InvestingDoc

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Crazy that this is my third year writing this update: First post and last years update


The days have been long but the years seem short.

For those who might be new to my journey. Here is the TLDR for the background: I am the first in my family to be a doctor, I grew up not well off financially at all but almost all of my family is some kind of business owner. I've been fortunate to have seen family run a business well and some run a business into the ground financially. Best to learn from their mistakes. My father is a welder, my mother a teacher. We all didn't really have much when we were young but my dad grew his business to eventually provide a good life for us in high school. My younger brother is a welder and my older brother started up an oil and gas business, took it public, then that later sold to another O&G company for 5.4 billion before moving on to other things.

I am an IM doctor who graduated, I was a hospitalist for 2.5 years then opened my own practice outpatient. I did everything by myself and created everything from scratch (including my website). Lets check in to see how things are going.


Workload:

I've decreased my workload from 100-150 patients a week to now about 100 patients a week. I have been taking more admin time to grow the practice. I also am no longer taking any new patients for myself personally unless its a family member of an established patient or a friend/colleague who requests me to see them.

We had just shy of 10k patient visits for the year of 2020....this despite COVID-19! This is about a 110% jump from the year prior.


Another New Doctor Employee Has Started

The lady physician I hired had a baby and took 4 months off for maternity leave in 2020. I also hired a new doctor who started in Oct 2020. There are currently 3 doctors in my office (myself included) with a plan to add another person probably in about 9 to 12 months.

I've also hired two NP's who will start working between our first and our second location that will open HOPEFULLY in another month or two.

By end of second quarter there will be 3MD's and 2NP's in the group. Crazy that I started this group 2.5 years ago!

Honestly it feels good that I'm on track to pay these doctors over 250k this year in a saturated market. Hell, the other primary care groups nearby are starting their doctors at 200-210 so I feel VERY happy about giving these doctors a great income.


Insurance:

We continue to add insurance payers but have been growing our cash based services. Cash services make up now 15% of our total revenue. We plan on trying to keep growing this.

We take payment at the time of service, so our collection rate is still > 90%. This helped us cross the 100k/month in gross revenue. There was a big dip with COVID-19 that I wrote about on my blog but we are back up and Jan 2021 was out busiest month ever.

We started the negotiation process with United since they are our lowest payer. If they don't budge we fully intend on dropping them by end of third quarter 2021. They pay us an astonishing 38% below our best payer and 25% below our average payer. We can't continue to take essentially a 30% pay cut seeing United patients. They pay us so little that we now make about $0.28 from giving the shingles vaccine to their patients. That is before overhead of paying electricity, storage costs, or MA salary to give the vaccine.



Personal Life:

We had our second child!!!!!! So far so good with growing the family :) I think we might be done....for now at least. My wife will kill me if I even bring up a third kid right now.

My wife still has to have her jaw tumor (odontogenic keratocystic tumor) removed later this year. That was delayed due to pregnancy and expected to be a pretty major surgery. I honestly haven't been thinking about it much because of everything else going on and there is nothing I can do right now about it. So, I just try to forget about it for now to get rid of the worry. Sadly, the condition that she has is an autosomal dominant condition so there is also worry in the back of my mind that one of the kiddos may have picked up the gene. Her brothers also have the disease but have not had any issues other than one time needing a small cyst/tumor removed as a kid and it never came back.

I have been trying to vlog more but man....things have been busy so I have not been great about that. I really really want to keep going with vlogging though since I honestly like it way more than blogging. I plan on diving way deeper into this with one video per week to upload. That's my goal going forward. Any votes for vlog vs blog vs you couldn't care less hahaha?

After driving a ford escape since 2002 I finally upgraded. I spoiled myself and bought a top of the line truck that I have wanted for a long time. Yeah, yeah I know my name is investingdoc and I could drive a beater while investing that money to retire earlier. However, smiles per mile is real. I love the truck, I love going to the ranch to cut down a tree and bring firewood back home. I love that its large enough for us 4 to comfortably drive around in. I have to be honest, I also feel more like a real boss driving it rather than the car I was driving around in medical school. I do seem to get a bit more respect pulling up to things with a nice truck compared to my 2002 ford escape that had a huge dent in the side and scratches down the back of the other side. Life is shot and this is one purchase I wish I would have spoiled myself earlier on.


My older brother is still acting a bit like an older wiser guide. Every time I feel overwhelmed with business decisions, he does a good job at grounding me while encouraging me. With all his experience he has been so wonderful to bounce ideas off of about how to best grow my business. While I was opening my new clinic, he was opening his new 30 million dollar ford dealership that he bought for his 4th location.


To date I have not taken a single dollar from family to start or maintain this practice.




Employees:



Same number of employees +2 from last year but we now offer 401k match, full dental/ vision/ and health insurance paid for by the business.



New Building:

I have purchased a clinic space for 1.7 million dollars after all was said and done. We were supposed to move in in early 2020, that move didn't happen until October 2020. COVID and construction delays like crazy.

We have our own phlebotomist and lab room but we still send off our blood. We went from 2 exam rooms to 9 rooms.

I'm currently touring a building to possibly buy into for our third location and I have purchased the location for the second location already. However, the second location is not in near as a desirable location (rural area) so everything was waaaaaaaaay cheaper than my first building.


Second Location + Maybe Third Location?



I am opening a second location in about 1 month. It was supposed to open Jan 2021 but credentialing is a disaster right now. Every email to insurance company takes days to respond from them. This process is taking about 5 months to complete it seems. Once that is done and we get our permit from the city, we will be ready to go! This second location already has a list of about 300 people waiting for us to open to come see us. That is very exciting since my first place had 0 people waiting for me to open.

I've also started looking at third locations in the event the second location works out. It takes about a year to fully find and develop a good location so I've started the hunt now just incase this works out well.



The future:

I'm talking to 2 more midlevels and another doctor in the event we keep expanding. I also have a brother in law who is a tech developer who has been building us an app for the business to make scheduling appointments much easier that integrates with our website. We have one now but is is quite limited on what we can do.

I've taken a bit less pay in the past 12 months as I've put a lot of money back into the practice. With growth over 100% in every metric we have measured in the past 12 months compared to the previous 12 months, I'm investing my money on continued good things to come. I really don't have a lot of living expenses and I'm willing to invest in the business to see how big I can grow this. I've also started to talk with 2 specialist to see if we can join forces to form a multispeciality organization. It could be a win-win as we have lots of patients who need specialist and we can argue for higher insurance rates.

I've also been very proud to be told that I was nominated as a primary care group to a new local professional soccer team that is coming to our city. That is still very early on so I really cant say much about it other than I've gotten a few emails and texts from a sponsor for the team that my place was nominated by several members of the admin for the team as the primary care group for the team. I have not received anything in writing from the official team yet though so we will see if that pans out.


Happy to answer any questions if anyone has any
 
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Congratulations and wishing you more success your way.
I'm puzzled, however, why you thought its appropriate to share specific health information of a family member. You can be 'anonymous' for now but its possible you could be revealed. Just my two cents.

I wish to learn more about starting Oncology practice but looks impossiblae and will revisit when the pendulum swing back to PP in the field.
 

InvestingDoc

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Congratulations and wishing you more success your way.
I'm puzzled, however, why you thought its appropriate to share specific health information of a family member. You can be 'anonymous' for now but its possible you could be revealed. Just my two cents.

I wish to learn more about starting Oncology practice but looks impossiblae and will revisit when the pendulum swing back to PP in the field.
I've already had people figure out who I am and messaged me "hi" so it is an interesting point that I find myself in. I'm getting more comfortable at putting myself out there but not to the WCI level of my full name directly attached to my website. I guess I'm in an in between and still figuring it out.

That was not always the case though. When I started the blog 3 years ago it really weirded me out not be anonymous online at all. Over time I've gotten way more comfortable with it. I think the emails from people reading my website that are so encouraging overwhelmed any fear I had of being totally anonymous. I also freaked out the first time someone nearby my practice subscribed to my blog. There was a feeling of..."oh ****, they are in a practice down the street from me and I know them." However, then I was getting texts saying how amazing what I was doing was. I also realized how much work it is to do what I'm doing and the idea that someone will copy me and open up next door is close to zero. It takes an insane amount of work to open your own practice and reading my blog may help in some ways but its still going to be a ton of work.

I'm not too worried about a patient finding my site with me on it. If they do, they will see that I work very hard to make a living for over 10 people at this point in time. No shame in that in my book and if they want to judge me for writing about how hard it is....they can find a different doctor.

Hell, even my vlog and blog I honestly look at it now and think it sucks. However, I have gotten nothing but kind comments on the vlog that are super supportive. Everyone has to start somewhere and like anything, the more your do it, the better it gets. I plan on continuing to vlog and blog so the videos will probably get better.

I never really say how much money I personally am making in my blog or vlog so I do try to keep that under wraps but you can assume its above a regular primary care doctor but not insanely above it at this point.

I want to show the good, the bad, the ugly of owning a practice and practicing medicine. My wife has a chronic medical condition that we are not afraid to talk about. Everyone has their burden in life and I want to show that I'm just a regular dude doing the best I can with the situation I have in front of me. Not everyone is comfortable with that, and that's cool.

If someone wants to use all this against me.....well that's on them. However, if my advice helps some doctors build up the courage and start their own practice or financially do better for themselves, then that is a win in my book.

I'm not trying to sell anyone anything, the advice is free. As the saying goes, some people will find my advise worth exactly what it costs them.
 
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Dec 13, 2020
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I've already had people figure out who I am and messaged me "hi" so it is an interesting point that I find myself in. I'm getting more comfortable at putting myself out there but not to the WCI level of my full name directly attached to my website. I guess I'm in an in between and still figuring it out.

That was not always the case though. When I started the blog 3 years ago it really weirded me out not be anonymous online at all. Over time I've gotten way more comfortable with it. I think the emails from people reading my website that are so encouraging overwhelmed any fear I had of being totally anonymous. I also freaked out the first time someone nearby my practice subscribed to my blog. There was a feeling of..."oh ****, they are in a practice down the street from me and I know them." However, then I was getting texts saying how amazing what I was doing was. I also realized how much work it is to do what I'm doing and the idea that someone will copy me and open up next door is close to zero. It takes an insane amount of work to open your own practice and reading my blog may help in some ways but its still going to be a ton of work.

I'm not too worried about a patient finding my site with me on it. If they do, they will see that I work very hard to make a living for over 10 people at this point in time. No shame in that in my book and if they want to judge me for writing about how hard it is....they can find a different doctor.

Hell, even my vlog and blog I honestly look at it now and think it sucks. However, I have gotten nothing but kind comments on the vlog that are super supportive. Everyone has to start somewhere and like anything, the more your do it, the better it gets. I plan on continuing to vlog and blog so the videos will probably get better.

I never really say how much money I personally am making in my blog or vlog so I do try to keep that under wraps but you can assume its above a regular primary care doctor but not insanely above it at this point.

I want to show the good, the bad, the ugly of owning a practice and practicing medicine. My wife has a chronic medical condition that we are not afraid to talk about. Everyone has their burden in life and I want to show that I'm just a regular dude doing the best I can with the situation I have in front of me. Not everyone is comfortable with that, and that's cool.

If someone wants to use all this against me.....well that's on them. However, if my advice helps some doctors build up the courage and start their own practice or financially do better for themselves, then that is a win in my book.

I'm not trying to sell anyone anything, the advice is free. As the saying goes, some people will find my advise worth exactly what it costs them.
I totally agree and undestand now the angle. Get After It!
 
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InvestingDoc

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Why are you hiring midlevels?
The clinic is located in a rural part of Texas where I am from about 2 hours from where I live. These two NP's are actually living on a ranch in that area. The only other clinic is 35 miles away from this location with a 4 month waiting list for new patients. So I will go there twice a week, they will be there every day to deliver care to a part of the state where there is no other clinic nearby. In the meantime they will take overflow urgent telemed visits for low acuity visits from our clinic (UTI's and such) until they get more busy at the second location.

Initially I was very on the fence about hiring midlevels but in this situation they want to deliver care to where no care is currently at. I've also practiced with them for 2 years as a hospitalist so I know that they have good experience. I feel like the stars aligned, otherwise I was a hard "no" for employing midlevels. Maybe I'm just making excuses but I am happy that these people in rural Texas will have better access to care soon instead of driving 30+ minutes to get to the clinic. I think it would be almost impossible to recruit a doctor and tell them that they will essentially have dial up internet, 1 bar cell phone service, and the only restaurant nearby is a dairy queen and a whataburger in this town.

Honestly I'm also using it as a bit of a dry run to see how it goes credentialing a second location and hiring more people. If it goes very well, then I know what to expect when I expand in my current competitive city limits. This will help me financially plan better and tell a new doctor more what to expect.
 
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Well done! Congratulations. Keep up the positive pursuits.
 
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