Setting up a practice?

[Merely]

So I had a theoretical question. If someone were trying to set up a practice and make like 1M dollars a year (Not sure why just a random hypothetical). Does it make sense that they would go to an area that is underserved, set up shop and as a result have an unlimited patient base so then they could just open up a large practice, hire like 3 NPs and 3 PAs and then start rolling in 1M+. What am I missing here about this made up fantasy scenario?

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[JustPlainBill]

So I had a theoretical question. If someone were trying to set up a practice and make like 1M dollars a year (Not sure why just a random hypothetical). Does it make sense that they would go to an area that is underserved, set up shop and as a result have an unlimited patient base so then they could just open up a large practice, hire like 3 NPs and 3 PAs and then start rolling in 1M+. What am I missing here about this made up fantasy scenario?

Sooo --- underserved --- there's usually a reason why they're underserved --- and usually it's because they have no insurance and no money -- that is the hard, cold reality -- or they have crappy insurance aka Medicare/Medicaid and you're out in the boonies or those areas of town where you drive an older car with an antenna that's NOT in the windshield and 4 spare tires in the trunk and usually have security in the lobby.

in order to get people to go to underserved areas, there's usually a state/federal program that pays back student loans without it being counted as income and the payment increases the longer you're in the area.

sorry to burst the bubble but trying that for real is likely to put you so far behind the power curve in debt that you'll never recover ---

how do I know? I got roped into something similar by a former mentor and once I figured out WTF was going on, I left quickly....very quickly.....

 

[DrMidlife]

So I had a theoretical question. If someone were trying to set up a practice and make like 1M dollars a year (Not sure why just a random hypothetical). Does it make sense that they would go to an area that is underserved, set up shop and as a result have an unlimited patient base so then they could just open up a large practice, hire like 3 NPs and 3 PAs and then start rolling in 1M+. What am I missing here about this made up fantasy scenario?

I kind of hate your priorities, but I love these questions.

With respect to the business of medicine, I suggest there are 3 bodies of knowledge that nobody is going to teach you, that you should want to acquire:
1. What does it take to run any business?
2. What does it take to identify and/or capture a promising new business opportunity?
(2a. What is the actual cost of failure, and how long does it take to get out if you fail?)
3. What does it take to run a medical practice?

And I suggest the following as possibilities for exploring those bodies of knowledge.

1. Get an MBA. This is "and/or" not "either/or" with the suggestions that follow. Plenty of people get MBAs and consider them useless. Plenty of people don't get MBAs and then fall on their faces making mistakes they wouldn't make if they had that MBA. A lot of med schools offer MD/MBA or DO/MBA.

2. Shadow a restaurant owner. The average restaurant goes out of business in about 7 years. Find out lots of reasons why. Back in the 1980's the #2 answer was coke, now it's health insurance. I'll leave it to you to imagine what the #1 reason is.

3. Spend time in a private FM or IM practice, a sole proprietorship, run by a doc close to retirement. This is not about the doc: spend time with the office manager. Write down questions, then take the questions to the doc. Count employees. Count square footage. Count software packages. Enumerate job functions. Who hires? Who trains? Who schedules employees? Who owns the instructions for how the office operates? Who answers the phone? Who takes vitals? What leased equipment is in use, such as a copier, A1C, xray? What vendors such as LabCorp are paid? What's the no show rate? How much does the EMR cost, and how much $/time does it take for a new non-professional employee to learn it? Where are the old paper charts? Pay close attention to the sources of stress for the non-MD/DO/PA/NPs. For extra credit use this time to develop skills for working successfully with high school grads working for hourly wages. Point being: you're in charge of all of this as a practice owner. You may be able to hire people to do some of the work.

4. Hunt down the business development office, or similar, in the hospital system affiliated with (or close to) your school. Find the people whose job it is to analyze where new offices should be opened. Why did Kaiser expand to the mid-Atlantic. Why did Sentara buy Norfolk General Hospital. Why did the University of Washington buy out Northwest and open a half dozen primary care clinics in just 3 zip codes. Why does a private practice sell itself to a health system, and why would a practice buy itself back after doing so? Pick a health system, find their website, click on Locations, contemplate. Use the fact that you're an interested med student to get yourself access to the decision-making process. Old retired docs can often tell great biz tales - find a retired managing partner.

5. Find a practice that's done the work to turn patient flow into a cash register. Is there a bariatric surgery (outpatient) center near you? Cosmetic surgery (botox)? Pain clinic? Can you get a principal to take you under his/her wing and explain what it took to get started, to hire up, to get licensed, to get market share? Why exactly is this different from running a primary care clinic?

6. Walk into a dialysis clinic, sit in the waiting room, and observe.

tl;dr: find out if you want to run a business by drinking a lot of high octane reality that med schools don't teach

Best of luck to you.
(P.S. for the record, I don't give a crap about running a profitable business as a doctor. That's the kind of thing I used to do, and I'd still be doing it if it was at all satisfying.)

 

[Merely]

I kind of hate your priorities, but I love these questions.

With respect to the business of medicine, I suggest there are 3 bodies of knowledge that nobody is going to teach you, that you should want to acquire:
1. What does it take to run any business?
2. What does it take to identify and/or capture a promising new business opportunity?
(2a. What is the actual cost of failure, and how long does it take to get out if you fail?)
3. What does it take to run a medical practice?

And I suggest the following as possibilities for exploring those bodies of knowledge.

1. Get an MBA. This is "and/or" not "either/or" with the suggestions that follow. Plenty of people get MBAs and consider them useless. Plenty of people don't get MBAs and then fall on their faces making mistakes they wouldn't make if they had that MBA. A lot of med schools offer MD/MBA or DO/MBA.

2. Shadow a restaurant owner. The average restaurant goes out of business in about 7 years. Find out lots of reasons why. Back in the 1980's the #2 answer was coke, now it's health insurance. I'll leave it to you to imagine what the #1 reason is.

3. Spend time in a private FM or IM practice, a sole proprietorship, run by a doc close to retirement. This is not about the doc: spend time with the office manager. Write down questions, then take the questions to the doc. Count employees. Count square footage. Count software packages. Enumerate job functions. Who hires? Who trains? Who schedules employees? Who owns the instructions for how the office operates? Who answers the phone? Who takes vitals? What leased equipment is in use, such as a copier, A1C, xray? What vendors such as LabCorp are paid? What's the no show rate? How much does the EMR cost, and how much $/time does it take for a new non-professional employee to learn it? Where are the old paper charts? Pay close attention to the sources of stress for the non-MD/DO/PA/NPs. For extra credit use this time to develop skills for working successfully with high school grads working for hourly wages. Point being: you're in charge of all of this as a practice owner. You may be able to hire people to do some of the work.

4. Hunt down the business development office, or similar, in the hospital system affiliated with (or close to) your school. Find the people whose job it is to analyze where new offices should be opened. Why did Kaiser expand to the mid-Atlantic. Why did Sentara buy Norfolk General Hospital. Why did the University of Washington buy out Northwest and open a half dozen primary care clinics in just 3 zip codes. Why does a private practice sell itself to a health system, and why would a practice buy itself back after doing so? Pick a health system, find their website, click on Locations, contemplate. Use the fact that you're an interested med student to get yourself access to the decision-making process. Old retired docs can often tell great biz tales - find a retired managing partner.

5. Find a practice that's done the work to turn patient flow into a cash register. Is there a bariatric surgery (outpatient) center near you? Cosmetic surgery (botox)? Pain clinic? Can you get a principal to take you under his/her wing and explain what it took to get started, to hire up, to get licensed, to get market share? Why exactly is this different from running a primary care clinic?

6. Walk into a dialysis clinic, sit in the waiting room, and observe.

tl;dr: find out if you want to run a business by drinking a lot of high octane reality that med schools don't teach

Best of luck to you.
(P.S. for the record, I don't give a crap about running a profitable business as a doctor. That's the kind of thing I used to do, and I'd still be doing it if it was at all satisfying.)

Thank you for this, I'll be honest about my priorities. I'm really hard working and want nothing less than the best for my patients. But I do not want to be a wage slave serving a corporate overlord/administrator. I can't imagine being a surgeon or doc that's told what to do/how to treat by admins and hospital CEOs. I want to own my own business, do the best for my patients running it my way, work very hard and make a lot of money. To each his own but I thought I'd be upfront with my intentions and I appreciate all of you older guys/girls and your insights.
With regards to Medicaid, I would certainly imagine that an underserved area has bad insurance but isn't that sufficient as long as they have insurance since youre being paid? Pardon my ignorance.

 

[DrMidlife]

Ah. Forgot one on my list. Also: this should be required learning in med school imho.

7. Get a private practice to let you shadow their billing supervisor and maybe their accounting manager. Look at some actual patient visit transactions that show the difference in reimbursement with private insurance vs. Medicare vs. Medicaid for the exact same services from the exact same doctor. Learn about how you have to code to the insurer if you want to get paid at all. Learn what gets rejected. Learn why "payor mix" is important. Learn about how money flows through the practice.

tl;dr: you know that other thread recently that was talking about how med students seem to think FM docs make $150k or less? Majority Medicaid docs are the ones making less than $150k. Medicaid is why pediatricians don't make money. You can't keep the lights on with majority Medicaid, without outside help.

 

[DrMidlife]

And if I haven't made it clear, you can do the work to get up to speed on the boring details of running a business, or you can gamble.

 

[JustPlainBill]

Thank you for this, I'll be honest about my priorities. I'm really hard working and want nothing less than the best for my patients. But I do not want to be a wage slave serving a corporate overlord/administrator. I can't imagine being a surgeon or doc that's told what to do/how to treat by admins and hospital CEOs. I want to own my own business, do the best for my patients running it my way, work very hard and make a lot of money. To each his own but I thought I'd be upfront with my intentions and I appreciate all of you older guys/girls and your insights.
With regards to Medicaid, I would certainly imagine that an underserved area has bad insurance but isn't that sufficient as long as they have insurance since youre being paid? Pardon my ignorance.

At a reimbursement rate of $0.30 on the dollar for Medicaid, I think that'll fit the definition of wage slave (Didn't Judas sell out for 30 pieces of silver? Coincidence? Happenstance? I think not...) --- The illustration I use with patients is: Go to your favorite grocery store and buy exactly $100 worth of groceries. Go through the checkout line and get it all bagged up and in the cart, ready to take out the door. Hand the cashier $30 and see how far out the door you get with the $100 worth of groceries.

Medicine is so screwed up right now because reimbursements are based on the relative risk of the procedure NOT on how healthy the patients are --- If I keep you healthy and out of the hospital/away from the knife, that counts for very little but in the trenches where you basically have to negotiate with patients to just get them to check their blood pressures 3 x a week and make them understand that diet sodas from Sonic are NOT helping their DM, there's very little value in that in pure dollars and cents, at least currently --- but if it's gotten bad enough that we have to start lopping off significant body parts starting with the lower extremities, that's where the large reimbursements occur as it's a riskier procedure.....

Until we start placing a value on keeping people healthy and doctors start demanding to be compensated for the amount of effort it takes to keep people healthy, we're not going anywhere ---

As the song says,"Welcome, my son, welcome to the Machine. Where have you been, it's alright, we know where you've been. You've been in the pipeline filling in time, provided with toys and scouting for boys...."

DPC is looking better and better all the time ---

 

[Ericslv]

So I had a theoretical question. If someone were trying to set up a practice and make like 1M dollars a year (Not sure why just a random hypothetical). Does it make sense that they would go to an area that is underserved, set up shop and as a result have an unlimited patient base so then they could just open up a large practice, hire like 3 NPs and 3 PAs and then start rolling in 1M+. What am I missing here about this made up fantasy scenario?

There are companies that will do analytics to show what are the best locations for a new practice. It will cost you.

Everything you just asked requires a skill not taught in medical school or residency. It looks simple but it is complicated. So hypothetically you would need to learn the business side. About half of the learning will happen on job through trial and error. Trial and error in business translates into losing money most of the time.

But the good news is if your resilient and keep going you can get to that million dollar clinic. Your problems won't end but then you will have your problems and a million dollar clinic.

Get ready to hypothetically work really really hard.

 

[BlackDynamite]

How much does it cost to hire a company to do the analytics for you?

 

[Ericslv]

How much does it cost to hire a company to do the analytics for you?

Several thousand. And that's just the start.

 

[Ericslv]

I kind of hate your priorities, but I love these questions.

With respect to the business of medicine, I suggest there are 3 bodies of knowledge that nobody is going to teach you, that you should want to acquire:
1. What does it take to run any business?
2. What does it take to identify and/or capture a promising new business opportunity?
(2a. What is the actual cost of failure, and how long does it take to get out if you fail?)
3. What does it take to run a medical practice?

And I suggest the following as possibilities for exploring those bodies of knowledge.

1. Get an MBA. This is "and/or" not "either/or" with the suggestions that follow. Plenty of people get MBAs and consider them useless. Plenty of people don't get MBAs and then fall on their faces making mistakes they wouldn't make if they had that MBA. A lot of med schools offer MD/MBA or DO/MBA.

2. Shadow a restaurant owner. The average restaurant goes out of business in about 7 years. Find out lots of reasons why. Back in the 1980's the #2 answer was coke, now it's health insurance. I'll leave it to you to imagine what the #1 reason is.

3. Spend time in a private FM or IM practice, a sole proprietorship, run by a doc close to retirement. This is not about the doc: spend time with the office manager. Write down questions, then take the questions to the doc. Count employees. Count square footage. Count software packages. Enumerate job functions. Who hires? Who trains? Who schedules employees? Who owns the instructions for how the office operates? Who answers the phone? Who takes vitals? What leased equipment is in use, such as a copier, A1C, xray? What vendors such as LabCorp are paid? What's the no show rate? How much does the EMR cost, and how much $/time does it take for a new non-professional employee to learn it? Where are the old paper charts? Pay close attention to the sources of stress for the non-MD/DO/PA/NPs. For extra credit use this time to develop skills for working successfully with high school grads working for hourly wages. Point being: you're in charge of all of this as a practice owner. You may be able to hire people to do some of the work.

4. Hunt down the business development office, or similar, in the hospital system affiliated with (or close to) your school. Find the people whose job it is to analyze where new offices should be opened. Why did Kaiser expand to the mid-Atlantic. Why did Sentara buy Norfolk General Hospital. Why did the University of Washington buy out Northwest and open a half dozen primary care clinics in just 3 zip codes. Why does a private practice sell itself to a health system, and why would a practice buy itself back after doing so? Pick a health system, find their website, click on Locations, contemplate. Use the fact that you're an interested med student to get yourself access to the decision-making process. Old retired docs can often tell great biz tales - find a retired managing partner.

5. Find a practice that's done the work to turn patient flow into a cash register. Is there a bariatric surgery (outpatient) center near you? Cosmetic surgery (botox)? Pain clinic? Can you get a principal to take you under his/her wing and explain what it took to get started, to hire up, to get licensed, to get market share? Why exactly is this different from running a primary care clinic?

6. Walk into a dialysis clinic, sit in the waiting room, and observe.

tl;dr: find out if you want to run a business by drinking a lot of high octane reality that med schools don't teach

Best of luck to you.
(P.S. for the record, I don't give a crap about running a profitable business as a doctor. That's the kind of thing I used to do, and I'd still be doing it if it was at all satisfying.)

Common mistakes. Instead of spending time and money trying to be jack of all trades just hire someone that know what they are doing and get the help you need. It will cost less in the long run in time and money.

 

[Ericslv]

At a reimbursement rate of $0.30 on the dollar for Medicaid, I think that'll fit the definition of wage slave (Didn't Judas sell out for 30 pieces of silver? Coincidence? Happenstance? I think not...) --- The illustration I use with patients is: Go to your favorite grocery store and buy exactly $100 worth of groceries. Go through the checkout line and get it all bagged up and in the cart, ready to take out the door. Hand the cashier $30 and see how far out the door you get with the $100 worth of groceries.

Medicine is so screwed up right now because reimbursements are based on the relative risk of the procedure NOT on how healthy the patients are --- If I keep you healthy and out of the hospital/away from the knife, that counts for very little but in the trenches where you basically have to negotiate with patients to just get them to check their blood pressures 3 x a week and make them understand that diet sodas from Sonic are NOT helping their DM, there's very little value in that in pure dollars and cents, at least currently --- but if it's gotten bad enough that we have to start lopping off significant body parts starting with the lower extremities, that's where the large reimbursements occur as it's a riskier procedure.....

Until we start placing a value on keeping people healthy and doctors start demanding to be compensated for the amount of effort it takes to keep people healthy, we're not going anywhere ---

As the song says,"Welcome, my son, welcome to the Machine. Where have you been, it's alright, we know where you've been. You've been in the pipeline filling in time, provided with toys and scouting for boys...."

DPC is looking better and better all the time ---

Welcome to the dark side.

 

[JustPlainBill]

Welcome to the dark side.

Do you have cookies? ;->

 

[Merely]

Anyone have any books or articles that would allow one to get some familiarity with the business side of medicine?

 

[deleted87716]

Welcome to the dark side.

Do you have cookies? ;->

 

[Ericslv]

Do you have cookies? ;->

Extra Dark chocolate chips.

 

[JustPlainBill]

BD -- Thank you for the best, deep belly laugh I've had all week --- that was what I needed after a full clinic today (Saturday)......

 

[Ericslv]

Anyone have any books or articles that would allow one to get some familiarity with the business side of medicine?

General accounting books.

Coding books.

business management books.

Marketing books.

HR books.

Sales books.

Investing books.

Loan books.

Amazon is a great place. But if you are a resident do you have the time?

 

[DrMidlife]

The OP is a 1st year med student. Got all the time in the world to learn how to master his/her universe.

I suggest that being the jack of all trades isn't necessary nor possible, not at 7 figures net. But the more trades you never jack, the more risk you accept.

I suggest that to build a successful profit-generating empire (small or large), that lives longer than the average restaurant, you want to respect the work you delegate to others, generously compensate those you make responsible for that distasteful work, and nurture their friendship and loyalty. You get nowhere without them. You will periodically get abandoned by them: build a river, not a pool.

Ideally your college roommate got an MBA and worked in pharm or medical devices or biz dev while you got through residency, and the conversations you start having at this summer's BBQs about starting a health care business together get increasingly frenzied & fun. This person needs to net as much as you do, if you're successful.

 

[surrender903]

Extra Dark chocolate chips.

only grumpasaurus' would say that...
(happy saturday)

 

[Ericslv]

The OP is a 1st year med student. Got all the time in the world to learn how to master his/her universe.

I suggest that being the jack of all trades isn't necessary nor possible, not at 7 figures net. But the more trades you never jack, the more risk you accept.

I suggest that to build a successful profit-generating empire (small or large), that lives longer than the average restaurant, you want to respect the work you delegate to others, generously compensate those you make responsible for that distasteful work, and nurture their friendship and loyalty. You get nowhere without them. You will periodically get abandoned by them: build a river, not a pool.

Ideally your college roommate got an MBA and worked in pharm or medical devices or biz dev while you got through residency, and the conversations you start having at this summer's BBQs about starting a health care business together get increasingly frenzied & fun. This person needs to net as much as you do, if you're successful.

I didn't notice he/she was a first year med student. I have a different suggestion.

STOP NOW. GO TO BUSINESS SCHOOL OR SOMETHING ELSE. GET OUT WHILE YOU CAN. YOU HAVE BEEN WARNED.

 

[Ericslv]

only grumpasaurus' would say that...
(happy saturday)

Black like my soul.

PS. You love me and you know it baby.

 

[FrustratedFamDoc]

It's hard to truly "want the best for your patients" while farming out their primary care to providers with significantly less training. I've always held a perhaps very false belief that if I provide the best possible care, bill correctly, accept all comers, accept as many same day appointments as I can stand and try to get a good payor mix that I'd end up doing pretty well. So far it has done pretty well for me.

 

[Merely]

It's hard to truly "want the best for your patients" while farming out their primary care to providers with significantly less training. I've always held a perhaps very false belief that if I provide the best possible care, bill correctly, accept all comers, accept as many same day appointments as I can stand and try to get a good payor mix that I'd end up doing pretty well. So far it has done pretty well for me.

It depends on your definition of pretty well, I suppose. What does pretty well mean to you?

 

[FrustratedFamDoc]

I'll agree, it does depend on your definition of pretty well. If your whole point of this post is money, which it seeming is, then I'm not the one who should be giving you advice. I personally work 4 1/2 days a week outpatient only, I see about 24 a day, don't work weekends or holidays and am on phone call every 6th weekend. My patients truly appreciate the care I can provide for them. I come home to my wife and son every evening at a reasonable hour, I drive a modest car and we live within our means. Student loans eat me up every month but there is a plan in place for that too. I do anything I want on the weekends and start back again on Monday. There is no perfect job (I've worked lots of em) but I feel like I have the perfect job for me. I make right at the national average for family docs in my area.

If money is truly your ultimate goal, then you're really in the wrong place.

 

[Merely]

I'll agree, it does depend on your definition of pretty well. If your whole point of this post is money, which it seeming is, then I'm not the one who should be giving you advice. I personally work 4 1/2 days a week outpatient only, I see about 24 a day, don't work weekends or holidays and am on phone call every 6th weekend. My patients truly appreciate the care I can provide for them. I come home to my wife and son every evening at a reasonable hour, I drive a modest car and we live within our means. Student loans eat me up every month but there is a plan in place for that too. I do anything I want on the weekends and start back again on Monday. There is no perfect job (I've worked lots of em) but I feel like I have the perfect job for me. I make right at the national average for family docs in my area.

If money is truly your ultimate goal, then you're really in the wrong place.

There are many FM docs that own their own practice and make 1M dollars a year. Why are you saying then that I'm in the wrong place? Are they, too, in the wrong place?

 

[Ericslv]

There are many FM docs that own their own practice and make 1M dollars a year. Why are you saying then that I'm in the wrong place? Are they, too, in the wrong place?

I million a year is possible but I doubt there are many doing it. If you know of a few can you name them?

 

[surrender903]

There are many FM docs that own their own practice and make 1M dollars a year. Why are you saying then that I'm in the wrong place? Are they, too, in the wrong place?

what he is saying is that generating profit and money akin to the bacchanal of wolf of wall street is not going to be found in family medicine. if you want to run a business and be a physician you can do it, but its not the majority of family physicians.

 

[FrustratedFamDoc]

Ok look, I generally don't get in to conversations about money but your post really rubbed me the wrong way. Our jobs on a day in and a day out basis is people... to cut to the meat and potatoes of the matter. In essence you want to run a mid-level patient mill, extract as much money as possible and somehow, someway, "want the best for your patients." (which you didn't actually come out and mention until your second post when you were called out) Dude, really? I'll come out and say that your intentions suck and as if going on a public forum and stating your intentions isn't bad enough... you're actually asking us to help you?

If you really want to try to make as much money as possible with a medical degree with the least degree of patient contact, open a pill mill or a doctor's weight loss and write narcs/benzos and adipex all day. your $1m goal is easily attainable there.

 

[Ericslv]

Ok look, I generally don't get in to conversations about money but your post really rubbed me the wrong way. Our jobs on a day in and a day out basis is people... to cut to the meat and potatoes of the matter. In essence you want to run a mid-level patient mill, extract as much money as possible and somehow, someway, "want the best for your patients." (which you didn't actually come out and mention until your second post when you were called out) Dude, really? I'll come out and say that your intentions suck and as if going on a public forum and stating your intentions isn't bad enough... you're actually asking us to help you?

If you really want to try to make as much money as possible with a medical degree with the least degree of patient contact, open a pill mill or a doctor's weight loss and write narcs/benzos and adipex all day. your $1m goal is easily attainable there.

You don't have to have a mid level patient mill to make 1 million in a practice. You can do it all by following evidence based guidelines, quality care and excellent service, multi-locations with a pure MD model. Providing services that include primary care, and other procedures. I'm not sure why you included weight loss with a pill mill (which is not ethical).

Quality patient care and good business is profitable when done correctly. You assumed his intentions were do milk the patient and make a million bucks. Maybe they are. I don't know him so I can't say but I do know that it's not good to assume.

If someone has the right skills they can develop a profitable business model. Most FP's want to work for someone (that actually is part of the problem but part of another post by itself).

So why not work for an MD rather than corpmed. If you don't like the idea of that MD making money from your efforts then welcome you are now thinking like a business man and will most likely do better if you own. But if you choose to work for someone and then get upset because they are making money off your efforts then it's really on you.

Lets say a doctor opens an urgent care and staffs it with MD's. Lets say things go well and in time he is able to open one or two more of them and at the end of the day the average doc there makes about 220k but the owner makes 1 mil. I see nothing wrong with that.

I see posts in here all the time with people wondering how much they can make or how they can make more. Owning is another option with higher income potential.

 

[FrustratedFamDoc]

I agree that it is entirely possible to do quality care staffed with MD/DO but he said himself that he wants to run an NP/PA establishment. I know the 2 aren't mutually exclusive, but certainly becoming increasingly difficult in the modern landscape.

It's not good to assume, but we ALL do it anyway, regardless.

I'll challenge that most FPs really don't want to work for someone else; lord knows I don't. I'm currently employed by the man, for now. I do know that most of us graduate from med school with huge debt, pending payments, and a family that is really depending on a stable income. The sign on bonus and guaranteed income for the first however many years is a life giving breath for those that have been drowning for the past however many years of school and residency. Going out on your own can be a really tough sell to a spouse/family. Now after some debt is paid, then sure.

I'm all for family docs trying to do as well as possible, financially. I'm an entrepreneur at heart and always have been. I'm actually personally pondering the example you gave. I

 

[Merely]

I agree that it is entirely possible to do quality care staffed with MD/DO but he said himself that he wants to run an NP/PA establishment. I know the 2 aren't mutually exclusive, but certainly becoming increasingly difficult in the modern landscape.

It's not good to assume, but we ALL do it anyway, regardless.

I'll challenge that most FPs really don't want to work for someone else; lord knows I don't. I'm currently employed by the man, for now. I do know that most of us graduate from med school with huge debt, pending payments, and a family that is really depending on a stable income. The sign on bonus and guaranteed income for the first however many years is a life giving breath for those that have been drowning for the past however many years of school and residency. Going out on your own can be a really tough sell to a spouse/family. Now after some debt is paid, then sure.

I'm all for family docs trying to do as well as possible, financially. I'm an entrepreneur at heart and always have been. I'm actually personally pondering the example you gave. I

I don't understand what your point is? I'm just saying that some of us might love FM and patient care but also want to not drive an accord the rest of our lives and want to drive a ferrari or something. I don't know why you think that I'm unethical and shady just because I want to be a well off doctor. Being rich is not a bad thing, as long as you get there without hurting others. Hiring MDs, NPs, PA, etc. is also not unethical or bad for patients. A lot of NPs are really good providers and as long as they are overseen properly there's nothing wrong with it.

 

[VA Hopeful Dr]

I don't understand what your point is? I'm just saying that some of us might love FM and patient care but also want to not drive an accord the rest of our lives and want to drive a ferrari or something. I don't know why you think that I'm unethical and shady just because I want to be a well off doctor. Being rich is not a bad thing, as long as you get there without hurting others. Hiring MDs, NPs, PA, etc. is also not unethical or bad for patients. A lot of NPs are really good providers and as long as they are overseen properly there's nothing wrong with it.

Your motivation is all well and good, but like my colleagues I would disagree that running a practice full of midlevels is really providing the best care. I think you could oversee a single midlevel and likely provide good care but any more than that per physician and I have my doubts.

Plus, and this is really just my opinion, midlevels can provide acceptable care but they certainly are not "the best for my patients" that you are shooting for.

Ericslv had the right suggestion - open your own practice and employ other physicians. That's how you make good money and provide the best care.

 

[Ericslv]

I agree that it is entirely possible to do quality care staffed with MD/DO but he said himself that he wants to run an NP/PA establishment. I know the 2 aren't mutually exclusive, but certainly becoming increasingly difficult in the modern landscape.

It's not good to assume, but we ALL do it anyway, regardless.

I'll challenge that most FPs really don't want to work for someone else; lord knows I don't. I'm currently employed by the man, for now. I do know that most of us graduate from med school with huge debt, pending payments, and a family that is really depending on a stable income. The sign on bonus and guaranteed income for the first however many years is a life giving breath for those that have been drowning for the past however many years of school and residency. Going out on your own can be a really tough sell to a spouse/family. Now after some debt is paid, then sure.

I'm all for family docs trying to do as well as possible, financially. I'm an entrepreneur at heart and always have been. I'm actually personally pondering the example you gave. I

I like your post. It has perspective.

Years ago the way doctors started their own practice was either to on their own or get together and start one. When they did it together it would reduce overhead. Later when they needed more doctors to join they offered a partnership track. Like a law or accounting or financial firm. This still happen today but much less often.

Find other like minded doctors you can team up with and see if you can reduce overhead and start something with about 3 or 4 of your colleagues. Single specialty MD/DO only and grow from there. Advertise as MD/DO only. People will respond to that.

You will have to moonlight for about a year perhaps two. It will be hard but at the end you will have something to show for it that's yours. The cost will be reduced between 4 doctors. There is more to it than that but you get the idea.

Think of it this way. If it fails you can always go back to work for the man. They need you.

And, I agree I looked back at the old posts and he did say NP/PA but I think it he was just giving examples of different models that are possible. Personally I feel MD's need to completely take over medicine and now train or allow any PA or NP in their space.

 

[Ericslv]

Your motivation is all well and good, but like my colleagues I would disagree that running a practice full of midlevels is really providing the best care. I think you could oversee a single midlevel and likely provide good care but any more than that per physician and I have my doubts.

Plus, and this is really just my opinion, midlevels can provide acceptable care but they certainly are not "the best for my patients" that you are shooting for.

Ericslv had the right suggestion - open your own practice and employ other physicians. That's how you make good money and provide the best care.

Yup, MD/DO only all the way. You have the skill and others want it. It took years to learn and it takes work to keep up so I say MD/DO only.

 

[Merely]

Yes, I agree with everything above. I agree that NPs and PAs aren't the best and that MDs are obviously the best to take care of patients. Thanks for all the insights.

 

[JustPlainBill]

I agree that it is entirely possible to do quality care staffed with MD/DO but he said himself that he wants to run an NP/PA establishment. I know the 2 aren't mutually exclusive, but certainly becoming increasingly difficult in the modern landscape.

It's not good to assume, but we ALL do it anyway, regardless.

I'll challenge that most FPs really don't want to work for someone else; lord knows I don't. I'm currently employed by the man, for now. I do know that most of us graduate from med school with huge debt, pending payments, and a family that is really depending on a stable income. The sign on bonus and guaranteed income for the first however many years is a life giving breath for those that have been drowning for the past however many years of school and residency. Going out on your own can be a really tough sell to a spouse/family. Now after some debt is paid, then sure.

I'm all for family docs trying to do as well as possible, financially. I'm an entrepreneur at heart and always have been. I'm actually personally pondering the example you gave. I

Doing it right now -- spent the first 2 years s/p residency clustering around with some bad deals but now linked in with a forward thinking group but still not a partner -- and make no mistake about it -- no matter how much you are told ,"It's your own practice" we all know who calls the shots in those situations ---

I'm giving it 3 years for either a) full partnership with voting rights at the big people table or b) learning everything I need to know and then jumping off with my own practice. Either way, I'm going to be either one of or the only HMFIC.....

 

[Ericslv]

Doing it right now -- spent the first 2 years s/p residency clustering around with some bad deals but now linked in with a forward thinking group but still not a partner -- and make no mistake about it -- no matter how much you are told ,"It's your own practice" we all know who calls the shots in those situations ---

I'm giving it 3 years for either a) full partnership with voting rights at the big people table or b) learning everything I need to know and then jumping off with my own practice. Either way, I'm going to be either one of or the only HMFIC.....

Excellent. Learn as much as you can from the business side. Find some like minded MD/DO's that may be willing to set sail with you. At least one to help with overhead and call. Look for practices that are profitable and for sale. Older doctor who are ready to retire. Look at adding procedural services. Go to CME focused on business of medicine and ancillary services. Learn medical coding.

 

[Merely]

Excellent. Learn as much as you can from the business side. Find some like minded MD/DO's that may be willing to set sail with you. At least one to help with overhead and call. Look for practices that are profitable and for sale. Older doctor who are ready to retire. Look at adding procedural services. Go to CME focused on business of medicine and ancillary services. Learn medical coding.

You seem to be knowledgeable..do you own your own practice and make big bucks?

 

[Ericslv]

You seem to be knowledgeable..do you own your own practice and make big bucks?

lol. There is a limit to how much I discuss online.

 

[Merely]

lol. There is a limit to how much I discuss online.

I respect that but I feel like talking about your practice set up is not info anyone can use to track your identity since there are thousands of docs across the country. Most docs on here, even in this forum, have discussed their practice setup and even gone into details. Obviously you're free to do as you're comfortable I'm just wondering like what the reasoning is behind that or if there is a downside to giving away too many details.

 

[Ericslv]

I respect that but I feel like talking about your practice set up is not info anyone can use to track your identity since there are thousands of docs across the country. Most docs on here, even in this forum, have discussed their practice setup and even gone into details. Obviously you're free to do as you're comfortable I'm just wondering like what the reasoning is behind that or if there is a downside to giving away too many details.

I just don't. I can give you advice (as I have been) but I don't get into anything specific. That's how I do it. I also don't do PM's. If I have something to say I want everyone to hear it.

Your in med-school now and have a long way to go. Concentrate on getting a residency and If you already matched, your first priority should be learning medicine. In your free time read financial and business books. Start with whitecoatinvestor.com great place to learn about managing your money and beyond. Another place is physican on fire.

Read about sales and marketing. When or if you chose to take the challenge and RISK of opening your own center(s) then you will need help from more experienced people than yourself. but you will need to know the basics so they don't take you to the cleaners. Notice I used caps on the RISK. No good businessman has ever risked and not lost.

I wish you the best. Doctors like all other people will quit at different levels of the journey. Many quit because they feel they are comfortable and have done enough and others just don't like the business side. No shame in either. But if you want to build your business to something very large as you aspire, it will need considerable work and time and RISK.

I wish you the best.

 

[Doctorsoon2011]

I can also recommend WCI. I have been following the blog for years. You will be far ahead of your peers if you make this a regular read (start at the "Start Here" page).

Personally, I have always found it hard to consider taking on the risk of your own practice - its a big risk. One of the major perks of going to medical school - low risk of change in your high income. If you apply some sound personal financing you will be more then fine without any added risk. Have I lived it, no. Do I know it to be true, yes.

 

[Merely]

I can also recommend WCI. I have been following the blog for years. You will be far ahead of your peers if you make this a regular read (start at the "Start Here" page).

Personally, I have always found it hard to consider taking on the risk of your own practice - its a big risk. One of the major perks of going to medical school - low risk of change in your high income. If you apply some sound personal financing you will be more then fine without any added risk. Have I lived it, no. Do I know it to be true, yes.

As an employee, you will never make 500k+ or anything close. If money is not important to you then being an employee is a good gig. Some of us want to make a lot and be entrepreneurial but for others it's not so important.

 

[Doctorsoon2011]

You will always have the potential for more reward when taking on more risk. Just dont sugar coat it, you are taking a hypothetical "more money situation". You are exposing your income to a lot more risk.

Personally, if I wanted to be an entrepreneur I would of developed those skills for ten years instead of my medical skills. There are are many people that make this world go around and the option is fine, just know what you are doing.

 

[TedStark]

Anyone (with a practice) care to comment on the ideal set up? Mid levels vs none. How many partners, etc?

 

[VA Hopeful Dr]

Anyone (with a practice) care to comment on the ideal set up? Mid levels vs none. How many partners, etc?

There's no single "ideal" universal practice. Everything depends on location, payer mix, your personality, what your scope is going to be, and so on.

 

[TedStark]

Anyone (with a practice) care to comment on (their opinion of) the ideal set up? Mid levels vs none. How many partners, etc?

 

[Ericslv]

Anyone (with a practice) care to comment on (their opinion of) the ideal set up? Mid levels vs none. How many partners, etc?

The number of partners you will have will grow with time. Start with one. Then you can choose to just hire docs or give them partnership. Mid levels should be your last choice. By the way it's getting just as hard to get a mid level to do primary care as it is a doctor.

I would approach starting a practice as if I were a dentist except without all the high start up cost.

Most dentist that start their own practice are cash based or out of network and go deep in debt to do it.

Stating a practice as a physician (primary care) won't cost you as much and you will be able to grow it slowly. Be prepared for working 12 -16 hrs a day for some time.