Starting a new practice

[deltaDawnMD]

I have been with a very large group since I left residency 16 years ago. I am one of the most productive doctors there and watch my salary go down as our income is pooled. Also feeling like I have little control over my schedule, offic help, etc. I am strongly considering leaving and starting my own office. On the one hand I am terrified, on the other excited and thrilled to think of having some control over my life. I am plowing through reading Starting your Own Medical Practice. What suggestions does anyone have? What to learn from your experience???

[GracieThree]

I looked into taking over an existing IM practice several months ago (wound up deciding against it, but that’s not the point) and I was surprised to learn several things. One is that you will need all new provider numbers for medicare, medicaid and most of the private insurance companies, and it can take months to get them. Another is that your malpractice coverage will change since your type of practice will be changing. You have to pay for hospital privileges in my area, which I did not know, and they take longer than they are purported to take to obtain. It took three weeks to get approval for my business loan from the bank, after they promised a one week turnaround, and three weeks to even get the papers filed to incorporate the practice (another “Oh it takes about a week” promise). Basically whatever time period I was told, it took 2-3 times longer.

Also, look at several billing packages and at several companies who do collections for doctors. The average rate for billing, coding and collections in my area of Alabama is 8-10% of your billable amount, not the amount you actually collect. Software exists such that you could hire someone to do this in your office for much less, but I was really reluctant to mess around with reimbursements and wanted to be sure the person doing the billing and accounts receivable knew exactly what he/she was doing so we did not lose money. So to me, that 8% would have been well spent.

You are going to pay a lot of money for good office staff – again something I thought was money well spent.

Anyhow, best of luck. Being your own boss will be wonderful, and stressful, but you have the added benefit of seeing how your office was run and what worked and what didn’t.

[psych]

I’m a psychiatrist and my overhead is much lower than an office with equipment and staff, but I still say go for it, especially if you have some money banked to cover the cash flow in transition. I think being in charge makes a huge difference, and being able to choose what kind of a doctor you want to be, how much time you want to spend, etc. makes a big difference for me. I may make less money than the docs who see 4-6 patients an hour for med management, but I am comfortable with my kind of practice where I actually get to TALK with my patients. I have also noticed that I get a lot of patients who transfer care from other doctors and large practices and who want the individual attention of knowing they have a doctor who they can reach directly, and I have almost no patient turnover unless they move away. If you’ve been in practice 16 years, I’m sure your patients will move with you. Just watch out for the non-compete clauses in both your practice contract and in any hospital contracts. Go for it!!!

[Tayo]

Hi, If anyone of you want to start your own practice. I own a billing company. However, I don’t mind giving free advice as far as getting contracts with insurance and credentialing. Which insurances to go with and things like this.
I will not try and sale you my service. I simply just love helping and love what I do. So, email me anytime no strings I promise. tayo@smartmedonline.com I have a lot of claims knowledge and I get some pretty nifty newsletter for practices and things that I can refer you guys to. I really love glad I stumble across this website. Because, eventually I want to go in to pyschotherapy.

[rs4]

I’ve been in solo practice (psychiatry) since leaving residency. One of the great aspects of this is the amount of control I have over my
schedule. I do direct patient care about 20 hours a week plus some paperwork and admin time.
This lets me be a bit of a stay at home mom for
my 7 year old. It also lets me collaborate with
other women in my office, for instance I sublet my
actual office 2 days a week to another mom who is
a licensed mental health counselor.

Downsides…I made BIG mistakes initially by not paying enough for a full-time office manager/billing person. I felt I couldn’t afford
a professional person with my part-time schedule.
For the last year I’ve had someone who is energetic and gets collection on money I thought I would NEVER see. She also cuts down on my paperwork and admin time, so that I can increase my billable hours if I want to.

I spend a lot of time with patients. This is what I love, what helps me have lots of referrals and what limits my income. It has been great to
have a nurse practitioner work for me the last year so that I don’t have to be present for the practice to have income! (She and I split 50/50 the collected $ from her work).

Is this useful information? Wish you well.

[psych]

Tomorrow I am having lunch with 2 men who were attendings during my residency and trained me — now are giving up on academic medicine and starting a private practice, and I’m doing a friendly tutorial on “how to start your private practice” etc. Never ever ever expected to see that.

[nina]

I finished my residency last year started working for an older physcian. His style did not match mine. Gave my resignation notice this month. Want to start a FP practice on my own. What is the minimum amount of loan i need. Does any body know which is the bank/lender which can give the best loans/best rates? I planning to start up in the same city 5 miles away (noncompete clause)as I am in now. What is the next few steps i need to do get started. Any input would be appreciated.

[FPmommyto2]

I joined an existing practice when I came out of residency 3 years ago, but am not “employed”. We are basically 4 independent practices (don’t share patients except for call or vacations) who share staff and overhead.

Upsides: total control of my schedule. Ability to hire and fire whoever we want. As much or as little vacation as I decide I want/can afford.

Downsides: dealing with personnel crap (9 women employees – and one of the docs has had affairs with many employees over the years :rolleyes: ). Paychecks are not steady or guaranteed I pay my own malpractice, hospital priv’s, disability, life ins, medical ins etc.

We have in house transcription and billing. We like having the in-house billing b/c we “know” what is happening with the accounts.

[Author]

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