Solo practice

[newpodgrad]

Hey guys

Seeking options and opinions here from seasoned docs such as yourselves.

What’s the future like for SOLO podiatry practice?
If you’ve followed some of my other threads you’ll see that I was in talks to maybe buy a practice.

Also considering starting it fresh from scratch.

It seems like dentists do very well solo and sometimes I see our filed kinda mirroring there’s and sometimes not .

So what are your thoughts ?

1. Solo from scratch
2. Buy existing office
3. Associate ship
4. Hospital gig (if any)

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[Boba Foot]

Hey guys

Seeking options and opinions here from seasoned docs such as yourselves.

What’s the future like for SOLO podiatry practice?
If you’ve followed some of my other threads you’ll see that I was in talks to maybe buy a practice.

Also considering starting it fresh from scratch.

It seems like dentists do very well solo and sometimes I see our filed kinda mirroring there’s and sometimes not .

So what are your thoughts ?

1. Solo from scratch
2. Buy existing office
3. Associate ship
4. Hospital gig (if any)

Currently a third year resident. I initially kicked the tires and looked into starting my own practice fresh out of residency. Banks are very reluctant to offer podiatrists startup loans fresh out of residency, so it pretty much ended there. Bank of America said no, Wells Fargo said to graduate first and then call them. I wasn’t willing to sit around hoping for a loan until after graduation. If it didn’t work out, I’d be scrambling for a job at the very last minute. Unless you have old money to back you, it’s pretty tough to come up with the money to start.

I ended up taking an associate job with a guy I actually got along with, and he’s looking to potentially sell out to me within the next 5 years, assuming everything works out well. If not, banks (BoA, Wells Fargo) are more willing to give decent loans once you have a year or two of associate under your belt. I believe banks are much more willing to give fresh grad dentists loans.

 

[NatCh]

5. Partner up with one or two other new grads so you can share expenses and fumble through things together?

 

[619]

I ended up taking an associate job with a guy I actually got along with, and he’s looking to potentially sell out to me within the next 5 years, assuming everything works out well. If not, banks (BoA, Wells Fargo) are more willing to give decent loans once you have a year or two of associate under your belt.

Besides a hospital gig/MSG/ortho gig straight out of residency, this is the most viable option. Start as an associate with plans to buy in or go solo in the next few years. I was an associate for 18 months before going solo and I made 2x more my first full year being solo and the rest is history. Obviously ymmv.

After residency, you need to get comfortable practicing medicine and getting your treatment routine down for common podiatric pathologies before starting to run a business. Yes you went to the best surgical residency in the world (that's what everyone says on this forum but who cares) however when you're out by yourself and first day in clinic, it's a whole different ballgame dealing with different patients and their needs, coming up with treatment plans and adjusting as needed, complications etc.

Proper billing is also very important including knowing co-pay, deductible, coinsurance etc should be second nature before starting to run a business. Shadowing an attending in office for a few weeks or months in residency is not the same as being out there as an associate where the bat is in your hand and the ball is in your court. You can't learn how to swim till you're in the water.

That's why most folks will advocate for starting as an associate before going solo. Even dentist do this also, they work for corps or another dentist and get up to speed with all the common procedures before deciding to go solo. This is how to be successful and not get burned out.

 

[619]

Partner up with one or two other new grads so you can share expenses and fumble through things together?

Blind leading the blind. What could possibly go wrong haha

 

[HardRoadPaved]

he’s looking to potentially sell out to me within the next 5 years, assuming everything works out well

hahaha classic PP DPM owner line. 5 years, settle down, get a mortgage + family then ask for the $$$$ to then have the privilege to buy me out when you increased the value of the practice.

 

[HardRoadPaved]

Blind leading the blind. What could possibly go wrong haha

Wife of Dr. X: How come Dr. Y only works til 3 and drives a fancier car?

 

[NatCh]

Blind leading the blind. What could possibly go wrong haha

EVERYTHING but at least it's only half your problem.

Besides, if you guys get in a jam just log in to this forum and everyone will tell you what to do!

 

[Feli]

Solo can be done.... but remember that nobody is ever truly solo.
You still need a doc to cover for your call/consults at hospitals, you still need peer references, you need good relationships with areas docs/groups since they will see your dirt and you theirs, etc. You also have potential to slide way behind the standards of care when solo unless you do good CME.

The huge downside to solo is that you have a ton of dead time whenever you're on vaca, CME, surgery, etc. The office just keeps costing staff, rent, bills, etc whether you're there or not. That is the strength of a group and why solo is much less popular. Solo is also less profitable than small/medium group in studies across podiatry and all specialties: solo is wasteful, large/huge gets inefficient with too much admin, small/medium is usually where it's at for $$$ and good hours.

I have seen the group of young DPMs starting an office work ok, but they typically do it with one or two or all of them having a lot of family money.

... looked into starting my own practice fresh out of residency. Banks are very reluctant to offer podiatrists startup loans fresh out of residency, so it pretty much ended there. Bank of America said no, Wells Fargo said to graduate first and then call them...

Post-Obama market crash, you won't have a prayer with big banks (even ones you have a relationship with) unless maaaybe you're talking to them about buying out a very proven and very profitable practice.

You need to try SBL, alt lenders, etc for startup or most buy in/out. I posted more in a thread on this (maybe this same kid's?).

Also, unless you have a defined buy-in price set before you started with your associate job, you probably won't get any fair price there (they will inflate price on value you added). The jokes above aren't jokes. Some are more ethical than others, but any PP owner dreams of an associate who is in debt, buys a house, likes the area, kids in school, didn't set buy-in price, needs cases for boards, has non-compete, etc... loses any and all bargain power.

 

[NatCh]

I like the "Have a lot of family money" business plan. I wish I'd done that. Where were you guys when I needed you???

 

[dtrack22]

Post-Obama market crash, you won't have a prayer with big banks (even ones you have a relationship with) unless maaaybe you're talking to them about buying out a very proven and very profitable practice.

BOA was lending to new practices all the way up until covid spring/summer. They continued to do acquisitions despite all of that. Sounds like someone tried to contact them, but their “practice solutions” loan program was traditionally a good option for start-ups.

Local credit unions would be the best option, they also traditionally are good for big lines of credit or start up loans with interest only payments for 12-18 months. Worst thing that would happen with one of them is they put you through an SBA program which is fine, just takes a little longer (typically 90-120 days from business plan/application submission)

 

[Feli]

BOA was lending to new practices all the way up until covid spring/summer. They continued to do acquisitions despite all of that. Sounds like someone tried to contact them, but their “practice solutions” loan program was traditionally a good option for start-ups.

Local credit unions would be the best option, they also traditionally are good for big lines of credit or start up loans with interest only payments for 12-18 months. Worst thing that would happen with one of them is they put you through an SBA program which is fine, just takes a little longer (typically 90-120 days from business plan/application submission)

Yep, local credit unions are usually best. ^^

That's cool BoA got back into the game... the more options, the better. They told me in 2013 they'd closed their physician/practice lending program (acquisitions or startup), and that I could go through the general biz loans (dead ended due to student debt-to-income) or try for a general 'physician loan' (only usually granted if you're doing house buy +/- pay off student loans). PNC was most helpful of the big ones I've ever tried, but I couldn't get anywhere significant there without co-signer.

The alternate ones or CUs were most promising (Kabbage before they froze/waitlisted apps with covid, Bankers Healthcare Grp, local CUs where would start/buy office, HACU via ACFAS, etc). It is a game I'm not eager to play again anytime soon

 

[Boba Foot]

You need to try SBL, alt lenders, etc for startup or most buy in/out. I posted more in a thread on this (maybe this same kid's?)

I was told that SBL also doesn’t loan to fresh residency grads until at least 1 year of experience. Never actually tried, like I did with the big banks, but that was the word.

 

[ExperiencedDPM]

I like the "Have a lot of family money" business plan. I wish I'd done that. Where were you guys when I needed you???

I told you I’d help out. Do you really think that asking for your first born was too much?