Forefront Physician Voices:
My path and advice to residents
Todd Rickett, MD, PhD, specializes in medical dermatology and contact allergy at Forefront Dermatology’s Louisville, Kentucky office. He joined Forefront in 2017 after completing his residency at Rush University Medical Center in Chicago. He earned his MD from Indiana University School of Medicine and a PhD from Purdue University.
“Forefront’s physician leaders and services have been extremely supportive in helping me learn the business of medicine and that support has helped me make a smooth transition from residency to practice.”
—Todd Rickett, MD, Board-Certified Dermatologist, Forefront Dermatology
A change of plan
Coming out of residency, I was looking to join a large group practice or university-based practice. I eventually opted to join the Louisville, KY office of Forefront Dermatology, a physician-led, private equity-backed group practice.
This decision might sound odd to residents who’ve been told again and again that private equity (PE) threatens physician autonomy and patient care. Now that I’ve actually worked in this setting, though, I’ve come to believe that those critiques are narrowing residents’ understanding of their career options. I’m adding my specific experience to the conversation so that residents get a more complete and even-handed view of where they may wish to practice.
Making the decision
In looking for the right place to practice, I had a few criteria in mind. I wanted a large, established group with excellent physician support as I had minimal experience with the non-clinical aspects of practicing medicine (billing, compliance, credentialing, MIPS, etc.). I also wanted to practice in my home state, so location was a paramount consideration.
I already knew the Forefront office in Louisville to be an established and respected part of the local medical community. Their compensation model and benefits package was competitive with or superior to my other offers. And the interview process, contract review, and negotiation were all very straightforward and forthright. But I still had to overcome some doubts before I made the decision to join.
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Grappling with the PE stereotype
As a resident, I had often heard that PE was a corrupting influence on medicine. The stereotype was that PE-backed practices were cutthroat businesses in which financial considerations trumped patient care and physician preferences. Many of the community Dermatologists I spoke with were concerned that PE took advantage of young doctors, requiring them to see unreasonable numbers of patients while depriving them of fair compensation.
After hearing those stories, I had some trepidation about even interviewing with Forefront. However, in my time observing the physicians in the Louisville office, I saw them making decisions
based on what was best for the patients. Their autonomy contributed to their professional satisfaction—a satisfaction that was expressed by both the senior physicians and the younger docs. What’s more, I genuinely liked and respected everyone who worked there, and my interactions with Dermatologists at other Forefront locations gave me confidence that our office wasn’t an anomaly. The physicians I spoke with were quite candid, and they all said they genuinely enjoyed working there. Believe it or not, this was not the case everywhere I interviewed!
Having since joined the office in Louisville, I feel even more sure that the stereotypes about PE do not apply here. My clinical decision-making is entirely my own. Any expectations with regard to finances or patient volume are no different from what I’d expect in a private practice. In fact, Forefront’s physician leaders and services have been extremely supportive in helping me learn the business of medicine, and that support has helped me make a smooth transition from residency to practice. I can only speak to my direct experiences with Forefront; other PE-backed groups might be run very differently.
Most important to me, my Louisville partners and Forefront’s physician leaders have been eager to help. They supported me as I ramped up my clinical practice and built my patient base. When I said I wanted to start a specialty clinic in contact dermatitis, they were all for it, and Forefront has been instrumental in getting that off the ground.
A physician-led culture
How has Forefront been able to avoid the PE stereotype? The answer is straightforward: it is truly physician-led. Leaders like our president, Dr. Betsy Wernli, a practicing Board-certified Dermatologist, have earned our trust by putting physicians’ and patients’ needs first. That trust has helped to make the culture here far more collegial than I had expected from such a large group.
That collegiality extends well beyond social pleasantries. One example is something I was uncertain about before I joined: my own career development. My hesitation came from thinking that for a group of Forefront’s size, a young Dermatologist’s professional development
would necessarily be a low priority. I was surprised to learn, then, that Forefront has a formal mentoring program where they pair young doctors with more senior physicians. I’ve been with Forefront for almost a year and a half now, and I’ve met with my mentor several times to discuss clinical work flow, practice challenges, and how to develop and grow my practice. I even spent a day with him in his clinic to see how he approaches patient encounters and documentation.
Another hesitation I had was whether or not I would be able to continue with academic medicine. Thankfully, I’ve found Forefront to be very open to academics including resident involvement and volunteering. Many of our Dermatologists publish in peer-reviewed journals and participate in clinical research, and some have authored chapters in Bolognia, lectured internationally, organized conferences, and edited major textbooks.
Advice for residents
My best advice for residents exploring their practice options is to spend some time in any clinic you’re considering. Try to meet all the Dermatologists and support staff to see if they really enjoy working there—and remember, any practice can look good on paper or during a 30-minute interview. Spending a few days in a clinic will give you a more authentic and complete feel for the practice environment.
As I said, I came to the end of my residency thinking that I was headed back to a university to practice medicine. I was able to make a different decision because of the people I met and my openness to listen to them. Ultimately, my decision has gotten me the things I wanted out of my early career: autonomy, high patient contact, supportive colleagues, and the freedom and support to refine my skills and grow my practice.