I can speak only for myself on the topic of starting a solo dermatology practice. As an aside, I initially had no interest in starting and running a small medical business. My post-training strengths, or at least my comfortable level of competencies, did not include marketing myself, choosing the right business location, buying all the right supplies, getting the right loans, hiring and firing staff, outsourcing things I couldn’t do, and the myriad of other things I didn’t have the experience to predict. Bigger than that, I was at that point in life where I wanted to spend every workday doing the work I loved, and also to find that personal balance that included non-work-related pursuits. I presumed that running a solo practice would not be the right career choice for all of the above reasons, but I discovered it was actually the best fit.
Starting from “Scratch”
When it became clear that having my own practice could be right for me, I met a retiring dermatologist who was looking for a buyer for his practice. I looked into this but quickly realized that I would have to make many changes to his practice in order to update and improve it and there was really no guarantee that his patients or staff would stay with a new, younger and female doctor. This discovery inspired me to create my own practice rather than try to paddle upstream.
This is one of the very valuable lessons I wish I had known much earlier in my career. My day-to-day working environment, my equipment and space, my staff and office culture are all much more important than I had ever consciously admitted to myself. In fact, all have proven to be critical for a successful career and top performance as a physician. Business and medicine rarely share the same operative motivations. As a physician solo practice owner, I have the opportunity to make choices that are in the best interest of my patients without feeling pressured to cut corners or make other compromises which might benefit a more profit-focused business model.
Hiring the Right Crew
The first impression a potential patient has of the doctor is actually of the person who answers the phone or email, for better or worse. This seems so unfair on many levels, but it is reality. Hiring a good staff is more than finding people who can function well as medical assistants, receptionists, billing coordinators, etc. Every employee in a small solo practice has a heightened responsibility of making a patient’s experience positive. Keeping in mind that patients only come to the dermatologist because they are anxious about a growth, suffering from a skin condition, or unhappy about their appearance, human nature dictates that every minute of that visit they will hold to unusually elevated scrutiny.
My worst yelp reviews (which, by the way, people really look at seriously) have been against certain staff interactions and not the actual doctor visit. Taking the time to find the right people to staff your practice and rewarding them regularly for their efforts and goodwill is priceless. My best staff hires have come from word-of-mouth recommendations, and I have only rarely been lucky with generic job postings.
For a solo practice owner, at least if you accept patients with many different health insurance providers, the cost of in-house billing services and some third-party services can far exceed the actual collections you hope to recover. This doesn’t mean you don’t need an employee dedicated to coordinating the billing process, scrubbing charts and communicating daily with claims issues, but having a hardworking, honest and accessible third-party billing service is absolutely invaluable. I went through a couple different billing situations in the past five years and suffered in the process. I wish I had known.
It’s also a good idea to pay for “fake audits” so that you are ready for the real thing at any time. If not only for peace of mind and being able to sleep at night, making sure your practice is always OSHA,- HIPPA,- CLIA,- etc.-compliant is good for the practice. It’s worth the time and money, plus it’s required.
Marketing the Practice (i.e. Yourself)
How you market your solo practice is entirely dependent on what kind of practice you want. That’s really it. This is a time when you sit down and decide exactly what you would like to do from opening to closing every day that you are at your office. For me, I am fellowship-trained in Mohs surgery and I also enjoy general dermatology, so I am basically interested in attracting patients of every demographic. Fortunately, I have been able to foster relationships with patients that have resulted in word-of-mouth referrals of family members, friends and neighbors.
I have also developed referral patterns with primary care doctors in my area through personal meet-and-greets and also through inviting the local hospital’s primary care residents to rotate through my practice as part of their elective training. Another large source of new patient visits comes from my online presence. Having an informative and attractive website is helpful for a new patient who otherwise doesn’t have anything else to go on. Yelp and other online review sites are common starting points for many prospective patients, but I do not pay for any as advertising resources. Online advertising, at least for me professionally, seems at odds with the integrity of what I do as a physician.
This part has everything to do with actually having a life in addition to having a successful practice. There are just too many things to do in a day for any single human being, no matter how capable, to run a business of six employees and over 4,000 patients. A good friend and fellow entrepreneur told me when I was starting out: “Make sure that everything you do is consistent with your level of training.” His example was scrubbing the bathroom floor—is my company benefitting from me spending time scrubbing the floor when instead I could be using my skill set to see patients? Good point. So, I delegate certain tasks to others—specific employees, solid third-party companies, dependable custodial services, etc. I recognize that a directed team approach is necessary to running a business.
Leaving Work at Work (As Much as Possible)
Many of my colleagues are scared off from the idea of solo practice by the “quality of life” question. Can a business owner, solo physician, if-I’m-not-there-will-life-go-on person be able to let work stay at work at the end of the day? This is definitely a good question, and one that will have a different answer for each of us. I make a point of having a four-day workweek. I am available to patients by email, cell phone and texting any time. But I go to the mountains and beach with my dog, family and friends on the weekends as much as I can. I do not take my career or practice lightly, but I do not take my free time lightly either; they complement each other. Personal balance is something we all approach in our own ways and I’m so very grateful that I can be the owner of this.
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