Since I can remember, I have always had an entrepreneurial spirit. From my pre-adolescent lemonade stands to starting a cleaning business in college, I always loved the idea of owning my own business.

When starting my journey as a physician I wasn’t quite sure how that passion would fit in to the type of surgeon I would become. But as time went on, it became clear that controlling my own dream was something I could not compromise on.

So that led me to the natural next question…

How would I start a private practice while finishing fellowship? It didn’t take long to realize how limited the published information on starting a private practice was i.e. no step-by-step guides or cookbook recipes to starting your own surgical practice. I began speaking with everyone I could. From financial advisors, practice management companies, attendings and residents.  I pretty much developed my own MBA training program! 

While networking, I was finally connected to a colleague, Dr. Rafi Fredman, who was a year ahead of me in training and starting a private practice. Rafi soon became my step-by-step book and business advisor. Every 15-40-minute phone conversation shed new light on the details, challenges and path towards starting a surgical practice. 

We all know that doctors don’t necessarily make the best businesspeople. It’s possibly the result of the more than 10 years we focus exclusively on medicine and surgery. Who has time to read about marketing, malpractice, real estate and finance while taking weekly call? Owning a business involves learning a completely different language from medicine and takes time to learn.

Many residents and fellows alike can feel that the stress of operating on patients is enough to worry about. Why would anyone want to add the concerns of business, overhead, liability and countless more unknowns to that?

I sat down with my colleague Dr. Rafi Fredman to help answer why we think private practice can be great, and how to get ready in that final year of training to open the doors August 1st! Here are the notes from our Stiletto Surgeon podcast – available through my website, iTunes, or Stitcher radio for your reference!

We hope it helps inspire and provide some guidance towards hanging your own shingle!

  • Why private practice for you?
    • Autonomy! With private practice, you are able to control your own narrative and goals for your surgical career.
  • Who were your sources of information?
    • Other residents that recently graduated, mentors in private practice, courses, professionals such as attorneys and practice management companies.
  • What do you see as the benefits of private practice?
    • Exponential grown as a direct result of your willingness to work.
  • Where do you start?
    • First decide if you really WANT to do it! Make sure the decision is truly yours. Discuss with your family and support systems.
    • Next you need to pick your location! Where do you want to be? Take family and friends into consideration.
    • Build your team of professionals.
  • Who are the “Team”?
    • Business attorney – Will need to start your entity LLC vs PA and discuss the legal liabilities and best direction for your practice.
    • Accountant – They will work with your attorney to set up the tax structure of your entity.
    • Real estate broker – Will need to start looking and secure a lease at least 6-8 months prior to start date. Will guide you on build-out and lease agreement. They will also work with your attorney to make sure the agreement is in your best interest. You will need to have your entity set up first before signing any agreement.
  • When do you need to start building the team?
    • One year in advance of your practice start date.
  • Should you use a small bank to seek out a loan? Small banks may be able to negotiate better terms. They can also provide a more personalized experience that will grow with you and your business. On the contrary, small banks are targets for buyouts so you need to make sure they have an established history.
  • What kind of loan should you take out and how much?
    • This may vary depending on your practice plan. You will likely need a line of credit between $100,000-200,000 to help with start-up costs, and a term loan of 150,000-500,000 beginning when your practice opens its doors.
    • The banks you approach will want to see your business plan. You need to build this plan to review your expenses and financial projections and really hone these numbers.
    • Most loans will need to be repaid before the end of your lease.
  • Writing a business plan, where did you find help with this?
    • Other mentors and residents who have written them. Also practice management companies can help with this, however it will cost money.
  • Lease space/buy space? What do these contracts look like?
    • Leasing a small space first with low overhead provides increased financial security. However, if you have an opportunity to buy something and can afford it, a deal is a deal – especially in a bad market. This is where your business plan can help. Furthermore, thinking ahead about things related to buy out options, operating room buildout, medical spa associations can be helpful in your search.
    • Where to set up your practice?
      • Research your area demographics. What is the city growth? Average household income? Other plastic surgeons in the area and their retirement outlook? Needs of the community. What special services can you offer?
  • What licenses do you need?
    • Will vary from state to state. Your state medical board can guide you. This can be done very early in advance.
  • Malpractice insurance and costs
    • Every surgeon needs malpractice coverage. Do your homework. Negotiate. It may be wise to go with the Cadillac plan here since you don’t have a large hospital to pay out settlements that may exceed what your policy covers.
  • Practice management company? Worth the money/time?
    • With little business experience, guidance by someone is always a safe option. These companies can be very expensive. However, they have different consulting plans that can help you starting one year out or one month prior to opening. This will come down to how much you are willing and able to do yourself.
  • How much office staff? What are their roles?
    • Start small! One to two staff. Hiring nurses is expensive so know your state guidelines on supervision requirements.
  • Association with hospital and privileging? What is the timeline here?
    • You will not be able to get privileges until you have a practice address and malpractice insurance policy number.  There is some nuance here. We suggest calling your hospital’s medical staff office to discuss in advance what they need.
  • Insurance credentialing timeline
    • Allow time for this (3-5 months). You can hire a company to get you credentialed which may be easier since it is a lot of paperwork!  
  • Electronic Medical Records (EMR) decisions?
    • This is a personal decision. Each EMR has a representative that can provide a test session and discussion of their platforms. 
  • Website design and marketing?
    • Will need to start writing content ASAP! Again, control your narrative. By the time you open, the easy part should be your website.
    • ABPS has specific guidelines on marketing and advertising before you are board certified – you must know these rules and follow them.