During medical school, T.C. (name abbreviated to protect privacy) never imagined herself in her own practice. "They don't teach the business side of things in medical school," she says. "I never wanted to be involved with that aspect of medicine."
Now several years later and after negative experiences as an employee in other people's practices, she is enjoying life as a solo-practice family physician in Tampa, Florida.
After taking another job with a flat salary and inflexible hours, she decided to turn in her resignation. With four months' notice to work, she had time to get funding and figure out how to start her own practice. Dr. C bought a publication from the AAFP on how to start a medical practice and found it was invaluable, telling her everything she needed to know.
How to start a medical practice: location
"The hardest part was finding the location. That was not a quick process," says Dr. C. Once a suitable office was found, next was securing set-up financing. Young, with no assets, and carrying medical students loans, Dr. C first tried her local banks. She then turned to a commercial bank but was declined. Finally, after seeing an ad in a medical journal, she called a lending company. In 48 hours, she had been given approval for her loan. Within a week, she was given a check to cover her starting costs and later funds to cover tangibles, such as computers, exam tables, office supplies, and so on. In addition, Dr. C was able to negotiate terms similar to a bank. Lawyers helped her get incorporated and obtain a business lease.
How to start a medical practice: computers, software, equipment
With a loan in place and suitable office found, she needed to find a computer system for her practice. "The computers were another challenge," Dr. C says. "Just getting them set up so everything worked took longer than we expected." Using the Internet and copies of the Physicians and Computers journal, she researched different software vendors and choosed a system that allowed her to run a totally paperless office.
With a computer in every room, including exam rooms, the system works extremely well. Her medical assistant was able to type in the notes, vitals, and reasons for the patient visit, and then in the exam room she could pull up the file and add her own notes. The software also allowed her to run searches or reports on patients taking a particular drug, or find out when they are due for their next mammogram. The EKG connected directly with the computer, read it for her, and allowed her to edit the reading, and then print or fax it.
Dr. C says that running a paperless office allows her to spend more time with her patients. Using an article describing the things you need for each room, she equipped her practice and added her own personal touches fairly easily. Luckily, the previous tenant left some key equipment such as examining tables, and the rest she ordered from medical supply companies.
How to start a medical practice: patients and insurance
Although she did not have a non-compete clause in her contract with her previous employer, she did have a non-solicitation clause. So Dr. C was not able to ask her patients to move with her. But once word was out, many loyal patients gladly followed her to her new practice. Even though she moved practices, she kept her credentials with several major insurance companies. Normally the credentialing process with the health insurance companies can take up to two months.
"The hardest part with the insurance companies was getting a fee schedule," she said. "We called in June, called again and again, then called everyday. And finally in September, they arrived." Using the resources of her regional family practice association, she was also able to find medical malpractice insurance at reasonable rates.
How to start a medical practice: hiring staff
Hiring staff was also easier than Dr. C first thought. Her medical assistant and front desk receptionist from a former employer decided to join her. Another key person she hired was a good accountant to help with many of the financial issues. Consider hiring an office manager to handle a variety of the tasks you need done. Working well as a team she was able to set the tone of how the office would be run and has much less stress on the job than her previous practice positions. She also made an arrangement with a colleague for emergency and out-of-town coverage.
How to start a medical practice: balancing work and family
Dr. C had her son during residency, and returning to work after maternity leave she saw her son for only 20 minutes a day. Pregnant with her second child, she was looking forward to balancing her family and thriving practice on her own terms. Even though she says setting up her own practice was more work and stress than she imagined, Dr. C is very happy about it and more fulfilled than ever.