Process of starting a private practice as a residency new-graduate?

[weeeeeeeesssss]

Hey there,

I was curious, after completing residency. What would be the process of starting a private (family medicine) practice as a new graduate? How would I bring in patients? How much should I expect to make? (urban area, pop. 450,201; coastal city) Should I work as a family medicine physician before going into private practice to get income (so that I can afford the cost of opening a private practice, ha)?

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[Cranjis McBasketball]

Hey there,

I was curious, after completing residency. What would be the process of starting a private (family medicine) practice as a new graduate? How would I bring in patients? How much should I expect to make? (urban area, pop. 450,201; coastal city) Should I work as a family medicine physician before going into private practice to get income (so that I can afford the cost of opening a private practice, ha)?

Do you have student loans? A wife and kids?

 

[weeeeeeeesssss]

Do you have student loans? A wife and kids?

Student loans, girlfriend (hopefully wife, and kids in the future)

 

[Sushirolls]

Read this thread to the end. You will find lots of good information to prime your ambition and give you a frame work to spring from. One post in there is a how to guide.

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

I recommend you use the EMR called Charm Health

Electronic Health Records, Practice Management, Revenue Cycle Management, Patient Engagement, TeleHealth

CharmHealth EHR is online web based, meaningful use certified, HIPAA compliant, collaboration driven, ambulatory EHR, Practice Management & Medical Billing Solution that dramatically improves quality of care for patients.

www.charmhealth.com

 

[Sushirolls]

Get patients by making sure you have a quality website.
Are listed on Google.
Have accurate listings on the Insurance websites if you take insurance.

Reach out to specialists and other clinics to introduce yourself in local referral community. Mostly you will learn who you will more likely want to refer to, but I as Psychiatrist have added or dropped people off my lists of PCPs I encourage my patients to establish with based upon contact or lack of contact with primary care clinic.

There are a few posters on FM/IM on here who have opened their practices, too. Look for their posts on SDN.

 

[weeeeeeeesssss]

Read this thread to the end. You will find lots of good information to prime your ambition and give you a frame work to spring from. One post in there is a how to guide.

Private Practice in Progress

Building a private practice, N of 1. Enjoy. Month zero: Grand plan was to use money from inpatient gig where independent contractor doing own billings to expedite insurance paneling, so all I had to do was switch over the practice address once opened. Long story short, not a quality place I...

forums.studentdoctor.net

I recommend you use the EMR called Charm Health

Electronic Health Records, Practice Management, Revenue Cycle Management, Patient Engagement, TeleHealth

CharmHealth EHR is online web based, meaningful use certified, HIPAA compliant, collaboration driven, ambulatory EHR, Practice Management & Medical Billing Solution that dramatically improves quality of care for patients.

www.charmhealth.com

Get patients by making sure you have a quality website.
Are listed on Google.
Have accurate listings on the Insurance websites if you take insurance.

Reach out to specialists and other clinics to introduce yourself in local referral community. Mostly you will learn who you will more likely want to refer to, but I as Psychiatrist have added or dropped people off my lists of PCPs I encourage my patients to establish with based upon contact or lack of contact with primary care clinic.

There are a few posters on FM/IM on here who have opened their practices, too. Look for their posts on SDN.

Thank you so much!

 

[FamilymedMD]

We've had quite a few docs start their own direct primary care (DPC) practices right out of residency.

Starting the practice isn't particularly hard nor expensive. I used a small SBA loan when I left my group practice. The harder part is how to support yourself for a year or so until your practice is making enough to support you.

There's lots of support regionally and online and even a few books written by DPC docs on this in the past few years. DPC Alliance

 

[travel30]

The user InvestingDoc has some good posts and a blog with details of starting a practice.

Don't be afraid to open in a desirable area. I'm in a location that when I started there were tons of other primary care doctors nearby. Several have since retired, several switched to concierge, and a few others moved. The 3 clinics who were my biggest competition changed their model and no longer compete with me at all. Some people want to go to a smaller more personalized feeling to getting health care. Not everyone wants to go to a huge massive building or group. They like calling up and getting the same person on the phone and knowing their doctor is there doing everything for them.

Keep costs low, sublease from someone in an area where you want to be. Really get laser focused on keeping costs down.

You most likely will turn a profit quicker than you think if you keep your initial cost low.

Keep up locums to have some income coming in because growth in the beginning is going to be slow with lots of days where you wonder if you did the right thing.

Go for it. Hell, if you want even more encouragement have a few drinks, message me and I'll call you to root you on and tell you to go for it!

 

[brianmartin]

its very possible if you have a way to support yourself for a year or two while you get off the ground. However, there are drawbacks. Paying all your own insurance premiums, license fees, etc gets really expensive. Dealing with an EMR on your own is more difficult. Insurance companies won't make your life easy at all, so hence all the people doing DPC, which is only really possible in higher income areas. Employed positions have the potential to make your life much easier, but you sacrifice control and autonomy. And if you want to work with low income patients, you basically have to be employed, or independently wealthy. You can always try the employed thing for a few years after residency, then decide how you want to proceed after that, when you have some money in the bank. IMO, you'll have more free time if you are employed in a good system with good clinical support. Ideally you see your patients and head home, instead of staying late at the office typing out referrals, trying to figure out why that lab didn't come back, tracking down payment from patients, etc. In employed practice, that gets replaced with "meet with your boss every 3 months, go to monthly meetings, do these online trainings, make sure your benefits are right with HR..." Even though these things are annoying, the peace of mind you get is worth something, and your time off really is completely yours. Of course in an employed situation, you are at the mercy of those above you, and you're generally there to get the job done and not ask too many questions. Which, depending on how well run the organization is, you might have LOTS of questions they don't want people asking, which can lead to burnout, disatisfcation, etc. Lots of people spend years doing that and finally decide, enough is enough, I can do this better on my own. Or you get lucky and find a job you really like and get along with the people, and you stay for a long time.
All I can say is, be willing to move or change situations if you aren't happy. Don't stay in a situation that isn't working for you.

 

[VA Hopeful Dr]

its very possible if you have a way to support yourself for a year or two while you get off the ground. However, there are drawbacks. Paying all your own insurance premiums, license fees, etc gets really expensive. Dealing with an EMR on your own is more difficult. Insurance companies won't make your life easy at all, so hence all the people doing DPC, which is only really possible in higher income areas. Employed positions have the potential to make your life much easier, but you sacrifice control and autonomy. And if you want to work with low income patients, you basically have to be employed, or independently wealthy. You can always try the employed thing for a few years after residency, then decide how you want to proceed after that, when you have some money in the bank. IMO, you'll have more free time if you are employed in a good system with good clinical support. Ideally you see your patients and head home, instead of staying late at the office typing out referrals, trying to figure out why that lab didn't come back, tracking down payment from patients, etc. In employed practice, that gets replaced with "meet with your boss every 3 months, go to monthly meetings, do these online trainings, make sure your benefits are right with HR..." Even though these things are annoying, the peace of mind you get is worth something, and your time off really is completely yours. Of course in an employed situation, you are at the mercy of those above you, and you're generally there to get the job done and not ask too many questions. Which, depending on how well run the organization is, you might have LOTS of questions they don't want people asking, which can lead to burnout, disatisfcation, etc. Lots of people spend years doing that and finally decide, enough is enough, I can do this better on my own. Or you get lucky and find a job you really like and get along with the people, and you stay for a long time.
All I can say is, be willing to move or change situations if you aren't happy. Don't stay in a situation that isn't working for you.

I would disagree with the bold. When I was doing DPC at least 50% of my patients were blue collar folks with either no insurance or very high deductible insurance.

 

[Sushirolls]

I would disagree with the bold. When I was doing DPC at least 50% of my patients were blue collar folks with either no insurance or very high deductible insurance.

The few in my local area re-iterate the same sentiments. Not restricted to a wealth area.

 

[FamilymedMD]

Dealing with an EMR on your own is more difficult.

Online EMRs (software as a service) make this very easy. EMRs that you run on your own server are a PITA but that was 15 years ago.

if you want to work with low income patients, you basically have to be employed, or independently wealthy.

Not true. My DPC has a nice mix of poor uninsured, poor on Medicaid (Medicaids pays for everything but me), insured and uninsured working class, employer sponsored, wealthy and retired patients.

Not only do I enjoy the variety but it makes the practice economically resilient compared to relying on one two classes of patients.

 

[Jack Donaghy]

its very possible if you have a way to support yourself for a year or two while you get off the ground. However, there are drawbacks. Paying all your own insurance premiums, license fees, etc gets really expensive. Dealing with an EMR on your own is more difficult. Insurance companies won't make your life easy at all, so hence all the people doing DPC, which is only really possible in higher income areas. Employed positions have the potential to make your life much easier, but you sacrifice control and autonomy. And if you want to work with low income patients, you basically have to be employed, or independently wealthy. You can always try the employed thing for a few years after residency, then decide how you want to proceed after that, when you have some money in the bank. IMO, you'll have more free time if you are employed in a good system with good clinical support. Ideally you see your patients and head home, instead of staying late at the office typing out referrals, trying to figure out why that lab didn't come back, tracking down payment from patients, etc. In employed practice, that gets replaced with "meet with your boss every 3 months, go to monthly meetings, do these online trainings, make sure your benefits are right with HR..." Even though these things are annoying, the peace of mind you get is worth something, and your time off really is completely yours. Of course in an employed situation, you are at the mercy of those above you, and you're generally there to get the job done and not ask too many questions. Which, depending on how well run the organization is, you might have LOTS of questions they don't want people asking, which can lead to burnout, disatisfcation, etc. Lots of people spend years doing that and finally decide, enough is enough, I can do this better on my own. Or you get lucky and find a job you really like and get along with the people, and you stay for a long time.
All I can say is, be willing to move or change situations if you aren't happy. Don't stay in a situation that isn't working for you.

This is all-around poor advice. My mentor has been running his DPC since 2010. As others have pointed out, it is anything but "wealthy care" only. 10% of his patients don't pay a dime and at least a quarter are medicaid patients.

Further, his malpractice is less $1,000 per year. Licensing fees are nominal. Biggest expense is rent, but he's working towards owning the building.

I would suggest learning more about the business side of DPC before spreading more misinformation online.

 

[d2305]

Your malpractice cost is way off. It's around 10K.

 

[XenophonMD]

Regarding this process of starting a new practice (IM primary care). I am a little confused about how to get proper information before jumping on. Is there a way to know before contracting with big insurers (Humana, Aetna, etc) if panels are closed to new PCPs in your area and avoid losing time/effort? Is this a situation that changes periodically or is more or less closed for good? I live in a competitive coastal area and some colleagues have told me that the main barrier to open shop here is that most insurers are no loger accepting new PCPs in network.

 

[Sushirolls]

They will let you know early on when you first reach out to their contracting/provider services telephone line.

Being full is BS, usually just a way of saying they don't want you and they want to restrict the service and/or restrict the service only to the larger Big Box shops in your area. This is okay. Build up a practice with the other patients from other insurance.

It's okay to think you are different and probably should. You are not a Big Box shop and aren't ever going to be a Big Box shop, so no sense feeling entrenched to the paradigm most of us know with larger entities. Its okay to not take some insurance. Its okay to go cash. Or do DPC style. Or opt out of medicaid and medicare. You will be 'Main Street' so offer main street style care, personable professional, and not rife with 30 minute long waits on the phone or refills that take a week, etc.

Also, are these people saying that the local insurance won't panel new docs, ever actually try to open their own practice? Or is this another case of the ignorant lying to more ignorant?

In my area one specialist didn't get paneled with one insurance because they wanted hospital prilieges and a covering doc with hospital privileges who is already paneled with their insurance company. This is a dual insurance / hospital system. This specialist was an outpatient based and has no need or reason for hospital privileges at all. This was really a tactic to be insular and push towards being an HMO without being an official HMO.

 

[XenophonMD]

One of them was actually

They will let you know early on when you first reach out to their contracting/provider services telephone line.

Being full is BS, usually just a way of saying they don't want you and they want to restrict the service and/or restrict the service only to the larger Big Box shops in your area. This is okay. Build up a practice with the other patients from other insurance.

It's okay to think you are different and probably should. You are not a Big Box shop and aren't ever going to be a Big Box shop, so no sense feeling entrenched to the paradigm most of us know with larger entities. Its okay to not take some insurance. Its okay to go cash. Or do DPC style. Or opt out of medicaid and medicare. You will be 'Main Street' so offer main street style care, personable professional, and not rife with 30 minute long waits on the phone or refills that take a week, etc.

Also, are these people saying that the local insurance won't panel new docs, ever actually try to open their own practice? Or is this another case of the ignorant lying to more ignorant?

In my area one specialist didn't get paneled with one insurance because they wanted hospital prilieges and a covering doc with hospital privileges who is already paneled with their insurance company. This is a dual insurance / hospital system. This specialist was an outpatient based and has no need or reason for hospital privileges at all. This was really a tactic to be insular and push towards being an HMO without being an official HMO.ctually one of them has a small office nearby.

 

[XenophonMD]

Actually one of them has his own practice, the others are from work. I have met several doctors with small solo practices in internal medicine and all of them seem more happy and satisfied that my hired colleagues. Thank you for your post.

 

[FrustratedFamDoc]

A real gut check thing to ask yourself: Is your spouse/family ready for the ride? Are you willing to take on another loan while trying to pay back your med school loans that are now coming due? Are you/your spouse/family willing to take on a very minimal lifestyle while trying to get your practice off the ground? You will have to have another source of *significant* income to pay on all of your loans/bills/rent/mortgage. Unless your spouse is also a high earner, you will find yourself working a ton to keep your head above water all while trying to start up your practice from scratch.

There are many who have started and done quite well with their own practice. Obviously, the less debt you carry, the less complicated this becomes. Be VERY careful with this decision.

 

[Sushirolls]

You don't need a loan.

N of 2. Myself and a doc subleasing from me.

 

[Cranjis McBasketball]

You don't need a loan.

N of 2. Myself and a doc subleasing from me.

How do people pay for it then if they’re just starting out??

 

[Sushirolls]

1) Use money they saved up from moonlighting in residency
2) pick up a side 'moonlighting gig' i.e. weekend coverage some where
3) lock in locums immediately after training for X amount of months to generate some money to kick start the whole process