How to start up a solo medical practice, deNovo!

From my hopefully upcoming book, Going Solo: What to do when you find yourself out on your ass!

The “to do list”—Getting started

In February 2006 I found myself, as I had predicted 5 years earlier, on my own. Solo. No more W2 income. It was the start of my dream! I had been in a larger group of Urologists and was unhappy. Luckily, I had savings, good credit, and a supportive family that enabled me to pursue my dream of going solo. While it has been the best thing I have ever done, professionally, it was not easy. Any young physicians who are considering going solo, as I have done, may benefit from reading on.

I had spent most of my medical career doing medicine; seeing patients, checking labs, rounding, operating etc. I came to work, did my thing, got paid. Period. When I found my self solo, the enormity of what I did not know from a business perspective became painfully apparent and caused for me a great deal of stress. What seemed to be basic issues, like how to go from seeing a patient to actually getting paid, how to collect co-pays, how to submit a claim, how to get a phone system, do payroll, FICA, and on and on now seemed impossibly complex. To make things worse, I had very few places to turn for advice on medical practice start up and management and what advice I did come across often was not practical for my situation. I was overwhelmed and panicked. You don’t have to be.

Medical practice is a small business just like any other. We may have issues that are unique to us, but the essence, obstacles, and, often, the solutions are the same for doctors, dry cleaners, pizza men, gardeners, chiropractors, dentists etc. In fact, a business entrepreneur friend gave me the best advice—the key to start up. What is key? The key is to define your ultimate goal, identify obstacles between you and your goal, and then to brainstorm solutions. List, actually list--on paper--obstacles on the left, goals on the right, and solutions in the middle. Do this, because it really, really works. Brainstorming relieves stress and enables you to focus, accomplish goals, and feel pride over reaching milestones. It is the first step in start-up.

Obstacles include everything that stands between you and your goal. My obstacles in February 2006 included lack of office space, little practice management knowledge, not enough money, no patients, no hospital staff privileges, no referring doctors, etc. Your obstacles may be similar to mine, but might be different, but you will have obstacles. Identifying them will help you to overcome them. It is essential that you list all--I mean all---of your obstacles. Slowly but surely, in a systematic fashion, you’ll overcome them.

Solutions encompass everything you are going to do to overcome the obstacles. My solutions in February 2006 included taking a loan, finding a real-estate broker, personally picking up an application for staff privileges at the local hospital, etc. I had a list of solutions on paper that corresponded to an each obstacle. As goals were accomplished and obstacles overcome, I would feel pride and relief. Make the list. You’ll feel better!

Finally, you must have goal. And not something like “to make a lot of money.” You’ll never have enough money. I mean to set a professional goal. What you want from your practice, profession, life, etc. My goal was my ideal practice—my dream practice. The practice I always wanted, but never thought I could have. If you don’t have a goal, get one. If your goal is nebulous, focus it, on paper. As you progress through the start up process, and beyond, the obstacles change and you must find new solutions, but the goal remains the same. Your goal is your rock. Your goal practice is your beacon of light that guides you through a very turbulent process—starting up, growing, and maintaining a modern medical practice. Without a clearly stated and written out goal, you will drift. Referring back to your goal will enable you to get back on course, complete the task at hand, and find happiness.
After making your list, you can start ticking off solutions. The list method is nothing new. In fact, my mother-in-law uses it quite frequently. And it may seem simplistic and juvenile, but it is not. Opening up a practice from scratch is an enormous undertaking and is best accomplished by breaking the process up into many smaller steps. The list method is a mental exercise and practical way to do this. You will find that with this method, you can be up and running, in business, seeing patients in 6-8 weeks, start to finish. Every day will have a goal directed purpose and you will make measurable progress with minimal stress.