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and beauty of the furnishings, and principally by the manner, tact and ability of the doctor.
Purchase of a Practice.-As a rule the young practitioner has some district in his mind in which he would like to commence practice. It will then be his object to look up the advertisements in the medical journals of practices, partnerships, or assistantships with a view to partnership, for sale in or about the desired locality. He may, however, hear privately of some such vacancy.
Very often, however, such are not advertised, but are on the books of some of the better-known medical transfer agencies. Though a large fee has to be paid to the agent, it is more likely that one will be fairly dealt with by purchasing through such an agency. It is the duty of the agent to inquire into the cash books and ledgers, etc., of the vendor and to satisfy himself as to the bona fides of the transaction. This duty is not, however, always performed by the vending agency, and, indeed, some of them state that it would be impossible for them to investigate all the practices offered, and that they simply repeat what the seller has told them. Some purchasers have learnt this lesson so much to their cost that they insist, in future transactions, on dealing directly with the vendor and without the intervention of any agency.
One cannot exercise sufficient care in making such a purchase. I have known several young men who have been swindled into purchasing practices which really did not exist. No doctor can sell his practice with the assurance that every one of his patients will transfer their patronage to the new purchaser,
but he expects that a very large proportion will do so. In many cases, however, where a practice is advertised for sale owing to the ill-health of the vendor it is a decadent one, and has perhaps been neglected by the seller owing to intemperance or actual illness; to build up a ruined practice is a very tedious or even doubtful undertaking. One has to examine the ledger carefully and note what the actual cash receipts for the past three years have amounted to, the number of private families on the list, and how many have recently been patients. In the case of a panel practice, the numbers of insured persons is the test of the income.
In the case of purchasing a practice after the death of the former practitioner one must see that the death has occurred but recently, as a practice soon dissipates itself if it has been left unattended for some weeks. Even where a locum tenens has been carrying on the business there may have been great leakage, and a practice which had been good and lucrative during the lifetime of the deceased doctor may dwindle greatly during the interval.
Again, a practice which has belonged to a doctor advanced in years is not always a safe one to purchase. Many patients may have kept to the old doctor through loyalty and even affection, but when he retires they may take the opportunity to transfer their patronage to some other and younger doctor in their neighbourhood, whom they already know. In the purchase of what is, therefore, called a "death vacancy," not more than one year's income should be paid, and this only if everything else is satisfactory.
In buying a practice from a doctor who is retiring
or merely leaving the district, it is the usual practice for the seller to give a personal introduction of the purchaser to each of his patients. This may extend over a period of from one to six months, depending on the size of the practice, during which time the purchaser usually lives in the house of the seller. In such cases the purchase price is usually from one and a quarter to one and a half years' purchase.
It is always advisable to rent or purchase the house in which the former practitioner has lived, even though it may not be entirely satisfactory. There is a sort of vested interest in the property, and people have got to know it as "the doctor's house." Of course, no extravagant sum ought to be paid for such occupancy, but one has always to remember that another doctor may take up residence in that house without having paid anything further than the rent or purchase money of the house.
Partnerships.—At first sight this would seem to be the best arrangement which could be devised, and in many cases it works admirably. Two, or even three medical men join together and carry on a practice in a certain district. One or two are therefore always available to do the work and to allow the other to take a holiday or to act during his illness. Outside consultants are not nearly so often required as probably each of the partners has some speciality, and often one is a fully qualified surgeon, and so most of the operative cases are undertaken by him, and so on.
On the other hand, however, partnerships between medical men are perhaps less satisfactory than they are between men in other professions or trades.
This is probably due to the personal factor which bulks so largely in medical practice. One partner, perhaps, is much more appreciated by the patients than is the other, and messages are sent asking him to visit and not the other partner; hence jealousy is aroused. One partner may not be nearly so active as the other—his work gets into arrears; thus more than his fair share is thrown upon the more active partner; this leads to resentment and, thus, not infrequently such partnerships are dissolved by mutual request.
Before, therefore, one settles down to a partnership, it is advisable first to go as assistant for some time, and in this way both are enabled to judge of each other, and to determine whether a partnership between them would be desirable.
Courtesy Calls on Brother Practitioners. It is expected that you should call and introduce yourself to those medical practitioners who reside in your neighbourhood. In cities and large towns this courtesy call may extend only to those living within half a mile of you; while in country districts this may extend to several miles. These gentlemen will be your colleagues, and you will probably be able to assist one another. It is only right, therefore, that you should make yourself known to them as soon as possible after you commence practice. Of course, if there are any whose acquaintanceship you do not desire to make, you need not call on them. It is courteous, however, for you to call on all your professional brothers, but unless you respect or esteem them, you need not follow this introduction by any further intercourse.
SUCCESS IN PRACTICE
IT is often the belief of the medical student or young practitioner that the greater the number of degrees or qualifications he can obtain, he will the more readily attract patients when he commences practice. Though it is only right that the young man should make himself as proficient as possible in his profession, one must warn him that mere learning may not enable him to succeed as a practitioner. In fact, statistics go to prove that only a comparatively small proportion of men who were brilliant students have succeeded in making themselves famous afterwards in their profession. On the other hand, it is not unusual to find that a man who, having followed some other business for some years, has commenced the study of medicine when far beyond the usual age, starts a practice and rapidly acquires an extensive clientèle; while on the other hand, the man who gained many prizes and scholarships may find it very difficult to attract patients. The true reason in many cases is that the former had during his previous business life learnt experience and had acquired, if he had not already possessed it, tact in the conduct of his profession; while, no matter how well educated the other may be, if he has a stiff manner and no tact, he will find himself unable to make a practice.