My first hourly, clock-punching job was working as a cashier and tortilla maker at Taco Cabana. Management ran the store with the bare minimum number of employees. I took pride in how much we were able to do with what we had. Around that same time, I remember going into a local Chick-fil-A and was shocked at the number of workers they had, nearly tripping over themselves behind the service counter. At that time, I underestimated the value of throughput in a system or business. The management at Chick-fil-A recognized the value of investing in sufficient labor to satisfy the needs of its customers in a timely and efficient manner. That was back in 1999 and Chick-fil-A, a privately-held company, has grown to ~ $4.5 billion in value. How does this apply to Urology and your career? Well, your ability to generate revenue in any type of practice depends highly on the throughput of the system. If the system is not designed correctly or if it’s not staffed sufficiently, then your clinic will be inefficient and sub-profitable no matter how hard or fast you work. As you look at job opportunities, I recommend that you pay attention to the staffing resources that will be made available to you. This is especially important if a hospital or multispecialty group is providing the staffing. I think it is important for the physician to have the decision-making power to decide who is hired and how many people are hired in the clinic. If adding an additional medical assitant (MA) to your clinic can help you see one more patient in a day, then that MA has more than paid for him or herself.