private practice. And so talk to your admin about how you are being marketed. I did a lot when I was first starting out, I did a lot of kind of meet and greets with different primary care doctors in the area. Um, not in the area we would drive over and I would, you know, I would go introduce myself. It was a little bit awkward, but you know, you just power through. Um, and that actually helped quite a bit. Um, and I got several referrals that way. Um, nobody wants to take more call, you know, obviously, um, you have a whole lifetime of call ahead of you, but, um, it definitely helped to be available in the, in the hospital. So where, where I am set up now, um, our office is kind of attached to the hospital. So it's easy to kind of shuttle back and forth. So if I'm not able to see a patient, um, during, uh, regular clinic hours, then sometimes, um, on a day that I'm supposed to be at the hospital, I'll just swing over at lunch and see them. And, um, that has also helped as well. Um, but I'd say it took me about maybe six, a good six to seven months. That's, um, that's also really great advice. And I mean, I know I've heard, um, from some others, other ways that they built up some practice volume was like for people who do peripheral, you know, introducing themselves to the podiatrist or the podiatry team. Um, that would be one example, um, you know, that I've heard of and, um, Poonam, any other suggestions? Yeah, I think there's, uh, three really important things, particularly first is good clinical care, right? So you got to do, um, just because you can do a procedure does not mean you should do it. This really have to apply your, um, I think it's easy to do a procedure. It's the analytical and the decision-making that's the most important that you learn really, um, well during your fellowship and you have to think about it. Guideline directed medical care is what I call it. And then before you do something, you know, or after you do something, just, it's really important to touch base with your referring providers, with the people who actually sent you those patients, or if you're, you know, doing a case for somebody who's on service, then follow up with them, ask them if it's okay to proceed with the intervention. So this is just, you know, your practice is going to grow by word of mouth. It's so important. And, you know, your outcomes are important. Your, um, communication is important. And so the more you communicate and the more you follow guideline directed care, nobody is going, you know, that's how people start sending you more and more patients is because they're happy with the way you follow up with them and, you know, you're following the guideline directed care. So, and the other thing is to keep your complications to the minimum in the first, you know, at least a year, year and a half. After that, if you have complications, people say, oh, that was a tough case or something like that. But initially, if you have a complication, it's always because, oh, she shouldn't have taken on that case. So really be, good clinical care too is promote yourself and promote the institution, promote the people you're working with, right? So if you're trying to build a program, find out what's needed by that program, and then try to grow that program. Talk to your, um, you know, in your own hospital, sometimes you may have a high volume that's not being referred to you. For example, why are these cases not coming to us? And your EPIC or whatever system you have, you have ways to find out how many patients are there with the diagnosis that you're interested in. So use those to your advantage. And let's say, for example, I started building a mitral program. So I can look up and see how many people were having mitral regurgitation, and I can tell why are these patients not being referred? So you kind of talk to your own internal people. You can give talks, um, use your, um, you know, admin folks, and then you can give talks to your referring providers. And so it increased that promotion. And three is that your patients, you know, they are, uh, they, it's a lot of word of mouth. Sometimes they come to you and think you're, oh, you're so young. How many procedures have you done? And all that kind of stuff. So now I'm ready with all that. I just go in and say, hey, I introduced myself. I've trained there. I'm here three years. This is how many procedures we have done. And so the first one minute I've answered all their questions and they get, and I've seen the difference. They're like so excited and happy about, okay, she's done some, you know, she's trained well. She's done so many procedures. And so I've seen a whole lot of difference when I interact with patients that way. And then you have to be confident about, you know, what you are doing. So know about the procedure, your institutional quality numbers, um, and all that kind of stuff and help with quality as well. So I think those three are the really important things. And it takes about a year to year and a half, to be honest, to be really respected. And, um, you know, you would start to build that practice that, you know, you could own and call yours. Yeah, absolutely. And I mean, I definitely think, um, good communication with referring providers is, is really important and you are your own best PR person actually. So, you know, if you had a good outcome, just shout it from the rooftops and tell people about it. And it's not about like self-aggrandizement it's, it's really just about like, you know, um, establishing, you know, that you're going to take good care of your patients and that you're a high quality provider and you're absolutely word of mouth. I mean, the only other thing I was going to add to that is that, you know, just kind of keeping your ears open for, um, for needs. So like we've, we've talked a little bit about, you know, how can you fill in for, um, things that maybe other people don't want to do, but maybe you could provide, um, you know, that service and, and be very valuable in that way. So like, for example, one of my colleagues, um, had found out that the renal transplant clinic was, you know, they, they wanted to have kind of like a go-to person that they would be able to get a hold of and that they had a relationship with. And so now like all of the patients who are undergoing renal transplant at the University of Michigan go oftentimes, not every single one, but like a lot of them see my colleague and there's a lot of stress testing that goes on and, and all that, you know, so I think that that's, um, like she, you know, she had her ears open and she kind of heard that there was a need for this. And so she established a clinic that was going to be, you know, um, evaluating patients undergoing renal transplant who had potential cardiac issues. So, um, Nishtha, what do you think? Any other comments? No, I agree a hundred percent with you. I think getting Nishtha, knowing what you can offer that's different from the rest, whether it's, uh, peripheral procedures, it's venous procedure, a lot of time industry will tell you that, um, about what's lacking in that program, what you can bring to the table. That's important. Uh, that is what's going to make you sustained busy. Uh, word of mouth is going to make you sustained busy. It's going to be word of mouth by a patient. They're going to bring family members. They're going to bring in their friends. Uh, it's going to be the referring physicians. They'll send you the patient the first time with all the marketing, but to maintain that the important thing is, uh, making, making sure there's a communication, there is a line of communication with them, uh, as far as getting busy quickly is concerned. Uh, so the, um, it depends upon the nature of the practice. I mean, are you inheriting somebody's practice or does the practice want you to go out there and get your own prey? You know, because I've been in both those settings. I've been in the setting where everybody has to get their own single patients. So you're going from office to office or, um, and the second scenario where somebody was retiring and I took over their practice. Um, of course that determines, but overall it just comes down to, um, your relationship with the referring and with the patient patients that you're seeing and the niche that you form for yourself.

developing a busy practice

patient platform

marketing efforts

growth of a practice

referring providers