I am a regular here at FWF. I am posting under a pseudonym because I am still in the proforma stages of starting a new medical office and I do not want people to know where this will be located at this time. If I use my regular name it will be easy to figure this out.

1) Has anyone here ever started a medical practice from the ground up, including building the office?

If so:

2) How difficult was it to find financing?
3) What percentage of the loan amount did you have to invest?
4) Did you have a separate business loan and construction loan?
5) Did you have to use personal assets as collateral?
6) Was your business loan set up as a fixed loan or business LOC?
7) If it was a business LOC would the bank let you initially roll the monthly amount due into the line of credit and if so for how long?
8) Did you have a partner?
9) If so how did you set up the partnership? (ie LLC, corp, etc.)
10) How did you set up the potential need for a partner buyout?
11) Did you make each partner sign a no compete clause?
12) How did you negotiate with insurance companies about fee schedules?
13) Who did you hire as a biller?
14) If you had a partner was a 50/50 split?

That should be a good start. If this thread takes off I will keep people updated on my venture into starting a medical practice and reveal myself once it has become common knowledge in my city. If there is no interest I will let the thread die. Thanks for any help.

Sounds like you finished up your fellowship. Financing may be tight with current liquidity issues keep that in mind.

You need a good lawyer and accountant. I prefer to go to big firms where the lawyers have many under a roof and each one does a certain aspect. Law is like medicine. You need to specialize to get any real money. Don't pick any one, make sure they have set things up before. If it's breaking away yourself or with others likely anything built or bought will need to conform to ADA standards which aren't cheap. Real myth of drs are they have $ but they're always so buried in debt it takes a LONG time to even break even.

Add to the list disability insurance on you as a key person(business) and personal. People are more likely in their working career to have an illness or injury that stops them from working.

Invest in going ALL digital. Get a mass scanner to fill away papers on patients and BACK IT UP. Have a server installed in office . Use desktops in each room or carry a wireless computer. That way in each room you can pull up their file and search it FAST. Medical offices need fire proof filing cabinets and I have yet to see them. Then encourage your patients to email you to your iphone or computer (tell them detail the problem) and respond to them. MUCH faster and allows multitask. They'll be so happy to get an answer and they won't waste time detailing their symptoms rather than prying it out over the phone.

In general, I'm not a fan of partnerships, someone always seems to become the bag holder ($/work).

UrsaMajor said:
Then encourage your patients to email you to your iphone or computer (tell them detail the problem) and respond to them. .

Like grandma is going to e-mail you about her kidney infection......

(All digital = Bad advice)

Just a med student - but I'd hope that new offices go the digital route. I say we look at the entire way we currently operate and restructure it. Consider the appointment hassle. To make an appointment you have to pick up the phone - call - wait - then wait some more - once you finally get to someone then it takes more time to find a suitable spot. Why can't we have online appointment scheduling for smaller private offices not just the big players. Sure there will be an initial capital investment in technology but not only will it provide a smoother patient experience but it'll reduce labor costs. What I'd like to see is an end to end modernization of the current system as it stands today streamlined to operate effectively. I say we can improve the patient experience and reduce our costs at the same time.

ymarker said:Just a med student - but I'd hope that new offices go the digital route. I say we look at the entire way we currently operate and restructure it. Consider the appointment hassle. To make an appointment you have to pick up the phone - call - wait - then wait some more - once you finally get to someone then it takes more time to find a suitable spot. Why can't we have online appointment scheduling for smaller private offices not just the big players. Sure there will be an initial capital investment in technology but not only will it provide a smoother patient experience but it'll reduce labor costs. What I'd like to see is an end to end modernization of the current system as it stands today streamlined to operate effectively. I say we can improve the patient experience and reduce our costs at the same time.

Amen, realize that the new generation is into using the net and email so yes they can book online and cut down on cost for them and the drs. Unfortunately, Drs don't invest in IT solutions to streamline things. I would LOVE to book my dr appointment online, and be done, I can do that on the road or at home rather than waste time on the phone.

The "little old lady "that needs to talk on the phone is going to change when they pass and the times change, so that's NOT an excuse. Even then THEY need to adapt if they want better service, less errors and cost.

Yes, you can have the tech in the small offices and it's NOT expensive (my company actually works on these things: setting standards, supplying support, and remote monitoring of system performance complete turn-key solution it's in beta testing right now). Cost of TECH is going down so it's a resource that must be tapped. TIME is the costliest factor, you can never buy it, but you can save it, PLUS give better service, access patient files like a google search (anywhere in the world), and have them printed and ported to all sorts of means. Tech also provides safe guards for flagging issues like meds that may be given by mistake, the list goes on.

gatzdon said:ymarker said:Just a med student - but I'd hope that new offices go the digital route. I say we look at the entire way we currently operate and restructure it. Consider the appointment hassle. To make an appointment you have to pick up the phone - call - wait - then wait some more - once you finally get to someone then it takes more time to find a suitable spot. Why can't we have online appointment scheduling for smaller private offices not just the big players. Sure there will be an initial capital investment in technology but not only will it provide a smoother patient experience but it'll reduce labor costs. What I'd like to see is an end to end modernization of the current system as it stands today streamlined to operate effectively. I say we can improve the patient experience and reduce our costs at the same time.

That's an awesome suggestion. I'm envisioning a website that is just like booking an airline reservation site. Heck, for doctors that don't fill 100% of their time, they can offer a small discount for scheduling your appointment during a slow day or time.

Devil's advocate here...I don't know that such a website would work for surgical specialities. I can't count the number of times patients have been pushed around in our office b/c one or both docs get called into emergency surgery, etc. So who's responsible for contacting the patient, etc.? And how do you schedule same day (urgent but not emergent) appointments? It may work for purely medical practices, and it's an interesting notion.