Setting up a practice

[NRAI2001]

How difficult/feasible is it to setup a new practice after residency? Like open your own office and rehab center type of setting? Maybe a small 10 to 15 bed acute rehab setup? What if you have 1 or more other PM&R docs as partners? Do many docs do this? Is this difficult if you have enough capital to start this sort of practice?

Sorry if this is a niave question, I ve developed a new interest in PM&R and don't know much about how PM&R is actually/practically run in the "real world"... thanks

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[RUOkie]

How difficult/feasible is it to setup a new practice after residency? Like open your own office and rehab center type of setting? Maybe a small 10 to 15 bed acute rehab setup? What if you have 1 or more other PM&R docs as partners? Do many docs do this? Is this difficult if you have enough capital to start this sort of practice?

Sorry if this is a niave question, I ve developed a new interest in PM&R and don't know much about how PM&R is actually/practically run in the "real world"... thanks

Initial costs are variable based upon region, but assume (for solo practice) a 1300-2000sq ft office with 2-3 exam rooms. Lots of file space unless you are jumping right into EMR (then cut your back office space, and buy a bunch of overpriced computers and software).

2 employees at $9-15/hr (again, depending on region)-if doing interventions in the office expect one more clinical staff who will cost a lot more.

EMG machine (MSK ultrasound?/ C-arm?)

Exam room equiptment (exam tables, cabinets etc.) and supplies.

Hire a billing service (or hire a part time person to do in house)

Hire an accountant to help with payroll/books.

Buy health insurance for employees (or don't, and pay the fine next yr)


I am in solo practice for 9 yrs. I am VERY happy in this setup, but could not have made it work right out of training. I worked for others for 6 yrs first. That way I learned to be a good doctor first, and a businessman second.

I still did not have the capital to do it on my own. I used a hospital relocation stipend/loan forgiveness package to set up my current practice.

 

[yappy]

I may be ignorant of what exactly PMR is but do you guys ever set up or manage "wellness" centers along with your practice? It seems like extra income that could be put under the same roof as a PMR practice. Does this type of business arrangement exist? Is their demand for it?

 

[RUOkie]

Oh, one more thing that I remembered while doing the books last night (end of the month=checkbook balancing/reviewing practice data)

You need to keep a significant slush fund in your business checking acct for the inevitable times that the government stops paying everybody. My AR has risen since the new year, since Medicare stopped paying everybody in my region for 4-5 weeks. (CMS blamed it on Trailblazers, Trailblazers blamed it on CMS). Luckily, the last 2 wks, they are starting to catch up.

 

[PMR 4 MSK]

How difficult/feasible is it to setup a new practice after residency? Like open your own office and rehab center type of setting? Maybe a small 10 to 15 bed acute rehab setup? What if you have 1 or more other PM&R docs as partners? Do many docs do this? Is this difficult if you have enough capital to start this sort of practice?

Sorry if this is a niave question, I ve developed a new interest in PM&R and don't know much about how PM&R is actually/practically run in the "real world"... thanks

New practice right after residency is difficult. You normally do not have any capitol or anything but your name and a few hundred thousand dollars of student loan debt. Who's going to loan you the money to start the practice.

You typically have no business training or experience. I thought to myself, "I can balance my checkbook, running a business can't be that hard." I'd estimate that thought process cost me $2-300,000 over the 5 years of my "solo from the start" practice.

Payment for services is going down as costs and inflation go up.

I may be ignorant of what exactly PMR is but do you guys ever set up or manage "wellness" centers along with your practice? It seems like extra income that could be put under the same roof as a PMR practice. Does this type of business arrangement exist? Is their demand for it?

There are plenty of people who do this. Figure out what the public wants and is willing to pay for out of pocket and sell it to them. Sometimes it is a separate business from your real practice, sometimes it is a big part of it.

 

[avatar]

How difficult/feasible is it to setup a new practice after residency? Like open your own office and rehab center type of setting? Maybe a small 10 to 15 bed acute rehab setup? What if you have 1 or more other PM&R docs as partners? Do many docs do this? Is this difficult if you have enough capital to start this sort of practice?

Sorry if this is a niave question, I ve developed a new interest in PM&R and don't know much about how PM&R is actually/practically run in the "real world"... thanks

I seem to remember my practice management course in residency, one of the consultants mentioned that it costs on average 750,000$ to set up a neurology solo practice, which they considered the closest to physiatry in terms of requisite overhead. You'll also have to consider the costs of things like EMG (though this can pay for itself within the first month, and leasing is a very cheap option at least temporarily), U/S, etc.