Dream Practice

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Alright...i am currently in the admission cycle for the class of 2014. My future wife is going to graduate w/ a BSN. Our dream would be to set up a private rural practice in the southwest rockies area of colorado, where it is just her and i making house calls, but i do not know if this is a feasible idea, and if it is, i have no idea where to go or who to talk to to pursue such an idea. also, i'm still in undergrad and i'm wondering if i should try to take any business/money management classes while i still can. any input would be appreciated!

Originally Posted by Sh3rlock

Alright...i am currently in the admission cycle for the class of 2014. My future wife is going to graduate w/ a BSN. Our dream would be to set up a private rural practice in the southwest rockies area of colorado, where it is just her and i making house calls, but i do not know if this is a feasible idea, and if it is, i have no idea where to go or who to talk to to pursue such an idea. also, i'm still in undergrad and i'm wondering if i should try to take any business/money management classes while i still can. any input would be appreciated!

I know quite a few Family Medicine doctors. The short answer is yes. You can set up such a system. I knew a FM doctor that purchased a conversion van and did pretty much that. You may not need to be "private practice". You may find yourself able to be the traveling doctor and employed by a rural/local hospital.

Based on my experience through med-school and residency and practice (not much), I would encourage you to learn as much about business as you can. You can also look for some of the national physician meetings that actually have some seminars.

Finally, there are quite a few Family medicine residencies with "rural tracks". Though, all of this is pretty much getting ahead of yourself. A good percentage of medical students change their original practice plans several times during clinical rotations. Focus for now on getting into medical school... take some business if you have the opportunity. Everything at its proper time and place.

JAD

Take a look at:

http://www.mobilemedicalpractice.com/

http://www.aafp.org/fpm/20060200/67cash.html

American Academy of Home Care Physicians

Originally Posted by Sh3rlock

Alright...i am currently in the admission cycle for the class of 2014. My future wife is going to graduate w/ a BSN. Our dream would be to set up a private rural practice in the southwest rockies area of colorado, where it is just her and i making house calls, but i do not know if this is a feasible idea, and if it is, i have no idea where to go or who to talk to to pursue such an idea. also, i'm still in undergrad and i'm wondering if i should try to take any business/money management classes while i still can. any input would be appreciated!

I have been doing rural medicine in colorado for the past year. Personally I don't see how you would be able to afford to set up your own practive right out of residency, it's about 100,000 to start up plus you need to cover your own malpractice as well. Colorado is a very poor state where most patients do not have health insurance or on the indigent care program. Doing house calls is ok, but I guarantee you that you will not get paid for your services. Better off either getting a job connected to the clinic where you are salary and have health care/clinic/malpractice costs covered by the hospital. Otherwise you can go through a locums company where they need doctors in all rural states including colorado where you go on assignment for a specific period to see if you like that area. Colorado is a very popular state and it is very difficult to get a stable perm position here. I hae struggled for the last year to maintiain employment and am leaving ASAP as soon as I get a contract elsewhere.

Originally Posted by cabinbuilder

Colorado is a very popular state and it is very difficult to get a stable perm position here. I hae struggled for the last year to maintiain employment and am leaving ASAP as soon as I get a contract elsewhere.

...so much for Family Physicians writing their own ticket for where they want to work.

Originally Posted by MLT2MT2DO

...so much for Family Physicians writing their own ticket for where they want to work.

Well, you can write your own ticket but you need to be where the market isn't saturated and the state has money to support you.

I suggest before you make any kind of major decision you take the time as a medical student to do a rural rotation some where. And I don't mean an hour out of DC. Montana, Colorado, Wyoming, Alaska, Central Texas, New Mexico, Arizona, Oklahoma, The Dakotas, Minnesota, Upper Peninsula Michigan, etc. Anyone out there is welcome to rotate with me just have to get yourself to my location, where ever that may be at the time. Them decide if you can financially fulfill your dream and really want to do what you envision.

Originally Posted by cabinbuilder

I suggest before you make any kind of major decision you take the time as a medical student to do a rural rotation some where. And I don't mean an hour out of DC. Montana, Colorado, Wyoming, Alaska, Central Texas, New Mexico, Arizona, Oklahoma, The Dakotas, Minnesota, Upper Peninsula Michigan, etc. Anyone out there is welcome to rotate with me just have to get yourself to my location, where ever that may be at the time. Them decide if you can financially fulfill your dream and really want to do what you envision.

Better be careful, I might take you up on that in a couple years.

Originally Posted by MLT2MT2DO

Better be careful, I might take you up on that in a couple years.

Not a problem, I do lots of procedures, OMT, and try to minimize cost for these rural folks with no money. You will get to do alot and see a lot.

Originally Posted by cabinbuilder

Not a problem, I do lots of procedures, OMT, and try to minimize cost for these rural folks with no money. You will get to do alot and see a lot.

Is this offer still open? I'm finishing up 2nd year at an Osteopathic school and looking to start arranging rotations for 4th year myself.

Originally Posted by Sugarrush

Is this offer still open? I'm finishing up 2nd year at an Osteopathic school and looking to start arranging rotations for 4th year myself.

Maybe in the fall, I am just starting a new job that is permanent next week in Oregon. Not really the rural I have been doing in CO and TX. I may be able to take students later in the year but not currently.

Just because a person or population base doesn't have insurance doesn't mean they can't pay you... There are plenty of physicians doing well in hard pressed areas with a cash only fee schedule similar to an urgent care.

Its okay to think outside the box. Also, by doing a cheap cash only fee schedule you won't be needing half the traditional office staff for billing. If you know business you won't need an office manager. Right there you have reduced your overhead.

Where is this $100,000 start up costs you talk about?
-blood pressure cuffs
-assortment of dressings
-assortment of I&D tool kits
-Sutures
-portable EKG maching ~$2000
-Fridge for vaccines (these can be expensive)
-A lap top with PDF or Word can suffice for an EMR
-one exam table with stirrups for pelvics (this can be pricy)
-Make your own exam tables out of wood with cushion and synthetic covering
-generic office supplices, chairs, staplers, etc can all be gotten second hand.
-fax/printer/scanner combo machine

I'm thinking $30,000 is the real start up for someone who isn't splurging on fancy things fresh out the gate.

Originally Posted by Sneezing

Just because a person or population base doesn't have insurance doesn't mean they can't pay you... There are plenty of physicians doing well in hard pressed areas with a cash only fee schedule similar to an urgent care.

Its okay to think outside the box. Also, by doing a cheap cash only fee schedule you won't be needing half the traditional office staff for billing. If you know business you won't need an office manager. Right there you have reduced your overhead.

Where is this $100,000 start up costs you talk about?
-blood pressure cuffs
-assortment of dressings
-assortment of I&D tool kits
-Sutures
-portable EKG maching ~$2000
-Fridge for vaccines (these can be expensive)
-A lap top with PDF or Word can suffice for an EMR
-one exam table with stirrups for pelvics (this can be pricy)
-Make your own exam tables out of wood with cushion and synthetic covering
-generic office supplices, chairs, staplers, etc can all be gotten second hand.
-fax/printer/scanner combo machine

I'm thinking $30,000 is the real start up for someone who isn't splurging on fancy things fresh out the gate.

Included in that 100,000 is the building rent, the utilities, your coder salary, your MA/nurse salary, your secretary. You have to have some start up monies to pay your staff before you start collections rolling in. Unless you are going to do it all yourself and not have any staff - some people do it but generally it's not practical overall. The number I came up with is what my friends have had to have up front to start a new practice. I have a friend of mine who actually took out a $1 million loan to start hers in order to ensure she would have cash flow to pay her staff first as well as equip, supplies, etc.

I will add that her practice is in Alaska so everything costs more in general.

Wow...
That's a lot of money! In rural areas I would think it would be hard to not accept medicare/aid, and insurance, so I assume a coder would be essential... I would also assume taking cash on a sliding scale would be a condition of the medicare/aid...

Just found the job that suits me perfectly. 2 weeks on/2 weeks off. Covering ER/Inpatient/outpatient clinic for a 12 bed hospital. My family is sick of moving so they won't have to go with me. Works out for us since I have been doing the travelling thing for the last 3 years. Should be able to take students once again after I get up and going. Pay is super excellent. I don't think I will ever work salary again.

Awesome!! Congrats! I'm assuming this is in OR still? That sounds like a great deal, my hospitalist friend does 7days on/off and loves it

Originally Posted by SBB2016

Awesome!! Congrats! I'm assuming this is in OR still? That sounds like a great deal, my hospitalist friend does 7days on/off and loves it

No, tired of trying to get a decent job with decent pay in Oregon. Very hard to do. Also the state income tax really rakes you over the coals. It's beyond ridiculous. Tired of working for nothing. I got the job in Nevada. Much better for my arthritis anyway. Family staying in Oregon for the school year. It works out for all of us.

Cabinbuilder has the coolest job / career path on SDN. I just wish I was further along in my own path so I could meaningfully compare notes and get advice from her. Someday!

Originally Posted by MT Headed

Cabinbuilder has the coolest job / career path on SDN. I just wish I was further along in my own path so I could meaningfully compare notes and get advice from her. Someday!

Thanks for that!!! Been quite the gypsy traveller for sure. 5 states in the last 4 years. Anytime you need advice, not a problem. I have been hired many times, quit many times, done tons of locums, moved 4 times, have 2 kids, can get out of a contract if need be, and refuse to be anyone's corporate slave. Oh, and I will never be a typist for an EMR ever again. Probably have the greatest medical contract lawyer for sure. Let me know.

Didn't know I had a fan club!!!!

You're pretty awesome... You get and deserve a lot of respect!

Originally Posted by SBB2016

You're pretty awesome... You get and deserve a lot of respect!

Wow, I appreciate that.

Welcome! I appreciate all the advice and help you've given!

Originally Posted by SBB2016

Welcome! I appreciate all the advice and help you've given!

Interesting that I am simultaneously adored and attacked here on SDN!!! I guess it takes all kinds. I'll just hang with the good guys here in family practice. Hah.

Originally Posted by cabinbuilder

I suggest before you make any kind of major decision you take the time as a medical student to do a rural rotation some where. And I don't mean an hour out of DC. Montana, Colorado, Wyoming, Alaska, Central Texas, New Mexico, Arizona, Oklahoma, The Dakotas, Minnesota, Upper Peninsula Michigan, etc. Anyone out there is welcome to rotate with me just have to get yourself to my location, where ever that may be at the time. Them decide if you can financially fulfill your dream and really want to do what you envision.

Since this post I have moved to Oregon but no longer practice there (long story) . I will be in rural Nevada this coming Spring and will be available for rotations after that time.

If you can find me, you can rotate with me. I will be doing ER, inpatient, and outpatient medicine.