Anyone here who started their own private practice?

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cyanide12345678

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How did you get patients? Did you send mailers? Just word of mouth?

I’m basically about to start my concierge weight loss clinic. Have only spent maybe $1500 so far and have website 80 percent done, emr is set up with full tele med capability, lab portal is set up. But once i got a quote for malpractice insurance, I’m starting to get cold feet.

The quote was for $5600, and that’s in fact for part time practice. And it’s a claims made policy so if i fail at the business or if it’s not making sense from a return on time perspective then I’ll have to purchase tail coverage that’s going to be 2 x annual premium. And not to mention the policy has a $2500 deductible.

Waiting on other malpractice firms to get back at me, hoping to get some occurrence based policy. But starting to get jitters and second thoughts since this is starting to be decent money and I’ve never been the most successful business entrepreneur. Customer acquisition i just suck at.

So…. Anyone who has run their own clinic, how in this world did you get patients???

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Are you boarded in obesity medicine? Would that lower the malpractice costs?
 
How did you get patients? Did you send mailers? Just word of mouth?

I’m basically about to start my concierge weight loss clinic. Have only spent maybe $1500 so far and have website 80 percent done, emr is set up with full tele med capability, lab portal is set up. But once i got a quote for malpractice insurance, I’m starting to get cold feet.

The quote was for $5600, and that’s in fact for part time practice. And it’s a claims made policy so if i fail at the business or if it’s not making sense from a return on time perspective then I’ll have to purchase tail coverage that’s going to be 2 x annual premium. And not to mention the policy has a $2500 deductible.

Waiting on other malpractice firms to get back at me, hoping to get some occurrence based policy. But starting to get jitters and second thoughts since this is starting to be decent money and I’ve never been the most successful business entrepreneur. Customer acquisition i just suck at.

So…. Anyone who has run their own clinic, how in this world did you get patients???
I didn't do just obesity medicine so take this with a grain of salt.

Most effective thing I did by far was radio ads. Spent a large amount of money on it (we're talking 15k/month or so) but I went from 5-10 new patients per month before that to 40-50 per month after.

I also had the advantage of being the first and only DPC practice in the area so it was new. You're entering a busy market so you'll need to figure out what makes you different from the 10 other obesity clinics in your area. If there are none, will be easier.
 
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How did you get patients? Did you send mailers? Just word of mouth?

I’m basically about to start my concierge weight loss clinic. Have only spent maybe $1500 so far and have website 80 percent done, emr is set up with full tele med capability, lab portal is set up. But once i got a quote for malpractice insurance, I’m starting to get cold feet.

The quote was for $5600, and that’s in fact for part time practice. And it’s a claims made policy so if i fail at the business or if it’s not making sense from a return on time perspective then I’ll have to purchase tail coverage that’s going to be 2 x annual premium. And not to mention the policy has a $2500 deductible.

Waiting on other malpractice firms to get back at me, hoping to get some occurrence based policy. But starting to get jitters and second thoughts since this is starting to be decent money and I’ve never been the most successful business entrepreneur. Customer acquisition i just suck at.

So…. Anyone who has run their own clinic, how in this world did you get patients???
Is the $5000 in addition to the malpractice insurance you pay for EM, or are you no longer doing EM and it’s your total for the year ?

If that’s your total premium, that’s nothing, even at $5,000 per six months. If it’s in addition to part time EM work, they should not be charging you extra. If you subtract out half an FTE of EM work and replace it with half an FTE of obesity medicine, there should be no increase in liability for you or them. In fact it should go down. You carrier either covers you for you full time work as a doctor or they don’t. Since when did seeing a handful of obesity patients instead of a handful of ED patients increase your med mal risk?

I’d get a second quote.

Either way, in the grand scheme of things, $5K in the midst of a business startup is nothing. I was six figures in the hole by 9 months ago into my practice and it took me a long time to dig out. It was a scary time, but I came through the other end better off for it.
 
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As far as ads, I’ve been lucky enough to get by with mostly word of mouth and a built-in referral base of sorts, since I’m not 100% solo. I did run a newspaper ad when I started, that worked well, but that was when our local paper still had decent circulation, which it no longer does. I wouldn’t do the same, if I had to do an ad now.

I’ve seen a couple competitors do billboards that I have to think are very effective since they’ve kept them up a long time. TV infomercials can be very effective but expensive; unless, you can get a local station to interview you for free. It wouldn’t be an ad, just a public interest thing. Call a station and see. They often need to fill time and how to lose weight and improve health is always of interest to people. The new meds are hot, too, so I bet they’d consider it.

One pcp around me does a local radio show for one hour on the weekend, as a host. I’m not sure if he gets paid by the station as a radio host or if he pays them and it’s an ad. But it plays like an actual radio show, on “interesting” medical topics, primary care related.

There’s always the internet. That’s where people stick their eyes the most. Find a way to advertise online. That could be paid ads, or your own free accounts, if you’re good enough at social medial to get viral on your own.
 
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I think you can get boarded in obesity medicine even if you can't it sounds like a good idea. It is like 60 CME credits which I think more fields should be like similar to cosmetic derm with botox. A PA I used to work with left the ER and made a testosterone business and he is making $$$$

Even during covid a group of EM and PAs started a covid testing business and made millions even though that business doesn't exist anymore.

if you do something really specific like Life extension medicine and prescribe statins and blood pressure medication and refuse to see anything else you can find a good market.
 
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Nope. This is assuming board eligible in obesity - i just have to go through a course and get 60 CMEs.
I am interested in your journey. I've completed all the CME and will sit for the exam in the fall, however i really have no idea what to do with this extra little badge.
 
I think you can get boarded in obesity medicine even if you can't it sounds like a good idea. It is like 60 CME credits which I think more fields should be like similar to cosmetic derm with botox. A PA I used to work with left the ER and made a testosterone business and he is making $$$$

Even during covid a group of EM and PAs started a covid testing business and made millions even though that business doesn't exist anymore.

if you do something really specific like Life extension medicine and prescribe statins and blood pressure medication and refuse to see anything else you can find a good market.

Notsurprised a midlevel would persue TRT business as the ethics are incredibly shady.

There's a narrow indication for TRT (true lab confirmed hypoT) and patients in the normal range who are "tired" or can't get it up, but T levels are in normal range, should not be prescribed TRT. Doing so has strong risks like profound central hypogonadism once they come off the med.
 
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I didn't do just obesity medicine so take this with a grain of salt.

Most effective thing I did by far was radio ads. Spent a large amount of money on it (we're talking 15k/month or so) but I went from 5-10 new patients per month before that to 40-50 per month after.

I also had the advantage of being the first and only DPC practice in the area so it was new. You're entering a busy market so you'll need to figure out what makes you different from the 10 other obesity clinics in your area. If there are none, will be easier.
I didn't do just obesity medicine so take this with a grain of salt.

Most effective thing I did by far was radio ads. Spent a large amount of money on it (we're talking 15k/month or so) but I went from 5-10 new patients per month before that to 40-50 per month after.

I also had the advantage of being the first and only DPC practice in the area so it was new. You're entering a busy market so you'll need to figure out what makes you different from the 10 other obesity clinics in your area. If there are none, will be easier.

There are 4-5 physical obesity medicine clinics in my area but I’m going to be 100 percent telemed so have less geographical restriction compared to these physical locations. One of them does Radio ads very effectively and has a practice with multiple NPs. But they charge $1100 for 10 mg of semaglutide. I’m pricing myself significantly lower than them ~ 650 ish, i pretty much have no over head, once everything is complete my monthly cost to run the thing is $100/mo plus malpractice cost.

How were you getting 5-10 new patients before that?

My biggest hesitation is if I’m working part time, whether spending 15k is going to even be worth it. Plus i would assume the lifetime value of a patient will be higher in a DPC practice as compared to medical weight loss.

What was your customer acquisition cost per patient through radio ads and other ad mediums that you used.

Are you still running your dpc practice?

It’s not the 5600 bothering me as much as the fact that if i fail, I’ll have to throw out another 11k on a failed business.
 
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Notsurprised a midlevel would persue TRT business as the ethics are incredibly shady.

There's a narrow indication for TRT (true lab confirmed hypoT) and patients in the normal range who are "tired" or can't get it up, but T levels are in normal range, should not be prescribed TRT. Doing so has strong risks like profound central hypogonadism once they come off the med.

Yes, all the other clinics in the area are ‘whole health clinics’ giving testosterone shots, peptides, b12 etc.

I don’t believe testosterone is a benign thing to be giving blindly. I’m solely focusing on semaglutide and tirzepatide. Nothing else.
 
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I think you can get boarded in obesity medicine even if you can't it sounds like a good idea. It is like 60 CME credits which I think more fields should be like similar to cosmetic derm with botox. A PA I used to work with left the ER and made a testosterone business and he is making $$$$

Even during covid a group of EM and PAs started a covid testing business and made millions even though that business doesn't exist anymore.

if you do something really specific like Life extension medicine and prescribe statins and blood pressure medication and refuse to see anything else you can find a good market.

I do plan to get board eligible in obesity. I’m not sure if I’m taking the boards right now ($1750 to sign up this year) but i plan to go through 60 cme credits through their obesity week course with is only $300
 
Is the $5000 in addition to the malpractice insurance you pay for EM, or are you no longer doing EM and it’s your total for the year ?

If that’s your total premium, that’s nothing, even at $5,000 per six months. If it’s in addition to part time EM work, they should not be charging you extra. If you subtract out half an FTE of EM work and replace it with half an FTE of obesity medicine, there should be no increase in liability for you or them. In fact it should go down. You carrier either covers you for you full time work as a doctor or they don’t. Since when did seeing a handful of obesity patients instead of a handful of ED patients increase your med mal risk?

I’d get a second quote.

Either way, in the grand scheme of things, $5K in the midst of a business startup is nothing. I was six figures in the hole by 9 months ago into my practice and it took me a long time to dig out. It was a scary time, but I came through the other end better off for it.

I already checked with my current malpractice insurance provider, they will not be covering any activities involving my side gig so i have to get my own malpractice.

But yes, it’s 5.6k total, waiting for other quotes, probably will get a few this week. If i could get an occurrence policy for 6-7k I’ll be happy.

You were 100k in the hole? Holy crap! What did you spend your marketing money on and what worked the best for you? Id newspaper ads all you did essentially?

Yeah I’ll probably call some radio shows and see what i can get. I looked at billboards and they were about $3000-5000 per month. Google ads etc can cost $1-2 per click. Ive done google and fb ads in the past for some side gigs, so know how to start and build a campaign, this time around i might use an actual marketer to help out and pay someone.
 
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I didn't do just obesity medicine so take this with a grain of salt.

Most effective thing I did by far was radio ads. Spent a large amount of money on it (we're talking 15k/month or so) but I went from 5-10 new patients per month before that to 40-50 per month after.

I also had the advantage of being the first and only DPC practice in the area so it was new. You're entering a busy market so you'll need to figure out what makes you different from the 10 other obesity clinics in your area. If there are none, will be easier.
At my first job, my hospital set me up with a local healthcare radio talk show and I did an interview with them. It was free and it led to a tidal wave of new patient referrals.
 
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At my first job, my hospital set me up with a local healthcare radio talk show and I did an interview with them. It was free and it led to a tidal wave of new patient referrals.

I guess i would have to call a bunch of radio stations then.

Wasn’t considering radio earlier since i thought it was very pricey, but good to know some of you guys have had free slots.
 
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There are 4-5 physical obesity medicine clinics in my area but I’m going to be 100 percent telemed so have less geographical restriction compared to these physical locations. One of them does Radio ads very effectively and has a practice with multiple NPs. But they charge $1100 for 10 mg of semaglutide. I’m pricing myself significantly lower than them ~ 650 ish, i pretty much have no over head, once everything is complete my monthly cost to run the thing is $100/mo plus malpractice cost.

How were you getting 5-10 new patients before that?

My biggest hesitation is if I’m working part time, whether spending 15k is going to even be worth it. Plus i would assume the lifetime value of a patient will be higher in a DPC practice as compared to medical weight loss.

What was your customer acquisition cost per patient through radio ads and other ad mediums that you used.

Are you still running your dpc practice?

It’s not the 5600 bothering me as much as the fact that if i fail, I’ll have to throw out another 11k on a failed business.
That's the risk of a business and why so many doctors don't do it.
 
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I didn't do just obesity medicine so take this with a grain of salt.

Most effective thing I did by far was radio ads. Spent a large amount of money on it (we're talking 15k/month or so) but I went from 5-10 new patients per month before that to 40-50 per month after.

I also had the advantage of being the first and only DPC practice in the area so it was new. You're entering a busy market so you'll need to figure out what makes you different from the 10 other obesity clinics in your area. If there are none, will be easier.
Are you dpc family med too then? Or is this obesity med a side gig?
 
Is the $5000 in addition to the malpractice insurance you pay for EM, or are you no longer doing EM and it’s your total for the year ?

If that’s your total premium, that’s nothing, even at $5,000 per six months. If it’s in addition to part time EM work, they should not be charging you extra. If you subtract out half an FTE of EM work and replace it with half an FTE of obesity medicine, there should be no increase in liability for you or them. In fact it should go down. You carrier either covers you for you full time work as a doctor or they don’t. Since when did seeing a handful of obesity patients instead of a handful of ED patients increase your med mal risk?

I’d get a second quote.

Either way, in the grand scheme of things, $5K in the midst of a business startup is nothing. I was six figures in the hole by 9 months ago into my practice and it took me a long time to dig out. It was a scary time, but I came through the other end better off for it.

It doesn’t make sense, but it’s the reality. I went through the same thing for a small concierge/urgent care gig. Seeing 10 patients per month max in addition to my ED job. Malpractice started at $4k per year, escalating over 8 by year 5. Plus applicable tail at the end. All the malpractice companies (I contacted a half dozen) were within 8% cost wise. It’s either collusion or their actuaries all went to the same night school.

Malpractice carriers are just like every other insurance sector in America: predatory, out to make big bucks, and we are the prey.
 
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You were 100k in the hole? Holy crap!
Primarily from having to buy a C-arm and build an in-office procedure suite (leaded walls, other equipment, radio-frequency machine, epidural trays, etc).

I didn’t spend much on advertising, but I share a building with PCPs and because of that didn’t need to spend much. It’s sort of a built in referral base.
 
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@cyanide12345678

P.S. I wasn’t 100% solo and didn’t have to put the money up myself. However, I did sign a somewhat risky contract with my group (who put up the startup money) that essentially allowed them to clawback the money, if I didn’t pay back that debt to them. The reason I signed it, is I got them to agree that once the c-arm and other equipment was paid off, I would personally own it outright. That was my Insurnace policy in case I needed to leave an truly start up on my own, 100% solo.
 
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Great comments, appreciate it. Are you all using a compounding pharmacy?
 
How much did you sell it for?

I don’t think EM docs are qualified to do dpc.

We have (had?) an EM doc in our group who left to do concierge DPC. I'll keep tabs on her to see how it works out.
I have my reservations about it as well. Big ones. Especially with this doc; I don't think it's a good fit when you are more high-maintenance than your patient base (being DPC, one has to imagine that these will be high-maintenance patients), but maybe I'm just being a harsh judge of character.
 
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Well, you're perhaps not as qualified as FM or IM, but are you more qualified than an unsupervised NP or PA?

A july 1st intern is more qualified than a PA/NP. Doesnt mean i should be practicing sub par medicine if someone else does it.
 
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Yes, all the other clinics in the area are ‘whole health clinics’ giving testosterone shots, peptides, b12 etc.

I don’t believe testosterone is a benign thing to be giving blindly. I’m solely focusing on semaglutide and tirzepatide. Nothing else.

As some one who does weight loss and HRT in my practice, I would urge you to slowly look into adding other services as well. IMHO, the only way to make money doing solely SGLT/TRZ, is by providing it to people who really aren't candidates, which would put you right up there with those scummy HRT clinics that put everyone on testosterone. You could legit offer nutritional guidance, meal plans, training programs, scheduled weigh ins and other things that would set you apart from looking like pill mill. It would cost no overhead, other than your time to learn it. Just my opinion.

As far as getting patients......I've been open for 3 years and this is what I've learned.....95% bang for the buck these days is FB and IG. Radio and TV are very expensive and dont even come close to touching my cost per lead from FB and IG. Billboards are a luxury, and we are finally getting one, but it isnt really to drive buisness. Everyone knows who we are now, and now it is really just about keeping a visual presence in the community. When we started I would go on IG, go to my competitors pages, go to their followers and like a couple of their pictures. I did this at least once a day. I got so many patients/followers this way and it cost me $0.

Other than that, I hired a marketing company, that created and managed the ads on those platforms. I had a grand opening with local DJs free booze.....all hyped and advertised by my marketing company. We also became involved with our local medical societies and sponser fundraisers. This helped us be seen as a legit part of the medical community.

Most importantly, is just be good at what you do. Marketing just gets'em in the door, you determine whether or not they come back
 
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As some one who does weight loss and HRT in my practice, I would urge you to slowly look into adding other services as well. IMHO, the only way to make money doing solely SGLT/TRZ, is by providing it to people who really aren't candidates, which would put you right up there with those scummy HRT clinics that put everyone on testosterone. You could legit offer nutritional guidance, meal plans, training programs, scheduled weigh ins and other things that would set you apart from looking like pill mill. It would cost no overhead, other than your time to learn it. Just my opinion.

As far as getting patients......I've been open for 3 years and this is what I've learned.....95% bang for the buck these days is FB and IG. Radio and TV are very expensive and dont even come close to touching my cost per lead from FB and IG. Billboards are a luxury, and we are finally getting one, but it isnt really to drive buisness. Everyone knows who we are now, and now it is really just about keeping a visual presence in the community. When we started I would go on IG, go to my competitors pages, go to their followers and like a couple of their pictures. I did this at least once a day. I got so many patients/followers this way and it cost me $0.

Other than that, I hired a marketing company, that created and managed the ads on those platforms. I had a grand opening with local DJs free booze.....all hyped and advertised by my marketing company. We also became involved with our local medical societies and sponser fundraisers. This helped us be seen as a legit part of the medical community.

Most importantly, is just be good at what you do. Marketing just gets'em in the door, you determine whether or not they come back
What is your gross income after overhead?
 
What is your gross income after overhead?
maybe i'm misunderstanding, but gross after overhead would be net. Our gross is usually anywhere from 40-60k/month. I personally usually take home about 5-10k/month from it, for about 30hrs/month in office
 
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maybe i'm misunderstanding, but gross after overhead would be net. Our gross is usually anywhere from 40-60k/month. I personally usually take home about 5-10k/month from it, for about 30hrs/month in office

Wow that’s a lot of overhead.

How much time are you spending in total including running the business, managing employees, figuring out marketing, figuring out ways to friends etc.

Do you think it’s worth it for 10k take home?
 
Wow that’s a lot of overhead.

How much time are you spending in total including running the business, managing employees, figuring out marketing, figuring out ways to friends etc.

Do you think it’s worth it for 10k take home?
We actually run pretty lean, but it adds up quickly. 15k for payroll, 3k for supplies, 5k for rent, 6k for advertising, 1k for software, etc. 5k-10k is what I take home for what i'm paid for my services. That doesn't include my distributions. I'm only there seeing patients 4-5 days a month for 6 hrs a day. My wife is the office manager who takes a salary as well, so she runs it. I have 2 partners and we were able to start up with only 300k. No loan. So I have only 100k in it. Its been worth it to me, because now Im working 25% (soon to be 30%) less in the ER, which means more time with my family. more weekends. more holidays. more nights. I make my own schedule, I work when I want, and it makes money when im not there. If you would've asked me that the first year and a half when we were not making enough for me to pay myself, I may have given you a different answer lol. This was not a career change, as much as an addition to my professional portfolio. I have income from the ER, nursing home, hospice, real estate and my practice, with more on the way. It really just gives me options, which, given the state of EM, is probably the best thing one can have going for them. My goal is to get down to working 4-6 shifts/mth in the ER, grow my other ventures and be able to pull 600k/yr. I'm getting close.
 
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We actually run pretty lean, but it adds up quickly. 15k for payroll, 3k for supplies, 5k for rent, 6k for advertising, 1k for software, etc. 5k-10k is what I take home for what i'm paid for my services. That doesn't include my distributions. I'm only there seeing patients 4-5 days a month for 6 hrs a day. My wife is the office manager who takes a salary as well, so she runs it. I have 2 partners and we were able to start up with only 300k. No loan. So I have only 100k in it. Its been worth it to me, because now Im working 25% (soon to be 30%) less in the ER, which means more time with my family. more weekends. more holidays. more nights. I make my own schedule, I work when I want, and it makes money when im not there. If you would've asked me that the first year and a half when we were not making enough for me to pay myself, I may have given you a different answer lol. This was not a career change, as much as an addition to my professional portfolio. I have income from the ER, nursing home, hospice, real estate and my practice, with more on the way. It really just gives me options, which, given the state of EM, is probably the best thing one can have going for them. My goal is to get down to working 4-6 shifts/mth in the ER, grow my other ventures and be able to pull 600k/yr. I'm getting close.

What else are you doing other than glp1 agonists?

Are you doing compound semaglutide ? Does the fact that novo sued a few people scare you?
 
We actually run pretty lean, but it adds up quickly. 15k for payroll, 3k for supplies, 5k for rent, 6k for advertising, 1k for software, etc. 5k-10k is what I take home for what i'm paid for my services. That doesn't include my distributions. I'm only there seeing patients 4-5 days a month for 6 hrs a day. My wife is the office manager who takes a salary as well, so she runs it. I have 2 partners and we were able to start up with only 300k. No loan. So I have only 100k in it. Its been worth it to me, because now Im working 25% (soon to be 30%) less in the ER, which means more time with my family. more weekends. more holidays. more nights. I make my own schedule, I work when I want, and it makes money when im not there. If you would've asked me that the first year and a half when we were not making enough for me to pay myself, I may have given you a different answer lol. This was not a career change, as much as an addition to my professional portfolio. I have income from the ER, nursing home, hospice, real estate and my practice, with more on the way. It really just gives me options, which, given the state of EM, is probably the best thing one can have going for them. My goal is to get down to working 4-6 shifts/mth in the ER, grow my other ventures and be able to pull 600k/yr. I'm getting close.
In a post previous to this you said you were putting in 30 hrs/week. Extrapolating out to 1 month that is 120 hrs/month. Could you clarify what you are doing the other hrs for this practice/business?
 
In a post previous to this you said you were putting in 30 hrs/week. Extrapolating out to 1 month that is 120 hrs/month. Could you clarify what you are doing the other hrs for this practice/business?
It says 30 hrs/month.
 
It says 30 hrs/month.

Ah he fixed it. Thanks for checking. Original post attached
IMG_5539.jpg
 


Saw this on the EM Reddit. Somewhat shady, in my opinion. Why not be honest and say it's yours for sale instead of trying to pretend it's an opportunity you're looking into hoping someone buys this from you?
 
I think weight loss could be a big money maker if you are able to jump on this fast. In a yr or two, there will be many popping up run by remote docs and NPs in house. This always happens. When there is money to be made, docs rush to make it until it becomes an equilibrium.

Jump in fast, make fast money, then when it dries up you can weather competition closing, and find that happy income.
 
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Saw this on the EM Reddit. Somewhat shady, in my opinion. Why not be honest and say it's yours for sale instead of trying to pretend it's an opportunity you're looking into hoping someone buys this from you?


Reddit doesn’t allow for sale posts, got moderated earlier and post was auto blocked. Makes more sense to post for sale than open up a business model to dozens of critics lol.

I have it listed at a slight loss and doesn’t take into account of how much time went into it. A part of me still wants to do it and want to cancel the listing, i think it’s a financially feasible business model.
 
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Reddit doesn’t allow for sale posts, got moderated earlier and post was auto blocked. Makes more sense to post for sale than open up a business model to dozens of critics lol.

I have it listed at a slight loss and doesn’t take into account of how much time went into it. A part of me still wants to do it and want to cancel the listing, i think it’s a financially feasible business model.
In your original post you say you have $1500 into it and listed it for $2350. That isn’t a slight loss, not including your time, as you say.

Regardless, this is a space full of people who don’t really care about health, they just want to make money. While a business needs to be profitable to stay in business, it’d be nice to see more people in the space who care. While I have no personal qualms, I just found it to be amusing.
 
I think weight loss could be a big money maker if you are able to jump on this fast. In a yr or two, there will be many popping up run by remote docs and NPs in house. This always happens. When there is money to be made, docs rush to make it until it becomes an equilibrium.

Jump in fast, make fast money, then when it dries up you can weather competition closing, and find that happy income.
Only if you're doing shady stuff.

I know very few PCPs who aren't willing to prescribe the newer weight loss medications. Insurance will usually cover office visits for this purpose as well.
 
In your original post you say you have $1500 into it and listed it for $2350. That isn’t a slight loss, not including your time, as you say.

Regardless, this is a space full of people who don’t really care about health, they just want to make money. While a business needs to be profitable to stay in business, it’d be nice to see more people in the space who care. While I have no personal qualms, I just found it to be amusing.

$1500 is cost of hosting, design, development, emr, logo design, favicon design, stock images and AI generated images. Rough back of the napkin estimate.

Doesn’t include the cost of the actual domain purchase which was several months ago or the money i spent to buy semaglutide to see what the package looks like and what the customer experience is and to test out the prescribing portal. And figure out the number of days for order processing and shipment.

Also flippa will charge a 10 percent completion fee in addition to their $40 listing fee. That’s also not accounted for.

Plus you assume it’s going to sell for list price, im assuming probably 1500-2000 after negotiation.

So a $2000 sale is basically $1760 take home.

So yeah, small loss. And the developer didn’t write the content - i did. That was so much time and effort.
 
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$1500 is cost of hosting, design, development, emr, stock images and AI generated images. Rough back of the napkin estimate.

Doesn’t include the cost of the actual domain purchase which was several months ago or the money i spent to buy semaglutide to see what the package looks like and what the customer experience is and to test out the prescribing portal. And figure out the number of days for order processing and shipment.

Also flippa will charge a 10 percent completion fee in addition to their $40 listing fee. That’s also not accounted for.

Plus you assume it’s going to sell for list price, im assuming probably 1500-2000 after negotiation.

So a $2000 sale is basically $1760 take home.

So yeah, small loss. And the developer didn’t write the content - i did. That was so much time and effort.
I can only go by what you say. I guess when you say you “have only spent maybe $1500 so far” you don’t really mean that. Just goes to show most people underestimate their own true startup costs and/or don’t take them into account and can’t calculate a true rate of return.
 
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I can only go by what you say. I guess when you say you “have only spent maybe $1500 so far” you don’t really mean that. Just goes to show most people underestimate their own true startup costs and/or don’t take them into account and can’t calculate a true rate of return.

i agree, the initial number was just a rough estimate. Didn’t even put much thought into it when i posted, wasn’t even thinking of selling at the time, was just thinking of the cost of malpractice, cme cost to become board eligible, board certification cost, tail coverage cost and the marketing cost. Those were the bigger numbers that made me pause and really evaluate what i wanted to do.
 
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i agree, the initial number was just a rough estimate. Didn’t even put much thought into it when i posted, wasn’t even thinking of selling at the time, was just thinking of the cost of malpractice, cme cost to become board eligible, board certification cost, tail coverage cost and the marketing cost. Those were the bigger numbers that made me pause and really evaluate what i wanted to do.

How much are you estimating for costs?

You seem decently risk tolerant (based on your other posts in the forum), so it's not fully clear to me why you're backing out of this one, unless the costs truly are very high.
 
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How much are you estimating for costs?

You seem decently risk tolerant (based on your other posts in the forum), so it's not fully clear to me why you're backing out of this one, unless the costs truly are very high.

Believe it or not, my options trading is actually much less risk than owning Sp500. At least right now. So while i have taken significant risk in the past, but those were very measured and calculated risks where downside was extremely protected and long term i was always going to make money. My risky bets were extremely asymmetric risk vs reward.

For example:

When meta went from $380 to $120, i made a massive bet on the sell off being overblown and the company being undervalued. The sell off was for 2 reasons - they were spending too much on the metaverse (totally in their control to stop that), and their user growth had stalled (2 billion daily active users but weren’t quite getting more users). For this, a 70 percent drop had happened and meta was trading at a price to earnings ratio of 9. This was a company with 2 billion daily users, 40 billion or whatever in the bank, and 30 billion of positive cash flow a year despite increased expenses. They were trading at a P/E ratio of 9 when their peers were trading around 20-35 P/E ratio. Screaming undervalued. I went really big when it was $120. They missed earnings, went to $90-100 for a couple weeks, i took 60k of unrealized loss in that week. Doubled down because the hypothesis still existed. Dropped my strike prices to $70, collected more premium and basically went all in. That’s risky right? But is it really? My worst case scenario was buying meta for $70 which was the price in 2014. A megacap with billions of assets and so much cash flow and 1/4th of the world as their customer. Literally the book value of meta was a share price of $60 ish. Imagine buying a megacap profitable giant for book value (literally the price of the money in the bank plus physical assets - while the userbase, the intellectual property, the on going income is free). And as history has shown meta reversed course on expenses, did lay offs, and Boom! As expected, went back to being priced appropriately. So was it a risky play having 240 contracts for $70 strike when it was trading around $90-100 (the lowest price in 7 years time). You tell me. It was always going to make money, the question just was - when was the reversal going to happen. See attached old screenshots from November when i held 240 contracts of meta and the associated premium with it. From November 6th to November 14 meta made me about 75k after announcing layoffs and expense control. Was it risky? Doing the same trade when meta is at $300 could be risky - but when it’s already hammered, is it really that risky? More like an opportunity of a lifetime, now if i was truly someone who took risk, i would have bought calls, rather than sold significantly out of the money puts that were literally near book price. If i had bought calls, gone all in, id probably have 5-10 million right now on that one trade. But i don’t have those kind of balls to buy calls.

So…with that in mind, let’s answer your actual question.

The costs were probably the following:

5600 1st year malpractice. 2500 deductible. Likely 15-20 percent increase year 2.

2 years of premium for tail coverage if i failed at the business model and had to close shop

$2500 to get board certified plus time to study. $1750 for exam cost, $300 for 90 cme through obesity week, $350 ish for rosh review before boards.

$1000-2000 per month for someone to manage and create the google ads And Facebook ads plus cost of ads.

Cost of above ads would be around $2000-3000 per month, but can rev up or down as needed.

And if i have the balls to do a billboard then it’s $3000-5000 per 4 week period depending on location.

16-18 cents per mailer if i sent one. Around 6-7 cents if i put it in a mailer like valpak.

When you start counting all the expenses, casually starting a side gig while having a full time job, a 3 year old, and a new born on the way, becomes a less attractive proposition. I mean….i can do it. But do i really want to work full time, go home to a crying infant, spend time with my daughters, and somehow find time to be successful at a business? I lack motivation and passion to do 80 hours a week of work now. There’s no motivation to do it. I have money, i have a great home, i have a good life. This year my family income will be north of 850k…the extra 100-150k that i could add working 15 ish hrs a week, after covering for costs and taxes, is basically just not worth it.

Plus Can i compete with other businesses in the area working 15-20 hrs a week, a half hearted effort essentially? Probably not. when it’s time to put real effort, do the work, slog through, i just don’t feel motivated. I’ve already done that for med school which got me here, but i don’t have it in me to do it again (unless i get extrinsically motivated again by losing everything).

The last straw was reading that novo sued a couple of compound pharmacies. The way around it is basically taking out the brand names ozempic/wegovy and replacing with glp1 agonist as a generic term and placing a disclaimer that it’s not to be confused with those brands - that’s what other companies are doing. But i also came across a news report where people got some fungal infection from a compound med from some pharmacy due to poor sterilization. That was the last straw. 1000s of people do it though. They do it for the money. There are so many clinics that are doing this. I set it up with the same greed as others, wanted to make money. But now that I’ve reflected on it, it’s not worth it. It’s not a business for me.
 

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When you get older and more settled financially, time becomes much more important.

When I first started RE 7 yrs ago, my goal was to have 25 homes/doors paid off when I am 60 and just live off the 300K cash flow. I am 50 easily could get to 25 in 10 years but there is a time costs. The extra work is just not worth it and I am starting to think of selling some towards other investments that are more passive.
 
I'm family med, not EM, but started my own DPC nine years ago. It wasn't that hard other than supporting my family during the transition.
 
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I'm family med, not EM, but started my own DPC nine years ago. It wasn't that hard other than supporting my family during the transition.

Did you set it up such that you dispense medications for a very low cost to your patients as well?
 
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