|PHYSICIANS PRACTICE | MARCH 2008WWW.PHYSICIANSPRACTICE.COM
patient dictated a business in whichhe contracts with no insurers andopted out of Medicare. Some might call this a concierge practice (sansretainer), but Dolhun says simply,“For me, it’s a back-to-the-future typeofthing. I see [everyone from] richindividuals to lower socioeconomicand middle-income individuals. But the model is very simple — ‘I’m payingXamount of money for him to treat me’ — and that’s refreshing.”Everyone
talks toabout starting a practice stresses theimportance of knowing what you want out of it — now, ﬁve yearsfrom now, 10 years from now —and putting serious thought into how you’ll go about getting there. “Theplanning stage is a very intense period.It’s expensive and time-consuming,”notes retired ophthalmologist William Hutton, now chairmanof MedSynergies, a revenue cyclemanagement ﬁrm. “I recommendusing your training and residency period to think about the kind of lifestyle you want and where you will search for opportunities that are aligned with your goals.”
“I teach at a lot of residency pro-grams,” says Borglum, “and they all want to know where the best location is. I tell them to ﬁrst decide where you want to live.” Unless you’re, say,aplastic surgeonconsidering setting up shop inBeverly Hills, odds are you’ll beable to establish a successful practicesomewhere near your chosen home. Your family’s preferences shouldcarry signiﬁcant weight in that choice,says Hutton. Borglum is more speciﬁc,noting that most physicians wouldprobably do well to consider locations within 50 miles of home.Hutton suggests interviewingdoctors in the area to gather initialdata and get the lay of the land. “Get an idea of the physician community,”he says, “because they’re very, very different. Some are quite adversarial;others are quite cooperative.” What political quirks are in play? How well will a new physician be accepted? “It’samazing the differences in different areas of the country,” Hutton notes.Next, Borglum advises, moredeliberately assess the competition.“There are all of these surveys you canbuy, and demographic information you can pay for,” he says. Like many consultants, though, he recommendsasimpler approach: “Call at least ﬁveor seven of the competing practices—those in your chosen area andspecialty — and ‘mystery-shop’ them,pretending to be a patient, the daugh-ter of a senior, mother of a child,depending on your specialty.Find out how long their wait for a new-patient appointmentis. If all the competitorshave no waiting time, it’sgoing tobe harder to open there.” You’ll almost certainly need
formal demographic informationfor ﬁnancial and other backers, but according to Borglum, “For strategicplanning purposes, your wait list will—within six to 12 months — equal
CMESTART IT UP
As a physician, your timeis your most valuable commodity;you shouldn’t spend it trying tobecome an expert in every areaof running a practice. Consider,instead, hiring a consultant.
There are plenty of readily availableresources for sorting out the detailsof setting up a practice — specialtyassociations, the AMA, state and localmedical societies, hospital liaisons,and the Small Business Administra-tion, for starters. As dermatologistBeth Santmyire-Rosenberger says,however,“What you need to run asuccessful practice is not just nutsand bolts. It’s an extension of life.”
have to do — or know —everything. Enlisting expert help withcredentialing is strongly encouraged,and is a must for the legal structuringof your business. You won’t abdicatedecision making, but a supportteamof specialists in their respective ﬁelds—accounting, law, and ﬁnance —will save untold wasted effort foryou, particularly if those people havespeciﬁc experience in the world ofprivate medical practice.
Formulate a business plan evenif you’re not seeking third-partyﬁnancing. The exercise will helpyou crystallize your vision for thepractice and ensure that you haveat hand the necessarytools to getyou to opening day and beyond.This information, in turn, will be afoundation for subsequent decisionsover the life of your practice.
Make sure your chosen locationwill accommodate your practice,specialty,and philosophy.Startbysimply talking with other physiciansin the area, then gather basicdemographics from sources likethe local chamber of commerce.