Practice Finance

[Disciple]

For those of us crazy enough to attempt starting a practice right after fellowship,

does anyone have any feasible or clever ideas on how to finance the start-up costs? Other than just taking out a huge loan?

I'm assuming the typical pattern for those not in a partnership track is to save up for a couple of years in a salaried position, then go out your own with or without a partner.

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[lobelsteve]

You can look into investment capitol groups. THey act like consultants and can provide turnkey ASC practices for the low low price of 25% OF YOUR PRACTICE. Try it like every other business. Write a proposol and take it to a bank. What? No trianing in writing business plans and knowledge of cost per SF, labor costs, depreciation, etc. It will be daunting. But it may be the most rewarding both financially and professionally.

 

[Doctodd]

start slow, lean, and mean....follow the recommendations on the painrounds.com page. You can also do what alot of docs do and that is start in a hospital and network, never have dinner/lunch alone, share office space by leasing a day or 2 at someone else's office....then after you have enough volume, go for it. There are different ways to skin a cat.

T

 

[C Fiber]

Has anyone out there( starting fresh out of fellowship) tried putting together a procedure suite in your office? Is it a dumb idea prior to getting the referral base?

 

[Force440]

Has anyone out there( starting fresh out of fellowship) tried putting together a procedure suite in your office? Is it a dumb idea prior to getting the referral base?

It depends on where you're practicing.

If you're in an area that is not saturated with pain docs, and you practice comprehensive pain management, you're likely to get plenty of referrals just because you put up your shingle. Trust me, referring docs have plenty of chronic pain patients to give you. If this is the case, I'd strongly consider leasing (or buying) a C-arm and hiring an RT that can double as an MA. The C-arm can cost a few thousand a month, but if you do 30+ procedures/wk, you'll more than make up for it. The downside is that it is hard to meet and greet when you're stuck in your office all day every day.

I'd suggest getting a medicare fee shedule. Look at the site of service differential. It's significant.

If you're in an area with a lot of competition, you may want to consider doing your procedures in an ASC for a while. You're reimbursement will drop, but so will your headaches. Your overhead won't be as high (no kits or meds to buy). You won't have to hire nearly as many people, and you won't need as much office space. You'll also be able to network more efficiently.

I'd lean towards getting the in-office c-arm. If you don't, you'll eventually wish that you did. Do your straightfoward blocks in your office. Do your RF's, discos, and neck work in an ASC. Eventually you'll want to invest in an RF generator (another 15-30K) to do these in your office too.

Good luck. . .

 

[Disciple]

With an in-office C-arm, is it necessary to have the walls of your procedure room lined with lead?

 

[Force440]

We had to line the walls the internal walls with lead. The walls that border the outside of our clinic did not need to be lined. This regulation varies from state to state.

 

[Spine Specialist]

We had to line the walls the internal walls with lead. The walls that border the outside of our clinic did not need to be lined. This regulation varies from state to state.

Doctor- Are you sure abt this? I thought modern fluro machines does not need lead lined internal walls. Anyone know the regulation for tri-state area? Thanks!

 

[Aether2000]

It does vary from state to state. MA and MI definitely require lead lined walls whereas some of the surrounding states do not. You can check with the State Health Dept Radiation division for specifics.
Also, you do not need a new C arm for office procedures. The entire point of office based procedures is cost efficiency since you are bearing all facility costs out of your own pocket, and cannot in general charge a facility fee. But Medicare typically pays 3 times as much in office vs in an ASC or hospital for physicians fees.
Goto http://algosresearch.org/PracticeTools/ManufacturerWebsites/index.html for links to manufacturers websites and also on the C-arm link, there is a list of those selling refurb or reconditioned C-arms. Also check www.dotmed.com as a good source of C-arms.
I recently purchased a dig subtraction 2002 pulsera for $27,500 via these sources, which is 1/4 the cost of a new machine.
I also purchased a used RF unit for $10k with 2 probes . You can find bargains, but need to look for them.
With respect to a RT: these are only needed in certain states, and can be quite expensive. We priced out RTs and MAs and found the RTs cost twice as much as a MA.

 

[Mister Mxyzptlk]

I would not do the procedure room at first. You want to have your name seen on the O.R. board at the local facilities for various reasons: advertising your name and services, showing that you support the facility, etc. You can also sit around in the lounge between cases meeting people.

You might consider part time locum tenens gas work. It will help pay the bills, and you can ask the anesthesia group to assign you to ortho and neuro cases. What better way to meet the surgeons?

Once you're blowing and going you can put in the procedure room. However, be aware that if your initial volume is good you may be recruited as a partner at an ASC, which will further enhance your referrals. Your distributions may exceed your in-office income if your ASC has a lot of busy orthos. You can hold back your Medicare for the office and catch the 3x fee differential. Lots of ways to skin the cat.

 

[Kwijibo]

For NYC you need to have the property inspected by a physicist. I have names of several of them if you want to pm me(some are from jersey). Also your local OEC rep is a good source of info.