I won’t answer everything but will share some thoughts from my point of view and experience.
New doctors are excited and ready to enter the real world. They tend to look at things in the near term. Land a job. Get the highest gauranteed paycheck. Get nice benefits. Buy a house and a nice car. Maybe get married or start a family. Its an exciting times as it should be.
But after a few years, the check doesn’t seem big enough. Reality sets in that what seemed like a lot of money when u had none, isnt that much once you have it. All the little things start to eat at you. Having someone else have control over you, telling you what to do, when you think you know better than your superior what is best for your patients. The driving, the hours, the call schedule, all of which was no problem starts to become inconveniences. This is the time when many venture off on their own, or go somewhere else, or renegotiate the contract. The grass always seems greener elsewhere and much greener if you control your own destiny.
Then towards the tail end of your career you become worn out by all the detractions required in running your own business. The stress of meeting payroll. Policy manuals. OSHA. Audits. Accounts receivables. Chasing past due balances. Everything costs money. Everything eats at your time. And you feel the burden of working harder for less. And you realize this business you spent so much time building really isn’t worth much if you were to sell. This is the time doctors sell out to hospitals, merge with groups, look for second careers, or simply burnout. Doctors just want to get back to the basics and take care of patients, doing what they loved to do in the first place.
So it seems to be a cycle. Nobody’s fault. Its just the natural progression of what your needs are at the time, and those needs change as you change. Of course there are a billion possible exceptions. And certainly I don’t want to paint a picture of gloom and doom.
Getting in insurance plans take a long time. My advice is hire someone that has done it. And make sure they stay after it with phone calls persistently. Because emails and faxes and voice mails seem to get lost rather conveniently. How long will it take? Months at the least.
location matters to some degree for patients. But i dont think being on the main drag is important. It’s helpful to be next to, across from, behind, a block away from, something. Be close to something where everybody knows where that is. Patients will gladly drive a couple blocks off the main line to see you. But what does matter is convenience. Make sure there is plenty of parking. Makes sure they don’t have to walk far. And make absolutely sure they don’t have to take stairs or elevators. Because if you don’t honor those things, you will hear about it all day long. The competitor that has no steps, no elevator, parking ten feet from their door will make your practice harder to attract patients.
healthcare always changes. The future is value (quality) based care. This will force the hands of primary care doctors who they refer to. How exactly I don’t really know yet. But to be prepared, I would seriously consider being in the same building, same surgery center, same group, or something that makes the relationships a little more secure.
with staffing, including billing, my advice is as much as cost permitted, dont put any one position on one person. Always try to cross train staff. because employees will get sick, maternity leave, vacation, and some will leave. If you have one biller and that person is gone, it stops the whole billing process. Finding well educated and experienced podiatry billers is hard. For that reason I would recommend hiring a billing service to protect yourself. But if you have someone, just be sure u Pay them well and make them feel appreciated. And that’s true for all your staff. The downside is, billing companies aren’t right there in your office, many don’t take patient billing calls. And many wont actually review your notes nor do your codes. So you may still want a coder who can also take billing calls and complaints.
$100-$125 per patient I think is high. Mine is about $90. Payer mix, population demographics, how u practice all affects this.
probably the biggest piece of advice I have that I wish someone told me 25 years ago when I started is....practice today like you want to be practicing 25 years from now. If you want to work four days a week, start out that way. If you don’t want to spend the day cutting toenails 25 years from now then don’t be doing it today. If you want to take vacations and travel, then do it now. If you don’t want to be open nights and saturdays, don’t do it now. Its easier to add something in later rather than take something away.
