When Keshni Lata Ramnanan, MD, finished her residency and began work as a hospitalist, she saw nothing but smooth sailing ahead.
“You come out of school, and you think that you have made it, and everything is just perfect and you've made it to your goal,” said Dr. Ramnanan, a Waukesha, Wisconsin-based internist and chair-elect of the AMA Private Practice Physician Section (AMA-PPPS) Governing Council.
“Right out of residency, I started working, did my beautiful one week on, one week off, and I lived my life,” Dr. Ramnanan recalled, adding that, before long, she began wondering if this was really what she wanted to do for the rest of her career.
“I had to relearn who I was and really what I liked and didn't like,” she said. “Because you spent so much time just studying and engaging in residency and school. And so now that you're working, I had a lot more spare time.”
Dr. Ramnanan shared her story for “The Importance of Physician Mentorship,” an episode of the AMA STEPS Forward® Podcast.
This included recalling being a bit flummoxed when the hospital chief of staff asked her where she saw herself in five years. For so long, Dr. Ramnanan had been concentrating so hard on her education and training that she never gave much thought about what to do after her goal of becoming a physician had been reached.
It took networking with colleagues, finding mentors and, eventually, being a mentor herself for Dr. Ramnanan to learn some valuable lessons. These included the importance of continuing to move forward, to find new goals when past goals have been reached and not to be afraid to reevaluate if where she was, was where she wanted to be.
“It didn't even dawn on me that there was more.” she said. “Five years? I thought: You go to school, and you work. And then that's it.”
The chief of staff invited her to a Waukesha County Medical Society event at the hospital and she went—persuaded in part, by the promise of free food. But when she got there, Dr. Ramnanan said it was the ongoing discussions that convinced her to stick around.
“I was like: Wait a minute, there's other physicians here and they're talking about things that I've never heard of before,” Dr. Ramnanan said. “They were talking about practice management, talking about billing and administrative burdens and burnout and all these different things.”
The experience helped Dr. Ramnanan realize that there was more to practicing medicine then she had previously thought. It also introduced her to the world of organized medicine. After first becoming involved with the county medical society, she later became active with the Wisconsin Medical Society and the AMA.
Dr. Ramnanan said it was at the county medical society where she met her first true mentor, who she says has opened doors for and has been her “cheerleader,” encouraging her to move beyond where she might have felt comfortable enough to stay.
“He said: You have the potential. What about this? What about that?” Dr. Ramnanan said. “Times are changing, medicine is changing and you—as a young physician—are part of the change.”
She took those words to heart. After serving as president of the county medical society, Dr. Ramnanan received the Wisconsin Medical Society Foundation’s Young Physician Leadership Award in 2015, which is presented to a young doctor who “demonstrates commitment to patients, the medical profession and the community.”
Dr. Ramnanan has gone on to serve as a Wisconsin delegate to the AMA House of Delegates and to sit on the state medical society’s board of directors.
Aligning work with life priorities
After about five years into her hospitalist job, Dr. Ramnanan said she was starting to feel symptoms of burnout. It was at that time that she met another mentor who, again, asked her a basic question: What are your priorities in life and does your work align with your priorities?
“At that point in time, working in hospital medicine and doing administrative work didn't really align with what I wanted, and what I had envisioned for life,” she said.
Dr. Ramnanan was encouraged to go into private practice—which she did with a focus on caring for
post-acute patients in rehabilitation centers and nursing homes.
“It was one of the best things that ever happened to me,” Dr. Ramnanan said.
And while, as a private practice physician, her interactions with other colleagues decreased, she didn’t feel isolated because “I had my medical society brethren,” she said.
With the help of another mentor whom she met through AMA connections, Dr. Ramnanan set up a direct primary care practice for uninsured and underinsured patients.
“It was just a network after network of resources just from this mentorship,” Dr. Ramnanan said. “My mentors have been with me throughout the entire time and so I am really thankful for them.”
Dr. Ramnanan believes mentors are a critical part of the culture of medicine. She now serves in that role, lending her guidance to physicians seeking to practice in the post-acute setting and in independent practice.
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“Some of these new docs are coming into our practice and they're asking questions: How can I create a practice that is sustainable from a longevity perspective?” she said. “Or: How can I create a practice that, from a financial perspective, is profitable so that I can pay my bills, my insurance and my loans back—but then still have a life?”
While she provides guidance in setting up a practice and hiring staff, Dr. Ramnanan said her mentees challenge her with new ways of thinking that spark creative solutions to issues in her practices.
“I really enjoy mentoring some of these new docs,” Dr. Ramnanan said. “I like them because they're also showing me how medicine is changing and that we as a company, as a group, need to change and adjust.”
For Dr. Ramnanan, being a mentor means being a resource, answering questions and, if she doesn’t know the answer, connecting them to someone who does.
“The key is just asking the questions,” she said. “There's always somebody who knows somebody” who can get the answer.
Mentoring for impact
“Mentorship doesn't have to be difficult or onerous, and it doesn't have to be something rigid and structured,” Dr. Ramnanan said. “Mentorship could just be a resource.”
For those looking for resources on how to be a resource, Dr. Ramnanan recommends the AMA’s Mentoring for Impact program, which she described as “connecting physicians with other physicians depending on what they they're looking for.”
The program, developed by the AMA STEPS Forward Innovation Academy, provides expert physician advisers at no cost who can support practices in addressing challenges and strategic priorities and help practices transform physician-led teams, patient experiences, save time and help provide quality care.
It takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.
Learn about the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.
