As a resident physician, are you thinking about where you want to build your future in medicine? Meet Roxanne Tyroch, MD, an internist and private practice physician, and a featured voice in the AMA’s “Finding My Place in Medicine” series.
In this series, physicians reflect on what influenced their personal decisions when choosing where to work—and what they wish they had known earlier. Explore Dr. Tyroch’s journey to help guide your own path toward a fulfilling medical career.
If you are looking for your first physician job after residency, get your cheat sheet now from the AMA. In addition, the AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice—including in private practice.
“Following” Dr. Roxanne Tyroch
Specialty: Internal medicine.
Practice setting: Private practice.
Employment type: Owner of a solo practice called Intellimedicine in El Paso, Texas.
Years in practice: More than 30 years.
Key factors that led to me choosing to work in private practice: I have practiced in many settings—Veterans’ Affairs hospital, military academic, university academic, locum tenens contract rural, employed urban hospitalist—and now I own my own primary care practice and telemedicine-solutions company.
Designing my own practice—called Intellimedicine—was so exciting. It reminded me of when we built our home. Every single design detail is by your choice. Your imagination, vision and dreams become reality at this point. This was only the very beginning of the development process, which is continuous.
What stood out to me during the process of starting my practice: At this point, I was the one doing the interviewing and hiring. It took quite a while for me to discover what character aspects of an employee were key, and how to find out if a candidate carried those virtues in their work ethic.
How feedback from peers and mentors influenced my evaluation process: I found assistance from my state and county medical societies, as well as other colleagues that I interacted with in the hospitals. Ultimately, I found a consultant who walked me through the process of opening a practice. He directed me in the applications of credentialing with insurance companies, getting a CLIA [Clinical Laboratory Improvement Amendments] license, finding a bookkeeper, lawyer and certified public accountant, creating the legal entity, trademark development, establishing at a bank with a line of credit, as well as shopping for medical liability insurance and commercial property insurance.
Factors I considered as I chose a practice setting to work in: Our family was settled in El Paso, Texas, already so that is why I chose the location. My husband had strengthened a university Level 4 trauma hospital over the years into a Level 1 hospital. Thus, we are invested in the community.
Having watched the practice landscape evolve over the years, I had this feeling that the longer I waited to launch my own practice, the more challenging it would be. I really wanted to create something from scratch that embodied the virtues I cherish. One must have faith that the future is bright and promising. That way you can make it happen.
The top three qualities for a great place to work:
- You look forward to going to work.
- You love the culture. Culture is the living, breathing essence of what an organization values, believes, says and does. It’s not one person, it’s everyone. The people you are interacting with (leadership, employees, patients) define the culture.
- Everyone is treated fairly and with compassion, yet you are always being challenged to be the best version of yourself.
How my current practice supports physician well-being and work-life balance: Intellimedicine has a no-harassment policy. Practice policy is clear on this and all patients must sign this policy for practice entry. The rules of engagement are outlined very clearly in the written, signed policy, including day-to-day matters such as how we communicate, what they can expect from us and what we expect from them. I believe this contributes greatly to developing a positive culture because it prevents major and even minor conflicts from happening. Everyone knows what to expect and how to behave—it’s a partnership.
In terms of work-life balance, the culture is that children come first. Nobody is expected to come to work if they can’t find care for their child or their child simply needs them above anyone else at that moment. Nobody has abused this so far. The practice is designed such that cross-training allows for staff absences not to be detrimental—someone else knows how to substitute. Also, staff like to leave at 4 p.m. instead of 5 p.m. due to child-care conflicts and would rather start the day earlier or take a tiny lunch break in order to leave early.
Benefits and workplace attributes that have contributed to my job satisfaction: Owning your own practice means you must find coverage, but you can make your own schedule. Of course, you have bills to pay and must be wise with this freedom.
It really makes a difference when you aren’t missing key events due to work. When I was employed, I really made it a priority to be present as much as I could for my children’s key events. It was very difficult to bargain for this time. Sometimes people just could not cover me and I missed out.
The biggest challenge I faced transitioning from residency to practice: We moved to Fresno, California, after I finished my chief residency year in order for my husband to complete his trauma fellowship. I joined a large primary care group in Central California.
There is no question that the most challenging thing I faced was child care. I didn’t know anyone in Fresno and the managing company for the practice had me scheduled out with back-to-back 15-minute visits for patients I was meeting for the first time. This was before phone app care-center cameras were an industry standard, providing reassurance that your child was safe and happy.
What I wish I had known about evaluating a job offer before choosing my first position: I called the hospitals in Fresno to find out what practices had openings. Although I am happy with the choice I made, I should have done a more thorough exploration of all the opportunities available to me.
What I would have done differently when choosing my first job: For me, family circumstances determined what city that I ultimately lived in. I still felt like I wanted to learn from senior physicians, so I liked being in a large group at that time.
I could have reached out to more people within the medical community at large in Fresno to just learn about private practice and what they did to succeed. This type of deeper knowledge isn’t found on Facebook, Instagram and X. It’s found in face-to-face conversations.
Why I changed practice settings midcareer: There had been some legislative changes that left me feeling like I would either take this leap of faith now or possibly even change career paths to something fiscally sustainable such as real estate or business and finance. However, the grass is not always greener on the other side.
I really wanted to work with a different EMR than the hospitals had. As a hospitalist, I would spend so much time doing repetitive, mindless things, like putting my password in seemingly every minute. I did a lot of demos of EMRs when I was designing my practice. I strongly recommend to anyone opening a practice that you view a lot of product demos.
How I knew I was ready for a change: I admired the patient-physician relationship that I saw in the patients and physicians that I would cover. As a hospitalist, I didn’t have that same type of long-term relationship with patients. I wanted to experience that.
How my current role compares with what I imagined: The slow erosion of payments for services and the lack of inflationary updates has led to a situation I did not anticipate as a resident. We must look into the future, even when it may be more comfortable to believe that “it will all work out somehow.”
Legislative details are important. We must energize those around us to be advocates for the future of our profession. It is critical that we make the correct decisions in what we will and won’t advocate for. We need to be creative and open-minded, yet firm in what we need fiscally to be viable. I want practice viability for all physicians.
