Starting a new practice

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podiatryrookie

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Hi there, I am interested in starting my own practice, however I have no idea how to begin. If I could get a breakdown of what steps I need to take that would be very helpful. I am in Florida btw.
 
Florida has very high temperatures. I would make sure that your office has an air conditioning system.
 
If you have to ask, you might not be ready unless you're willing to take over an existing practice
 
I don't mean this unkindly, but its hard to help people who won't help themselves. Why don't you tell us what you think the steps to starting a practice are and then people can give feedback on the steps or discuss what you might be missing.

There really is information out there about this on the internet - obviously in some places its a little sparse, but asking people how to get credentialed on an insurance panel and asking them how to start a practice from scratch are two different things.

Your request is kind of like asking "How do I climb Mount Kilimanjaro". We don't know anything about you.

Are you a student, a resident, an associate, a hospital doctor etc. Why do you want to open a practice?

There are at least 2 (maybe 3) people within the last few years who post on here intermittently and have started practices. One I believe would consider themselves successful, but I my vibe from the other is that starting a practice can be lean.
 
Agree with others this it is too broad. You can search through old threads on here and elsewhere. Look at IPED on FB. If you have no mentors you might consider going to American Academy of Practices Management conference to network.
Hopefully you can get at least some common office forms from a mentor.

You need to pick your location wisely or find a good sublet. You likely will need permits.

You might need a CPA

You might want to form an LLC

Decide realistically on how much you can spend on equipment and furniture etc. Do not buy too many supplies they can be shipped fast when needed. Do not lease too much equipment or your monthly note will be too high. Used equipment and office furniture is an option in the beginning

Your priority will be a presentable and professional office and at least one really personable and competent staff.

Hopefully you have money saved, a partner with a good job, nursing homes to bring in money or a parents home to live in. There is no guarantee how long it will take to break even and also how long it will take to bring in 6 figures after expenses. A couple of good referral sources and some are doing pretty good after a couple months and other times you could be 2 years in and mentally and financially drained and about to give up and then it suddenly turns a corner or doesn't and you do give up.

Credentialing is time consuming and not always predictable as to how long it takes to get on plans. Some people pay others for this service.

You better have a decent knowledge of coding and what various procedures and DME pay with different common plans in your area. You have to figure out a couple money makers without being too scammy once you figure out your patient population.

You need an EMR (some are free) and billing company. Some billing companies offer software also.

You will likely need an IT person

You will need a good website with SEO

You will need a phone system

You obviously still have to pound the pavement meeting new doctors and going to health fairs etc.

Bad insurances will bring you patients, but be careful it is a trap and you seriously might only be breaking even or worse. You can accept these patients initially, but will need a plan to limit the amount on your schedule even in the beginning. Limit or even stop taking patients or at least new patients from these plans ASAP.

Managing and obtaining employees is not easy and there are no easy answers and every market is different. Some are too mean with employees and some let employers walk all over them. You have to be in the middle and it takes time to perfect being in the middle. Make sure you know the passwords for absolutely everything including email accounts. Have checks and balances for about everything, especially anything that involves money. You also need employees that are nice to patients but are not to weak to collect money.

There are plenty of laws that pertain to employees, less so with a very small business, but you better read up.

This is just the start. It is a lot.

It why we often say consider being a PA. You are here though now obviously and many have done this and will continue to do this. Solo private practice has not died yet in our profession.
 
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Thank you all for the replies, my main question is, do i need to have a physical location to then begin the credentialing process for insurances? Seems odd to pay rent for months before seeing any patients.
 
podiatryrookie said:
Thank you all for the replies, my main question is, do i need to have a physical location to then begin the credentialing process for insurances? Seems odd to pay rent for months before seeing any patients.
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Yes, you do. your DME MAC will do an in person check of your dispensing location in fact.

You could start with a simple office space rental agreement and use that as a "first location" but then you need to have medicare come out to different locations
 
Not sure what part of your career your at, but if you're a soon-to-graduate the best advise would be: don't. I considered opening my own straight out of residency but that plan was shot down by lack of financing options out there for new grads. It was a blessing in disguise though, as now that I am out working I am realizing there's no way I would've known how to properly run a practice without working for one first. There's ALOT of little things that you need to know and plan for that you don't realize as a resident. Yes, working for someone else is not ideal, but it reduces the possibility of crash and burn when you do get to the point of opening your own.
 
podiatryrookie said:
Thank you all for the replies, my main question is, do i need to have a physical location to then begin the credentialing process for insurances? Seems odd to pay rent for months before seeing any patients.
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As stated already….yes, unless you are just doing Medi/Medi nursing home. For nursing home work a home address might be enough.

For private insurance and Medicare DME you will need the physical location you are going to treat patients at. You will also need some additional insurance and there is a fee for the Medicare DME license (It all adds up in the beginning).

I have known some to use an address they know they will for sure have a few months in the future for a sublet or office space (signed contract) and got away with saving a few months rent that way.

This is one more reason a source of cash (savings, family, spouse) or cash flow (nursing homes/wound care center etc) is so important until the office gets busy. It not only takes time to get busy, but time to even get credentialed.

Most that start an office right out of residency have family money a high earning partner or keep overhead extremely, extremely low with a sublet initially and do nursing homes. Even sublets might be harder to find now with less solo doctors in other specialties having an office or multiple offices they want to sublet.
 
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I just opened my office a few months ago. It has been trying. Mostly, because I came from a high volume surgical practice where I had developed a reputation in the area and was operating very frequently - to now - maybe once a month. It is frustrating after this many years of schooling and experience to have to explain and re-explain what it is that we do - another reason for sour grapes. Not everything in life comes down to money.

The best analogy I can give to starting a practice cold is if you have ever worked in sales.

You have to get used to rejection and little victories. You almost have to learn to like the rejections, make a mental game out of it. Little victories are the referrals you get in the beginning of your practice. Sympathy referrals. You have to continue to go out there and knock on doors and do bootstrap marketing; and all the while be extremely happy and grateful for that doctor who sent you a nail fungus patient. That's what they think you do, so now treat it. And maximize your profits while causing no harm.

I am 3 months in, and I am no where near breaking even or making a profit. All in all, I invested approx. 45 K of my own capital to get things off the ground. I have one employee. I started off seeing 1 or 2 patients a week at the end of January. I am currently seeing 15-20 a week. A single surgery for the month.

There are many ways to do it and depends on how hungry you are. You can take hospital call and build a rep there, but that comes with its own headaches which has already been commented on. You can take out a private loan from a lender since banks won't give you one (you are a risk investment given your loan burden). You can have a spouse that works. You can start a practice after you have saved a little and have experience. You can do nursing homes and do part time. It's been done a million times before you; so understand that while it is indeed daunting - it's nothing that hasn't been done before. You are not in uncharted waters. Just remember, other podiatrists have done it. A million unethical ways to make money in this God awful profession.
 
podiatryrookie said:
Thank you all for the replies, my main question is, do i need to have a physical location to then begin the credentialing process for insurances? Seems odd to pay rent for months before seeing any patients.
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Your business/ billing address can be your home. Some things will only ship to a biz address. You can credential as long as you have the required stuff. I'd strongly suggest you hire a cred company or biller who does that. Some do it themselves; it is tedious and also highly important.

Google 'checklist for starting medical office.' Ein, tin, insurance x10 types, biz lic, payer interactions x30, suppliers x10, etc etc. There are about 100+ things. Literally.

As mentioned, be an associate for a year or two to learn and bank $.
 
malleolusman said:
I just opened my office a few months ago. It has been trying. Mostly, because I came from a high volume surgical practice where I had developed a reputation in the area and was operating very frequently - to now - maybe once a month. It is frustrating after this many years of schooling and experience to have to explain and re-explain what it is that we do - another reason for sour grapes. Not everything in life comes down to money.

The best analogy I can give to starting a practice cold is if you have ever worked in sales.

You have to get used to rejection and little victories. You almost have to learn to like the rejections, make a mental game out of it. Little victories are the referrals you get in the beginning of your practice. Sympathy referrals. You have to continue to go out there and knock on doors and do bootstrap marketing; and all the while be extremely happy and grateful for that doctor who sent you a nail fungus patient. That's what they think you do, so now treat it. And maximize your profits while causing no harm.

I am 3 months in, and I am no where near breaking even or making a profit. All in all, I invested approx. 45 K of my own capital to get things off the ground. I have one employee. I started off seeing 1 or 2 patients a week at the end of January. I am currently seeing 15-20 a week. A single surgery for the month.

There are many ways to do it and depends on how hungry you are. You can take hospital call and build a rep there, but that comes with its own headaches which has already been commented on. You can take out a private loan from a lender since banks won't give you one (you are a risk investment given your loan burden). You can have a spouse that works. You can start a practice after you have saved a little and have experience. You can do nursing homes and do part time. It's been done a million times before you; so understand that while it is indeed daunting - it's nothing that hasn't been done before. You are not in uncharted waters. Just remember, other podiatrists have done it. A million unethical ways to make money in this God awful profession.
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Keep on trucking. You made a call for long term success. I literally would drive home my first few months and wonder what I'm doing wrong. Now I'm seeing 30 per day a few years in. Pounding on doors works and you'll be shocked how patients that have a great experience will tell others. Get out to urgent centers staffed by np/pa and give your direct number so when emergent treatments are needed they can come right over to your office. They won't be sending you nail fungus.
 
HardRoadPaved said:
Get out to urgent centers staffed by np/pa and give your direct number so when emergent treatments are needed they can come right over to your office. They won't be sending you nail fungus.
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Have you ever had issues with these centers referring to ortho FA instead?
 
The key is making a personal connection with the mid-level providers. Its all the minor fracture care and injuries that are important. People want their ingrown fixed or their dislocated toe popped back in. So as long as you sell it that you're there to facilitate transition of those cases they'll look like a hero that they got the patient where they need to be for whatever the injury is.
 
podiatryrookie said:
Thank you all for the replies, my main question is, do i need to have a physical location to then begin the credentialing process for insurances? Seems odd to pay rent for months before seeing any patients.
HardRoadPaved said:
Yes, you do. your DME MAC will do an in person check of your dispensing location in fact.

You could start with a simple office space rental agreement and use that as a "first location" but then you need to have medicare come out to different locations
Click to expand...
Click to expand...
Actually if you register as a mobile podiatrist, you do not need a physical location. You can start credentialing as "mobile" and then transition to "stationary". I recently asked that question to a credentialing lady and she actually recommended that. You can also find a lease that starts 5+ plus months from now. And you can start applying under that location, or find some very cheap location (half a day once a week) and then after credentialing is done, transfer to a more permanent place.
 
dysonrichard801 said:
Starting a new practice can be an exciting and rewarding endeavor, but it also requires careful planning and execution to ensure success. Here are some general steps that you can follow to start a new practice:

  1. Identify your niche: Determine what type of practice you want to start and what services you will offer. Consider your experience, skills, and interests, as well as the needs of your target market.
  2. Conduct market research: Research the market demand for your services, as well as the competition in your area. This will help you identify potential clients, pricing strategies, and marketing opportunities.
  3. Create a business plan: Develop a comprehensive business plan that outlines your practice goals, strategies, financial projections, and timelines. This will help you stay focused and organized throughout the startup process.
  4. Secure funding: Determine your financial needs and secure funding sources, such as loans, grants, or investors.
  5. Register your practice: Register your practice with the appropriate state and local authorities, obtain any necessary licenses and certifications, and set up your business structure, such as a sole proprietorship or LLC.
  6. Set up your practice: Acquire any necessary equipment and supplies, set up your office or workspace, and establish your practice policies and procedures.
  7. Build your team: Hire any necessary staff, such as administrative assistants, clinical assistants, or other practitioners, and provide them with proper training and support.
  8. Launch and market your practice: Launch your practice and start marketing your services to your target audience through various channels, such as social media, advertising, and referrals.
Starting a new practice can be challenging, but with careful planning, hard work, and dedication, you can build a successful and fulfilling career as a practitioner.
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Did chatGTP 4 write this?
 
dysonrichard801 said:
why do you think so?
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Because that was the most generic sounding reply ever. The only mention of this being medically related is the use of the term practitioner. This could have been written for a podiatrist, a neurosurgeon or even someone wanting to open a dildo removal service.

Edit:. And even practitioner is not exclusive to medicine. Dr Strange is a practioner of the dark arts.
 
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diabeticfootdr said:
In California, you can get an income guarantee from a hospital and they will partially (mostly) fund your start up and ongoing practice costs (for a 1-2 year period).
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Any more details on this? Sounds too good to be true.
 
diabeticfootdr said:
In California, you can get an income guarantee from a hospital and they will partially (mostly) fund your start up and ongoing practice costs (for a 1-2 year period).
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ToeFather said:
Any more details on this? Sounds too good to be true.
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It's not just in CA, and it's "true", but good luck making it happen on favorable terms. Don't get me wrong it still occurs, but it's a very different landscape now with direct hiring. The idea is you're providing a needed service to an underserved area, and the hospital profits with your consult/inpatient/OR business. You can forget about it in populated areas. A colleague of mine almost signed a contract, but they required free 24/7 call and buy his practice in 5 years. It's rare even in the MD/DO world, I have one neurology buddy that had hospital support in, you guessed it, a rural town (which has since been flooded with the storms).
 
My personal experience is that I received an income guarantee in 2009, I paid nothing back to the hospital. It was paid by time (2 years) practicing in the hospital’s primary service area. I’ve also recruited 4 doctors on a hospital income guarantee (2011-2016). 1 paid back some money because they moved out of the area before their repayment period (time) was over.

Additionally, while with APCA, I helped several hospitals in California recruit podiatrists with income guarantees for limb salvage centers.
 
diabeticfootdr said:
My personal experience is that I received an income guarantee in 2009, I paid nothing back to the hospital. It was paid by time (2 years) practicing in the hospital’s primary service area. I’ve also recruited 4 doctors on a hospital income guarantee (2011-2016). 1 paid back some money because they moved out of the area before their repayment period (time) was over.

Additionally, while with APCA, I helped several hospitals in California recruit podiatrists with income guarantees for limb salvage centers.
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Income guarantees are an easy way to screw doctors. It’s just a loan. Completely different from a guaranteed base salary.
 
Pronation said:
Income guarantees are an easy way to screw doctors. It’s just a loan. Completely different from a guaranteed base salary.
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A loan that is forgivable if you stay a certain amount of time in the area. In most ways it is not as good as being employed and the assistance you get from the hospital might be taxed as income. If you leave for any reason prior to putting in your time they will go after you for their money.
 
Pronation said:
Income guarantees are an easy way to screw doctors. It’s just a loan. Completely different from a guaranteed base salary.
Click to expand...

This. My last job tried to recruit an additional hip/knee ortho and it was partnered with our local hospital for an “income guarantee” for 1-2 years. No bite for a while because if this doc leaves he will be on the hook for paying back the money because it is a “loan”. Granted ortho has a plethora of job opportunities they can easily turn this down. Not the same for pods.
 
I’m not sure if it’s in the area I’m in or not, but honestly hospitals do not care to hire more than maybe 1-2 pods. Those 1-2 pods will stay there until they either retire or die. Podiatry isn’t really a profession that thrives in employed hospital settings. It certainly exists in some models, and perhaps it’s more lucrative in places like California. Some of the bigger names we see on here are the guys that started years ago, generated and introduced a certain niche for the hospital and eventually developed the entire department.

But folks, please don’t think that once you’re done with residency, the hospitals are waiting for you. They are not. With 400-500 new grads per year for maybe what, 30-50 hospital positions that sporadically open over time, per year? Mathematically this is not in your favor. Possible, certainly.
Additionally with the new trend of NP’s now being hired to do nail care at hospitals, all that really shows admin is that “hey we don’t need that many pods to do this work.” We’re doing it to ourselves and it’s dangerous to the profession.
 
thefootfixer said:
I’m not sure if it’s in the area I’m in or not, but honestly hospitals do not care to hire more than maybe 1-2 pods. Those 1-2 pods will stay there until they either retire or die. Podiatry isn’t really a profession that thrives in employed hospital settings. It certainly exists in some models, and perhaps it’s more lucrative in places like California. Some of the bigger names we see on here are the guys that started years ago, generated and introduced a certain niche for the hospital and eventually developed the entire department.

But folks, please don’t think that once you’re done with residency, the hospitals are waiting for you. They are not. With 400-500 new grads per year for maybe what, 30-50 hospital positions that sporadically open over time, per year? Mathematically this is not in your favor. Possible, certainly.
Additionally with the new trend of NP’s now being hired to do nail care at hospitals, all that really shows admin is that “hey we don’t need that many pods to do this work.” We’re doing it to ourselves and it’s dangerous to the profession.
Click to expand...

Hospitals hiring NPs to clip toenails? Are you kidding me? 99.9% of NPs will refuse to do that crap. On the other hand, we are hiring an NP so that I can spend more time in the OR while they handle the clinic and post ops. More cost effective than hiring another pod.

So yes, even less hospital employed positions will be available to pods in the future. Everything else you said we’ve all been parroting for a while now, hopefully folks looking into this saturated and redundant profession will pick up on this.
 
Pronation said:
Hospitals hiring NPs to clip toenails? Are you kidding me? 99.9% of NPs will refuse to do that crap. On the other hand, we are hiring an NP so that I can spend more time in the OR while they handle the clinic and post ops. More cost effective than hiring another pod.

So yes, even less hospital employed positions will be available to pods in the future. Everything else you said we’ve all been parroting for a while now, hopefully folks looking into this saturated and redundant profession will pick up on this.
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Place I’m talking to has this as well. Two surgical podiatrists and two nurse practitioners. Keeps the clinic flowing very effectively.
 
Pronation said:
Income guarantees are an easy way to screw doctors. It’s just a loan. Completely different from a guaranteed base salary.
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Disagree.

It is an interest-free, forgivable loan to start YOUR practice. Hospitals can not require you to even work at that hospital. Instead they have to require you to work in the primary service area of the hospital. Your repayment is time and it’s usually only 2-3 years while you’re being fully paid in private practice.

In my case, in 2009, I got an income guarantee for $270,000/yr which was $22,500/mo. At the end of every month I’d show the hospital my receipts for collections (not billed). They took $22,500 minus collections and wrote me a check for the difference within 10 days.

They also gave me up to $48,000/yr in allowable business expense reimbursement (health insurance, malpractice, billing, legal, etc).

Then I got a clinic provided by the hospital (which isn’t required to get the agreement) and all staff and overhead covered.

Additionally, I received $20,000 for relocation.

My repayment was 2 years inside the service area. If I left early, the total amount of the $$ taken would be calculated as a loan and prorated by 24 months and I’d have to pay back the percent that I left early. (Interest would start at that point on the remaining amount, but was set to the fed)

Try to get the same deal from a bank!

You also complain about negative consequences of being an associate (I agree with those). But try getting this same deal from another podiatrist!

Funny enough, everyone I ever recruited, I advocated for, and got them, the same deal I got.

Everything in the profession (in this case private practice medicine) can’t be negative, can it?

So instead, why not say … that’s not a bad deal? And compared to what your complaints are about other offers … this is a great deal.

And I was “out of my guarantee” at 5 months. Meaning in 5 months my monthly collections were more than $22,500 and there was no difference for the hospital to pay. However, the allowable business expense reimbursement continued for the year.

It’s a great deal and make sure you get a good lawyer that knows these agreements. Never sign one without negotiating it. If you need recommendations on good California attorneys for Income Guarantees and Provider Service Agreements, send me a PM.
 
icebreaker32 said:
A loan that is forgivable if you stay a certain amount of time in the area. In most ways it is not as good as being employed and the assistance you get from the hospital might be taxed as income. If you leave for any reason prior to putting in your time they will go after you for their money.
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Business speak here, but you are not taxed on the money from the hospital because it is a loan. The money goes into your S-corp and then you pay yourself a salary. Your S-corp is responsible for normal withholdings and income taxes via W2.

There is back and forth about the forgivenesses part being taxable. California tax rules are complex and you need a good accountant to advise you. In the end, I don’t think mine was taxable because I already paid income taxes on it at the time of the draw.
 
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wakaflocka88 said:
This. My last job tried to recruit an additional hip/knee ortho and it was partnered with our local hospital for an “income guarantee” for 1-2 years. No bite for a while because if this doc leaves he will be on the hook for paying back the money because it is a “loan”. Granted ortho has a plethora of job opportunities they can easily turn this down. Not the same for pods.
Click to expand...

If you leave a regular job before 1-2 years there will be consequences too. Depends on your contract, you usually pay back recruitment bonuses and have an exclusion zone in a non-competition clause.

ALWAYS, ALWAYS, ALWAYS … have an attorney with expertise in Physician’s agreements review ANY agreement you intend on signing. The $1,500-$2,500 you pay for that is a hard hit, but it will save you hundreds of thousands of dollars and headaches.

Additionally, it was pretty public (google it) that I sued my hospital (after I separated and long after my income guarantee was repaid) for disparagement … and received an undisclosed, confidential settlement.

I was only able to do this because my attorney made the non-disparagement clause bilateral (the original agreement said I couldn’t disparage the hospital, but didn’t prevent them from disparaging me).

Because of that, the disparagement - which is hard to fight in court - was a “breach of contract” and was simple to prove.
 
thefootfixer said:
I’m not sure if it’s in the area I’m in or not, but honestly hospitals do not care to hire more than maybe 1-2 pods. Those 1-2 pods will stay there until they either retire or die. Podiatry isn’t really a profession that thrives in employed hospital settings. It certainly exists in some models, and perhaps it’s more lucrative in places like California. Some of the bigger names we see on here are the guys that started years ago, generated and introduced a certain niche for the hospital and eventually developed the entire department.

But folks, please don’t think that once you’re done with residency, the hospitals are waiting for you. They are not. With 400-500 new grads per year for maybe what, 30-50 hospital positions that sporadically open over time, per year? Mathematically this is not in your favor. Possible, certainly.
Additionally with the new trend of NP’s now being hired to do nail care at hospitals, all that really shows admin is that “hey we don’t need that many pods to do this work.” We’re doing it to ourselves and it’s dangerous to the profession.
Click to expand...
NPs are being hired to do a lot more than nail care. They are seeing non op tx as primary provider. And doing a good job. Nail care doesn't need to be done on 90% of people having it done, and in a hospital setting it makes ZERO sense even for those that it is justifiably billed.

And yes most hospitals need 1 or 2 pods then a AHP for each eventually, not 3- 4 pods. There will be less and less hospital pod jobs going forward.
 
diabeticfootdr said:
If you leave a regular job before 1-2 years there will be consequences too. Depends on your contract, you usually pay back recruitment bonuses and have an exclusion zone in a non-competition clause.

ALWAYS, ALWAYS, ALWAYS … have an attorney with expertise in Physician’s agreements review ANY agreement you intend on signing. The $1,500-$2,500 you pay for that is a hard hit, but it will save you hundreds of thousands of dollars and headaches.

Additionally, it was pretty public (google it) that I sued my hospital (after I separated and long after my income guarantee was repaid) for disparagement … and received an undisclosed, confidential settlement.

I was only able to do this because my attorney made the non-disparagement clause bilateral (the original agreement said I couldn’t disparage the hospital, but didn’t prevent them from disparaging me).

Because of that, the disparagement - which is hard to fight in court - was a “breach of contract” and was simple to prove.
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So much good info in here, thanks for the last few posts and the detail you went into regarding your deal, very helpful
 
619 said:
I was going to reply and give my 2 cents but then OP conveniently avoided answering this important question.
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Why? because i rather make my own money than be exploited by some other podiatrist as an associate.
 
HardRoadPaved said:
If you have to ask, you might not be ready unless you're willing to take over an existing practice
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I would agree there.^

The best way to learn how to run a practice is to be an associate at a (well-run) private practice. Pick a supergroup or a small group or whatever you want. Most are fairly similar in principle... you will eventually want to copy some parts and trash other parts of any group's methods.
Reading helps a lot, but it can only go so far. I can talk about and read about deep sea fishing all day, you know? A day actually doing it is eventually necessary.

Florida is ok in some parts, but it's generally very saturated and poor payers. Anything can work, but some areas require more marketing and/or more shady tactics for PP to be viable.
 
Feli said:
I would agree there.^

The best way to learn how to run a practice is to be an associate at a (well-run) private practice. Pick a supergroup or a small group or whatever you want. Most are fairly similar in principle... you will eventually want to copy some parts and trash other parts of any group's methods.
Reading helps a lot, but it can only go so far. I can talk about and read about deep sea fishing all day, you know? A day actually doing it is eventually necessary.

Florida is ok in some parts, but it's generally very saturated and poor payers. Anything can work, but some areas require more marketing and/or more shady tactics for PP to be viable.
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The idea of working in a well run practice sounds great but if you are tied to a location, working for that practice puts you in a non-compete and you're locked out of that area.
 
Is it tough to get a loan for a practice after 1 year of associate position or does one typically need at least 2 or more?
 
PTPuser said:
Is it tough to get a loan for a practice after 1 year of associate position or does one typically need at least 2 or more?
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Yes it is tough even with an established practice of less than 3 year to get a loan. I did not say impossible. There might a few banks that would take the risk. I am not sure what banks are worth a try, maybe ask on IPED.
 
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