Best medical Specialty for the entrepreneurial minded?

[bobthesun]

By this I mean what specialties are best for setting up a practice and expanding it to become a large multi-million business.

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[RapplixGmed]

I doubt that a practice can ever become a multi million dollar business just because of the fact that as a physician, you make money based, on average, on the amount of hours of mental and physical work you put into diagnosing and treating patients. At best, you can find a few partners and you guys in aggregate will be making >millions but yourself you will be making about the same. Another idea is to actually own the treatment or imaging machines involved in patient care and you can take the payment for device usage but that requires insane capital requirements. You aren't going to become wildly rich from being just a doctor. At least with the creation of healthcare infrastructure, the days of the Mayo brothers are long over.

On the other hand, if you have an idea that you can turn into a product or a company, then you're in business. The problem is that if you are also a doctor on the side, you will almost never have the time to develop this idea and put the enough effort into it to make it work. Remember that most founders work 24/7 and that startups fail the vast majority of the time.

The best specialty is the one in which you will have the most time on your hands to think through your idea until it is ready to go. Even then, you have to decide if you want to quit practice and dive into the great unknown as an entrepreneur or license it away to somebody who will pull it off (you don't get nearly as much money but then again, you're not doing nearly as much work).

If you have skill in investing, it is possible to put the profits from your practice into things that will generate money without you actively working... but if you're interested in that, you might as well go work for wall street but remember, if you're going to invest, it is much better to do it under your own name than your practice's since those things can be taken in a lawsuit.

I am in the process of trying to license some of the stuff I did for research over the summer. Keeping my fingers crossed.

 

[loveoforganic]

I know a plastic surgeon who probably makes millions and whose facilities alone are probably worth >10 million, but good luck establishing yourself to that extent.

 

[Mean Muggin]

By this I mean what specialties are best for setting up a practice and expanding it to become a large multi-million business.

This issue is always on my brain. I think the specialties in which you provide a service for other doctors (e.g. path, rads, other diagnostic-type specialties) are the most conducive to commercialization. From what I've heard, competition is really tough because, unless you've got something new to offer, your competitive advantage boils down to how cheaply you can provide a given service, which is very hard to do for a startup for obvious reasons. But there are a ton of ways around these typical challenges...No matter how you do it, I think you will inevitably have to choose between being a doctor or being a businessman with an MD.

 

[cbrons]

Concierge medicine, but you would have to be pretty business savvy to make it work.

 

[michaelrack]

Sleep medicine. http://www.aasmnet.org/resources/sleepedseries/WinterCourses2010.pdf

 

[MossPoh]

It is going to become significantly more difficult to have your own surgical centers and other things that net lots of money in the future. It has kind of been discovered (and no big surprise) that physician owned facilities are tremendously expensive. It isn't an intentional thing usually, but you do have incentive to use all those expensive new toys when they may not be warranted.

Best bet is probably to use a large percentage of your income as starting capital and investing wisely.

 

[surftheiop]

There is an ER doc in my town who has started 3-4 "private ER's" and I think he makes a killing.

He has scribes and has patient education note packets already pre-made for any typical conditions. I remember going there because I had massive upper jaw pain, he walked in, said hello, asked my problem, looked in my ears - told me I had swimmer's ear, told me what meds I was getting and the scribe handed me a packet with more info than I could ever need about treating swimmer's ear and preventing it. I literally spent about 45 seconds with him, but got more information than I would if he had spent 10 minutes talking with me.

I'm not positive, but I think you have to pay full price up front and then you can get reimbursed by insurance, and if you can't pay they would point you across the street to the "real hospital".

Must be really profitable because he started with 1 and about 5 years later opened 2 more.

 

[bobthesun]

beside and path, rads what else is diagnostic

also i think that making a lab is very much doable...my father was a cytopath and although he was salaried he said he received countless offers for an investor to give him the money to buy the lab if they split the profits.

Don't know the exact percentages but he said it was something like 50/40 cost 50/50 profits, but my dad was planning on retiring in 5 years at that point and did not want to go through the hassle.
1 million dollar down for a lab is very doable!

 

[painmd87]

Sleep medicine. http://www.aasmnet.org/resources/sleepedseries/WinterCourses2010.pdf

I second this.

I work in an 11-bed facility that has not had an empty bed in at least the last 18 months I've worked here. Add to that the clinical visits by the 2 MDs and 2 midlevels (which are negligible in terms of income), the ample amount of research (which is a staggering amount of income), and you've got yourself quite a business. Our boss is very entrepreneurial and has a strong base of referring docs.

Aside from sleep med, specialities where you do a lot of procedures will bring you into the 7-figures. Build an excellent relationship with referring docs and have a well insured patient base and the above-par entrepreneur can get it done.

 

[Kevin Baker]

By this I mean what specialties are best for setting up a practice and expanding it to become a large multi-million business.

I don't think this is specialty specific, but getting heavy into research and patenting some ideas seems like the way to go. I'd look into less researched fields like immunology, but a lot of the big money is going to be in targeted drug delivery systems.

 

[DOwnage]

There is an ER doc in my town who has started 3-4 "private ER's" and I think he makes a killing.

He has scribes and has patient education note packets already pre-made for any typical conditions. I remember going there because I had massive upper jaw pain, he walked in, said hello, asked my problem, looked in my ears - told me I had swimmer's ear, told me what meds I was getting and the scribe handed me a packet with more info than I could ever need about treating swimmer's ear and preventing it. I literally spent about 45 seconds with him, but got more information than I would if he had spent 10 minutes talking with me.

I'm not positive, but I think you have to pay full price up front and then you can get reimbursed by insurance, and if you can't pay they would point you across the street to the "real hospital".

Must be really profitable because he started with 1 and about 5 years later opened 2 more.

So is this guy basically a glorified urgent care doc? I don't quite understand the value he provides if you can go to the hospital across the street. Unless the value you're stating is his pre-made packets of information?

I second this.

I work in an 11-bed facility that has not had an empty bed in at least the last 18 months I've worked here. Add to that the clinical visits by the 2 MDs and 2 midlevels (which are negligible in terms of income), the ample amount of research (which is a staggering amount of income), and you've got yourself quite a business. Our boss is very entrepreneurial and has a strong base of referring docs.

Aside from sleep med, specialities where you do a lot of procedures will bring you into the 7-figures. Build an excellent relationship with referring docs and have a well insured patient base and the above-par entrepreneur can get it done.

This really intrigued me. I never thought sleep med docs made that kinda money before but it's really interesting. What do sleep docs do that pays so well, or is it just the sheer volume of that clinic?

 

[painmd87]

This really intrigued me. I never thought sleep med docs made that kinda money before but it's really interesting. What do sleep docs do that pays so well, or is it just the sheer volume of that clinic?

It depends. My lab is mostly the volume, but the clinical research is an enormous amount of income.

Other sleepdocs are directors for multiple labs that are run by techs/ancillary staff. They simply score the studies at a contract rate ($100-200 per study).

Or at least that is my understanding.

 

[surftheiop]

So is this guy basically a glorified urgent care doc? I don't quite understand the value he provides if you can go to the hospital across the street. Unless the value you're stating is his pre-made packets of information?

Maybe I didn't explain right, its more like a "normal ER" than it sounded, the packs of information were just something I hadn't seen anywhere else and lets him see more patients. He has imaging equipment, can do some labs,etc.

The real value to patients is being able to go in there with broken arm or laceration and get seen in 10 minutes instead of languishing in the ER waiting room surrounded by homeless guys.

Off the website here is what they say:

On-site Imaging
We have on-site imaging capabilities including :
CT Scans
X-Rays
Ultrasound
Echocardiography
Vascular Studies

Laboratory Services
We have the following on-site services :
Cholesterol
Blood Chemistry
Urinalysis
Hematology
Pregnancy
Flu Screen

 

[Mean Muggin]

beside and path, rads what else is diagnostic


1 million dollar down for a lab is very doable!

I was thinking heme/onc because some of them do their own bone marrow biopsies.


I think scavenging is a better option than starting up. That 1 mil will go a lot farther, especially if you can find a desperate owner willing to sell his/her company at a substantial loss.

 

[DoctwoB]

By this I mean what specialties are best for setting up a practice and expanding it to become a large multi-million business.

You don't make multi-millions by talking to patients or even by doing procedures. You get there from ancillary income and facilities fees.

When a surgeon does a case, much more reimbursement goes to the hospital than the surgeon to pay for the facility fees for the OR. If Surgeon owns his own OR, then you make much more money (though with much higher initial investment)

Examples:

-Surgeons owning or partially owning surgery centers
-Urologists buying IMRT machines for radiation therapy in house
-Basically any private practice docs buying CT-s, MRI-s, X-rays (though X-ray reimbursement is relatively minimal)

The list goes on and on.

The downsides to this are:

1. Overutilization and the possibility of abuse by self-referall with a major financial stake in the decision to refer. Costs go up and potentially harm patient with unnecessary care
2. Laws that are increasingly restrictive of physician hospital/surg center/major capital equipment ownership

 

[bobthesun]

2. Laws that are increasingly restrictive of physician hospital/surg center/major capital equipment ownership

what laws are these? what do they prohibit? can someone expand on these? they can't just make a law that says you can't buy your own xray machine, ct, and use it in house...that completely prevents setting up clinics...

 

[DOwnage]

Maybe I didn't explain right, its more like a "normal ER" than it sounded, the packs of information were just something I hadn't seen anywhere else and lets him see more patients. He has imaging equipment, can do some labs,etc.

The real value to patients is being able to go in there with broken arm or laceration and get seen in 10 minutes instead of languishing in the ER waiting room surrounded by homeless guys.

Do you mind sharing what kind of area this type of practice exists in to give an idea of the market necessary to support it?

It depends. My lab is mostly the volume, but the clinical research is an enormous amount of income.

Other sleepdocs are directors for multiple labs that are run by techs/ancillary staff. They simply score the studies at a contract rate ($100-200 per study).

Or at least that is my understanding.

Who pays for these studies?

what laws are these? what do they prohibit? can someone expand on these? they can't just make a law that says you can't buy your own xray machine, ct, and use it in house...that completely prevents setting up clinics...

I know there's a hell of a lot of regulation for building hospitals. I know that a lot of places, you need certificates of need to justify your hospital's existence and at the same time existing hospitals can lobby against you, dragging out the process for years. I heard the whole Certificate of Need idea it was something Nixon came up with to keep health care costs low but it had the opposite effect. I don't know the reasoning behind it although it's likely political, but I see very few privately owned surgery centers in my area. Also, I heard that the health care law made it more difficult for physicians to own hospitals, although it was something I heard in passing. I think setting up clinics is easier, because I hear that more frequently, but setting up your own surgery center has a lot more hoops I believe.

 

[Charles_Carmichael]

You don't make multi-millions by talking to patients or even by doing procedures. You get there from ancillary income and facilities fees.

When a surgeon does a case, much more reimbursement goes to the hospital than the surgeon to pay for the facility fees for the OR. If Surgeon owns his own OR, then you make much more money (though with much higher initial investment)

Examples:

-Surgeons owning or partially owning surgery centers
-Urologists buying IMRT machines for radiation therapy in house
-Basically any private practice docs buying CT-s, MRI-s, X-rays (though X-ray reimbursement is relatively minimal)

The list goes on and on.

The downsides to this are:

1. Overutilization and the possibility of abuse by self-referall with a major financial stake in the decision to refer. Costs go up and potentially harm patient with unnecessary care
2. Laws that are increasingly restrictive of physician hospital/surg center/major capital equipment ownership

It's the technical fees associated with the Linacs that bring in the big bucks. Not IMRT reimbursement itself. That's the benefit of owning your own machines.

However, like you said, these kinds of things will be heavily scrutinized. Look at Urorads, for example. There's a huge thread about it in the radonc forums, several damning articles regarding overutilization of radiotherapy at Urorads centers have been published, etc.

 

[musafirah]

i second everything suggested (and third sleep apnea clinics!!)

and just wanted to add IVF to the list.. shadowed/worked at one of those. get in on the money... plenty plenty plenty of women out there trying to get pregnant (after spending so many years trying to NOT get preggie)

 

[surftheiop]

Do you mind sharing what kind of area this type of practice exists in to give an idea of the market necessary to support it?

Its fairly affluent southern "suburbia", each of the 3 sites is in a different city, each one with maybe 60k people. I think it was a timing issue that allowed him to strike it big, our city had one hospital built like 30 years ago and then the city population exploded. He started these freestanding ER's maybe 8 years ago, but in the last year or so two new "upscale" hospitals opened in town. I don't think he could of established himself had the other hospitals opened before him.

So in summary I would say that if you look for a place where wealthy/upper middle class folks are consistently sitting in the same crowded ER waiting room as the uninsured, "rougher" crowd there may be a market.

 

[C5toC9]

dermpath

 

[BigRedBeta]

Sleep medicine. http://www.aasmnet.org/resources/sleepedseries/WinterCourses2010.pdf

Co-sign, especially if you'd open a center that would include children (which you would because why would you cut out a whole section of your potential clients when you're so business savvy).