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You do not need 3 years working for someone else to be "ready" to start your own practice. 1 year maybe if you want to see how things are run.
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Yes, that is what I said in
the other thread.
Many residencies are weak or VERY weak on actual podiatry billing and private practice training/exp.
One or two years as an associate in a
good PP is not bad. There is serious learning value.
It is also basically impossible to get onto most plans/hospitals while still a resident (that time gap doesn't matter if family $$, though).
Ergo, the employed year or two can work well. It's best to pick a well-run PP in the target area. This does assume there
not enforceable non-competes in the target state/area... and you will still have a bit of an adversary in the employer once you leave. C'est la vie.
"
There are two ways to learn: your mistakes, or someone else's.
One's cheaper, and one is faster... and they're the same one."
It is a LOT to take on doing the clinical/med/surg right out of training AND doing the biz/admin/boss aspect. That is the main reason to do it stepwise. It can be done fresh out.... but one doesn't know what they don't know. You gain a ton of ideas from working in a good PP... with hopefully mentorship and low consequences. It is rough figuring out your pre-op logistics while having staff interviews or bickering or stealing from you. For that reasoning, I would stagger going solo a bit even if one has the family/own money to start solo right away (I'd say only <10% do). Personally, I staggered it about a decade due to building funds and finding a good place to do it... but you learn all the way at every stop.
...as said in the other thread, for buyouts, the goodwill and its
transfer-ability is what is possibly worth buying (or spending time/money to quicken with a startup office). It is nearly impossible to find buyouts truly worth it, for many reasons. For example: my branding or phone number or my physical location are not too valuable (rent office). My office chairs and instruments and computers and etc are worth very little. The staff or "system" I created is worth little as a buyer would change system and likely lose most/all staff. The facts that my biller is great or I'm on all are plans are not valuable as any buyer would get a new TIN/EIN and get their own systems.
However, the fact that I get 10+ new
patient refers daily and have solid connections in my town and surrounding areas is the value and what is hard to build (or VERY hard to displace as a competitor). My ability (or refusal) to stay a bit to help transfer to a new doc those connections to primary care docs who refer, other specialist docs, hospital folks, current patients, community folks holds the main value. If I share my past marketing successes and intel of the community, that's probably a bit valuable. It's largely subjective.
Overall, there are just so many types of practices. Many podiatrists are successful due to the rep and popularity of the doc; some are skill of the surgeon (rarer procedures or whatever). Those types are
not easily transferable
unless the outgoing doc is highly cooperative and new doc is similar personality/skill. Other podiatry offices are just toenail cutting farms or wound slop Medicaid mills or only-doc-in-town rural ones... that stuff
is fairly transferable... but also very easy to just build from scratch in most places. That is why practices are so hard to put a $ figure onto.
For simple numbers, office value is usually net income (avg of last 3 years) or half gross income (avg of last 3yrs) for the practice... but that's assuming that in that timespan:
- no major docs came/left or reduced/raised hours
- no major location/staff/area/services changes
- no major competitors have moved into area
- new doc can offer same or more services
- old doc wasn't inflating numbers with fraud or nonsense (such as a bunch of "graft" revenue... soon basically not done)
- maybe 3-6 months overlap by old doc to actively transfer goodwill by making introductions and marketing tour with new doc
There are a lot of pricing factors. Any major equipment or furniture or bad/missing stuff could +/- price. Real estate may or may not be included (unlikely for podiatry). There will generally be huuuge difference in valuation by buyer and seller - often rightly so by both of their logic. I've only seen it work fairly well a couple times (both rural "only show in town" type practices, retiring doc sold for a decent price... other one was a too high price imo, but buyer liked it, so that works fine). At the end of the day,
any practice is "worth" the price the seller will accept and buyer is willing and able to pay... Nothing more or less. Hospitals and supergroups buying small/solo pod offices use ebita, yeah (and they actually use it to grind way down on offices they acquire)... but very unlikely for doc to doc sales to use that. All of this is why it's just better to start your own and build it to your own specs an style and liking (whenever she has ideas and feels ready for that). GLuck
