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Tuesday, February 06, 2007

Going Solo?: Build your practice by bootstrapping.

Going solo requires a huge commitment personally and financially and is an enormous undertaking. The task of developing a mature practice can seem daunting if approached with the wrong frame of mind; that is if you only see the end product and how much work and effort and money must be needed to get there. Do not think this way and do not try to get there to fast. Successful entrepreneurs don’t try for everything at once. They start their businesses with what they have available to them, financially, skill wise, etc, and they simply start-up. As they grow, they re-invest the capital they acquire into their business and grow it. They outsource, hire people, get expert advice, but really, in essence, they just do it. No excuses. The founders of Nantucket Nectars started their company from an apartment and sold the beverages from a skiff in the harbor. They said, in later interviews, that if they knew all that would be needed to start and grow their business, they would never have done it in the first place. Interesting! Professional services are the same, only easier.

If you look at a mature medical practice or law firm, you’ll see a large office with numerous staff, furniture, complex phone systems, equipment, supplies, credentialing issues, licensing, financing, etc. When you start your practice, you have none of that, nor do you have any chance of getting it anytime soon. But you do have 2 of the most important things, a brain and drive. With those 2 qualities, you can bootstrap your way to the rest. You can pick yourself up by the bootstraps and grow. Here is an example.

You have $15000 to put into the practice. Ok. You get a laptop computer, leased over 2 years, for $26 per month. You get a cell phone with service contract for $75 per month. You search for a 1-3 session per week sublease from another doctor for $300 per session. Voila’, you’re in business. You outsource your billing and credentialing, and you do the rest. As you grow, you reinvest and decide to bring your billing in house and have your biller double duty as a receptionist and a medical assistant. You grow some more, and decide that now is a good time to rent an office of your own and you find a small one. You grow some more and decide to take some laboratory work, such as doing a CBC, in-house. It turns out to be profitable, and you re-invest the earnings to purchase an ultrasound unit. You grow some more, and decide to hire a nurse practitioner to see patients as well. You grow some more and decide to reinvest and buy an office. You grow some more, and sell your office to buy an office building and now you lease unused office space to others. And on and on and on. You get the point.

Over the course of your career, by this method, you can develop into a significant and sizable enterprise that has true value, and you started it from scratch. You bootstrapped and built one success upon another. You used early successes to bankroll future successes. You are self made. It is not easy, but neither is working for someone else. Feels good, eh? I believe that this is the perspective that one must take when faced with the challenge of going solo.

Good luck!