Fledgling pain clinic in the Houston area

[Scarbesi_90011]

Anesth/interventional pain MD: Started out at roughly $550K in another state, quit and started up a clinic in Houston ~1.5 years ago. Purchased our building and c-arm.

The first year's been tough (credentialing was slow during Covid), but family support and savings (plus having paid off all loans) is helping the start-up efforts now, though growth has been slow. Roughly 50 pts a week, mix of FUs, NPs and some procedures. Mixed payors.

Suggestions from any established self-employed solo practitioners?

-What did you do for medical marketing, hire a firm or an in-house marketing manager?
-Is joining a med group suggested -- even if preference is to remain solo? (Autonomy is the goal, after all.)
-Is hiring a physician liaison a good move now? Is there a more economical way to attract referral sources?

Any and all advice is appreciated.

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[drusso]

Anesth/interventional pain MD: Started out at roughly $550K in another state, quit and started up a clinic in Houston ~1.5 years ago.

The first year's been tough (credentialing was slow during Covid), but family support and savings (plus having paid off all loans) is helping the start-up efforts now, though growth has been slow. Roughly 50 pts a week, mix of FUs, NPs and some procedures. Mixed payors.

Suggestions from any established self-employed solo practitioners?

-What did you do for medical marketing, hire a firm or an in-house marketing manager?
-Is joining a med group suggested -- even if preference is to remain solo? (Autonomy is the goal, after all.)
-Is hiring a physician liaison a good move now? Is there a more economical way to attract referral sources?

Any and all advice is appreciated.

Been there. Keep your hand in the fire. It's a 5 AM to 9 PM job. Lots of networking and marketing. Take docs out for coffee/drinks. Spend time together at kids' events. Host docs and spouses at dinners. Nothing is better than word of mouth. SEO and Facebook are all saturated. Go to Rotary meetings, Toastmasters, Elks, etc. Get your practice name by sponsoring community events, health fairs, etc. It will pay off in time.

 

[robellis]

Been there. Keep your hand in the fire. It's a 5 AM to 9 PM job. Lots of networking and marketing. Take docs out for coffee/drinks. Spend time together at kids' events. Host docs and spouses at dinners. Nothing is better than word of mouth. SEO and Facebook are all saturated. Go to Rotary meetings, Toastmasters, Elks, etc. Get your practice name by sponsoring community events, health fairs, etc. It will pay off in time.

Damn this is actually really annoying though having to schmooze people over..the guaranteed paycheck seems a lot more attractive

 

[Chelsea FC]

Damn this is actually really annoying though having to schmooze people over..the guaranteed paycheck seems a lot more attractive

Isnt that the beauty of it all though? All that schmoozing will pay off with a higher pay and more freedom by being your own boss. Its all a give and take.

 

[lobelsteve]

Sky is the limit. Be out and about and visiting other docs in your area every day if possible. Bring people coffee and bagels.
Send out mailers. Buy a book on marketing or go out to dinner with some sales or realtor folks. They know how to close and sell. You know you and that's what you are selling. And do a good job. Be nice to your patients and their family and friends will come.

 

[nvrsumr]

Congrats!

office fluoro suite
google adwords
Find two busy spine surgeons and make friends
IMEs to fill time and generate some cash flow
Find a few busy auto injury attorneys and make friends with them and their chiros.

Dont waste money liaison or marketing person( or hire for a short period of time for WC and auto introductions). Everyone gets paid the same per procedure. You can only control costs

 

[robellis]

Sky is the limit. Be out and about and visiting other docs in your area every day if possible. Bring people coffee and bagels.
Send out mailers. Buy a book on marketing or go out to dinner with some sales or realtor folks. They know how to close and sell. You know you and that's what you are selling. And do a good job. Be nice to your patients and their family and friends will come.

Bring people coffee and bagels..ugh that just sounds so pathetic and needy like a drug rep..but I guess you’re right you gotta do what you gotta do

 

[lobelsteve]

Bring people coffee and bagels..ugh that just sounds so pathetic and needy like a drug rep..but I guess you’re right you gotta do what you gotta do

Nothing wrong with treating people with kindness and respect. Do it right. Be sincere. It can lead to pain med baller status.

 

[painfree23]

Anesth/interventional pain MD: Started out at roughly $550K in another state, quit and started up a clinic in Houston ~1.5 years ago. Purchased our building and c-arm.

The first year's been tough (credentialing was slow during Covid), but family support and savings (plus having paid off all loans) is helping the start-up efforts now, though growth has been slow. Roughly 50 pts a week, mix of FUs, NPs and some procedures. Mixed payors.

Suggestions from any established self-employed solo practitioners?

-What did you do for medical marketing, hire a firm or an in-house marketing manager?
-Is joining a med group suggested -- even if preference is to remain solo? (Autonomy is the goal, after all.)
-Is hiring a physician liaison a good move now? Is there a more economical way to attract referral sources?

Any and all advice is appreciated.

Why’d you leave your old gig? What would the med group be- mainly orthos? I don’t know about a liaison…I think the referring docs want to see you, not some liaison

 

[Agast]

Don't hire a marketer. They are not capable of managing the part you need - boosting positive reviews to drive interest. And marketers visiting PCPs and potential referring doctors is not going to encourage them to feel connected to you. Since you're not overly busy, I would recommend clearing a half day a week to put in the legwork yourself to woo the referral sources. COVID puts a damper on things but figure out a way to wine and dine them. There's a reason drug and device reps are scrutinized for meals and gifts - they totally work. Meet them in person and give them something and they will feel like they owe you something.

We use PatientPop which automatically sends an email asking patients to rate their experience and then posts the good ones to google. It may be pricy for a solo practitioner but it goes a huge way towards legitimizing your practice.

 

[drusso]

Don't hire a marketer. They are not capable of managing the part you need - boosting positive reviews to drive interest. And marketers visiting PCPs and potential referring doctors is not going to encourage them to feel connected to you. Since you're not overly busy, I would recommend clearing a half day a week to put in the legwork yourself to woo the referral sources. COVID puts a damper on things but figure out a way to wine and dine them. There's a reason drug and device reps are scrutinized for meals and gifts - they totally work. Meet them in person and give them something and they will feel like they owe you something.

We use PatientPop which automatically sends an email asking patients to rate their experience and then posts the good ones to google. It may be pricy for a solo practitioner but it goes a huge way towards legitimizing your practice.

And direct to the consumer marketing too: Elks, Eagles, Moose, Lions, VWF, OddFellows, Masons, Kiwanis, Shriners, etc. Show up for a happy hour at those places and give a talk. Believe me, you won't be disappointed. You can't swing at a dead cat without hitting someone with spinal stenosis or failed back at those joints.

 

[Scarbesi_90011]

Why’d you leave your old gig? What would the med group be- mainly orthos? I don’t know about a liaison…I think the referring docs want to see you, not some liaison

Long story short - I left because the clinic owner was unethical. I was told to go against my morals, better judgment and state regulations. When I said no I was threatened, so I left. I realized the only way to do things "my way" -- the workflow I prefer, etc. -- was to hang out my own shingle.

 

[strike5858]

Pick up some per diem anesthesia gigs to keep busy and the bills paid. the worst is behind you with covid and credentialing issues resolved.

pack your schedule as best as you can to free up marketing time. Christmas is right around the corner, use that as an excuse to introduce yourself. A Christmas card and chocolates can’t hurt

 

[Scarbesi_90011]

Pick up some per diem anesthesia gigs to keep busy and the bills paid. the worst is behind you with covid and credentialing issues resolved.

pack your schedule as best as you can to free up marketing time. Christmas is right around the corner, use that as an excuse to introduce yourself. A Christmas card and chocolates can’t hurt

I've been looking for locums work but haven't had luck -- the last time I was in the OR was about 3.5 years ago.

 

[painfree23]

I've been looking for locums work but haven't had luck -- the last time I was in the OR was about 3.5 years ago.

Really? In Houston? Seems like a big enough market for some locums. Use an agency , they may help you find something

 

[Scarbesi_90011]

Really? In Houston? Seems like a big enough market for some locums. Use an agency , they may help you find something

I meant to say I’ve been rejected by some *because* I haven’t been in the OR in a while. Though yeah, an agency might be a good call at this point.

 

[Agast]

You can pick up some extra cash doing utilization review. I’m assuming that’s what my Peer to peers are doing cuz I Google them later

 

[Multimodal]

+1 for schlepping oneself to local PCPs. I too felt dumb going to PCP's offices with doughnuts and lunches but it was a great way to sit down for an hour and have the staff sit down with us one by one in their break rooms to discuss what we can do. this was all precovid of course but it did generate some good referrals and leaving our referral pads/pens made it much easier for docs to refer to us. I partnered with BSCI since I use their SCS alot and they paid for all the lunches lol. it might take a few months but if youre the only one showing up to these offices with goodies, then you should start to expect referrals.

 

[painfree23]

You can pick up some extra cash doing utilization review. I’m assuming that’s what my Peer to peers are doing cuz I Google them later

What’s this?

 

[Agast]

What’s this?

Freelance for Evicore and other utilization companies

 

[Pain Applicant1]

Anesth/interventional pain MD: Started out at roughly $550K in another state, quit and started up a clinic in Houston ~1.5 years ago. Purchased our building and c-arm.

The first year's been tough (credentialing was slow during Covid), but family support and savings (plus having paid off all loans) is helping the start-up efforts now, though growth has been slow. Roughly 50 pts a week, mix of FUs, NPs and some procedures. Mixed payors.

Suggestions from any established self-employed solo practitioners?

-What did you do for medical marketing, hire a firm or an in-house marketing manager?
-Is joining a med group suggested -- even if preference is to remain solo? (Autonomy is the goal, after all.)
-Is hiring a physician liaison a good move now? Is there a more economical way to attract referral sources?

Any and all advice is appreciated.

Have had my own practice now for 10 years. I agree that autonomy should be the goal. Once you taste that freedom you can't ever really go back. Kind of like Aldous Huxley. I recommend telling your stim rep your situation. My stim rep is my best employee and he's free. They do all the work and pay all of the bills. Have him or her set up lunches for your referring docs at their offices. Just introduce yourself and let them know what you do. Once their patients like you the referrals will pile in. It really is that simple.

 

[gdub25]

I started private practice straight out of fellowship four years ago and have had a lot of success in growing it to as busy as I can be. I will echo what others have said. You have to go out and beat the streets. You have to go out and meet doctors every chance that you get.

I am pretty passionate about helping young guys be successful in private practice and I’m happy to talk live if you’d like. Feel free to PM me anytime.

 

[gazzer]

Damn this is actually really annoying though having to schmooze people over..the guaranteed paycheck seems a lot more attractive

I've been schmoozing since day 1 even in an employed model in private practice. Building a patient base from scratch. Is this not the norm?
Dedicated marketing person only helps with getting past the various layers of administrative staff and setting up a face to face meeting with a physician. You could easily eliminate the need for this with a little motivation, showing up with your cards and some cookies. Although, I am also surprised at how many doctors will not make themselves available for a quick chat and would prefer to be herded by their corporate overlords and admin staff.

 

[hyperalgesia]

I don't know how you guys can hustle like that. I find it degrading and demoralizing. I agree it's often necessary but it's not in me. Guess that's why I'm a permanent employee.

 

[robellis]

I don't know how you guys can hustle like that. I find it degrading and demoralizing. I agree it's often necessary but it's not in me. Guess that's why I'm a permanent employee.

I agree

 

[lobelsteve]

I don't know how you guys can hustle like that. I find it degrading and demoralizing. I agree it's often necessary but it's not in me. Guess that's why I'm a permanent employee.

Attitude is everything. I love going around telling people how wonderful I am.

 

[nvrsumr]

I have hospital employed spine surgeons bring me and staff lunch several times a year

 

[robellis]

I have hospital employed spine surgeons bring me and staff lunch several times a year

Wow ok this takes the cake..a spine surgeon bringing lunch..those guys are 1M+ ballers and they’re even bringing lunch..damn

 

[drusso]

I don't know how you guys can hustle like that. I find it degrading and demoralizing. I agree it's often necessary but it's not in me. Guess that's why I'm a permanent employee.

 

[RoloTomassi]

I enjoy meeting people and networking, and I love to eat, so I don't mind this stuff at all.

 

[Barleycorn]

I enjoy meeting people and networking, and I love to eat, so I don't mind this stuff at all.

It seems more demoralizing and infantailizing to have another adult constantly observing and micro-managing your time and energy

 

[ateria radicularis magna]

Attitude is everything. I love going around telling people how wonderful I am.

But what words come out of your mouth?

 

[lobelsteve]

But what words come out of your mouth?

I start with a championship belt like boxers wear. It says world champion pain doctor. I then motion to my pointy shoes. Occasionally a little pantomime.

 

[RoloTomassi]

I start with a championship belt like boxers wear. It says world champion pain doctor. I then motion to my pointy shoes. Occasionally a little pantomime.

 

[ateria radicularis magna]

I enjoy meeting people and networking, and I love to eat, so I don't mind this stuff at all.

Do you talk about whatever comes to mind or do you try to talk about what you do in your clinic? I have done a ton of lunches and it still feels ridiculous. It would be easy if I were the only guy around but there are like 20 of me. I feel intense self loathing if I present a false front, and I basically just end up saying some quick mash up of…hi, I see a lot of back pain and neck pain, I don’t prescribe a lot of opioids but sometimes I do, I don’t have a mid level and see every patient myself, do every procedure in the office, I will get people in fast if you let me know it’s urgent, here’s my card with my cell (<1% call rate), and that’s it, I got nothin else, and I feel like I’m wasting their charting time and every second that ticks by is a second of work they will have to do at home or after hours.

 

[ateria radicularis magna]

I start with a championship belt like boxers wear. It says world champion pain doctor. I then motion to my pointy shoes. Occasionally a little pantomime.

Please post a selfie next time, or a tic tok even better

 

[lobelsteve]

Please post a selfie next time, or a tic tok even better

That was a heavier me. Down 45 pounds so far.

 

[RoloTomassi]

Do you talk about whatever comes to mind or do you try to talk about what you do in your clinic? I have done a ton of lunches and it still feels ridiculous. It would be easy if I were the only guy around but there are like 20 of me. I feel intense self loathing if I present a false front, and I basically just end up saying some quick mash up of…hi, I see a lot of back pain and neck pain, I don’t prescribe a lot of opioids but sometimes I do, I don’t have a mid level and see every patient myself, do every procedure in the office, I will get people in fast if you let me know it’s urgent, here’s my card with my cell (<1% call rate), and that’s it, I got nothin else, and I feel like I’m wasting their charting time and every second that ticks by is a second of work they will have to do at home or after hours.

Yeah I just shoot the ****, find common ground. You're more likely going to get a referral if they remember you and like you than if they hear the same stuff. On the clinical side talk about an exciting advancement or crazy case. Ask them about what part of their job they're passionate about, figure out how you can help their business.

 

[Agast]

That was a heavier me. Down 45 pounds so far.

Awwwwwwww “Lobelsteve” and “adorable” were not two words I would have considered in the same sentence. I’m not sure about the methodology of this study though.

 

[Agast]

If you’re going to do lunches, I recommend pre-eating. Because it’s hard to brag about how cool you are and shovel a sandwich into your mouth at the same time.

 

[myrandom2003]

For you private folk that are in S-corps, what is a reasonable salary to pay yourself? My accountant says it should be an average for your area so as not to trigger an audit. I was thinking more like $100k salary which I pay Medicare, SS, etc taxes. Take additional compensation as distribution from practice which I am the solo doc/owner.

Also sep-Ira vs solo 401k? Can I do both?

 

[drusso]

For you private folk that are in S-corps, what is a reasonable salary to pay yourself? My accountant says it should be an average for your area so as not to trigger an audit. I was thinking more like $100k salary which I pay Medicare, SS, etc taxes. Take additional compensation as distribution from practice which I am the solo doc/owner.

Also sep-Ira vs solo 401k? Can I do both?

Title yourself "medical director" or something and pay yourself as little as possible.

You can do both if you set up a consulting LLC for other activities.

Hire your wife and kids and pay them too.

 

[callmeanesthesia]

For you private folk that are in S-corps, what is a reasonable salary to pay yourself? My accountant says it should be an average for your area so as not to trigger an audit. I was thinking more like $100k salary which I pay Medicare, SS, etc taxes. Take additional compensation as distribution from practice which I am the solo doc/owner.

Also sep-Ira vs solo 401k? Can I do both?

I’ve read some of the proposed tax changes would significantly affect pass throughs, so talk with a tax attorney who is familiar with possible legislation before you go through great lengths to set this up (if you haven’t already).

 

[Nodolor]

For you private folk that are in S-corps, what is a reasonable salary to pay yourself? My accountant says it should be an average for your area so as not to trigger an audit. I was thinking more like $100k salary which I pay Medicare, SS, etc taxes. Take additional compensation as distribution from practice which I am the solo doc/owner.

Also sep-Ira vs solo 401k? Can I do both?

The 2 Accountants I have worked with said you want your salary and distributions about 50/50 if you are worried about avoiding an audit

If you have relatively few people on payroll look into a Cash benefit plans combined with a profit sharing 401K can put much more away

 

[painfree23]

For you private folk that are in S-corps, what is a reasonable salary to pay yourself? My accountant says it should be an average for your area so as not to trigger an audit. I was thinking more like $100k salary which I pay Medicare, SS, etc taxes. Take additional compensation as distribution from practice which I am the solo doc/owner.

Also sep-Ira vs solo 401k? Can I do both?

Do solo401k , a sep-Ira may disqualify you from backdoor Roths.

Not financial advice, I just like the stock

 

[Pain Applicant1]

Damn this is actually really annoying though having to schmooze people over..the guaranteed paycheck seems a lot more attractive

It's not. You don't really need to be a salesman. You're just introducing yourself and letting them know what you do. I try to spend all of my free time with my wife and kids and don't like going out too much but I did make a few doctor friends doing this. These doctor friends have really helped me, well beyond medicine since they are more familiar with the area and know nearly all of the local business people.

I only went out and met doctors at the beginning but don't do it anymore since I'm established now. When a new surgeon comes to town, they typically come to me now or we go out to dinner compliments of Boston Sci. That's just the way it works. I don't think there is any business that doesn't operate this way in one form or another.

 

[Pain Applicant1]

Wow ok this takes the cake..a spine surgeon bringing lunch..those guys are 1M+ ballers and they’re even bringing lunch..damn

It's not as big of a deal as it sounds. When you're new you have to let people know you're here. It doesn't matter what specialty you're in. It doesn't even matter if you're an NP or PA or IMG or whatever. You go where the pts are. That's the way it works. There are plenty of pain docs who bring in far more than spine surgeons. I'm assuming you're still in training. If so, the private practice world doesn't really operate the way things do in academia.

 

[Doctodd]

join an ortho umbrella group for instant contracts and most with higher rates than you would get alone. Your practice is still your own and you can run your own PA under the same roof for the IME, PI, cash patients, and anything the ortho group doesnt take.

Did someone mention joining an ASC? I wish i would have done that from the beginning....id be partner by now and would own an island in the Bahamas.