Joining a practice and getting partnership

[Pain Applicant1]

How do you combat against this?

If I had to break it down I would say:

90% chance there's nothing I can do about it. Either that or that's my perception of the situation.

10% chance there is. I guess I can try and find another PHO which essentially acted as a union for me. I think there are also companies that will negotiate on your behalf. A friend of mine who posts in here periodically has better rates than I do. Maybe he'll chime in on this one.

Don't let me discourage you. I'm closer to retirement than to starting up so my motivation to deal with insurance companies any more than I have to is close to zero. Not worth it to me at any price at this point. It would've been the opposite at the beginning.

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[Ducttape]

“Oh don’t listen to this guy..he’s so jaded and miserable”


except... you are.


each different job has its pros and cons. you choose to ignore the pros and have focused exclusively on the cons.


i know you will now say that there are no advantages towards HOPD...


i never have to worry about where my next paycheck is coming from. there is significantly more job security, especially for someone just starting out or at the end of their career.

if i take some time off - the clinic wont go under.


i dont have to make medical decisions based on what is best financially for the clinic, over the patient.


for all the employed docs that you claim are complaining about, there are a lot more that are happy with the fact that they can go home and leave work all at, well, work, and not worry about spreadsheets, or payroll, or that disgruntled employee, and can focus on their kids, their cars, that nasty golf slice, etc.

 

[Pain Applicant1]

3) own shop..yeah good luck with that, hope you have generational wealth

There are ways to find funding but you just have to be creative and figure them out. As concocted as it may sound I was able to convince the hospital to not only pay my start up cost but to also guarantee me a salary above it.

I forgot what the exact number was but I think I negotiated a guaranteed salary after my overhead of about $480 or something like that. They paid all of my overhead except the big picture items like my fluoro. I bought that at about 3 months in and brought my procedures in house.

They guaranteed me for I think up to 18 months but I terminated the contract after 10 months since I generated above the income guarantee at that point.

I just identified underserved areas using Google maps and wikipedia for population numbers. Then I called the surrounding pain docs to ask how backed up they were and how long it took to get an appointment. Front desk girls will usually spill all of the beans you need to know. Same with clerks in the courthouse.

Once I found locations, I cold called the local hospitals asking if they would offer me an income guarantee. When I found one that would consider it, they brought me down and I gave a presentation to the admins. My plan worked out and I started up my practice in 2011.

 

[Pain Applicant1]

Btw, it's called income guarantee with loan forgiveness. There might be some hospitals still offering this if you want to call around. You pay the loan back with time. For every month they pay, you have to remain in the area for 2 months.

They "benefit" by improving care for the community but what they really want are the MRIs, referral to their surgeons, procedures in their surgery center, etc. so be sure to include that in your presentation.

Little did they know that had they offered me $1 I still would've done the exact same thing and opened up in the area. Never show your cards when negotiating or make the first offer. Also, when giving them your presentation just walk in kind of like you own the place. Not arrogantly but confidently, kind of like you know what you're doing even if you don't. Fake it 'til you make it like Anna Sorokin. You'd be surprised what you can convince people of.

 

[Pain Applicant1]

For anyone interested in starting on their own here's one more thing I did that was helpful. There are, or at least there were, several consultants who could be hired to help get you started.

I just contacted them and asked for an itemized list of what they would offer me and how much they would charge. I took the lists and turned them into check boxes and did each task myself. This helped verify that I wouldn't miss any steps.

 

[Chelsea FC]

Any advice on books/courses on starting a practice ?? Also interested in books/courses on medical practice marketing and engaging with the community. See good books written by Dentist/therapist/PT but none from docs

 

[drrosenrosen]

Any advice on books/courses on starting a practice ?? Also interested in books/courses on medical practice marketing and engaging with the community. See good books written by Dentist/therapist/PT but none from docs

My wife bought me a book called "how to be a rock star doctor" by rebekah bernard,md. It's a silly title, of course, but it does have some good stuff about patient satisfaction, marketing yourself, creating a professional persona. I found it worth flipping through

 

[Chelsea FC]

My wife bought me a book called "how to be a rock star doctor" by rebekah bernard,md. It's a silly title, of course, but it does have some good stuff about patient satisfaction, marketing yourself, creating a professional persona. I found it worth flipping through

Read that and loved it already! If you have time ask your wife if she has any more recs.

 

[Chelsea FC]

What incentives do solo pain docs have to add on a new person?? Assuming they are genuine and not trying to screw the new person over. Sharing overhead I guess but then the headache of working with someone else might not be worth it. Doesnt seems like there is a big profit margin/upside by doing so without being labeled as taking advantage of your new employee.

 

[GoBeers]

What incentives do solo pain docs have to add on a new person?? Assuming they are genuine and not trying to screw the new person over. Sharing overhead I guess but then the headache of working with someone else might not be worth it. Doesnt seems like there is a big profit margin/upside by doing so without being labeled as taking advantage of your new employee.

to help scale and to help share costs of overhead.

i guess that's why there is the 2 year dating period first to see if philosophies, motivations align

 

[Agast]

What incentives do solo pain docs have to add on a new person?? Assuming they are genuine and not trying to screw the new person over. Sharing overhead I guess but then the headache of working with someone else might not be worth it. Doesnt seems like there is a big profit margin/upside by doing so without being labeled as taking advantage of your new employee.

Cross coverage and volume management. Some people prefer to tackle this problem with a midlevel.

 

[Chelsea FC]

to help scale and to help share costs of overhead.

i guess that's why there is the 2 year dating period first to see if philosophies, motivations align

Can you explain the scale part to me? Because adding someone else wont make you any more busy. If u reach the point you want to bring someone in that normally means your are super busy and maximizing on ur money. Adding someone is just going to be a huge expense until they get up to speed. Juding that it taks a while to build up to be productive a 2 year dating period doesnt seem like it works out to be financially worth it to bring in a partner becauce 6 months out of the first year they arent even productive but would still demand a pay. Do the solo guy just continiously take part of the new employee productivity even after getting partner after year 2?

 

[Chelsea FC]

Cross coverage and volume management. Some people prefer to tackle this problem with a midlevel.

Yeah Mid-lvl seems like a way better move because you bring them on and profit off of them indefinitely. So ur not directly trading ur time for money. A physician would want partner after 2 years and in which 6 months+ of the year they arent being super productive and prob costing the practice. Im just not seeing how bringing in a partner is useful to the solo practitioner other than cross coverage and overhead

 

[callmeanesthesia]

Yeah Mid-lvl seems like a way better move because you bring them on and profit off of them indefinitely. So ur not directly trading ur time for money. A physician would want partner after 2 years and in which 6 months+ of the year they arent being super productive and prob costing the practice. Im just not seeing how bringing in a partner is useful to the solo practitioner other than cross coverage and overhead

I’m not in a solo group so I don’t bear the full brunt of the start up costs, but I’m at a point where I’ve done all I can with mid-levels unless I want them to start training them to do epidurals too.

 

[GoBeers]

Can you explain the scale part to me? Because adding someone else wont make you any more busy. If u reach the point you want to bring someone in that normally means your are super busy and maximizing on ur money. Adding someone is just going to be a huge expense until they get up to speed. Juding that it taks a while to build up to be productive a 2 year dating period doesnt seem like it works out to be financially worth it to bring in a partner becauce 6 months out of the first year they arent even productive but would still demand a pay. Do the solo guy just continiously take part of the new employee productivity even after getting partner after year 2?

i suppose you have to think bigger picture and longer timeline.
midlevels don't do procedures
you as owner will get some % cut of the backbreaking labor your new associate physician will do so you still amplify your money theoretically and everyone is happy. but of course eventually they'll want a piece of the pie and that's where bridges may burn and time/money lost.

you are only one person who can be at one place at one time. if you are busy enough to expand to new clinic, then you leave in place a provider at the established old site while you build practice in new site. then once that is busy, you put a new provider at that site while you move onto the next. midlevels work really well but procedures is what brings in better money and at some point you can't do all the procedures alone.

solo owner hopefully has done the math for 1 year, 2 year, 5 year and 10 year timeline for all potential scenarios before hiring a physician

 

[Chelsea FC]

i suppose you have to think bigger picture and longer timeline.
midlevels don't do procedures
you as owner will get some % cut of the backbreaking labor your new associate physician will do so you still amplify your money theoretically and everyone is happy. but of course eventually they'll want a piece of the pie and that's where bridges may burn and time/money lost.

you are only one person who can be at one place at one time. if you are busy enough to expand to new clinic, then you leave in place a provider at the established old site while you build practice in new site. then once that is busy, you put a new provider at that site while you move onto the next. midlevels work really well but procedures is what brings in better money and at some point you can't do all the procedures alone.

solo owner hopefully has done the math for 1 year, 2 year, 5 year and 10 year timeline for all potential scenarios before hiring a physician

Ideally this would work. But most physicians want partner after 2 years. That physician we hire will only give the owner around 1years worth of money/profit/ROI since the first year they will be unproductive and cost the practice money. Doesn’t seem like a good scale with the added risk of giving up ownership to someone else. If you as the partner took % even when the person became partner that would make more sense but listening to people on here doing that would make you a bad employer . I just don’t see how u can scale appropriately without continuously taking a sizable % profits from physicians you hire even if you give up some ownership to them.

 

[GoBeers]

Ideally this would work. But most physicians want partner after 2 years. That physician we hire will only give the owner around 1years worth of money/profit/ROI since the first year they will be unproductive and cost the practice money. Doesn’t seem like a good scale with the added risk of giving up ownership to someone else. If you as the partner took % even when the person became partner that would make more sense but listening to people on here doing that would make you a bad employer . I just don’t see how u can scale appropriately without continuously taking a sizable % profits from physicians you hire even if you give up some ownership to them.

maybe most solo owners dream of a juicy PE buyout? maybe it's simply to share the stress, responsibility of running a business and that alone could be seen as worth it.

i'd be curious what others will say as well

 

[Chelsea FC]

maybe most solo owners dream of a juicy PE buyout? maybe it's simply to share the stress, responsibility of running a business and that alone could be seen as worth it.

i'd be curious what others will say as well

Agreed but it doesn’t seem as a huge profit making venture brining someone else on. Unless you do what hospitals do an take %of profits to yourself even with partnership. Maybe being a super-partner as an owner.

 

[Ferrismonk]

You all make good points, but there are a few reasons why a physician partner makes sense.

1. They'll help cover call, vacations, sick days, weekends, holidays, etc.
2. They'll help supervise more NPs or allow the NPs to work on days you want off.
3. By being larger, your group can carve out more market share and thus get better referrals and better contracts.
4. Some of the overhead is shared. For example, you likely will only need one physical office, one office manager, one fluoro suite, etc.
5. There will be a buy-in, so you get a few hundred thousand for selling part of your company.
6. If you get large enough to warrant building/buying an ASC, that will financially benefit you.

These are some of the financial reasons. There are other personal ones such as having a similar person to talk to, bounce ideas off of, etc.

 

[Chelsea FC]

You all make good points, but there are a few reasons why a physician partner makes sense.

1. They'll help cover call, vacations, sick days, weekends, holidays, etc.
2. They'll help supervise more NPs or allow the NPs to work on days you want off.
3. By being larger, your group can carve out more market share and thus get better referrals and better contracts.
4. Some of the overhead is shared. For example, you likely will only need one physical office, one office manager, one fluoro suite, etc.
5. There will be a buy-in, so you get a few hundred thousand for selling part of your company.
6. If you get large enough to warrant building/buying an ASC, that will financially benefit you.

These are some of the financial reasons. There are other personal ones such as having a similar person to talk to, bounce ideas off of, etc.

This list makes sense! Seems like scaling isnt a way to make alot of $$$.More about easing some headaches or trading one headache for another. Do owners still take margin off profits after 3-year vesting and buy- in of junior partners? Or after you buy in its equal footing and you but really profit from them.

 

[Dr. Ice]

He’s saying an ortho group sounds safe because you’re getting consistent referrals and a stronger insurance reimbursement contract, except everyone in his world is an entitled Millenial except him

Oh Agast..no..only entitled millennials are entitied millennials.

Also quite exquisitely sensitive and constantly need apologies for the worlds bad behaviors especially those damn “boomers” as they (you, she/her, he/him) would like to say. I’m sorry my feabile mind can’t grasp all the pronouns these days..

 

[Dr. Ice]

“Oh don’t listen to this guy..he’s so jaded and miserable”


except... you are.


each different job has its pros and cons. you choose to ignore the pros and have focused exclusively on the cons.


i know you will now say that there are no advantages towards HOPD...


i never have to worry about where my next paycheck is coming from. there is significantly more job security, especially for someone just starting out or at the end of their career.

if i take some time off - the clinic wont go under.


i dont have to make medical decisions based on what is best financially for the clinic, over the patient.


for all the employed docs that you claim are complaining about, there are a lot more that are happy with the fact that they can go home and leave work all at, well, work, and not worry about spreadsheets, or payroll, or that disgruntled employee, and can focus on their kids, their cars, that nasty golf slice, etc.

Your entire livelihood is based on a ridiculous SOS as drusso has aptly put it over and over. Get off the high horse dude. Your luxuries are based on a really convoluted system. You have stated how many of your patients are Medicaid. What is your hospital contract with your states Medicaid? Especially for pain management services? Those people may not show up for their appointment but you are salaried based on SOS which I’m sure is quite nice for you

 

[drusso]

Your entire livelihood is based on a ridiculous SOS as drusso has aptly put it over and over. Get off the high horse dude. Your luxuries are based on a really convoluted system. You have stated how many of your patients are Medicaid. What is your hospital contract with your states Medicaid? Especially for pain management services? Those people may not show up for their appointment but you are salaried based on SOS which I’m sure is quite nice for you

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[Ducttape]

Your entire livelihood is based on a ridiculous SOS as drusso has aptly put it over and over. Get off the high horse dude. Your luxuries are based on a really convoluted system. You have stated how many of your patients are Medicaid. What is your hospital contract with your states Medicaid? Especially for pain management services? Those people may not show up for their appointment but you are salaried based on SOS which I’m sure is quite nice for you

oooh.... critiquing me because of SOS...

im soo scared.

you are wrong in almost everything you state.

- the only SOS generated are the ASC facility fees, which go to the separate ASC, not my department. there is no SOS for office visits. procedures are ASC based.

- the hospital has no contract with Medicaid regarding pain treatments.

- i have a minimum rvu i have to meet per year, and then a small bonus after i hit that mark. i do pay close attention to what i am generating. but wrvus are not based on SOS.
-

but you are salaried based on SOS which I’m sure is quite nice for you

fixed it for you and exactly my point. i think you flossed over the entirety of my post and chose to focus on your ire towards HOPD practices.



fact of the matter is, your livelihood is also based on the promise that an insurance company will pay you for your services, as i am pretty darn sure you are not 100% self pay. your luxuries are based on the fact that an insurance company will most likely pay you multiples of what Medicaid pays.


go ahead and hate on HOPD practices, but directing your ire at doctors that work at those places is misdirected. if you want to direct your ire, it should be at the convoluted and misdirected system that we call healthcare in the US.

 

[Pain Applicant1]

I have no interest in hiring someone as I don't want to manage anyone else. Not worth it to me. If I did, I would almost most definitely hire an NP or a PA. I know it's a direct threat to providers in here so they're going to hate on it but from a business perspective that would be my best option.

Medicine is becoming a checklist conveyor belt. MIPS contributes to this and once the pt develops trust in a provider they don't really care about credentials. Just look at all of the alternative med people out there.

I would have no problem teaching procedures to midlevels if I wanted to expand my practice. I'm here to compete in business and help my practice survive. I like reading y'alls opinions on here and I appreciate the back and forth but loyalty to other physicians is of zero concern to me.

 

[MitchLevi]

I like reading y'alls opinions on here and I appreciate the back and forth but loyalty to other physicians is of zero concern to me.

This is a POS statement. I didn't call you that, just the statement.

 

[Pain Applicant1]

This is a POS statement. I didn't call you that, just the statement.

lol, it's okay if you call me that. I don't know what to tell you. Expected loyalty in medicine reminds me of the same expected loyalty with meme stocks. In the end, everyone is on their own. It's an inevitable part of healthcare evolution anyway.

 

[MitchLevi]

lol, it's okay if you call me that. I don't know what to tell you. Expected loyalty in medicine reminds me of the same expected loyalty with meme stocks. In the end, everyone is on their own. It's an inevitable part of healthcare evolution anyway.

The two aren't the same.

 

[Ducttape]

well, there is healthcare as a calling and a profession, and healthcare as a business.


i choose not to think of medicine as such, but quite a few of you seem to relish reminding me of the latter.

 

[Chelsea FC]

I have no interest in hiring someone as I don't want to manage anyone else. Not worth it to me. If I did, I would almost most definitely hire an NP or a PA. I know it's a direct threat to providers in here so they're going to hate on it but from a business perspective that would be my best option.

Medicine is becoming a checklist conveyor belt. MIPS contributes to this and once the pt develops trust in a provider they don't really care about credentials. Just look at all of the alternative med people out there.

I would have no problem teaching procedures to midlevels if I wanted to expand my practice. I'm here to compete in business and help my practice survive. I like reading y'alls opinions on here and I appreciate the back and forth but loyalty to other physicians is of zero concern to me.

How do you effectively scale ur business then? Ur private practice/Business is basically capped at the amount you can trade your time for money.. I don’t see a smart way to scale and improve profits in private practice because every young freshly minted fellow wants partnership. So basically no one out there u can leverage their time for profits . At this point I see NP/PA the only logical choice if docs are t willing to be employees in PP.

 

[Chelsea FC]

Have strictly employee only contracts for docs =POC pain owner
Hire NP/PA=POC pain owner
Work with industry = POC pain owner..

Seems like all the straight forward ways of scaling is very controversial. So basically you should take all the risk , start a practice and you have severely limited ways to scale ur small business to get more profits.. seems off to me.

 

[Pain Applicant1]

How do you effectively scale ur business then? Ur private practice/Business is basically capped at the amount you can trade your time for money.. I don’t see a smart way to scale and improve profits in private practice because every young freshly minted fellow wants partnership. So basically no one out there u can leverage their time for profits . At this point I see NP/PA the only logical choice if docs are t willing to be employees in PP.

Not necessarily but I definitely do NOT want to grow my medical practice, lol.. When you were younger, have you ever been in a relationship you didn't really want to be in but couldn't break it off for whatever reason because there were some benefits to it? That's how l kinda feel about my practice, lol. Let's just say that I wouldn't be too upset if external forces resulted in my practice going out of business. Then it wouldn't have been my decision to close up and I wouldn't have regrets, lol!

But I say not necessarily because you can add different types of revenue generators that can be passive. I did DME (no longer) and UDS. You can hire lower waged employees to help with these if necessary so it'll be more passive for you. My guess is that there are millions of opportunities of how to increase revenue. Just look for some slick greased-back hair doc selling weekend courses describing what to do.

You can always start other businesses. You can use your practice revenue for the seed money for these other ventures if you wanted to.

 

[Chelsea FC]

Not necessarily but I definitely do NOT want to grow my medical practice, lol.. When you were younger, have you ever been in a relationship you didn't really want to be in but couldn't break it off for whatever reason because there were some benefits to it? That's how l kinda feel about my practice, lol. Let's just say that I wouldn't be too upset if external forces resulted in my practice going out of business. Then it wouldn't have been my decision to close up and I wouldn't have regrets, lol!

But I say not necessarily because you can add different types of revenue generators that can be passive. I did DME (no longer) and UDS. You can hire lower waged employees to help with these if necessary so it'll be more passive for you. My guess is that there are millions of opportunities of how to increase revenue. Just look for some slick greased-back hair doc selling weekend courses describing what to do.

You can always start other businesses. You can use your practice revenue for the seed money for these other ventures if you wanted to.

Dam thought PP was supposed to be freeing. Seems like u traded one handcuffs for another .

 

[nvrsumr]

@Pain Applicant1 has a good bit of truth in his post. No one will ever love u back.

The way to scale the practice is to be a “pain surgeon” with 4 nps per doc writing <90mme to all comers and funneling pokes for pills patients into single specialty asc. Get to 4 docs (20 providers) and sell to PE. Been done 100 times.

This is the way

 

[Pain Applicant1]

Dam thought PP was supposed to be freeing. Seems like u traded one handcuffs for another .

Well keep in mind that it's all relative.

Let me keep things in perspective.

I'm in private practice but I only work 16 hours per week now. I'm still only in my mid to late 40s and I have other businesses that generate more than enough for my family and me. IOW, I don't need the money from my practice anymore so that motivator is gone.

When I went down to two 8 hour days per week I thought it would make things easier but it actually made it harder. Do you know how that Monday back at work after a long weekend vacation is difficult because you have to get back into work mode again? That's how it is each week for me, lol.

With that said, I don't want to come across as complaining or unappreciative of my situation.
-I still enjoy listening to and helping my patients.
-My practice is what allowed me to start up my other businesses since I wouldn't have been able to borrow or invest as much without it
-My practice runs smoothly since I've been at it for over a decade now. It generates good revenue and is pretty easy money. That's why it's so hard to give up.

...but i still have to be available to my patients since they depend on me. I still have to deal with insurance, billing, etc and the hospital because I must maintain my privileges.

i wouldn't necessarily call it handcuffs but as a doctor people definitely depend on you more so than in other occupations. There's a lot of responsibility that comes along with that. Just look at @Ducttape, if you want to do a good job you have to stay on top of articles like he does. I just don't want to do that. I would much rather work outdoors in nature, on my own terms, with my hands and doctoring doesn't allow me to do that. That's the main reason I want to shut my practice down but not everyone has the same strong desire to do that as i do.

 

[Chelsea FC]

Well keep in mind that it's all relative.

Let me keep things in perspective.

I'm in private practice but I only work 16 hours per week now. I'm still only in my mid to late 40s and I have other businesses that generate more than enough for my family and me. IOW, I don't need the money from my practice anymore so that motivator is gone.

When I went down to two 8 hour days per week I thought it would make things easier but it actually made it harder. Do you know how that Monday back at work after a long weekend vacation is difficult because you have to get back into work mode again? That's how it is each week for me, lol.

With that said, I don't want to come across as complaining or unappreciative of my situation.
-I still enjoy listening to and helping my patients.
-My practice is what allowed me to start up my other businesses since I wouldn't have been able to borrow or invest as much without it
-My practice runs smoothly since I've been at it for over a decade now. It generates good revenue and is pretty easy money. That's why it's so hard to give up.

...but i still have to be available to my patients since they depend on me. I still have to deal with insurance, billing, etc and the hospital because I must maintain my privileges.

i wouldn't necessarily call it handcuffs but as a doctor people definitely depend on you more so than in other occupations. There's a lot of responsibility that comes along with that. Just look at @Ducttape, if you want to do a good job you have to stay on top of articles like he does. I just don't want to do that. I would much rather work outdoors in nature, on my own terms, with my hands and doctoring doesn't allow me to do that. That's the main reason I want to shut my practice down but not everyone has the same strong desire to do that as i do.

How do you pay for overhead working 16hours a week? Do you have midlvls or partners/ non-partner employees ?

 

[drusso]

@Pain Applicant1 has a good bit of truth in his post. No one will ever love u back.

The way to scale the practice is to be a “pain surgeon” with 4 nps per doc writing <90mme to all comers and funneling pokes for pills patients into single specialty asc. Get to 4 docs (20 providers) and sell to PE. Been done 100 times.

This is the way

 

[Pain Applicant1]

How do you pay for overhead working 16hours a week? Do you have midlvls or partners/ non-partner employees ?

No, solo practice as in solo, uno, nada mas. Just me and one employee. Remember my barebones statement from above. I wasn't bullsheeting you about that.

What overhead are you referring to? Labor costs? One time this was my biggest expense so I chipped away at it. I trained my one front desk girl to do everything that I don't do - scheduling, collecting payments, prior auth, moving the fluoro, etc. - so we have a smooth-flowing well oiled, conveyor belt type of system. If she's out, I can just plop someone else in her position if I have to.

What other overhead? Rent? I own the building I rent from and then I sublease my office space to two other tenants. I also have tenants occupying the other suites in the building.

Athena helps me with billing and is commensurate since it's a percentage. Same with malpractice, it was reduced since I'm part-time. Supplies are also commensurate.

What else is there? I think that's most of them. My overhead probably runs at 20-25% and that includes my rent, which as I mentioned I pay to myself ie. transfers from one LLC to the next.

---

Same with managing and buying my properties. My wife got her real estate license for me so I keep the commission when I buy and i do my own property management, maintenance, and lawyering. She also now has a license to sell title insurance since that's also a big expense. Snow removal and landscaping became a big expense for my building so I bought a truck with a plow and a garden tractor and did away with those.

 

[Pain Applicant1]

How do you pay for overhead working 16hours a week? Do you have midlvls or partners/ non-partner employees ?

If you want midlevels don't let anyone in here try to guilt you out of it. Do what's in your own best interest. Guilt is an effective way to manipulate people but don't fall for it. In PP you're on your own, period. If your private practice fails there's not one person in here that's going to come to your rescue or donate money to you so you can support your family.

Remember that kid in med school who always tried to ace the exams and do better than everyone else or the kid you competed with for that residency spot? These are the same people you're now competing with in the business world. Don't tell me that all of a sudden they're now looking out for your best interests.

 

[Chelsea FC]

No, solo practice as in solo, uno, nada mas. Just me and one employee. Remember my barebones statement from above. I wasn't bullsheeting you about that.

What overhead are you referring to? Labor costs? One time this was my biggest expense so I chipped away at it. I trained my one front desk girl to do everything that I don't do - scheduling, collecting payments, prior auth, moving the fluoro, etc. - so we have a smooth-flowing well oiled, conveyor belt type of system. If she's out, I can just plop someone else in her position if I have to.

Who takes vitals, rooms patients etc? how is ur worl flow set up if you have one person doing all of this when patients are coming in to be registered, people calling the phone etc? Thats a lvl of lean startup I only dream of but havent seen pulled off. Also you said if she gets sick you just"plop" someone else in her position but seems like u heavily rely on this one person to wear many different hats which is hard to find a replacement for on short notice.

 

[Pain Applicant1]

Who takes vitals, rooms patients etc? how is ur worl flow set up if you have one person doing all of this when patients are coming in to be registered, people calling the phone etc? Thats a lvl of lean startup I only dream of but havent seen pulled off. Also you said if she gets sick you just"plop" someone else in her position but seems like u heavily rely on this one person to wear many different hats which is hard to find a replacement for on short notice.

Pt comes in and sees my front desk girl in the front. She brings the pt to the room and takes vitals and documents her part of the note. I go see the pt while she rooms the next pt or brings the pt to the fluoro suite. I come out of the room and the pt leaves to check out while I see the next pt. If it's a procedure, I set up the pt and wait for my front desk girl to come in. We do the procedure and she leaves once the procedure is over. She returns to the front and processes the next pt while I get the pt off of the table and bring the pt to the post procedure suite. I then go see the next pt she set up for me while she places the vital sign monitor on the pt and we keep going round and round like that.

Also, my laptop is with me while seeing the pt. By the time the visit is over my note is typically completed and signed off on Practice Fusion and my claim is submitted through Athena. I'm typing while speaking with the pt.

At worst, pt calls go to voicemail and she'll return the call later. Also, many of my pts are telemed suboxones so it makes it much more conducive for this type of practice. However, I still ran a similar operation prior to telemed (covid).

Pts who don't like going to voicemail or don't like me or my system won't come back to see me. Pts who I don't trust or feel that I can help I won't typically see. The practice evolved into pts, staff, and one doctor (me) who are pretty happy and understand the operation. I'm fortunate in that i can pretty much cherry-pick my pt population.

I rely on her but I did all of the work that she does so I was able to set up a system that allows for this flow. I essentially dumbed everything down to make it easy enough that anyone can manage it. She was out for a few months on maternity leave and I made it through just fine.

 

[DrMDAware]

Dam thought PP was supposed to be freeing. Seems like u traded one handcuffs for another .

we all serve someone. Don’t kid yourself. The lords can be hospital admin, the referring physician, your patient, the insurance companies, etc. we’re all beholden to them in one way or another. Some of us more than others. And some of us realize it more than others.

 

[DrSpine]

I would rather quit medicine than to ever be an HOPD doc working under an MBA Admin. Literally, I'd rather just enter the restaurant business world or do something else. I'm too entrepreneuer to ever submit myself to golden cuffs. Also, I've never met anyone who says, "I love being employed by the hospital, and I'm successful today because of it." But I've sure met a ton of Physicians who have opened their own practices and said, "I love what I do, I wish I would've done it sooner, and I'm successful today because of it."

 

[Pain Applicant1]

I would rather quit medicine than to ever be an HOPD doc working under an MBA Admin. Literally, I'd rather just enter the restaurant business world or do something else. I'm too entrepreneuer to ever submit myself to golden cuffs. Also, I've never met anyone who says, "I love being employed by the hospital, and I'm successful today because of it." But I've sure met a ton of Physicians who have opened their own practices and said, "I love what I do, I wish I would've done it sooner, and I'm successful today because of it."

You make good points but more importantly, what kind of restaurant business would you want to open up? Do you have experience? Are you a chef?

 

[DrSpine]

You make good points but more importantly, what kind of restaurant business would you want to open up? Do you have experience? Are you a chef?

Yes, I do. And yes, I know a chef.

 

[Pain Applicant1]

Yes, I do. And yes, I know a chef.

That sounds cool. I'm interested in hearing more about that venture if you're willing to divulge. What kind of restaurant, type of food, location, etc? If not willing to divulge more personal info, that's completely understandable.

 

[DrSpine]

That sounds cool. I'm interested in hearing more about that venture if you're willing to divulge. What kind of restaurant, type of food, location, etc? If not willing to divulge more personal info, that's completely understandable.

I like to keep my business propositions to myself.

 

[Pain Applicant1]

I like to keep my business propositions to myself.

Understandable.

Anyone else in here have any other businesses they're considering jumping into? Might be an interesting thread to chat about.

I have a few other ideas I'm considering. One of them involves a restaurant type of idea that I really think can make it. A niche in the market that I think holds a good deal of potential.

 

[Ferrismonk]

I've got a whole bunch of ideas for products/businesses, but I'm still salaried working towards partnership and have a family and student loans. Time and capital is limited. Once partnership happens, I'll be going through my book.

 

[Chelsea FC]

Any opinions on physical therapist, massage therapist, talk therapist/psych ,DME sales , other aesthetics to grow a practice or none of these are worth the headache and the profit margin are low. Seems like regenerative Med the best additional money maker and that’s still trading your time for money.. doesn’t seem like there is a viable option to leverage others Time for money