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Start A Private Practice Without Losing Money

What I love about blogging is that over a long enough time span, you can really see how a physician’s career evolved. You can follow the timelines when they tried something and learn how they failed or maybe why they succeeded.

Over the years, I’ve had all sorts of entrepreneurial interests. I pretty much failed at most of them, which has been really helpful – I learned a lot from these experiences.

Auto Mechanic Shop

My auto mechanic shop was probably the most successful endeavor because it achieved everything I wanted it to achieve in a short period of time.

I stumbled into that one and had the right support to make it a possibility. I was already spending a ton of time at a friend’s shop and he had an extra bay to rent out.

I capitalized on this opportunity and partnered up with a mechanic friend. It worked out really well and the shop still exists though I sold my share to my partner right before going through a divorce.

The Blog

The blog isn’t so much a money-maker as a door opener and it has served that purpose many times.

Don’t assume that you have to follow the same business model as another blogger. You can use your blog to make money in all sorts of ways.

Ad revenue and affiliate marketing is certainly profitable but it might limit your content.

Real Estate

I’ve tried to start some real estate but as soon as I get close enough to pulling the trigger, something holds me back. It’s either because I’m not ready for it or because I haven’t come across the right opportunity.

Though, I did purchase my condo in hopes of turning it into a profitable rental once I’m ready to leave Portland.

Aesthetic Medical Practice

My most recent endeavor was to open a laser hair removal clinic which ended up not working out. It’s probably a good thing because I had no idea that the California medical board was going to suspend my license. There would have been ways around it, but it may have been too much of a headache.

It’s still not out of the picture. My business partner and I are still working on the business plan and throwing ideas back and forth.

Clinic “Partnership”

Towards the tail end of my residency at UCLA Family Medicine I was approached by a clinic owner who wanted a new MD to be his partner.

Long story short, the whole thing was a very elaborate scam. I did sign on and I did have to deal with a massive FBI investigation but, fortunately, I caught on to the scam real quick and stashed the money the scammers were going to steal (~$60,000) and handed it over the FBI.

But let me tell you son, it didn’t end there. After threats from the scammers (Russian mafia) and threats from the FBI, I ended up telling them both to fuck off and somehow made it through the ordeal only to have to fix the situation with Medicare.

I managed that too, all while studying for my family medicine board exam.

 

Private Practice Urgent Care

So, now, I have my eyes set on starting my own urgent care. Well, “now” as in, for a couple of years I’ve been thinking about it. But that’s how I am, afraid of commitments and slow as molasses.

I’m still throwing ideas around in my head and writing it out on my spreadsheet. I’ve considered a cash-only urgent care, a tiny urgent care with no x-ray, pr a massive urgent care with ultrasound and drug testing.

I’m not set on the location yet, either. I could do it in Oregon but there would be good reason to do it in California as well. Problem is that I don’t want to live in California.

The first Year

It’s really hard for a legit urgent care to go out of business. There are far more patients than clinics to service them.

But it’s easy for a greedy urgent care to go out of business. If you’re trying to be too much for too small of a population then you could fail by running out of funds.

The first year will be the toughest because you’ll have to adjust to your clientele. Maybe you thought you’d get a ton of cash patients and realized that’s not the case – so you have to roll with the punches and try to get more of the insurance payers.

Getting through the first year  seems to be the toughest. You might have high employee turnover until you find the right fit. And the first EMR you use might not be the best one.

The billing company which was recommended to you might turn out to be shit. Your CPA will fuck you over and your lawyer didn’t do a good job drawing up your contracts. All fixable but drama for your mama.

The Overhead

The overhead for a young urgent care can be a little overwhelming. From what I’ve learned, you sometimes need a full-time office manager just to handle all the bills.

But a bigger concern is being able to afford the overhead. Will you have enough money in reserves to pay your staff who might be standing around doing nothing? Pay your flat fees for the billers and EMR? Go through a bunch of bottles of Toradol and Rocephin because they get used once and expired?

Then there is rent and malpractice and workman’s comp, utilities, lawyer fees, new software, and subscriptions.

 

Twiddling Your Thumbs

A buddy of mine started a massive urgent care maybe 3 years ago and he said the first 6 months he was seeing 2-3 patients a day. He was bored out of his gourd.

He was sitting around twiddling his thumbs for 11.5 hours of the day. He was trading stocks online, shopping on Amazon, and eventually resorted to copulating with this part-time MA’s.

Fortunately, he’s much busier now and has brought on a part-time associate and stopped all the other nonsense. One thing he didn’t do is …. telemedicine!

Telemedicine

I’ve talked to a few of you now on clarity.fm and telemedicine seems to have been a solid workaround for a young urgent care or primary care clinic. It’s a great way to earn some income while you’re sitting around doing nothing.

Telemedicine can supplement your income from your fledgling clinic until the pace picks up. Why let the electricity and rent go to waste.

The key is to get credentialed early so that you can transition smoothly with your time and safely quit your day job and focus on your private practice.

The nice thing about a telemedicine gig like Teladoc is that you can log on and log off whenever you want, allowing you to prioritize your patient flow in your clinic.

With JustAnswer you can start an asynchronous conversation with a customer and get back to them when you have some extra free time. There is no rush and, again, you can focus on your clinic patients when needed.

 

3 replies on “Start A Private Practice Without Losing Money”

Hi. I am a 34 year old primary care physician. I’ve been working outpatient for the past 5 years and HATE it. As I type this, I just left the office at 9:34 pm and I’m sitting in my car pondering the meaning of life. I gave my 90 day resignation today. I had a patient throw a fit because I was 19 min late in seeing her for her physical because she had a nail appt to go to. Pretty sure that is going to be a bad review online. I haven’t eaten today. I had the pleasure of seeing an out of control kid brought in by a parent who doesn’t discipline and expects me to do it or diagnose her with ADHD (and to top it off the brat spat in my face). The EHR demanding I push every button known to man to get PCMH and quality credit. Constant Mychart messages from patients. I’m tired. I can’t take it. I’ve signed up for telemedicine and hopefully it will be successful for me because I can’t go into that prison, I mean clinic, everyday for the rest of my life.

I’m sorry about your day and I mean that in the most genuine way imaginable. To be a physician who is fed up with treating sick people – an incredibly simple concept for us but made insurmountable by all the external factors, none of which have made our patients healthier or decreased fraud or improved access.
No doubt that telemedicine will be a good option, you should have no trouble getting credentialed. There is teladoc and doctor on demand and american well and just answer.
The work as a clinician is hard enough and involved, you don’t deserve to be mistreated by anyone, much less patients.
One thing I can say is that there are options and I would love to brainstorm with you if that would be of help.
All 4 of my readers on this blog will have read what you wrote and I’m sure their heart goes out to you. Wish I was there to buy you a beer instead of you sitting in your car when you should be celebrating your life as an accomplished 34 yo woman.

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