Adapting with intention: Tips for joining an established practice

By Emily Margosian, Senior Editor, July 1, 2025

DermWorld talks to Brittany Smirnov, DO, FAAD, about advice on assimilating to a new work culture when joining an established practice.

DermWorld: Tell us about your practice.

DermWorld: Tell us about your post-residency career path.

Dr. Smirnov: I graduated eight years ago from residency in south Florida at Broward General. After, I took a position at a practice in Delray Beach largely because my husband was starting his postdoc nearby and we needed a place to call home. It was a small private practice that was a part of a much larger group. After three years, I started thinking about partnership opportunities and realized I didn’t want to be in Florida forever.

I moved back home to the Northern Virginia area, which is where I’m originally from. At the time, I was in contact with my current boss who was in practice with his father. His dad had been a practicing dermatologist for over 40 years but wasn’t quite ready to retire yet when I first came back to the D.C. area. In the meantime, I took a position with a very different practice model and that wasn’t the right fit for me. Fortunately, the owner of my current practice reached out to me and re-offered me the position. I was very excited for the opportunity and joined his practice three years ago.

DermWorld: What aspects of your current practice’s culture made it a good fit for you?

Dr. Smirnov: One thing about joining a larger group is that you don’t have as much control over your schedule. That tends to be a bit more challenging if you have young children or want hours that reflect your kids’ schedule. Those flexibilities just aren’t available at some of the larger practices. That’s not uniformly the case but is very frequent. I found previously that I was also required to take on a lot of smaller roles that I have no special training in as a dermatologist. For example, at my last practice I was answering a lot of direct emails from my patients as opposed to them being filtered through medical assistants or other people who could probably just as easily answer some of the questions.

A lot of that non-clinical work really added up and started to eat away at my personal time. I was working longer hours, and on top of it, I was charting and answering emails far beyond what I would normally have done. I think that’s an easy transition to make if you’re right out of residency, because you don’t know any different. At my current practice, I have more control over what insurance I take, my schedule, patient population, the procedures I do, and the times that I schedule them. For me, that kind of control really equates to a much better quality of life.

DermWorld: What kind of onboarding did you receive when you joined your current practice?

Dr. Smirnov: At my practice we still use paper charts, so I didn’t need training in an EHR system. I am fluent in most of the different EHRs that exist just because residency tends to do that for us. I think that the onboarding process is essential if you have an EHR, because it’s going to be different at every practice. You want to get catchphrases in place and develop templates for your notes. That’s critical at the start of joining a practice that has an EHR. With physical notes, no onboarding was necessary.

However, I did start out a bit light on my schedule, which we did on purpose. I was seeing about 25 patients per day for the first week or two, and then we increased it to a normal volume, which for me is anywhere between 35 to 55 patients a day, depending on if it’s a surgical day.

DermWorld: Did you ask about office culture when joining your practice?

Dr. Smirnov: Yes, and I think these are some of the most important questions to ask. That might seem silly because obviously compensation is important, but a lot of us are willing to negotiate on compensation if we know that we’ll be happy. One of the most crucial questions that I ask is how long have staff been there? I think if you have reliable and loyal staff who are on board for long periods of time, that generally reflects a healthy workplace culture. If you have staff who are constantly switching jobs and leaving, usually that reflects a more tumultuous workplace. At my current practice, for example, someone just retired who had been there 35 years and my current medical assistant has been here for 18 years. These are big commitments that staff have made to stay with us. I have found one of the best reflections of the overall workplace environment is staff retention.

Prior to joining my current practice, I also reached out to a lot of other dermatologists in the area to get their opinion of my current boss. I asked who had trained with him, who knew him, and who had interacted with him. Often, other dermatologists in the community can give you a good idea of who a person is. Are they reliable? Are they ethical? Are they compassionate? Do they treat people with decency and respect? If the resounding replies from everyone you speak to are ‘yes,’ then that gives you a lot more confidence going into a new role.

DermWorld: Many workplaces have unwritten rules or long-standing dynamics that might not be always obvious to new employees. Do you have any tips for working through that adjustment period, particularly when you’re joining a team that’s been together a long time?

Dr. Smirnov: This is hard for a lot of type A personalities that we find in competitive fields like medicine, but the biggest thing I would say is to enter the situation with laid back and relaxed expectations. I’ll give you an example. Early in my career, I would get so frustrated if I went to the front desk and saw there were patients who needed to be roomed while my staff were joking around or exchanging pleasantries in the back. I used to not like rooming my own patients because I thought it showed that the practice wasn’t well-run. I was a little bit more vocal about that early on in my career. Ultimately, it made a lot of people unhappy, and I didn’t necessarily change anything for the better by complaining.

What I realized with time is that our staff are all human too. They want to have a little bit of fun at work. I think that’s totally fine now. I realized that walking someone to the back isn’t going to kill me. I think going in with a laid-back notion of what to expect from some of your people and being flexible goes a long way. Honestly, it makes you happier as the physician as well, because if you don’t constantly measure people up to unrealistic expectations, then you’re not constantly disappointed. If you enter an established practice with a laid-back attitude, it usually goes a lot smoother.

Most of us got to where we are by working our tails off. We have worked so hard for so long in our careers, and we expect the same from everyone around us. I think that’s a very unrealistic expectation because the most important thing for your staff is that they show up on time and are reliable. If they have a little fun and room a patient a little bit later, those things are forgivable if they’re a valuable team member otherwise.

DermWorld: Do you have advice on how to make connections and build relationships with existing staff when joining a practice as a new physician?

Dr. Smirnov: I’m extremely friendly with my staff. I care about every person that I work with. I like to get to know them and learn what their interests are. I also think it’s important to keep some barriers of professionalism in place. It’s a fine line to walk, but overall, I just try and be friendly and understanding. If someone’s having a hard day, I try to cut them more slack, because we all have rough days. Likewise, when you see people doing great things, congratulate them. Recognize their accomplishments and their hard work.

DermWorld: Were there any habits from previous workplaces that you had to unlearn when joining your current practice?

Dr. Smirnov: At previous jobs, I was looking for the perfect assistant. I was looking for the work ethic of a medical student in my medical assistant. I think that’s an unrealistic expectation to achieve and meant I was constantly disappointed. Once I relaxed that expectation, I realized that if my staff are reliable and kind to my patients, then they’re invaluable. I think that shifts your perspective in a way that makes the transition much smoother.

DermWorld: Is there any advice you wish you could give yourself earlier in your career when looking for the right practice fit?

Dr. Smirnov: Pay attention to red flags — constant turnover, medical assistants crying during the workday, emotional turmoil. Turnover not just among staff but also physicians who work there should be taken seriously as a big red flag. I would recommend heavily vetting practices by reaching out to other dermatologists in the community who you trust. It seems simple to do a quick Google search, but there may be things like outstanding ethics cases or Medicare fraud investigations that are buried in the fifth webpage of a search. However, a lot of times the community will know that information. Reach out, and exhaust all the information that you can about a practice to make sure that you feel good going in.

I would also say good work culture is more important than so many other things. Be willing to look for the right fit for long-term happiness versus short-term assurances. For me, I take a pretty low base and most of what I get paid is on production, but I love that because it works for me. Look for things that will keep your lifestyle happy — good hours, appropriate ability to change schedule if things come up, flexibility to take time off so that it corresponds to your kids’ schedules. Consider the bigger picture.

Brittany Smirnov, DO, FAAD, is in private practice in Falls Church, Virginia.

This content was created with the particular needs of early-career dermatologists in mind. See the rest of our Career Launch resources for young physicians.

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