is this practice model realistic?

[spitfire5454]

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hey guys. im about to be a 4th year and am considering FM. i have some thoughts on how i might run my practice and i wanted some feedback. please dont flame me b/c im really serious and am looking for a good conversation. is it possible to have an almost exclusive procedural practice? i am a really hands on guy and dont really enjoy management of of HTN or DM. i was thinking that through derm, cosmetics, pain alleviation, etc. one could have a nice practice going on. i guess kinda like a "minor" multi specialty clinic. it seems to me, though good marketing, good buisness sense, low overhead and actually being good at the things you do would make this quite profitable. additionally, if this was mostly cash only practice, you could reduce overhead quite a bit, put prices lower than specialists thus increasing your competativness and adding to your profits. i would think that marketing would be key to a practice such as this. we always see ads for "med spas" and stuff, why couldnt a practice like this take the same initiative? you would have great hours, less red tape and better pay, but more liability. many doctors arent very good buisness men, and it would be risk for an established doctor to switch to cash only practice, but if one was to start from scratch with a model like this, only to have it fail, he could always just accept insurance and just be a little behind the 8 ball. what do you think? it sounds good in theory. is it certain to fail, or does one just need to have the balls to try it? thanks in advance for your advice

 

[Shinken]

it seems to me, though good marketing, good buisness sense, low overhead and actually being good at the things you do would make this quite profitable.

Sound easy, doesn't it? 😉

Actually, I've heard of people doing what you propose, but they don't make millions. They make good money, maybe even more than the average (AVERAGE) Family doc, and they do something that makes them happy. But they still struggle with the same things (good marketing, good business sense, low overhead...). Not as easy as you think, but definitely doable.

 

[AwesomO]

You could do anything with the right business model. Don't let anyone tell you different. Thats not to say there will not be challenges.

One I can think of right off the bat is where are you going to get all your patients? Most FM docs get their procedures through established patients who they see for their DM or HTN.

If you are going to try and compete directly with Derms for cosmetic procedures it will be tough since most people will look up a Dermatologist in the phone book or get a referral from their PCP to see one. The average american is also pretty medically savy these days. If they are paying cash they either want a) their PCP who they trust to do the procedure or b) someone who is specialized to the high heavens.

And depending on the local politics you could very well be muscled out of town. It could get real ugly if you open up a clinic that essentially syphons procedures away from FM, derm, and maybe even plastics.

That all said if you found the right town and political environment you could pull it off. Although a much easier way may be to just do derm or even plastics and not have to worry about any of the above issues.

 

[EdibleEgg]

One of the things I absolutely love about family medicine is the tremendous amount of flexibility. There really are a large variety of viable practice models. I know several people doing well in cash only practices and a couple who just do derm/cosmetic procedures.

However, I recommend that you stay away from family medicine if you don't at all enjoy ambulatory medicine. I love procedural medicine myself. It would be tough for me to make it through the day without a few procedures to break things up. I'm not at all saying something like this couldn't work in the right setting, but it will be difficult. Ambulatory medicine is only a part of what we do, but it really is the bread and butter. You don't want your plan B to be something you hate.

 

[spitfire5454]

You could do anything with the right business model. Don't let anyone tell you different. Thats not to say there will not be challenges.

One I can think of right off the bat is where are you going to get all your patients? Most FM docs get their procedures through established patients who they see for their DM or HTN.

If you are going to try and compete directly with Derms for cosmetic procedures it will be tough since most people will look up a Dermatologist in the phone book or get a referral from their PCP to see one. The average american is also pretty medically savy these days. If they are paying cash they either want a) their PCP who they trust to do the procedure or b) someone who is specialized to the high heavens.

And depending on the local politics you could very well be muscled out of town. It could get real ugly if you open up a clinic that essentially syphons procedures away from FM, derm, and maybe even plastics.

That all said if you found the right town and political environment you could pull it off. Although a much easier way may be to just do derm or even plastics and not have to worry about any of the above issues.

i was thinking of getting patients through marketing the procedures themselves at competetive prices (TV, newspaper, internet). Doctors traditionally dont advertise much at all. i am also well aware of the turf war that may ensue, and am more than prepared to defend practice from doctors who dont like the competition. ive never understood that, do doctors think that the rules of competion in buisness dont apply to them? You are right about the average american though. However, i also believe that many americans are always looking for the best bang for the buck. so if you can offer something of value for less, there should always be people that will take advantage of it. now, please dont get wrong, im not all about money, but i am a buisness man and will be a doctor. I also believe that this model will only work in long run with a doctor who knows his limitations and accepts the fact that you cant do it all and somethings need to be reffered. but for other simple things, i think regular buisness rules should apply. for example: pt wants to get a wart removed, he can A) wait 3 months to see the dermatologist and pay $80. or he can B) come to my clinic that day, get it removed for $40. And really, can a dermatologiest remove a wart better than me? Some will take A, but im sure some will take B. My theory is that the niche is there (people without insurance, people with insurance but a high deductabile, people that dont like waiting, etc). what do you think?

by the way, how is one muscled out of town? ive heard of it done before but how is this actually accomplished? do they run thier own ads that say "Dr. X sucks"? thanks for thoughts so far

by the way the reason im going through this is because i have realized that i never ever want to work in or for a hospital. i was considering anesthesia b/c i enjoyed it and a great pay. but i think there is no greater feeling in the world than knowing the only one you work for is yourself - hence the private practice of FP

 

[sophiejane]

I do think you'd be in for some turf wars, but not from the dermatologists. Rather, it'd be from your FM colleagues in town. Lots of FPs enjoy and do office procedures--some more than others--but, to use your example, I don't know that many people go to a dermatologist for wart removal, since it is a ridiculously simple procedure and I haven't seen an FM practice yet that doesn't do that one.

Having their PCP do minor procedures in clinic is convenient for the patient and a nice way for us to pad the profit of a regular clinic day. Going from their own PCP to your clinic would acutally add a level of complexity that I think most patients would rather do without. New patient paperwork, insurance, yadda yadda. They KNOW their family doc, and they wouldn't know you from Adam. That is huge for people who DO have a "medical home." Plus it provides continuity, which is what we are all about.

I feel like marketing cheaper procedures from a procedure specialist would undermine some of that continuity and would ultimately hurt other FPs more than anyone. Plus, it's just one more splinter in an already fractured health care system.

And don't forget that procedures are becoming a hot ticket in FM training. Almost everyone we interviewed this year wanted to know about procedural training. There is a resurgence in interest in office procedures among young FPs and I'd be surprised if you could make a living doing only procedures by the time you graduate, because so many of your colleagues (myself included) will already be doing them as part of their full-spectrum practice.

And I do agree with EdibleEgg that not wanting to deal with chronic illness or ambulatory medicine at all, other than procedures, is going to make you one unhappy camper if you can't pull it off. Hopefully you can fake it for three years, because if you do FM, you are about to spend a whole lotta time in the hospital...

 

[Doowai]

It is typically said that you can compete with either price, quantity or quality of service. That being said, people often associate quality with cost. if you charge less people will assume you are not as good. Some Lexus and Camry are made on the same assembly lines, using similar parts - but one costs much more - people assume its a better car although made much the same. Cost tells people how good it is.

I would compete more on quality of service : same day service as you mentioned, cappucino maker in the waiting room, pedicure whatever - but keep your price up so people do not think you are crappy.

I have owned several businesses. I struggled my first 3 years in business, until I hired a business consultant. First thing he had me do was raise prices. I was scared, I was starving as it was - if I raise prices I was sure I would lose what existing clients I already had. But my business grew in volume rapidly. When my prices went up people assumed I was better.

 

[Doowai]

Yeah the programs I was most interested in were the ones strongest in procedures. Ones that taught colonoscopy and not flex sig for ex.

 

[sophiejane]

I would compete more on quality of service : same day service as you mentioned, cappucino maker in the waiting room, pedicure whatever - but keep your price up so people do not think you are crappy.

Has it really come to this? Are we becoming such salespersons that we have to start putting cappucino makers in our waiting rooms? How about being good at what we do, having reasonable wait times, and good relationships with patients?

If I walked into a doctor's office and was offered a pedicure or a latte, I think I would RUN the other direction. There is a cheese/sleaze factor there that I don't think belongs in a medical practice. Go to the nail salon for your pedicure, Starbucks for your latte, and your doctor for medical care.

 

[AwesomO]

Realistically at discounted prices of about 40 dollars you would need to get about 2-3 patients an hour to generate an average FP salary. Thats a huge number of simple procedures for nonestablished patients. Without referrals it will be very hard to get those kinds of numbers.

 

[AwesomO]

Has it really come to this? Are we becoming such salespersons that we have to start putting cappucino makers in our waiting rooms? How about being good at what we do, having reasonable wait times, and good relationships with patients?

If I walked into a doctor's office and was offered a pedicure or a latte, I think I would RUN the other direction. There is a cheese/sleaze factor there that I don't think belongs in a medical practice. Go to the nail salon for your pedicure, Starbucks for your latte, and your doctor for medical care.

I don't think it's a matter of lattes and pedicures but patients reacting to the current practice environment. I know from my years of going to various PCPs I am usually treated to insane weight times, short physician visits, and most of all rude support staff. I know that some nurses and techs think giving sass to docs is cool but I can say that as a patient I'm not really in the mood to be snapped at. So given the option I'm sure most people would prefer to have the cheezey artificial niceness over the genuine rudeness.

 

[sophiejane]

I don't think it's a matter of lattes and pedicures but patients reacting to the current practice environment. I know from my years of going to various PCPs I am usually treated to insane weight times, short physician visits, and most of all rude support staff. I know that some nurses and techs think giving sass to docs is cool but I can say that as a patient I'm not really in the mood to be snapped at. So given the option I'm sure most people would prefer to have the cheezey artificial niceness over the genuine rudeness.

But what you would REALLY like is shorter wait times, right? Why not just fix that problem, which can be done with an organized office and well-trained staff, both of which require an investment in TIME and MONEY. Personally, I will be putting my money and time into paying and treating my staff well and running an efficient front and back office rather than superfluous niceties in the waiting room to distract the patient. I believe patients are smarter than that and see right through it.

 

[AwesomO]

Yes but I think customer service plays a big part.
Now I'm certainly not a Patch Adams but I think little things can go along way for patient experiences. For instance at my dentist office the staff ranging from the receptionist to the dentists would often come out and chat with people in the waiting room. One instance that really struck me was when one of the hygienists came out to play with some this young mother's crying child. Now this certainly had no affect on the medical outcome but I can garuntee you that young mother will be taking her child back to that office for a long time.

If you tried to tell the staff this at a PCP office you would be met with "Thats not my bleeping job! I'm a highly trained tech/nurse/physician! I'm here to do medical work!" And that seems to be the big difference. At a typical physicians office it's all about "We're here to treat medical issues and we could care less about your other issues." But at the dentists office its "How can we transform the patient experience to make it more enjoyable for them?"

Although I do agree that it's possible to go overboard and fall into the sleeze area. Though while Latte's in the waiting room may appear tacky here in the midwest I'm sure they are almost a prerequisite on the west coast lol/

 

[Terpskins99]

Has it really come to this? Are we becoming such salespersons that we have to start putting cappucino makers in our waiting rooms? How about being good at what we do, having reasonable wait times, and good relationships with patients?

If I walked into a doctor's office and was offered a pedicure or a latte, I think I would RUN the other direction. There is a cheese/sleaze factor there that I don't think belongs in a medical practice. Go to the nail salon for your pedicure, Starbucks for your latte, and your doctor for medical care.

Actually, providing above-average accommodations has become the norm for many practices that rely on elective procedures for the bulk of their income.

Check out this clip from my consumer hero John Stossel. 😉 It also features a FM clinic that follows a rather unique business model with regard to providing procedures.

[YOUTUBE]http://youtube.com/watch?v=E_KCLm9cekU[/YOUTUBE]