Since I was fired, I've found one job possibility--one of the large practices in my neighborhood has a small office in another neighborhood which is not doing too well (staffed only by a PA). I was offered the position of going in and building up that office. It got me thinking that maybe instead of working so hard to build someone else's office, I should just start my own! I'm very nervous about a few points and hope someone has some advice.
1. what happens if you need to take a day off in solo practice? If I'm open 6 days a week, when do I get a break? Also--my mother has Alzheimers and lives in another state so I need to be able to go there every few months to help out.
2. how long does it take to start seeing some income? I'm only <1 yr out of residency and still have huge loan payments and almost 4 kids!
3. starting with paper charts definitely cuts overhead, but is it worthwhile if everything is turning paperless?
4. Is it worthwhile to hire a billing service and if so how do you find a reliable one?
Definitely hire a billing service. Ask people you trust in the practices you use (pediatrician, ob/gyn) about their billing manager, go talk to those managers and ask who they know who might be interested and available at least part time or contractually, etc.
I think you need a mentor who is doing this already who could give you the heads up about what to do. The paperless office is clearly the way of the future but I think the initial outlay is fairly high.
You said almost 4 kids. If you're pregnant, could you wait to start the practice til you're back, start part time and gradually add hours (and patients)? I think the hardest part if you just start is if you have to be there all the time but you don't have that many patients yet. If you can gradually add time by half days as you schedule new patient appointments, that might give you some flexility and easing in options. You need a really good office manager/scheduler who gets your situation to let you do that.
Re coverage, that's why you need a mentor. In psychiatry I AM the off hours coverage. If I go away for a weekend or a vacation, I arrange coverage by one of my friends who is also in solo practice (we all cover each other and so far it has worked fine, even for maternity leaves). I don't know how easy that is for other specialties, though. That being said, I don't think there's any more flexible arrangment. I love being solo. Good luck!
I know that other members have been involved in considering new solo-practice so hope you get some other responses. I just wondered what you thought about the offer of building up the small office - it could offer you some of the autonomy you seek, maybe with some flexibility available which I've found so important, without being entirely solo...
First congratulations on passing your boards...I was the guest that posted in another forum regarding my difficulty with passing mine. While it's a different specialty, try looking at the Association of Women Surgeons website. There are some career resource materials available online...one specifically discusses solo practice and has a reading list that you might find helpful.
I'm just out of residency myself, and after looking at the groups that were attendings in my old residency, I realized I didn't really want to start in a large group. I also managed to find an out of the way place that the nearby hospital needed built up. The best thing is that they guaranteed income for the first year with possible extension to 1.5 years..that means that AT LEAST I KNOW I'll be making a certain amount a month. Of course it is a low interest loan, but if the practice just doesn't build up, I can either pay it back or get 1/48th of it paid off a month that I work. Yes it's risky, and scary...but I'm excited about it as well. There is a lot of work starting up a new business, and a lot to learn, but it helps that the hospital wants me to succeed...I'll pretty much be the only Ob-Gyn in town, and I'll be sharing 1/4 call with 3 FP's that have been doing c-sections so I lucked out there. It's going to be tough for you with kids...I've got no commitments so I was willing to be oncall every other day if I had to. At any rate..my advice to you is to see if you can get some kind of income guarantee in the beginning, especially since you have 4 little ones counting on you to bring home the bacon:-) Good Luck
1 - Listen, maybe you should start off slow and open your practice part time. You do not have to open 6 days a week and you do not have to be open for 8 hours a day. Try just evening hours or the opposite.
2 - The most important thing after you have covered your legal state law issues is to contact insurance companies and become a network provider. Especially, now in New York City where HMO's are leading the way.
3 - Definately use paper charts (my opinion). Electronic charts is good, but not dependable unless you have a excellent data recovery and back up system. But paper claims on the other hand, that is a no no. Paper claims are much more expensive than electronic claims, lets not forget to mention trial and error.
4 - If you need a good billing center I can definately recommend one to you. They are located in Queens, NY. Also have offices in CT & NJ. And if cost is your concern, don't worry they will not break you. You can go to their website.
They also have consultants to help you get started.