How to prepare for being a Consultant

What the textbooks don’t tell you and how to set up in private practice

Charlie Chan - Cheltenham

The New Boy or GirlBeginner’s Guide

First two years are the most challenging

Get it right, as it’s hard to catch up

Two jobs or One?Not everyone wants to do private practice

But if you do, then you will have two jobs

Time management and organisation are the keys to success and will stop you going mad

NHS JobBEFORE the interview ask aboutSECRETARYOFFICETheatre EquipmentTravelling – peripheral clinics

MAKE IT CLEAR WHAT YOU MIGHT EXPECT IF YOU GET THE JOB

Everyone needs Miss Moneypenny

Your secretary is worth her weight in gold

Try and choose your secretary yourself

Tell the hospital when you get the job that you want to make the appointment

The OfficeAsk about the office when you come for pre-interview visit

Do not accept a broom cupboard when you arrive

It has to fit you, your PA plus your paraphernalia

Other essentialsTheatre equipment – will there be a small

budget for you to buy your favourite bits?

Do you have to travel?

Who do you have to support you?

Mentor

Keep in touch with an old bossIt’s ok to call him/her for advice

AppraisalLogbookCPD recordsThank you cards & complimentsComplaints(360 MSF later)

Thank you cardsIf someone writes or gives you a present

Write back!

Keep a copy of the card/letter and reply in the notes. It might just save your bacon!

Keep a copy for your Portfolio

Private PracticeStill the 4 As

AvailabilityAffabilityAffordabilityAbility

When to start Private Practice?

Think about it before you start the jobYou will get asked in the first month or two by a

NHS patient, who is insuredIt takes time to organise

What do you need to do?Get recognition from insurance companiesTell your Medical Defence OrganisationVisit your local private hospital to arrange

practice privileges (PPs)Think about secretarial supportSort out a bank account and accountant

MoneyRemember that the contract is between you and

the patientYou treat the patient and charge a “customary

fee”The patient is liable for the feesThe insurance company reimburses (either you

directly or the patient)

FIPO charter

http://www.fipo.org/pdfs/FIPO_Patient_Charter.pdf

Insurance companiesYou will need to be recognisedYou need to apply to each insurer individually

Letter of appointment to substantive postSpecialist Register entryReferences from consultant colleagues

Not all insurers are the same

BUPA 42%AXA PPP circa 20%

Aviva, Pru Health, WPA, SimplyHealth, CIGNA

Exeter Friendly, Multiplex, Westfield, Beneden, Healix, Saga, Permanent Health, Universal Provident, Health On Line etc

Fee assured consultants

BUPA and AXA PPP – 65% of the marketBUPA and AXA PPP set the fees, NOT youYou bill them directly – no shortfalls or billing

patientBUPA have just reduced the reimbursement for

60% of the most common procedures by average 25% below 1992 levels

CurrentlyYou might expect to spend c. 35-40% of your

income on practice expensesi.e. 60-65% is net income subject to income tax

If insurers squeeze doctors hard, this might go up to 60-65%

i.e. only 35-40% remains subject to income tax

Practice PrivilegesNeeded for every private hospital you wish to

work atVisit Hospital ManagerComplete application formIncluded letter of appointment, specialist

registration, referencesOccupational Health screeningAwarded by MAC (Medical Advisory Committee)

How do you get known?The patients are your customersThe GPs are your corporate customers

Write to the GPsOffer to visit themCALL THE GP WHEN YOU HAVE BAD NEWS OR A

PROBLEM WITH A PT – NHS OR PPGive them your mobile number

Manage your time

Learn to say NO!Do not take anything else on in your first year

or twoConcentrate on getting your feet under the

tableEnjoy it!

Finally be politeNever be rude to anyone – you never know who

their best friend might beYou cannot divorce your consultant colleaguesSmile and make it enjoyableYour patients will notice – they will tell their GPs –

you will get more work!

Insurance companiesBUPA AXA PPPWPA ClinicareCIGNA Legal & GeneralAviva HealthnowSimply Health QBE HealthPRU Health GroupamaExeter Friendly Health On LineUniversal Provident Permanent HealthBenenden Saga HealthCivil Service Healthcare Healix