Micropractice in addition to full time job

[AFMD]

There have been other threads about micropractices. I think you guys are pretty traditional, but also seem to be fans of DPC, and I really wanted to know what you thought about my ideas.

I couldn't find much about doing a practice only on the weekends and evenings in past threads. I work for the government doing patient care, and don't have any opportunities do expand what I am doing or work more at my current job. I do some Addiction Medicine at my current job, but I'd like to do more. Especially to get more hours for the clinical practice pathway for Addiction board certification.

I also am on tract to register with the state to recommend medical cannabis. It could be an interesting part of a practice.

There's a pretty big void in the community for buprenorphine, as there is many places. There is also way more demand for cannabis providers. I could also do OMT.

I'd also like the explore getting a TMS machine, CES, tDCS, or possibly doing ketamine or esketamine. Just some off the wall ideas that may not be possible. I really enjoy exploring novel evidence based treatments that help people.

I think I have some good services to offer, but I really enjoy the job I have with the government. Is a weekend/evening only availability very feasible?

I plan on doing cash only. I can't deal with insurance. I don't believe I can opt out of Medicare with my full-time job, so I just won't be able to see anyone Medicare eligible, unless there is another way around that. Can I only take Medicare? Would that even make any sense?

I got a quote from The Doctors Company for quarter time, less than 10 hours a week, and it starts at less than $700, and matures to just over $2000 which is pretty doable. I plan on getting a couple other quotes. Anyone in particular I should go with?

I plan on talking to a few providers to try to sublease something for the weekends and weeknights only. That should be pretty inexpensive.

My DEA can only be used with the government. I got a second one, and am switching my buprenorphine waiver to the outside DEA so I can use it both places. I'll need to be careful to stay below my 100 patients.

I started making a website with Wix, it's super easy and patients can book appointments online, and it's around $20 a month. What do most other people do for a website?

I've heard of others making their own EMR, are the privacy requirements hard to do? Is there a good inexpensive alternative? Most I can find are at least $100 a month, which seems way too much for my volume. Maybe paper makes more sense for me. I'm sure there are rules for this as well I'll need to be familiar with.

Do I need to talk to a lawyer to make sure all my forms and releases are right? Is this pretty doable on my own?

Accounting pretty doable for this? Anything else I'm forgetting?

Is there a good standard guide for doing something like this?

Thanks guys.

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[deleted87716]

Starting, Closing, or Selling a Practice

xxxx

www.aafp.org

 

[VA Hopeful Dr]

Starting, Closing, or Selling a Practice

xxxx

www.aafp.org

Part of that article is wrong, at least for my state. In SC medical records can absolutely be part of the sale.

 

[deleted87716]

Part of that article is wrong, at least for my state. In SC medical records can absolutely be part of the sale.

Interesting. What if the buyer just says "no?" Honestly, I think it would be easier to start from scratch in a new practice and treat everyone as a new patient rather than deal with somebody else's potentially crappy charts (been there, done that). But, that's just me.

 

[Sushirolls]

1) Medical marijuana is a farce.
2) Thinking of ketamine, esketamine and TMS you are diving into Psychiatry and if you are in belief that medical marijuana is a thing, I fear a clinical disservice by branching into these areas of Psychiatry. You will risk not getting referrals from psychiatrists. TMS machines will require a physician presence in the building, as standard of care, even if you aren't administering the treatment. Weekend practice wouldn't be conducive to that.
3) Doctors company quote you got was likely for claims made - as they don't really offer occurrence based, but string you along for something like 10 years before it magically converts over to Occurrence. Be aware of that. Unless you are 100% sure you plan to do this for the long haul, don't risk the Doctors company shady trap with the claims made policy. Pay the extra money up front for occurrence with another company.
4) Luminello / Charm / Eclinical works will be your EMR friends, look into each of these three. Don't waste your time looking at others. Luminello sort of has a built 'website' profile that could allow you to skip the need for a website at this juncture. But on the flip side, if you are looking to do cash only, you may need to truly spend some money on a quality website. Bad website, I'd be prone to look elsewhere. If this professional can't even put out a quality professional web presence, why do I want to trust them with my professional health decisions?
5) The simple fact that you would be a FM working weekends as a micropractice will be its own selling point. Don't fear or fret that you need extras like cannabis, suboxone, TMS, ketamine, etc. I wish there was a Micropractice FM in my area just doing weekends. That would be amazing. Sadly, the local DPC docs all went and hired ARNPs. No thanks, not going to spend my money to get midlevel care.
6) Don't do OMM unless you truly enjoy it. You will get quality, loyal patients if you do, and are good at it.
7) Much of the suboxone population is medicaid. There are now enough ARNP /PA and commercial telemedicine entities, that its actually a saturated market.

 

[Sushirolls]

You open a weekend only micropractice with cash only, retainer style. Quality website. Quality EMR with electronic messaging. No MA, no RN, just you the doc who also does the vitals, etc. You will find patients who are willing to pay for that. Make it clear up front, this a weekend practice, and messages during the week will be minimal, brief, and if requires extra time on your part, you will charge for it.

 

[VA Hopeful Dr]

Interesting. What if the buyer just says "no?" Honestly, I think it would be easier to start from scratch in a new practice and treat everyone as a new patient rather than deal with somebody else's potentially crappy charts (been there, done that). But, that's just me.

If I were the seller, in that instance I wouldn't sell. Otherwise I'd be responsible for the records.

 

[AFMD]

You open a weekend only micropractice with cash only, retainer style. Quality website. Quality EMR with electronic messaging. No MA, no RN, just you the doc who also does the vitals, etc. You will find patients who are willing to pay for that. Make it clear up front, this a weekend practice, and messages during the week will be minimal, brief, and if requires extra time on your part, you will charge for it.

Retainer style as in DPC? I was think just a charge for phone, tele, or f2f based on 15 minute increments. Do you think people would go for a monthly rate for access only on the weekends?

 

[Sushirolls]

N of 1, I would. This really would be a major decision, and potentially shape the nature of the practice and possible patients you would get. Spend a lot of time on figuring this out. Which direction to go?

Don't discount what weekend access means. Your working professionals are working. And lots of hours. Groceries, oil changes, bank visits, and doctor visits are a pain that all typically require time away from work. Now if only they could get their health care on the weekend too, and not have to get from an ARNP at walmart... Weekends are valuable.

 

[VA Hopeful Dr]

Retainer style as in DPC? I was think just a charge for phone, tele, or f2f based on 15 minute increments. Do you think people would go for a monthly rate for access only on the weekends?

Maybe, if you market as just that: "Always have access to a doctor on weekends/holidays".

 

[deleted87716]

If I were the seller, in that instance I wouldn't sell. Otherwise I'd be responsible for the records.

What I was getting at is that the records don’t necessarily add value. If the seller was charging something for the “privilege,” I’d decline.

 

[deleted87716]

Maybe, if you market as just that: "Always have access to a doctor ONLY on weekends/holidays".

FTFY. It’s called “urgent care.”

 

[Sushirolls]

This would be different from UC because of continuity with same physician.
Minor contact/messages outside of weekend:
"hey doc, running low on that Lisinopril 10mg, I only got 5 months, and our appointment is in 6 months. Let me know if you send that off."
"hey doc I got tripped up over the dog yesterday. My knee is killing me. I'm hoping Ice/rest/motrin will fix it by this weekend, but cautiously can you add me to your Saturday schedule?"
"Hey doc, I'm sick with something, taking the rest of the week off, but my job requires a doctor note. Can you add me this weekend to go over my symptoms and hopefully get a note I can submit for Monday?"

Urgent care you risk being seen by midlevels. Urgent care you have no continuity.

 

[VA Hopeful Dr]

What I was getting at is that the records don’t necessarily add value. If the seller was charging something for the “privilege,” I’d decline.

I basically just sold my DPC records. At the 24 month mark, 50% of the patients were still with that practice meaning still generating income.

 

[VA Hopeful Dr]

FTFY. It’s called “urgent care.”

Seems like fewer and fewer of those actually have physicians these days.

It'd be a hard sell, but if you do it right I think it's possible.

 

[deleted87716]

This would be different from UC because of continuity with same physician.
Minor contact/messages outside of weekend:
"hey doc, running low on that Lisinopril 10mg, I only got 5 months, and our appointment is in 6 months. Let me know if you send that off."
"hey doc I got tripped up over the dog yesterday. My knee is killing me. I'm hoping Ice/rest/motrin will fix it by this weekend, but cautiously can you add me to your Saturday schedule?"
"Hey doc, I'm sick with something, taking the rest of the week off, but my job requires a doctor note. Can you add me this weekend to go over my symptoms and hopefully get a note I can submit for Monday?"

Urgent care you risk being seen by midlevels. Urgent care you have no continuity.

But, when everything is "urgent," you'd be surprised. I have people go to urgent care because they can't wait for a few HOURS until we open the next day (we have same-day appointments). They sure as heck aren't going to wait until the weekend.

 

[deleted87716]

I basically just sold my DPC records. At the 24 month mark, 50% of the patients were still with that practice meaning still generating income.

I suspect your records were decent, though.

 

[Sushirolls]

But, when everything is "urgent," you'd be surprised. I have people go to urgent care because they can't wait for a few HOURS until we open the next day (we have same-day appointments). They sure as heck aren't going to wait until the weekend.

If building a micropractice, I suspect the opportunity to be selective in patients. A micro population of those who are respectful of boundaries and the timing of things.

 

[VA Hopeful Dr]

I suspect your records were decent, though.

Very very concise since I didn't have to use them for billing.

That's one of the main things I miss about DPC.

 

[deleted87716]

If building a micropractice, I suspect the opportunity to be selective in patients. A micro population of those who are respectful of boundaries and the timing of things.

Good luck with that. FWIW, a micropractice needs more than a "micro population" to succeed.

Personally, I think a weekends-only primary care practice is a boondoggle. People want you to be available when they need you. Two days a week won't cut it.