Hi Adam, sorry for the delay but thank you very much for the email and for the questions. Very exciting to hear that our model could help medical students realize the full potential in family medicine. The direct primary care model allows for greater patient satisfaction, physician satisfaction, physician income, decreased stress etc.
Establishing practice -
-What were your economic, marketing, minimum patient base, etc goals for the first month, first year, etc?
Economics A practice can be started on any budget. I moonlighted heavily in residency to start with a nice office and a fair amount of medical equipment. However these are personal decisions based on your goals and your budget.
Marketing although we some limited print media advertising, the most effective advertising was radio. For approximately the same price as our print advertising, we were able to get significantly more results.
Patient base typically we say 400-600 patients per physician. However this can vary depending on your model or specialty. For instance a pediatric practice may have 1000 or more patients but at a lower price. Initially we hope to grow at 10 patients per month but we routinely grow at 30 to 50 patients per month. I believe this is in large part to our value proposition. Atlas MD is a high value low cost model with our unlimited visits, no co-pays, free procedures, wholesale pricing on medicines and labs. We're now approaching our 34th month with nearly 1200 patients, so we are several years ahead of schedule.
-Where was/is your economic breakeven point, time-wise?
Your profitability depends a lot on your overhead and your desired income. You could be profitable at around 400 patients in the remainder 200 would be additional income.
-What equipment/material minimums did you start with?
Due to my heavy moonlighting for startup capital, we were able to start with a dexa scanner, EKG, Holter monitor, spirometry, ultrasound, medical laser.
-How difficult was arranging agreements for labs, and establishing a referral base for consults/referrals?
It was very easy to work with labs, pharmaceutical distributors and imaging centers for negotiated rates.
-Were there any steps along the way that made you doubt the practice viability, any hurdles that nearly broke your idea?
Every entrepreneur has sometimes where they are nervous or question their plan. Thankfully, we did a significant amount of preparation to ensure success. I really appreciate the quote "the harder I work, the luckier I get."
Training-
-If I wanted to pursue this path in my home community in the next 10 years (~100,000 population)...
-Would there be any advantage to additional training beyond FM, say a combined FM/EM program? I've heard good things about them.
Share. Any extra training you can get is very beneficial. I was fortunate enough to spend a significant amount of time moonlighting in the ER during my second and third years of training. That your experience has been very beneficial in my practice both financially and professionally. If you can moonlight in the ER as well, you may not need a dual board certification. Any additional skills like ultrasounds, procedures, counseling, are all very beneficial to your practice.
-What additional services/care do you believe I could provide with the EM exposure/certification? Increased care of EM type complaints in house? Purchase additional equipment to cover these scenarios? or just send them to the local ER?
Laceration repair, biopsies, joint injections, casting, splinting are all excellent skills.
-Would I benefit from working 1-3 years in the local hospital system, both to pay off loans, and to establish patient relationships/familiarize myself with the style of patients in the community?
That is a personal decision. However I think you'd be better off to start the practice right of residency. You are able to moonlight and urgent care, ER, locums, hospitalists etc. as your practice gets off the ground. I think by the time you get close to finishing residency, direct primary care will be much more common. This will make it easier for you to start your practice.
-If I love my job (feels like this would provide that potential), then I'm not as hung up on the thought of income. However, I will have substantial loans to combat in my first 5 years as an attending (think 300-400 after interest). I'm also looking at the Midwest, in an area with large health care facilities within <1hr drive. I can not find any direct care providers in my state, let alone area. So, can a FM/EM in your model expect to make 200-250 and still maintain a healthy physician-patient-personal lifestyle balance? How does the potential income stack up in a climate like this?
Absolutely. The basic math is as follows: an average of $50 per patient per month times 600 patients equals 30,000 per month times 12 month equals $360,000 per year -30% overhead equals $240,000 per year. This is just basic math, but very similar to how our practice operates.
I hope that helps, but feel free to ask any other questions.
Thanks!
