It’s important to truly evaluate the risks, demands, expectations etc. before starting a practice and I wanted to go over how I manage some of the hurdles. This list is from the pros/cons of the Private Practice section:
- Financial Risks: High startup and operational costs, including rent, equipment, and liability insurance. You can’t really prepare for the costs or know how much to save, especially in this economy but overall, DO NOT quit the day job, until there’s a consistent profit or you truly have a reliable major caseload. In general, get multiple estimates for supplies, tasks, items, etc.
- Administrative Burden: Managing billing, licensing, marketing, and staffing takes time and resources. Please consider outsourcing, (I plan on listing some resources, but I know some people who use their (adult) kids, spouse, or whoever and make sure the person is PROFESSIONAL)
- Initial Instability: It can take months or years to build a stable client base. With marketing, internet, facilities… people can build a (full-time) case load within 6 months to a year… I also gauge the “instability” according to the profits… I’m making about >2K a week…that could be a lot for others, but for me, my target is to make that in a day. However, I started making way less, and sometimes nothing for weeks, so my goals weren’t always money-related. Initially, I just wanted everything to work before I thought about the money. I still have hiccups but the point is, my initial goal wasn’t only about money.
- Legal and Regulatory Challenges: Navigating compliance with state laws, HIPAA, and insurance requirements can be complex. Knowing the limits and expectations varies state to state, be aware of this prior to starting… If you’re not in a full-practice state, -you have to factor in collaborative fees and again to see if it’s even worth the hassle. I recommend ONLY doing a practice if you have full-practice authority because fees in general are getting more unbearable. I would say possibly DOUBLE the expenses or cut the income by a third if you don’t have full authority.
- Isolation: Solo practice can feel isolating without colleagues for consultation or support. This is somewhat psychological, when I work in community mental health, I’ve been on my own from the beginning. I don’t recommended going private practice right after school, but it mainly depends on your comfort levels. Another interesting perspective, since doing private practice -I’m able to control the kind of patient population to deal with… so it makes the job more tolerable (mentally), thus not feeling as isolated.
- Unpredictable Income: Earnings fluctuate depending on patient load and reimbursement rates. Again, have a back up source of income or consider other means of income until you’re financially stable.
- Limited Time for Non-Clinical Work: Balancing patient care with running a business can be exhausting. Outsource and delegate what you can, another important factor is to keep the care/services simple, at least starting out or consider specializing to have a limited population, but that can also affect your income.
- Marketing Responsibility: Attracting and retaining clients requires effective branding and outreach. This issue goes back to your BRAND and vetting process, overall think about what kind of patient population YOU want to attract and maintain… in other words, quality over quantity- so don’t name your practice Pills on Wheels.
- Competition: Competing with established practices and healthcare organizations for patients and referrals. Don’t worry about this. There is a severe lack of access.. I’m already considering either hiring another NP and referring patients out… Even if the state isn’t full practice, it only means that you have to go through more red tape, but it’s still a huge demand and possibly greater due to the lack of access… I know people making +200K in states that are not full practice, but it takes time and having the right support/connections.
- Burnout Potential: Balancing clinical work, business management, and personal life can be overwhelming. Honestly no matter what you do in healthcare or in society, it’ll be a burnout. We’re just living in those times so think about private practice as a means of a long-term investment and an overall the lesser of evils.
My Tools
I reluctantly started my practice because I thought my clinic was going to close, thankfully it got bought out -but that created other issues with my productivity… so this was like a last minute resort. I don’t recommended doing things in a panic because I made most of my decisions impulsively. It also didn’t help that I thought starting a business was like rolling out the bed and ordering stuff on Amazon. I really didn’t put much thought into this. With that being said, I’m glad I started it back then because I wouldn’t have done this now. Why? Because I had enough on my plate, I still work community, and I knew this was going to be MORE work….and I can handle stress but somewhere along the line, I felt like everything was in Chinese. I finally came to my senses but yes running a practice is not for the weak so take this with a grain a salt. It was very little research involved but thankfully it worked out well. Here’s the rough order I went in:
- Start with Headway, Alma, Grow Therapy: they got me credentialed very quickly and I started to see patients within 2 months. Zocdoc is a hit/miss, but I’m using them for other states. In the meantime of being credentialed:
- Create a Website: I hired someone and it cost me <1K.. I’m familiar with websites but not with formal services. The person I used retired but she was the most affordable. Some people/websites charge >5K, so I did get several estimates.
- Hello Rache: I got an assistant immediately because I had to make sure the person was familiar with my EMR.. she wasn’t but at least I was able to provide materials to get the person familiar, prior to starting…
- Purchase the EMR: I use Valant. Yes it’s expensive. ALL of them are. I used the one that I was already using at another clinic to make it a quick and easy transition. Icannotes, is another one that I heard was helpful and easy to integrate.
- Telehealth: I use MS Teams. It’s free and easy but the credentialing platforms have (free) telehealth software as well.
- Other Tools:
- Google Docs: I use spreadsheets to track my expenses. Apps and programs didn’t include or transfer all my expenses so yes taxes was a crazy but overall it was easy with Turbo Tax. You can use an accountant, but yes that’s more $$$$$. Avoid lawyers.
- Online Banking: I use Relay, it’s been super awesome and easy without extra banking fees. For credit I use BHG -They offer credit cards with 0 interests! If you want reward points you’ll have to use other (major) cards, but for emergencies I use BHG to not worry about my credit score and they give a great credit card limit.
- Telecommunications: I use multiple means – Spruce to call patients and Ring Central: my assistant is based in another country and Ring Central allows them to make calls, Spruce doesn’t allow the calls in another country, but both platforms can send messages and faxes. The phone I use is iPhone.
- Malpractice: I still use Berxi, but now it’s asking for a physical address. I just got one, but prior it wasn’t mandatory. Berxi is also still the cheapest for me, however, with time and more states, the expenses can double -including the malpractice insurance so consider shopping around. I don’t prescribe scheduled medications in other states, but regardless, DEA is requesting a physical office in order to get a license and you need that (a DEA) for insurances… So don’t waste your money like I did, thus I offer private pay and/or people found me through their insurance from other states.
In Conclusion
I plan on listing more resources in a general area. I just wanted to quickly post something about starting a practice, which was way more than what I was aware of… I can’t stressed enough how it’s more than a 9-5 or 12 hours, I didn’t have a mentor, time to scourged the internet, ask social media groups or anyone… I barely have free time in general…. If you have a young family or other situations that are super demanding, DON’T RUSH. Having a private practice is rewarding, but it may take months and years to get the right traction, especially if you’re on your own. It’s worth it but be patient and don’t beat yourself up or think it’s a failure if you don’t have thousands of patients…I have less than a 100, so gauge your success and the process according to your mental health and your tolerance, not just a pocketbook.
