Private practice advice

[2006MD]

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I have always wanted to hang my own shingle and help my community, but I've been hearing discouraging news on the state of small private practice groups over my past years in residency. Reimbursements take 6-9 months, sometimes you have to resubmit to get paid for services already rendered, and the amount goes down each year, and so on.

There are two of us (maybe 3) that want to set up shop in southern California. I am somewhat interested in pain and think that a fellowship would enhance our offered services. The possible 3rd resident is interested in doing a sports fellowship. My co resident thinks we all have enough skills to start up. I've been told by an attending that I should probably work for a few years for someone before starting on my own.

My questions to those out practicing are:

1) Is a general PM&R residency enough to start and maintain a successful private outpt practice?

2) What should the minimum number of people in the community be per physiatrist (25K to 1?).

3) How do you inform the public that you exist? Do you go from PCP to PCP alerting them of the wonderful specialty that they may have never heard of?

4) ???

 

[PMR 4 MSK]

1 - yes. Fellowship is if you want to concentrate in and excell in 1 particular area of PM&R, and did not get enough experience in it in residency.

2 - No stats to support this. I'm currently in a town of about 150K with catchman area of 400K, we have 7 full time physiatrists, one part time, most are independant, 3 work together at the local *********** inpt rehab. We all appear to be busy.

3 - The best way is to get referrals is to meet the referring docs and educate them on what you and PM&R do. Start working on your presentation now. Set up lunch at their office, or maybe a breakfast meeting at the hospital around their rounds. Food is the best way to get their attention for many docs. Call them when they refer a pt to thank them and let them know your thoughts and plans - include them in the treatment plan. Don't steal patients - give them back when you are done.

Going directly to the public can work if you can get a target audiance for a particular problem. Back pain and OA have worked very well for me - getting between 50 and 150 in the audiance, leading to self-referrals. Most of these will be Medicare most likely. Find local groups that sponsor these talks - Arthritis Foundation, local groups for the elderly. I gave a talk once on female althletic problems at a woman's gym.

If you are good, word of mouth will pread ahead of you - your patients are your best marketing tool..

 

[RUOkie]

I am a physiatrist who is in solo practice in a semi-rural area in OK. I have been solo for 6 years following academics and a large group practice.

I would advise anyone to at least get some experience in a group PRIOR to "hanging a shingle". There is a lot more business to deal with than just seeing patients. You need to learn coding, labor law, tax issues and more.

That and learning to be a physician. I have learned more each year in practice than all of residency.

That being said, in response to your question, the best marketing is word of mouth, good reports, and communication with your referral sources. When I came to this town of 50K people, I brought homemade lasagna for lunch to a physician practice every week for 6 months. I am still remembered for this 6 years later. We travelled up to 100 miles to bring lunch. In a word, I let the other docs know that I was HUNGRY! I never complained about "bad" referrals, and always said thank you. I saw Medicaid and no-pays. I continue to show up at our hospital 6 or 7 days a week (even if I don't have an patients--misery loves company!) In rural areas it is important to let the other docs know you are there to work.

In all I work much harder than I did elsewhere, have less time off, and my stress level is MUCH LESS🙂🙂

I would recommend it to anyone!

 

[Bleurberry]

Great post, thanks for your advice. So if you don't mind, what kind of ailments do your patients typically come to you for treatment, what kind of referrals do you get? In effect, what's your bread-and-butter case in this quasi-rural environment? I love the hot homemade food idea, kudos.

I am a physiatrist who is in solo practice in a semi-rural area in OK. I have been solo for 6 years following academics and a large group practice.

I would advise anyone to at least get some experience in a group PRIOR to "hanging a shingle". There is a lot more business to deal with than just seeing patients. You need to learn coding, labor law, tax issues and more.

That and learning to be a physician. I have learned more each year in practice than all of residency.

That being said, in response to your question, the best marketing is word of mouth, good reports, and communication with your referral sources. When I came to this town of 50K people, I brought homemade lasagna for lunch to a physician practice every week for 6 months. I am still remembered for this 6 years later. We travelled up to 100 miles to bring lunch. In a word, I let the other docs know that I was HUNGRY! I never complained about "bad" referrals, and always said thank you. I saw Medicaid and no-pays. I continue to show up at our hospital 6 or 7 days a week (even if I don't have an patients--misery loves company!) In rural areas it is important to let the other docs know you are there to work.

In all I work much harder than I did elsewhere, have less time off, and my stress level is MUCH LESS🙂🙂

I would recommend it to anyone!

 

[RUOkie]

Great post, thanks for your advice. So if you don't mind, what kind of ailments do your patients typically come to you for treatment, what kind of referrals do you get? In effect, what's your bread-and-butter case in this quasi-rural environment? I love the hot homemade food idea, kudos.

EMG is what pays the bills, and my preference is non-interventional spine care. However, in this type of environment (I am 50 miles from Tulsa), you have to be willing to see all comers. I have spinal cord injured patients (I recently saw a new quad), cancer rehab, stroke etc. I try to weed out TBI patients before they get to me, but some sneak by (not my favorite). You have to be open minded. If someone wants to be a specialtist physiatrist (ie. ONLY musculoskeletal) go to a city.

 

[2006MD]

I am a physiatrist who is in solo practice in a semi-rural area in OK. I have been solo for 6 years following academics and a large group practice.

In all I work much harder than I did elsewhere, have less time off, and my stress level is MUCH LESS🙂🙂

I would recommend it to anyone!

Wow sounds like you work really hard but are enjoying it very much. Being in a solo practice, what do you do about call? Did you work in a group practice/academics in OK or near where you practice now? Thanks again for the advice.

 

[2006MD]

1 - yes. Fellowship is if you want to concentrate in and excell in 1 particular area of PM&R, and did not get enough experience in it in residency.

2 - No stats to support this. I'm currently in a town of about 150K with catchman area of 400K, we have 7 full time physiatrists, one part time, most are independant, 3 work together at the local *********** inpt rehab. We all appear to be busy.

3 - The best way is to get referrals is to meet the referring docs and educate them on what you and PM&R do. Start working on your presentation now. Set up lunch at their office, or maybe a breakfast meeting at the hospital around their rounds. Food is the best way to get their attention for many docs. Call them when they refer a pt to thank them and let them know your thoughts and plans - include them in the treatment plan. Don't steal patients - give them back when you are done.

Going directly to the public can work if you can get a target audiance for a particular problem. Back pain and OA have worked very well for me - getting between 50 and 150 in the audiance, leading to self-referrals. Most of these will be Medicare most likely. Find local groups that sponsor these talks - Arthritis Foundation, local groups for the elderly. I gave a talk once on female althletic problems at a woman's gym.

If you are good, word of mouth will pread ahead of you - your patients are your best marketing tool..

Thanks a lot for the detailed reply. Is your practice near a large metro or academic institution? Did you join the group after it was established? If this was the case, did you know someone there or did you find the position by word of mouth?

 

[RUOkie]

Being in a solo practice, what do you do about call? Did you work in a group practice/academics in OK or near where you practice now?

I am "on call" 24/7/365. When I am out of town or unavailable, the patient's PCP usually covers for any emergencies or on inpatients. I work this out on a case by case basis. 2 years ago I went to Hawaii for 2 weeks and dealt with a problem while driving through Hilo. The key in this situation is to be upfront with the other docs and with your patients. People do understand that we can't work all the time. I very rarely get called at night now, and when I do, it is usually very important. My cell phone is my pager.

Regarding my previous places of employment. I was in an academic practice in a Gulf coast state for 2 years (I hated academics), and prior to that in a 15 doctor (yes you read that right) PM&R group in Colorado. I loved the work, but had a difference of opinion on the running of the business😱 (I will leave it at that). When I moved to OK, I knew NOBODY except my wife and animals.

 

[PMR 4 MSK]

Thanks a lot for the detailed reply. Is your practice near a large metro or academic institution? Did you join the group after it was established? If this was the case, did you know someone there or did you find the position by word of mouth?

I'm about 90 min from a big city. Practice has been here since the 60's. I got it via a headhunter.