IBR makes the debt payable at any income, but there is still some basic supplies/rent to deal with even though a start up doc wouldn't really need a staff member until they got themselves rolling
IBR repayments in a for-profit setting sounds pretty risky, assuming one is going that route for the 10-year (120 consecutive payment) PSLF, since it will no longer qualify. Otherwise, I'd rather be paying off those loans ASAP. Could be digging oneself a huge hole to climb out of, especially while in the process of building a practice. I can't see this working out for many, if they plan on starting from scratch without financial backing from another source.
IBR for a year or so while you get set up is what I was talking about....
I understand. I just think it's a big risk for those with average debt (+ interest of those 3 years of training + the costs for that year of set up - income, which will dig one further into the hole). I think DPC is a great model, but everything really needs to be close to ideal to get the ball rolling. I honestly doubt many can do it successfully without significant financial backing and/or low/no debt. Now someone with less debt, money coming in from significant savings (or family/friend backing), and keen business-oriented knowledge… yeah they can pull it off. But let's face it, that's a very small (tiny) percentage of residency grads. That said, I doubt we will see this model dominate a large proportion of the sector, unless these practices can grow to the point where they are hiring new grads fresh out of residency. I guess that's a possibility.
If you need to find patients all you would have to do is give your business card to any urgent care clinic. I would say about half of the patient's I see do not have (and need) a primary care doc. Now whether those folks are willing to pay cash is another thing.
I assume so, but being ~200k in the hole leaves one in quite a vulnerable position to go even further into debt while trying to build a practice from the ground up. Why not spend a few years working elsewhere to knock that debt down before jumping in on the game? Otherwise one is really taking a huge gamble. I guess for a very small minority, it would be one worth taking.
True. I'm not thinking sympathy though. I'm thinking of a campaign where they pledge money in exchange for something, in this case a membership. Sympathy would be more like gofundme where donors get only good karma for donating.
$50k should be plenty to start, particularly if you are moonlighting at first. And you can get $50k from a bank
Idk. I have all the equipment and supplies to buy. I'll need to build out my space, more than likely. I'll need at least 3-4 months operating expenses in the bank. I'm working with Atlas Md for the next week so pricing and business plan development should be mostly sorted out by then.
Equipment isn't as pricey as you'd think. I outfitted 2 full rooms with way more stuff that I actually need to start for right at 40k, so figure half that for 1 room. For start up, you don't actually need very fancy office space. You can easily moonlight for operating expenses.
I think atlas does 600. There's no law about it but you are selling easy access and good service so you need a panel small enough to deliver that....if I'm paying you a membership fee I want same day service when I have an issue
Bingo. You can set the number at whatever you want, but the more patients you have the greater the chance that your service suffers as a result.
Assuming all of your over head is around 100k, that leaves you about 260 take home and you have to pay your own malpractice? You can find 8-5 jobs nowadays that pay 240-250k without the risk of starting a practice. But of course you'll be seeing more patients. And is starting a DPC practice as easy as people think? Everybody makes it seem as setting up in a rural location, lease out a 4 room building, buying a couple of exam tables, hiring an MA/ Secretary, get a cheap EMR and your ready to go.
But that "I don't have to be the business owner" comes with the fact that someone else is and they make you churn and burn so they can make money off you. If I went FM i'd want the environment where I got to decide how much time a patient needed and I determined who the staff where and I referred out to who I wanted based on their treatment of my patients and not based on their affiliation. It's not for everyone but it seems like an easy choce for me
Malpractice is cheap. Standard for FM is 10k, though there is a group offering a special concierge/DPC plan. I'm paying 3k for that.
Absolutely.
You raise prices by $10/month after a few years if you feel so inclined. That is not much for each individual patient but will give you an extra 72k per year.
Definitely a drop, but for how long depends on you. I would be earning just under 8k/month except my office rent is a higher than most.
You can funnel patients via the UC, just have to be coy about it.
At the beginning your patient load is small enough that its not usually a big issue, plus you can still handle most of your patients' issues over the phone. Once you're busy enough that UC work becomes a problem you should be earning enough to not need it.
I finished residency in 2013, start my DPC practice in June of 2015.
I don't know how you sell "enhanced care" to patients and then have them see an NP all the time. I'm a demanding patient, but I wouldn't buy that
