a guide to starting a successful practice? anywhere?

[Dr McSteamy]

is there some kind of resource that guides newbie licensed FP docs on how to start an efficient successful private practice?

this appears to be the biggest complaint- no biz training.

wouldn't it be nice if residents could come out and hit the ground running...

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[AwesomO]

May not be exactly what you are looking for but the Dr. at Patmos Clinic has a self start up guide for those wanting to do a low overhead practice.

http://www.patmosemergiclinic.com/

Click on new clinic manual.

 

[deleted87716]

See my response in this thread: http://forums.studentdoctor.net/showthread.php?t=511198

 

[Doowai]

May not be exactly what you are looking for but the Dr. at Patmos Clinic has a self start up guide for those wanting to do a low overhead practice.

http://www.patmosemergiclinic.com/

Click on new clinic manual.

I did not get to read his entire manual before my computer did something funny, but he and I have similar ideas. He says he runs his clinic something like 8-1 M-F, and 9-1 on Sat. He only has one staff person, and together they handle all the volume. I think that is brilliant - the guy thinks like a chiropractor.

However I would never ever ever in a million years have just one staffer. I always want two - in case one goes kookoo you can fire them and have one person to depend on. I had a clinic that was designed to be slow and give me plenty of time off - I worked it about 15 to 20 hours per week ( 8-noon and 3 - 6 three days per week). I hired 2 people to work it - one in the morning and one in the afternoon. [I also had one staff person who only did billing, but that was nothing - she came in once a week and pushed a button basically and transmitted it electronically. The software did most of it from the daily transactions. SHe only had to update the diagnosis codes.]. But with 2 people, if someone goes kookoo you can fire then and just ask the other person to fill in as much as possible until you hire someone new.

Obviously Dr. Patmos who wrote the guide had someone go kookoo - near the bottom of his list, way down below the new clinic guide, he has a button that reads "backwoods justice". It tells about how his receptionist embezzled $60,000 from him - that is kookoo. I had something similar happen once. I will share how I reduce the risk of embezzlement in my "16 years..." thread. If he fired her right away after finding out she was stealing (which I am assuming he did), then he is left in a little pinch without a trained person at the desk - but since she does not work in a nursing capacity or do insurance billing its not that big of a deal.

But each time you hire staff, the overhead goes up to cover their salary - then you need to see more patients to pay that salary - and as you see more patients your overhead goes up due to more supplies you have to buy, and more cost from being open longer - and it snowballs. Patmos obviously has struck a balance between work and private life - how can I serve my sick patients well, make good money, yet have enough free time to really enjoy life. Patmos looks like he works about 34 hours a week - that is essentially retired in practice, which is a point I have tried to stress in my 16 years thread. I think his ideas are pretty good. If the economic environment stays roughly the same you should not have to work more than 30 hours per week to make $100-200 as a FP - chiropractors do it all the time.

 

[deleted87716]

He says he runs his clinic something like 8-1 M-F, and 9-1 on Sat. He only has one staff person, and together they handle all the volume.

I'm not sure he's really "handling" it all that well, however. He states that he's actively looking for another doctor to share the workload, and readily admits that he is "not accessible to patients outside of clinic hours," which implies that he has no after-hours call coverage. IMO, this is unacceptable.

See: http://www.patmosemergiclinic.com/DoctorNeeded.html

The semi-retired solo doc, cash-on-the-barrel, limited-hours, walk-in clinic model may work for some patients, but it's not a panacea, and certainly isn't the be-all-end-all for the future of family medicine. We can do better.

 

[Doowai]

I'm not sure he's really "handling" it all that well, however. He states that he's actively looking for another doctor to share the workload, and readily admits that he is "not accessible to patients outside of clinic hours," which implies that he has no after-hours call coverage. IMO, this is unacceptable.

See: http://www.patmosemergiclinic.com/DoctorNeeded.html

The semi-retired solo doc, cash-on-the-barrel, limited-hours, walk-in clinic model may work for some patients, but it's not a panacea, and certainly isn't the be-all-end-all for the future of family medicine. We can do better.

I am sure he has his headaches. About the time I opened my first chiropractic business, we had our first child. I was a chiropractor, studying acupuncture, and so my wife had a natural childbirth - she wanted to as well. No drugs. I found a T-shirt that read : Natural childbirth and owning your own business. 2 of the most over rated things. (or something like that).

After 16 years, I got sick of owning my own business. If the copier broke it was my headache. If the toilet got clogged it was my headache. One reason (not the main reason , but one of the reasons) I wanted to become an MD was so I could simply be employed and salaried. I can leave when my shift is done, and if the toilet clogs - its not my problem.

I would always have some sort of business of my own. So that I can enjoy some life that is not taxable. There is no law that says a business ever has to make money, just that you try. When my chiropractic business was booming I ran a martial arts school. I had studied martial arts since 1972, and was obsessed with it until like 1998 (Okay, admittedly I am geeky). My martial arts business never made a profit - I tried to, I tried to gain more students, I charged etc - but it never made a profit. I used my income to pay for my journeying around the country to learn from great masters - I spent thousand and thousands a year on trying to learn from every great master from California to Virginia. Those trips were all legitimate tax decutions because it was continuing education for my martial arts business - my martial arts business never came close to making a profit - which allowed me to legally write off even more income.

If you are a salaried MD making $150K, and you have a hobby business of teaching people to race boats - you have business expenses of the boat etc etc etc, all of which become business expenses and therefore non-taxable. You need an accountant, since what I am saying is not entirely accurate since I am not a tax professional- but you get the idea

But despite any difficulties Patmos may have handling it, he is only working 34 hours per week and probably making some great money. That is success. Real retirement is not all that great either. I had a medicare based practice for 5 years or so - I cannot count the numbers of time some retired person told me something like "The golden years are very tarnished". Life always has struggles and headaches. But if this guy is trying to get someone to share the work load, he has a successful business. As someone self-employed its always better to be too busy than too slow.