About This Series
Have you been pondering striking out on your own, making the leap from employed associate to practice owner? Or are you just starting out in practice and wondering if it’s worth going even deeper into debt to start your own venture rather than getting “a job”?

Whatever your situation, Physicians Practice is here to help. Welcome to the first installment in our comprehensive six-part guide to starting a medical practice. In addition to the pre-opening day planning advice you may have seen in other such guides, we’ll delve deeper into the key milestones you’ll need to meet for success long after you cut the ribbon.

Despite dire predictions trumpeting the imminent demise of the U.S. healthcare system, you could still do a lot worse than to go into private medical practice. In fact, we’ve spoken with plenty of physicians who’ve recently made the leap and couldn’t be happier.

Take Beth Santmyire-Rosenberger, MD, PhD, who opened her Fairmont, W.V., dermatology practice two years ago. Now, she says she’s financially stable and, more importantly, has “a genuine feeling of enjoyment and accomplishment at the end of the day.”

“As long as you do your homework and take all of the steps correctly, it’s really hard to fail,” says consultant Keith Borglum, who’s advised hundreds of nascent practices. “The reason people fail is they’re either oblivious to some step and they make a mistake, or they don’t do proper planning.”

Ahh, the planning — not much fun, we know, and more easily said than done. This article and the next in the series will focus, respectively, on general planning and financial planning, aka budgeting. Planning, of course, underpins all elements of starting a practice. Your philosophy, in turn, will guide all planning.

A word of advice from family physician Eduardo Peña Dolhun, whose practice has also been open for two years: “There’s too much risk involved in medicine [to go into it and] to not love it. You’ve got to tap into that core of passion.”

So what is it about medical practice that truly floats your boat? What drew you to the profession in the first place?

For Dolhun, who runs a small but thriving cash-only practice, people themselves are the draw — so much so that spending ample time with each patient dictated a business in which he contracts with no insurers and opted out of Medicare. Some might call this a concierge practice (sans retainer), but Dolhun says simply, “For me, it’s a back-to-the-future type of thing. I see [everyone from] rich individuals to lower socioeconomic and middle-income individuals. But the model is very simple — ‘I’m paying X amount of money for him to treat me’ — and that’s refreshing.”

Everyone Physicians Practice talks to about starting a practice stresses the importance of knowing what you want out of it — now, five years from now, 10 years from now — and putting serious thought into how you’ll go about getting there. “The planning stage is a very intense period. It’s expensive and time-consuming,” notes retired ophthalmologist William Hutton, now chairman of MedSynergies, a revenue cycle management firm. “I recommend using 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.”

Location, location

“I teach at a lot of residency programs,” 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, a plastic surgeon considering setting up shop in Beverly Hills, odds are you’ll be able to establish a successful practice somewhere near your chosen home.

Your family’s preferences should carry significant weight in that choice, says Hutton. Borglum is more specific, noting that most physicians would probably do well to consider locations within 50 miles of home.

Hutton suggests interviewing doctors in the area to gather initial data 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’s amazing the differences in different areas of the country,” Hutton notes.

Next, Borglum advises, more deliberately assess the competition. “There are all of these surveys you can buy, and demographic information you can pay for,” he says. Like many consultants, though, he recommends a simpler approach: “Call at least five or seven of the competing practices — those in your chosen area and specialty — and ‘mystery-shop’ them, pretending to be a patient, the daughter of a senior, mother of a child, depending on your specialty. Find out how long their wait for a new-patient appointment is. If all the competitors have no waiting time, it’s going to be harder to open there.”

You’ll almost certainly need some formal demographic information for financial and other backers, but according to Borglum, “For strategic planning purposes, your wait list will — within six to 12 months — equal everyone else’s.” He also points out that a location as few as 10 or 20 miles away could be dramatically different.