MD Starting a solo cash-only private practice after internship year

[Whale]

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There’s a group locally in my town run entirely by NPs and they have a strong social media presence and are doing incredible business. There’s a huge market, the good products work well...

Do you know how big the market is for minimally invasive aesthetic procedures? Business revenue/profit? Only in big cities I suppose?

 

[Epilepsy365]

Yeah, all the turks and arabs in the region lose their hair quick, and young too. Those dudes are desperate for hair plugs

Does OP take barrels of crude instead of US dollars?

 

[KeikoTanaka]

FootFetish,

Just my 2 cents. I'm not business-savvy and I'm only a 2nd year student, so literally I only have 2 cents to offer.

If you fail to make it into a Derm residency, I really think you should consider a rural/unopposed Family Medicine residency and just finish the whole thing.

You mentioned above that you would be interested in not only providing beauty and cosmetic modalities to your practice, but also would like to take care of the occasional Hypertensive patient, diabetic, etc. etc.

You won't be limiting yourself at all in the beauty world since you can do it without a board certification in a specialty, but having a broad specialty like FM be your board certification, it can just be an additional tool you have in your toolbox when assessing patients with beauty complaints/needs.

You can always go to Turkey anyhow and learn hair transplant and what not, but I just think that having a couple extra years in residency will make you more confident treating a wide array of patients, and at the end of the day, will not hinder your capacity to do beauty work down the road. I mentioned a rural FM residency because I heard that in rural areas FMs do a lot more dermatologic procedures like biopsies and stuff. You could get a lot more practice in that realm doing this.

Good luck with whatever you choose.

 

[operaman]

Do you know how big the market is for minimally invasive aesthetic procedures? Business revenue/profit? Only in big cities I suppose?

Well I haven’t opened such a business myself but from the number of them I see popping up there is clearly a demand for it. I think it extends well beyond the bigger cities too.

The Established products Just work and are priced similarly to other High end health and beauty products. Take a standard 50U vial of cosmetic Botox - about $600-700 cost to patient and that’s enough to do a solid treatment. Many of these people are dropping hundreds every month on creams and serums that don’t do much at all, so 600 for something that truly works and lasts 3-4 months is pretty awesome.

I’m also amazed at the range of services and products available. Botox, fillers, kybella, peels, hydra, cryo - lots of high demand things that have relatively low materials cost. You can add lasers pretty easily too just by renting them and passing costs on to your affluent cash paying customers.

From a cash flow standpoint it seems very doable. Easy to scale to demand as well by hiring ancillary staff to administer products for you. I’ve even heard of people doing the food truck model too where they have a mobile injection center and go to all these high end gyms and coffee shops and whatnot or do Botox and filler parties for private groups.

 

[nimbus]

Yep. Just need a license. Many clinics have nurses and aestheticians who do the actual procedures while a doc “supervises” them. There’s a group locally in my town run entirely by NPs and they have a strong social media presence and are doing incredible business. There’s a huge market, the good products work well and are fairly easy to use, the crappy ones still seem to convince rich aging people to pay for them, and if you’re careful you really have minimal risks to deal with so I’m sure Med-mal coverage is probably reasonable too.

Yep one of my former partners left anesthesia to do Botox full time. I asked him how he got interested in it and he replied that he was tired of paying so much for his wife’s Botox so he decided to go to an allergan course and learn to do it himself. He now has become one of the top injectors by volume in our city and hired another MD and a NP. He’s got hundreds of 5 star yelp reviews, 2 offices, a boat, and an Aston.

 

[hallowmann]

Yeah ironically enough the lack of training may be somewhat protective from a medicolegal standpoint. Standard of care is defined in terms of what someone with similar background and training would do. This protects NPs and well as undertrained MDs. We have an OBGYN here banging out cosmetic facial procedures he has no formal training in. Not the same as GP but same idea.

As far as I understand it, medicolegally physicians aren't necessarily judged on standard of care based on their same background of training, they're judged on standard of care for the individual procedure or medical treatment that they offer, which is often defined by the specialty organization known for such a procedure. An FM delivering a baby for example is typically judged by the standard of care of physicians delivering babies, not say nurse midwives. They ultimately are judged on ACOG or similar standards.

FSMB | State Specific Requirements for Initial Medical Licensure

www.fsmb.org

The vast majority do allow it however, including NY and CA, which surprised me. IDK why for some states that require 2 years for MD only require 1 for osteo.

CA has changed its law to make it 3 yrs. Also, its because we already have 200 hrs of practice in bone wizardry, so obviously that's worth a year of GME compared to our MD counterparts.

 

[You shall know the Truth]

Yep one of my former partners left anesthesia to do Botox full time. I asked him how he got interested in it and he replied that he was tired of paying so much for his wife’s Botox so he decided to go to an allergan course and learn to do it himself. He now has become one of the top injectors by volume in our city and hired another MD and a NP. He’s got hundreds of 5 star yelp reviews, 2 offices, a boat, and an Aston.

So your saying I should forgo a surgical residency and just do Botox all day everyday?

 

[nimbus]

So your saying I should forgo a surgical residency and just do Botox all day everyday?

Depends on what you want out of life.

 

[You shall know the Truth]

Depends on what you want out of life.

I like things easy going, I especially hate having wrinkles thrown into my plans.

 

[nimbus]

I like things easy going, I especially hate having wrinkles thrown into my plans.

There’s your answer😉

 

[Mass Effect]

An FM doc can handle lupus with ease

On what planet are FM docs "handling lupus with ease"? Rheum is almost always involved in the care of lupus patients.

Choosing to leave residency for solo practice is ridiculously stupid, in my opinion.

 

[scoopdaboop]

I’m sure you need some amount of cash to really get a good business started. finishing your residency, saving some money then starting up a med spa doesn’t seem that hard to do if you have some extra moola in your bank account. I would hesitate to do it fresh out of school or residency because of the risk.

 

[takeurmeds02]

lmao why did you set yourself up like this

 

[LoGo]

On what planet are FM docs "handling lupus with ease"? Rheum is almost always involved in the care of lupus patients.

Choosing to leave residency for solo practice is ridiculously stupid, in my opinion.

You may not know, but the theme of this thread and consensus among those who will never step foot in a derm/plastics clinic is that “you can be anything”, and that regardless of your training (or lack there of), everyone is a dermatologist/plastic surgeon.... I presume the same terrifying assumption is there for rheum....

 

[tofoo]

Yeah I was perplexed by the whole “finger dry gangrene” thing. We frequently let those autoamputate unless there’s a complication. That is a weird thread.

He was sent to the largest hand surgery clinic with board certified orthopedic surgeons, and they felt that amputation would be in the best interest of the patient (early rehab), which was what happened.

Fingers are not toes. A person can walk with gangrenous toes, but the same person cannot feed oneself with gangrenous fingers.

 

[radsisrad]

While hair transplant is one thing that perhaps FM could do (and btw some derm programs and accredited fellowships do get residents some exposure in it), I don’t think a GP/FM could diagnose and medically manage all kinds of hair loss.

Vast majority of pts who present to hair transplant clinics are obviously suffering from androgenic alopecia. Not hard to order ANA, TSH, CRP for borderlines cases.

 

[libertyyne]

As far as I understand it, medicolegally physicians aren't necessarily judged on standard of care based on their same background of training, they're judged on standard of care for the individual procedure or medical treatment that they offer, which is often defined by the specialty organization known for such a procedure. An FM delivering a baby for example is typically judged by the standard of care of physicians delivering babies, not say nurse midwives. They ultimately are judged on ACOG or similar standards.



CA has changed its law to make it 3 yrs. Also, its because we already have 200 hrs of practice in bone wizardry, so obviously that's worth a year of GME compared to our MD counterparts.

The standard of care is usually defined by state, but there are many precedents where the question comes down to a person with similar training, not necessarily specialty training. So the fm would be judged by fm standards and not by obgyn standards .this is another reason why NPs can get away with care that would seem negligent by a physician standard.

The Standard of Care: Legal History and Definitions: the Bad and Good News - PMC

The true meaning of the term “the standard of care” is a frequent topic of discussion among emergency physicians as they evaluate and perform care on patients. This article, using legal cases and dictums, reviews the legal history and definitions of ...

www.ncbi.nlm.nih.gov

 

[Sleepingdoc]

Sure... NP's and PA's are giving care without any residency... and an online degree.

 

[LoGo]

Vast majority of pts who present to hair transplant clinics are obviously suffering from androgenic alopecia. Not hard to order ANA, TSH, CRP for borderlines cases.

I forgot that derm is just that easy. Thanks for the reminder!

 

[radsisrad]

I forgot that derm is just that easy. Thanks for the reminder!

Disorders of Hair Follicles section in Fitzpatrick 5th ed. is about 30 pages long. No, hair loss is not that complicated.

 

[slowthai]

Sure... NP's and PA's are giving care without any residency... and an online degree.

I was laughing too until I found out about this:
MD & DO - PA/NP RESIDENCY at UNC????

 

[LoGo]

Disorders of Hair Follicles section in Fitzpatrick 5th ed. is about 30 pages long. No, hair loss is not that complicated.

By your logic, cutaneous lymphoma should be worked up and managed by FMs as well since it’s also 30 pages, and histocytoses, ectodermal dysplasias and perforating disease should be a breeze for any NP since those sections are only 20 pages or less. I’d suggest being a little less naive.

 

[Splenda88]

We have 'Board Certified Registered Nurse' where I am doing residency... WTF!

 

[Sleepingdoc]

I was laughing too until I found out about this:
MD & DO - PA/NP RESIDENCY at UNC????

The general public are the real losers here... they get to be treated by a nurse instead of a physician... sorry did not mean to offend anyone who has relatives or are nurses but this is really shameful...
Nurses should be nurses, and not act like doctors wearing a white coat.

 

[Sleepingdoc]

I honestly am ok with getting doctors who graduated from med school, with an internship acting as a Midlevel though.

 

[Sleepingdoc]

We have 'Board Certified Registered Nurse' where I am doing residency... WTF!

What ever the hell that means... everyone is a doctor now, want to act like one.. take the medical board exams of a real physician then.

 

[radsisrad]

By your logic, cutaneous lymphoma should be worked up and managed by FMs as well since it’s also 30 pages, and histocytoses, ectodermal dysplasias and perforating disease should be a breeze for any NP since those sections are only 20 pages or less. I’d suggest being a little less naive.

MPB is nowhere in the same league of complexity and potential morbidity as CTCL or the like.

Fact: MPB is easy to dx. I think a med student would be ill-advised to complete just one year of residency before striking out, as more and more states are requiring 2+ years of training for licensure, but I have no issue with a GP (or anyone who did one year of residency) performing hair transplants.

 

[Engrailed]

Tsk tsk, you should know better, Mr. "Turkish chair." Lol.

Turkey is unambiguously the global leader in hair transplantation. The best hair transplant surgeons in the world are Turkish.

Lol

 

[LoGo]

MPB is nowhere in the same league of complexity and potential morbidity as CTCL or the like.

I agree, which is why your argument regarding the number of pages in a textbook is nonsense.

Fact: MPB is easy to dx. I think a med student would be ill-advised to complete just one year of residency before striking out, as more and more states are requiring 2+ years of training for licensure, but I have no issue with a GP (or anyone who did one year of residency) performing hair transplants.

I don’t disagree with that, and if you read my first post that’s exactly In agreement with what I said - a GP can do hair transplants with additional training if they want and that’s fine. No issues here. What they can’t do is be a hair expert, because (A) that’s a dermatologist and (B) it’s not as simple as do an ANA, CRP and call it a day - no matter how many pages it seems to be in the textbook. Can a GP call themselves as good as a radiologist because they too can say “Could be normal, could be malignancy, clinical correlation required”? Hell no. Same goes for derm.

 

[nimbus]

The general public are the real losers here... they get to be treated by a nurse instead of a physician... sorry did not mean to offend anyone who has relatives or are nurses but this is really shameful...
Nurses should be nurses, and not act like doctors wearing a white coat.

I’m a doctor who hasn’t worn a white coat since I lost mine 25 yrs ago in residency.

 

[Mass Effect]

I honestly am ok with getting doctors who graduated from med school, with an internship acting as a Midlevel though.

I'd be on-board with this. I'd even be on-board with medical school graduates who didn't match acting as midlevels under attending physicians, like the Missouri program.

 

[PikminOC]

As far as I understand it, medicolegally physicians aren't necessarily judged on standard of care based on their same background of training, they're judged on standard of care for the individual procedure or medical treatment that they offer, which is often defined by the specialty organization known for such a procedure. An FM delivering a baby for example is typically judged by the standard of care of physicians delivering babies, not say nurse midwives. They ultimately are judged on ACOG or similar standards.



CA has changed its law to make it 3 yrs. Also, its because we already have 200 hrs of practice in bone wizardry, so obviously that's worth a year of GME compared to our MD counterparts.

Ask a malpractice lawyer this

 

[PikminOC]

So your saying I should forgo a surgical residency and just do Botox all day everyday?

It's a very competitive market

 

[libertyyne]

I’m a doctor who hasn’t worn a white coat since I lost mine 25 yrs ago in residency.

I saw a dude wearing a labcoat pushing a cart full of trash the other day. Title was Logistics coordinator or something like that. Got a good laugh out of it.

 

[radsisrad]

I don’t disagree with that, and if you read my first post that’s exactly In agreement with what I said - a GP can do hair transplants with additional training if they want and that’s fine. No issues here. What they can’t do is be a hair expert, because (A) that’s a dermatologist and (B) it’s not as simple as do an ANA, CRP and call it a day - no matter how many pages it seems to be in the textbook. Can a GP call themselves as good as a radiologist because they too can say “Could be normal, could be malignancy, clinical correlation required”? Hell no. Same goes for derm.

Are you a derm resident?

And a more correct comparison WRT radiology would be a question of whether a GP can become equally good as most radiologists at reading bone age XRs. And the answer would be: yes.

Doctors are generally ambitious adults. Odds are that a physician can read enough on a limited area such as alopecia to be competent in its evaluation and treatment.

 

[yungspleen]

So, there are 33 states in the US that will give me a license to practice medicine after just 1 year of GME. This is incredibly liberating to me; it takes off so much of the pressure of matching into dermatology. I have checked off all the little cookie-cutter boxes they want from me: high step 1 score, research, Honors, etc. I will give this cycle my very best effort. But, if I fail to match derm, I will not lose a SINGLE wink of sleep over it. I will just complete my preliminary medicine / transitional year and hang out my shingle in one of those 33 states. Cash only. I may even fly to Turkey before internship year to learn hair transplantation. The best part is no one can stop me, and I am beholden to no one with this route.

Inb4 "wahhhhh, b-b-b-but you didn't suffer through a soul-crushing 5-year general surgery residency. It's not fair!!11 You don't deserve to be a surgeon!!" Tough luck, kiddo. No such credentialing is needed. And no, my patients won't care at all. I'm a highly effective salesman and know how to FUD my competition in a cut-throat market (i.e. "Psshhh..Honey, 5 years of butts and guts won't teach you the artistry of hair restoration" ). Oh, and LOTS of BOTOX®...Lots and lots of BOTOX®. I will undercut every dermatologist and plastic surgeon in the state if I have to. The Rothschilds will make me an honorary family member. Again, all of this is just my PLAN B. I would still much prefer to be a dermatologist.

Anyone have similar plans?

What ended up happening to you? Did you match derm?

 

[Neopolymath]

What ended up happening to you? Did you match derm?

He failed out of med school at the end because he got addicted to an Onlyfans account of cute feet. It was really sad.

 

[slowthai]

He failed out of med school at the end because he got addicted to an Onlyfans account of cute feet. It was really sad.

Bro, I really wish Foot Fetish was here to terrorize the scene again. I have fond memories of him regaling us with his legendary stories of 12 hour days and straight 100s on every preclinical exam

 

[Neopolymath]

Bro, I really wish Foot Fetish was here to terrorize the scene again. I have fond memories of him regaling us with his legendary stories of 12 hour days and straight 100s on every preclinical exam

That and our fearless short man failedatlife lol

 

[penpenclown]

He failed out of med school at the end because he got addicted to an Onlyfans account of cute feet. It was really sad.

That and our fearless short man failedatlife lol

 

[Kardio]

@slowthai @Neopolymath I’m so glad the two of you mentioned that guy. Just stumbled into this and have been lol’ing the past hour. Hands down, best quote I’ve ever read on SDN:

All I've ever wanted in life was that blonde haired, blue eyed sorority girl. All she has ever wanted has been Chad the 6'2 dude with a 260 and top tier Ortho residency.

 

[slowthai]

View attachment 315774

I know...I know. It will be alright.

@slowthai @Neopolymath I’m so glad the two of you mentioned that guy. Just stumbled into this and have been lol’ing the past hour. Hands down, best quote I’ve ever read on SDN:

Yes, he was the closest to being SDN's national treasure. He said so much little, yet contributed so little much to the community. Some might call him the Michael Jordan of trolling. All we can do, is bid our final farewell, and lay his soul to rest. A moment of silence.............

 

[Kardio]

Yes, he was the closest to being SDN's national treasure. He said so much little, yet contributed so little much to the community. Some might call him the Michael Jordan of trolling. All we can do, is bid our final farewell, and lay his soul to rest. A moment of silence.............

When the NBME was still just considering a switch to P/F, I bet the pro-P/F camp just started reading his post history out loud.

 

[deleted1064759]

@slowthai @Neopolymath I’m so glad the two of you mentioned that guy. Just stumbled into this and have been lol’ing the past hour. Hands down, best quote I’ve ever read on SDN:

There was another guy a few years ago named Idiotface who had a 2+ year troll thread