Difficult to teach when you have a small practice

Recently, my alma mater, Creighton University, approached me to teach medical students. Sadly, I told them no.

I enjoy teaching. Medical students and residents always lift my spirits. I think I’m a good neurologist, with a decent grasp of practical issues (esoteric ones, not so much), and I like sharing it with those starting out on this road.

So why did I tell them no? It’s quite simple: I can’t afford it.

Solo practice in medicine is an "eat what you kill" world. You try to see patients, dictate notes, review tests, answer questions, and refill meds in a continuous blur from start to finish.

Teaching – at least worthwhile teaching – takes time. Questions have to be answered, take-home points explained, and exam findings pointed out. The last time I did routine teaching (2001), it added 1-2 hours to the end of each day. I had to make up the office work on weekends, which didn’t sit well with my family.

The alternative is to schedule extra time on teaching days – like an open 30 minutes twice a day – to compensate, but the problem with that is then you have empty time where you aren’t seeing patients and, hence, not making money. In a small practice on a thin margin, cash flow is critical and can’t be ignored.

It doesn’t seem fair to ask medical students and residents to pay, say, $500 a week to cover that time. Their tuition is high enough as it is.

Of course, the program they pay tuition to doesn’t offer a stipend to cover this, either. I don’t know why. I’m not privy to their finances, but I assume they’re facing the same challenges I am. I’m not greedy. I’m just trying to make ends meet.

This bothers me because I think I’m a good teacher. Back when I did it more, in my early days of solo practice (before reality kicked in), electives with me got high ratings from those who took them. I liked sharing my personal knowledge and experience with the next generation of doctors, and I hope those who were there gained something from it.

But the current nature of the education system makes that impossible and limits teaching primarily to academic practices or those large enough to absorb the loss through other means. That is sad because small practitioners have a lot to contribute, too.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, my alma mater, Creighton University, approached me to teach medical students. Sadly, I told them no.

I enjoy teaching. Medical students and residents always lift my spirits. I think I’m a good neurologist, with a decent grasp of practical issues (esoteric ones, not so much), and I like sharing it with those starting out on this road.

So why did I tell them no? It’s quite simple: I can’t afford it.

Solo practice in medicine is an "eat what you kill" world. You try to see patients, dictate notes, review tests, answer questions, and refill meds in a continuous blur from start to finish.

Teaching – at least worthwhile teaching – takes time. Questions have to be answered, take-home points explained, and exam findings pointed out. The last time I did routine teaching (2001), it added 1-2 hours to the end of each day. I had to make up the office work on weekends, which didn’t sit well with my family.

The alternative is to schedule extra time on teaching days – like an open 30 minutes twice a day – to compensate, but the problem with that is then you have empty time where you aren’t seeing patients and, hence, not making money. In a small practice on a thin margin, cash flow is critical and can’t be ignored.

It doesn’t seem fair to ask medical students and residents to pay, say, $500 a week to cover that time. Their tuition is high enough as it is.

Of course, the program they pay tuition to doesn’t offer a stipend to cover this, either. I don’t know why. I’m not privy to their finances, but I assume they’re facing the same challenges I am. I’m not greedy. I’m just trying to make ends meet.

This bothers me because I think I’m a good teacher. Back when I did it more, in my early days of solo practice (before reality kicked in), electives with me got high ratings from those who took them. I liked sharing my personal knowledge and experience with the next generation of doctors, and I hope those who were there gained something from it.

But the current nature of the education system makes that impossible and limits teaching primarily to academic practices or those large enough to absorb the loss through other means. That is sad because small practitioners have a lot to contribute, too.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, my alma mater, Creighton University, approached me to teach medical students. Sadly, I told them no.

I enjoy teaching. Medical students and residents always lift my spirits. I think I’m a good neurologist, with a decent grasp of practical issues (esoteric ones, not so much), and I like sharing it with those starting out on this road.

So why did I tell them no? It’s quite simple: I can’t afford it.

Solo practice in medicine is an "eat what you kill" world. You try to see patients, dictate notes, review tests, answer questions, and refill meds in a continuous blur from start to finish.

Teaching – at least worthwhile teaching – takes time. Questions have to be answered, take-home points explained, and exam findings pointed out. The last time I did routine teaching (2001), it added 1-2 hours to the end of each day. I had to make up the office work on weekends, which didn’t sit well with my family.

The alternative is to schedule extra time on teaching days – like an open 30 minutes twice a day – to compensate, but the problem with that is then you have empty time where you aren’t seeing patients and, hence, not making money. In a small practice on a thin margin, cash flow is critical and can’t be ignored.

It doesn’t seem fair to ask medical students and residents to pay, say, $500 a week to cover that time. Their tuition is high enough as it is.

Of course, the program they pay tuition to doesn’t offer a stipend to cover this, either. I don’t know why. I’m not privy to their finances, but I assume they’re facing the same challenges I am. I’m not greedy. I’m just trying to make ends meet.

This bothers me because I think I’m a good teacher. Back when I did it more, in my early days of solo practice (before reality kicked in), electives with me got high ratings from those who took them. I liked sharing my personal knowledge and experience with the next generation of doctors, and I hope those who were there gained something from it.

But the current nature of the education system makes that impossible and limits teaching primarily to academic practices or those large enough to absorb the loss through other means. That is sad because small practitioners have a lot to contribute, too.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.