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Building An Ideal Practice On The Side

Yesterday, after going to an artist pop-up, we all decided to grab some fancy Mexican food at Casabel, where I met a dude named H. He is an actor and does a lot of theater work. He’s a very fit 47 yo guy, originally from Holland, working as a waiter to fuel his real passion. He is working and funding his dream job by doing something he isn’t as passionate about.

As a physician, I find myself working in random urgent cares and family medicine clinic while building my dream practice. For some reason, this seemed like a failure until I met this vivacious dude.

My Ideal Medical Practice

Okay, the “dream” part is a little much, but I definitely have an ideal medical practice in mind. It definitely doesn’t involve seeing someone for amoxicillin for their runny nose. No narcotic refills and nobody who replies with “I dunno, you tell me, doc!”

I’m being harsh, I know, but this is my dream medical practice, I get to be picky. I don’t want to practice in a prison cell with no windows, and I don’t want to see patient after patient like I’m a barista.

My dream medical practice isn’t going to be easy, either. I will have to stretch myself past my comfort zone. There is the business side of it, the customer service, the legal side, and the marketing. I know that.

My ideal medical practice involves using my brain for patients who have bought into my service. These patients feel a sense of autonomy and empowerment and believe their actions will affect their health.

Building a Practice on the Side

The money I earn here—about $140/hour—has been going towards some investments, taxes, travel, and other day-to-day expenses. But, honestly, I haven’t put that much towards building my businesses. I’m not sure why.

There has been this idea that working on the side is a failure; I should already have a flourishing virtual medical practice. And though I can’t complain, it’s not where I want it to be. And that takes time and money to invest, which I haven’t done.

If you’re building a physical practice, you need to be on-site, spend money on marketing, build out the place, and hire staff. If you’re building a virtual medical practice, you must put most of your resources into marketing and getting your name out there.

There is No Perfect Practice

No medical practice in the world will make me happy, bring me joy, satisfy my needs, or make me whole. That stuff has to come from me, and I realize that. However, the practice of medicine is complicated, and if I can make the patient-doctor interaction more pleasant, that will go a long way.

There will be patient complaints, lawsuits, mistakes, and fired employees. Or, maybe there won’t be. But that’s the nature of anything we do.

An ideal medical practice should be 80% good and 20% grind. The grind is the admin side of things, and the 80% good is where you have meaningful interactions with patients and improve your skills in the niche you’re most interested in.

There are ways to build a medical practice with fairly consistent income, kind of like the direct pay guys do it. It’s not a bad thing, really. But it’s not for everyone. For most of us, income from a business will vary. In some months, you’ll make a lot, and in other months, you’ll skip the farmer’s market.

It’s Not About Being an Entrepreneur

Look, it’s not about being a business owner or entrepreneur. I am not trying to build my ideal medical practice just so I can say, “I own my own clinic.” Perhaps in the ’50s and ’60s, when pensions started disappearing, having your own business was a thing. Now, not so much; anyone can do it and many end up in miserable solopreneur positions.

I want to cut out the middleman for no reason other than having no use for them. I don’t want to deal with the insurance company. I don’t want to deal with a marketing agency that will send me patients. I want my patients to find me and do my best to care for their health.

The business side of things requires a set of skills which are no different from being a good employee. If you can’t control your nose hairs, show up to work on time, and avoid picking fights with your MAs, you’ll get fired quickly.

As a business owner—having owned plenty of my own businesses—I have a similar skillset but slightly different. You have to do some bookkeeping, forecasting, hiring, marketing, and customer service—nothing we haven’t done before.

Feeding The New Practice

A new medical practice needs money and time. The first few months will be quite hungry, and after that, it’s up to you how much you want to suffer.

Money. This is easy because you can either cash out some investments or work to feed income to the business. Take 1/10th of your expected 5-year gross income out of your savings and put that towards your business. Hoping to make $200k a year for 5 years? That’s $100k you’ll need to fund your practice.

Time. Full-time. No other way around it unless you have some hidden talents or incredibly good at delegation. You will spend about 6-8 hours every day working on your business and that’s before you’ll even have any patients.

This is the secret sauce to having that ideal medical practice. What you want it to be in the future, it doesn’t have to be that right away. You can take your time and build it up slowly and reiterate it as you go.

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