Am I Ready to Start My Own Practice
David W. Unkle, MSN, APN, FCCM, FCCP
Medcorps Asthma & Pulmonary Specialists, Linwood, NJ
Am I Ready to Start My Own Practice?
If you want something you’ve never had, you must be willing to
do something you’ve never done—Thomas Jefferson
Am I Ready to Start My Own Practice?
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Incorporating the practice—your name is more than a
name…it’s a brand.
Name must be easy to remember—especially for social media.
Yes, people do look online to view your practice before they call.
Federal Tax ID number.
Am I Ready to Start My Own Practice?
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Choosing the physician collaborator—are they on-board with
YOUR philosophy of practice?
Does your state allow nurse practitioners to employ physicians
or must they be paid a monthly collaboration fee.
Am I Ready to Start My Own Practice?
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The practice philosophy should be one of the first things that
you do.
You build the practice around it—it’s more than words on paper.
It should drive how your practice operates.
Personnel decisions, operating policies, patient interactions all
should reflect back on this document.
Here is a copyrighted example…
Am I Ready to Start My Own Practice?
Providing healthcare should be simple. It’s about patients seeking answers to
basic and advanced medical problems in an environment where they can have
open dialogue with a physician or nurse practitioner. It’s where a scheduled
appointment means that they won’t have to wait for 45 minutes beyond their
scheduled time to see their provider—a mutual respect for the time factor on
both ends of the equation. And when that encounter does occur, your
physician or nurse practitioner is actually concerned about what you have to
say…someone who takes the time to take a thorough history and get your
thoughts on your illness/disease.
Am I Ready to Start My Own Practice?
That concept was embodied Sir William Osler (1849-1919) who
stated, Listen to your patient, he is telling you the diagnosis.
Healthcare is also about treating the individual patient—not a
cookbook approach but an individualized, evidence-based
approach using the most recent (and proven) methods of
treatment. Osler spoke to such an approach…the good physician
treats the disease; the great physician treats the patient who has
the disease.
Am I Ready to Start My Own Practice?
Healthcare is also about educating the patient about the disease
and the available treatment options. When it comes to symptom
control and limiting disease progression, adherence is the most
important factor. A patient who understands their disease and
works together with their provider on designing the most
effective, individualized treatment based on their preferences is
most likely to remain adherent to their regimen.
Am I Ready to Start My Own Practice?
It should be an expectation that need not be stated but in today’s
fast-paced world is easily overlooked by many—respect, courtesy
and compassion. It is an essential element of every encounter in
our practice and is a cornerstone tenet of our practice.
Am I Ready to Start My Own Practice?
Credentialing with commercial carriers/CMS: allow six (6)
months.
• Hire someone—little things like not signing in BLUE ink for CMS
applications can delay credentialing for MONTHS!
• Reimbursement—negotiate rates.
• Determine your payor mix—an undesirable mix will kill your
practice. Block schedule accordingly.
• No-show fees: YES or NO? And how much?
• Credit Card: Can you book a hotel room without
paying in advance? Healthcare is a business and
you can’t provide service if money is left on
the table!
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Am I Ready to Start My Own Practice?
Employee Handbook: Everyone gets one and signs. Updated
Annually.
• Better Business Bureau (BBB): Great Way to advertise your
practice.
• OSHA: yes they do come to office-based practices. Do annual
training. If you’re unsure…ASK Ken!
• Insurance: Internet, Office and Office equipment supplies.
• Malpractice Insurance.
• Key-Man Insurance: Covers you if you need to
find locum tenens physician coverage due to
long-term illness/injury
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Am I Ready to Start My Own Practice?
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Line of credit: $$ flow will be slow for at least six months.
Payroll: Automate!
401K: contributory/non-contributory?
Benefits: Who pays and what coverage?
Security/Fire Alarms?
Contractors: Get plumber, HVAC on board. Don’t wait until it
breaks!
Vendors: Research for best prices?
Equipment: new or refurbished?
Am I Ready to Start My Own Practice?
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Equipment Leases: Some require a physician to lease?
Accountant: Find one before you open.
Billing: This will make or break your practice—must be up-todate and they educate YOU.
Am I Ready to Start My Own Practice?
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Hiring staff—another major challenge
Firing staff—it’s like a colonoscopy, you know you have to do it
but you keep putting it off!
Hiring family and friends—a recipe for disaster.
The doctor’s spouse—the worst hire.
Am I Ready to Start My Own Practice?
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Evaluating the practice: it’s more than profit or loss.
HIRE someone to do this…
Make changes based on trends over time.
Expect to lose money in Year 1 and perhaps Year 2.
Expect headaches, heartaches, and heartbreaks.
Am I Ready to Start My Own Practice?
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Would I do it over again…YES. But I’d do it differently!