Buying a practice

[icebreaker32]

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Don't hospital ER and urgent care centers already do this routinely. Send the private insurance to their own group or friendly docs for follow up and send medicaid or self-pay to others. Quid pro quo is imbedded in every aspect of society. Nothing new to see here.

To an extent. Hospitals probably have a bit more oversight these days. Most hospitals and non profits have a mission statement also, but they still try to find a way to minimize things.

Everyone else their quota is full or only take paid call at the hospital to treat the poors.

 

[Feli]

My big take on the above is that discussing the follow-up isn't glamorous but its a great way to tie together the encounter. It also gives you an opportunity restate their situation - doing better or not, need more care or not...

...Meanwhile in PM News podiatry onychomycosis billing - you see a patient, order labs, and then arrange a follow-up visit to prescribe a medication that you already told them you'd prescribe if the labs are normal.

The more chronic conditions, the better. Ask young Chris... It's all about the comeback.

 

[mandrew]

This is a great take. There’s are some days where I’ve seen the schedule and it’s maybe 15-17 or so, but based on what you guys stated even that’s low.

You can do quite well seeing 15 patients per day if you keep your expenses reasonable. I do not want to see 35 patients per day. I think 20 is the sweet spot. You always want to have room in your schedule for an urgent appointment, like the 15 year old with an acute paronychia.

 

[Feli]

You can do quite well seeing 15 patients per day if you keep your expenses reasonable. I do not want to see 35 patients per day. I think 20 is the sweet spot. You always want to have room in your schedule for an urgent appointment, like the 15 year old with an acute paronychia.

Yep, this is why I think more ppl don't start their own office (or buy out a retire/wind-down pod office).

There is the misconception that because pod groups push their DPM associates to see 25 or 30 or 35+ patients per day or do a bunch of DME/proc that you need to do that to be profitable. They push that simply because they are taking 20-30% of every dollar the associate brings in... the more, the better... longer hours, more pts/hour, more $/visit, etc are the way for owners to line their pocket. It is also hard for the associate to make a living seeing much fewer than 25+ per day when they're making only 30-40% of their collections, taking a lot of MCA and low/no pay visits, usually seeing free hospital ER call/consults, etc.

...People don't realize how quick they can break even (usually 8-10pt/day) or even be making fair profit (12-15/day) in most offices as the owner if rent and overhead is modest.

I agree it is better to see 20/day or more to correct for some no-shows and last minute cancels and slow/no pays. Those can be minimized with good staff training, but some payer areas are just rough for those factors no matter what you try. There is definitely no need to kill yourself seeing a high number and working late like an associate, though... esp when revving up a new office and not wanting bad reviews or area PCPs hearing back that you rush visits, run up bills, run late for appts, etc.

 

[mandrew]

You contradicted yourself in the same paragraph. This is not well run.

Why is he wanting to sell after only being in practice for 10 years?
10-12 patients a day is at most 1000-1200 gross a day?
How is he in business for a decade with only 10 people a day?

Any panels that are closed that he is on are worthless if they aren't sending referrals to him.
A decent solo practice you should be seeing about 25 a day to make decent money.
RFC pays and is easy. Great pathology but seeing no one will make you bankrupt.

Why even bother "buying" this guy out. At those numbers he's only grossing at max 120k a year. Unless he accepts an offer of like 35k which includes all the equipment anything else is too high.

Harsh

 

[mandrew]

Hey SDN!

I’m a graduating resident. Looking for jobs, but most of them look pretty crappy.

I came across one guy that seems ok, but he’s looking to just sell his office.

It’s about 10 years old , big city. Seems well run.

Open right now 2-3 days a week, with about 10-12 patients or so per day.

I don’t really know what the full collections are but what should I be looking for in buying a practice?

I haven’t ventured down this route before so I’m not too sure.

Also, how many patients should be seen during a day? From my limited time there there wasn’t many RFC patients. But decent pathology with office procedures orthotics X-ray etc.

My previous office experience in residency, our attendings would have 25-40 patients in a day. Granted a ton were routine dm patients .

So I’m not sure on how or what to gauge on.

Any insight at all is much appreciated. I wish we learned this stuff in school or residency but I feel like I’m walking in blind

So what did you end up doing?