Starting solo practice in NJ - chances of success

[jerseymd2010]

I’ve heard all the doom and gloom, I’ve been thru 7 years of employment in various settings (Hospitalist; UC, and traditional FP). I’m sick and tired of being employed and being a cog in a wheel for a hospital or health system.
I’ve saved prudently, and I would like to open a solo family practice in central NJ. All I hear is to do cash only, or concierge. I want to do a traditional practice, outpatient only, and take all major insurers. What are my chances for success? What should I look out for? How long will it take to break even? What is my income potential? I have savings and my wife has a steady paycheck. I’m not worried about $, but what are my chances that I’ll be successful in 12 months? Thanks in advance, I derive a lot of motivation thru the ppl on this forum!

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[InternistDO]

InvestingDoc has a post (series of posts?) where he blogs about opening his own practice successfully in the suburbs of Texas. He does traditional insurance/FFS and seems to be doing quite well.

 

[jerseymd2010]

Yep I saw his blog; very inspiring!

 

[jerseymd2010]

Bump

 

[AMEHigh]

As you can see this board doesn't get a TON of traffic. Your post is still at the top, so no need to bump it lol.

I don't have personal experience so can't give specifics, but yes I think in general family medicine is "safe" and you can still build a practice if you're dedicated to putting in the work/always being "on" as an owner.

 

[anthroguy]

I'm originally from NJ and interviewed with 4-5 of the hospital groups there (I think some have merged since then) and ended up leaving the area to work for kaiser because I felt the NJ groups were all lowballing me.

I have a friend in south jersey who went solo and RAVES about it. I'll try to get him on here, but he does traditional FFS via insurance and was profitable within a few months.

I feel with loans and herd mentality, we've all joined these groups (myself included) for quick easy money and lost some of our autonomy in the process.

I think if you keep overhead low, pick a good location, you will definitely succeed. hopefully at some point I can move back up there and start something similar!

 

[Sushirolls]

I'm Psych. Here is my journey so far with opening an insurance based practice. Some differences for sure, but you will still find kernels of knowledge buried in my thread I keep updating.

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 know a Sleep Doc about to open a private practice and this person has run the gauntlet of EMRs in review.

emedpractice – Excelling in Electronic Healthcare Solutions

www.emedpractice.com

This EMR will be your best priced and for all the features. Skip athena health, or practice fusion, or advancedMD, etc. This has all the bells, whistles, with a decent price. Still though, make sure they give you a decent price point break for the first 3-9 months.

You are primary care, that is GOLD. That means people come to you first. We specialists (less so Psychiatry) are reliant upon your good graces and referrals. As the health system is fracturing you will quickly realize there are the Big Box Shops and then there are the Free Folk, North of The Wall.

Look to the Psychiatrist websites in the area to ascertain which select insurance companies they are paneling for. That will be telling as to which are likely to be better at reimbursement rates. Start there and slowly consider expanding into other insurance. That EMR is Medicare /MIPS/MACRA/Bureaucracy certified. Or simply skip medicare and medicaid...

Invest in a website. A quality website. I spent about 5K on mine for development.

So much to learn, so many mistakes to make.

But make the leap. The freedom you will feel is the real cure to burn out. Regain your professionalism. I encourage you to start a thread like mine. Do monthly posts and once things settle in, switch over to quarterly posts.

I wish I had liked primary care more than Psych. You guys have such potential that is so often wasted on Big Box Shops.

Make your practice your own. Enjoy the process. Best wishes, and start yesterday.

 

[Sushirolls]

I’ve heard all the doom and gloom, I’ve been thru 7 years of employment in various settings (Hospitalist; UC, and traditional FP). I’m sick and tired of being employed and being a cog in a wheel for a hospital or health system.
I’ve saved prudently, and I would like to open a solo family practice in central NJ. All I hear is to do cash only, or concierge. I want to do a traditional practice, outpatient only, and take all major insurers. What are my chances for success? What should I look out for? How long will it take to break even? What is my income potential? I have savings and my wife has a steady paycheck. I’m not worried about $, but what are my chances that I’ll be successful in 12 months? Thanks in advance, I derive a lot of motivation thru the ppl on this forum!

Your chances of success, will morph how you define success. But I suspect in the 3-6 months of your own practice you will have felt regret for having not done this years ago.

 

[deleted941485]

I'm originally from NJ and interviewed with 4-5 of the hospital groups there (I think some have merged since then) and ended up leaving the area to work for kaiser because I felt the NJ groups were all lowballing me.

I have a friend in south jersey who went solo and RAVES about it. I'll try to get him on here, but he does traditional FFS via insurance and was profitable within a few months.

I feel with loans and herd mentality, we've all joined these groups (myself included) for quick easy money and lost some of our autonomy in the process.

I think if you keep overhead low, pick a good location, you will definitely succeed. hopefully at some point I can move back up there and start something similar!

Probably south jersey and some of the more remote northern parts of the state would be a good bet.

Otherwise it’s just like any other state with near monopolistic or oiligopoly set up you’ll never get enough patients to make it viable or you’ll be seeing all the patients the hospital systems would be glad to get off their backs

 

[InvestingDoc]

I’ve heard all the doom and gloom, I’ve been thru 7 years of employment in various settings (Hospitalist; UC, and traditional FP). I’m sick and tired of being employed and being a cog in a wheel for a hospital or health system.
I’ve saved prudently, and I would like to open a solo family practice in central NJ. All I hear is to do cash only, or concierge. I want to do a traditional practice, outpatient only, and take all major insurers. What are my chances for success? What should I look out for? How long will it take to break even? What is my income potential? I have savings and my wife has a steady paycheck. I’m not worried about $, but what are my chances that I’ll be successful in 12 months? Thanks in advance, I derive a lot of motivation thru the ppl on this forum!

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!

 

[jerseymd2010]

I follow your blog investingdoc; I will keep you posted! Thanks a lot for your encouragement!

 

[Njdevils30]

Were you thinking of opening in the Monmouth County area?

 

[jerseymd2010]

No clue yet; just in the 'contemplating' stage for now.

 

[FamilymedMD]

I was co-owner of a traditional FFS practice here for 13 years. We worked hard and smart, adding inhouse labs, subleasing space and everything else feasible to keep revenue up or expenses down. I walked away from that five years ago at a loss as it was still just one small problem away from financial collapse.

My solo DPC was simple to start and I'm making more with a much more sustainable work life than I ever had in FFS practice. It's affordable with a good socioeconomic mix of patients and we donate some charity care. With that alternative available, I can't imagine why anyone would want to start a FFS practice now.

 

[jerseymd2010]

This is the exact reason why doctors like me are hesitant to start a practice; this is in stark contrast to investingdoc. Who do you trust more?

 

[FamilymedMD]

This is the exact reason why doctors like me are hesitant to start a practice; this is in stark contrast to investingdoc. Who do you trust more?

Business is like clinical medicine, you have to make decisions based on incomplete information with varying degrees of uncertainty.

You can reduce that somewhat by reading and asking more about your options. However, keep in mind that all of us have unconscious biases, especially us business owners that have committed large amounts of time, money and our reputations to our businesses and business models.

Besides anecdotes, consider trends. I don't have data for NJ or TX but I'm very familiar with Maine's. There are only one or two docs in our small (pop. 1 million) state starting or taking over independent, insurance paid primary care practices compared to dozens of pratices that have gone out of business in recent years. I'll wager that none of those closed practices have blogs online or forum threads describing their failures.

I did read some of the posts you linked from the thread you cited and cringe at the idea of having 7 employees per physician, losing tens of thousands due to billing/insurance credentialing issues and seeing 100-150 patients per week again. I've been there, done that.

 

[InvestingDoc]

I try to show on my blog that it is hard work and not always glamorous running a business. I've had almost the entire crew get sick with COVID. I've had insurance companies screw me out of tens of thousands of dollars. I work my ass off and put in a ton of hours to make my own website, to do as much as I can myself to lower my overhead. Times have been tough occasionally since starting a business is not for the lazy. You will work very hard on the business side going fee for service.

FamilymedMD has been there and done that. There is a lot to be said for that. I have not done DPC or concierge model so I can not speak to that. So, if I were a reader I would put a lot of weight into what he or she is saying.

I am simply offering my anecdotal experience online to show that if you work hard it can be successful going the old model.

It is a lot of work. There is no sugar coating that.

However, even in spite of the shortcomings, I'm still back on track to make about 400k+ this year even using the old fee for service and billing insurance. It also is nice to have physician employees that help pay my rent and put money in my pocket every time they see patients.

I do work my ass off and see a ton of patients weekly. There is no other way to make good money in primary care without doing procedures or cash pay services.

You millage may vary depending on how hard you work and your area. I tend to think you get out of life what you put in, and believe me, I'm working my ass off to make my company grow as fast as it can while trying to be as lean as we can.

 

[Osteoth]

I was co-owner of a traditional FFS practice here for 13 years. We worked hard and smart, adding inhouse labs, subleasing space and everything else feasible to keep revenue up or expenses down. I walked away from that five years ago at a loss as it was still just one small problem away from financial collapse.

My solo DPC was simple to start and I'm making more with a much more sustainable work life than I ever had in FFS practice. It's affordable with a good socioeconomic mix of patients and we donate some charity care. With that alternative available, I can't imagine why anyone would want to start a FFS practice now.

What do you think were the main factors leading to financial instability?

 

[FamilymedMD]

Payments that didn't keep up with increasing expenses such as health insurance for us and our employees, increasing insurance and Medicaid hassles requiring more employees/overhead, EMR expenses that didn't add to efficiency (still worth doing but didn't help financially), competition for doctors from hospital loss leader clinics subsidized for the referrals and tests they produce from the higher insurance payments a regional hospital monopoly can negotiate from payers.

 

[Sushirolls]

This is the exact reason why doctors like me are hesitant to start a practice; this is in stark contrast to investingdoc. Who do you trust more?

You trust them both. They each are speaking truth.

Its all the other variables that will determine for a specific location which one's practice model may vibrate with more success. You as a doctor are also one of those variables.

 

[scharnhorst]

why does this forum not get more traffic ? are there other doctors forum?
I joined a fp group but I dont like that everyone can see your name when u post and its WAY too political with people calling each other racists etc it gets ugly a lot so i stay away from fb