HR & Other Aspects of Private Practice: A Conversation with Tien-I Karleen Su, MD, FACR

Early in her career, Tien-I Karleen Su, MD, FACR, Amicus Arthritis & Osteoporosis Center, Whittier, Calif., saw firsthand some of the challenges of working as a rheumatologist for a large healthcare system, leading her to explore other options. Now, she is part of a private practice and founder of the Rheumatology Private Practice Alliance (RPPA). She’s also helping support other private practice physicians as chair of the ACR’s new Community Practice Council (CPC). Recently, she spoke with The Rheumatologist about her work.

The Rheumatologist (TR): Could you tell us a little about your background getting started in private practice?

Dr. Su: I completed my fellowship in 2010 and started a part-time employee position at a large medical group where one of the attending physicians from my fellowship also worked. My co-fellow and I worked there for about five years, gaining firsthand experience of the bureaucracy in a large medical group. We faced challenges, such as issues with billing, collections, no-shows and high overhead. We also realized the group was geared more toward primary care [than rheumatology].

In 2014, the group adopted a new EHR [electronic healthcare record] system that made it burdensome for us to finish our charts. [The EHR] contributed to my decision to leave [the practice] in 2015. I initially thought about taking a sabbatical to travel, but three of us in the medical group decided to start a private practice on our own.

We faced many challenges early on because we lacked knowledge on running a practice efficiently. [We were] advised that having an office manager would make things easier, but we encountered many difficulties—going through five office managers in eight years; I found out human resources (HR) was the most challenging part of the business.

By the third or fourth year with the new practice, I was thinking that other rheumatologists must be dealing with similar challenges. In 2018, I connected on Facebook with the founder of a woman’s rheumatology group and formed a Facebook group dedicated to rheumatology private practice, which became the RPPA. Only rheumatologists or rheumatology fellows are eligible to join this group, so it provided a safe platform for us to share information and ask questions. There are so many people out there eager to connect that the group has organically grown to more than 1,000 rheumatologists.

Dr. Su

The experience of connecting so many rheumatologists to support one another in the RPPA had such a positive impact on my mission. I wanted to find more ways to help private practice rheumatologists. When I learned about the ACR’s Community Practice Council (CPC) seeking volunteers in early 2023, I applied and became the chair of CPC.