When applying for colleges, I begged my parents to allow me to attend the University of Miami. Largely so I could take advantage of their prestigious pre-medical program, but between us, I was also chasing the allure of warm weather. Alongside my twin sister, I embarked on this journey to South Florida and eventually my career in Urology.

Fast-forward 15 years later…I came back to Miami to start my own private practice. Over the last year building and running this practice, I’ve learned more about business, networking, contracts, and exit strategies than I have in the prior 36 years combined. I still have a lot to learn.

So in this Practice Building series with menMD, I’m going to give you the highlights of the lessons I’ve learned (and am still learning) in my quest to establish my own practice with my twin sister who is now my business partner—though if you ask her, she’s the boss.

In part one of this series, we’ll take a look back and focus on the essentials of building the foundation prior to starting one’s own practice.

You don’t have to figure out what you want to do for the rest of your life or career. That’s not the relevant question. The relevant question is just how do you keep as many doors open as possible?

Like any new physician, once I was done with training, I needed to build my foundation of confidence as a surgeon.

My fellowship director asked me where I wanted to go and what I wanted to do, to which I replied, “I’ll go anywhere. I’ll do anything.” He wasn’t convinced. He suggested I look at a map and create a “yes,” “no,” and “maybe” column of states I would consider for job opportunities. Iowa didn’t show up in either the “yes” or “maybe” list based on geography, but the job opportunity included a leadership role to direct the men’s health service line. Minus the cold winters, Iowa was, in so many ways, my dream job. So, with no ties to the Midwest, I made the move to Iowa.

An interesting thing happens when we finish training and start our first job. Nearly overnight, we transition from being a trainee to assuming the role as an expert in our respective fields.

Here is what I learned from my first dream job.

Ask, Ask Again, then Ask a Slightly Different Question

Fortunately, there was already a men’s health program at the university before I started. I, nonetheless, had big dreams to expand the program from day one. I consider it a blessing and a curse that I knew no one in the entire state of Iowa when I started.

It meant I could ask questions and make requests that would have made me cringe during training. I asked for equipment, support, money, meetings, and expansion of service lines. I wasn’t afraid that anyone was going to run into someone I knew, so I asked away. I received many “yes’s” and an equal number of “no’s.” I asked the same question to different people and different questions to the same people. I learned to adequately prepare prior to asking questions.

My initial job experience taught me a valuable lesson: sometimes, despite the importance or benefits for patient care, certain requests may not be feasible due to financial constraints.

Initially, I took such rejections personally, but I’ve since realized that as a business owner, hearing “no” is simply part of the journey. Understanding that “no” is often temporary, I’ve come to appreciate that with the growth and financial stability of my current practice, what starts off being “no” may one day transform into a “yes.”

Build the Team

On day 1 in Iowa, I assumed the role as Director of the Men’s Health Program. This leadership opportunity was instrumental in building my confidence early on in my career. It gave me the fearlessness to reach out to chairmen and chairwomen of medical and surgical departments to ask for meetings, as well as the dean of the medical school and CEO of our hospital system.

I was on a mission to build a comprehensive and multidisciplinary men’s health program spanning the medical and undergraduate campuses and infiltrating into the locoregional community. I didn’t know exactly who I needed on the team (turns out, that a medical anthropologist and young adult hip orthopedic surgeon were key members of the team) or where to find them, but I figured if I sent enough emails, I would figure it out.

Building this team of over 50 people (within the university and across the state) provided me with the confidence to know I could build another comprehensive and multidisciplinary team, and I now knew which team members/specialties/areas of expertise were most important for my patient population.

Over the last year, I’ve been able to build a similar team across South Florida. Once again, I didn’t know where I was going to find them, but I’ve sent a lot of emails, and I’m figuring it out.

Learn New Skills

Collaborating with residents during the beginning of my career proved transformative. This experience not only bolstered my confidence but also ensured round-the-clock care for my patients with a dedicated team. Moreover, the presence of residents afforded me the opportunity to experiment with new surgical techniques. Alongside faculty peers who shared similar expertise, I refined my surgical skills and efficiency.

In my current practice where I’m a solo urologist, I’m grateful for my time in Iowa during which I was able to hone my abilities as a surgeon, supported by residents and faculty alike. The surgical confidence and expertise I developed in the first 4.5 years in Iowa would have likely taken me decades to develop had I started in solo practice straight out of training.

Closing thoughts

The reality is, very few of us even know what our dream job is when we are still in or finishing training. It takes our first job (or perhaps several first jobs) to refine what “dream job” even means.

The thousand-foot view of starting a practice with my twin sister appears dream-esque, but the reality more closely resembles a really exciting, yet humbling, time in my life that allows me to make really big and small decisions on a daily basis, many of which I’ve never had to make before and have nothing and everything to do with medicine.

And a year after starting my own practice, I’m still in business, so I’ll take that as a win!

Stay tuned for the deets on getting a practice up and crawling in Part 2 where I’ll go in depth about pitfalls you can avoid within your first year.