How to successfully open a private practice

Many consider private practice a way of the past. Truth bears this out when we see the large number of doctors selling their practices to hospitals and large healthcare systems. And the overall healthcare system suffers because of this.

In the current environment, the thought of starting a practice provokes fear in many, but it shouldn’t cause the demise of that practice type. In fact, patients receive the best care when their physicians maintain control of the way they practice.

Starting a successful medical practice is doable and offers many advantages, such as autonomy and ability to make business decisions affecting the practice. Despite all the changes happening in healthcare, I still think this is the best way to go.

Over the years, through successes, failures, trials, tribulations, gambles and experience, I devised the following tips to assist in starting a medical practice.

1. Location is key. You need to be in a highly visibly, heavily trafficked area. You will get patients just by being visible.

2. Rent, don't buy until you are sure you're staying. Commercial real estate is risky these days.

3. Credential with the insurance companies early. Some take 6 months to complete the process. If this paperwork is not something you can get done quickly, get help. There are many companies that you can contract to do it for you.

4. Prepare a marketing strategy. The best marketing is actually meeting people face to face. We went out and introduced ourselves to people in the community: pharmacists, the police department, the township. We gave talks at senior centers and the public library. In contrast, newspapers ads rarely bring in any patients.

5. Having good staff is essential. Patients will "chose you or lose you" just based on who you hire. We started with just one employee to answer the phone and added more as we got busier.

6. Get a good accountant. We went through five accountants until we found a good one. Business taxes are very confusing and not all accountants know the nuances of medical practices. You can contact your state medical societies for recommendations.

7. Incorporate. There are tax benefits, with perhaps the largest being that you will be able to deduct benefits, such as medical insurance, travel expenses and daily business expenses. As an incorporated business, you can also deduct your business losses, which is much more difficult if you are a sole proprietor. You can also write off or deduct items you already pay for, such as your car if you use it to drive to work. Moreover, income earned as a corporation is not subject to Social Security taxes, only the portion you take home as salary. Lastly, corporations tend to be taxed at a lower rate than self-employed business owners.

8. Hire a good attorney as well. As a business owner, you will be entering into many contracts, from leases to sub-contracting. It is always wise to have an attorney review your contracts.

9. Shop for office supplies and equipment.  We get many items from Amazon.com for a lot less than what we would pay medical supply companies. For big equipment, negotiate. If possible, try to purchase at the end of a quarter because you can get better deals — companies are trying to improve their numbers and want to make the sale.

10. Get A-rated malpractice insurance. This is not something to skimp on. Occurrence is better but more expensive. Also keep in mind that malpractice insurance is in effect only while you are paying for the premium. You should buy a "tail" when you change jobs or carriers because you will not be protected for prior past acts by your new carriers. A tail covers what you did in the past.

11.  Don't be afraid to say no. It can be tempting to grant favors when you have few patients and someone requests something that your policies prohibit. If you give in, you will find your practice filled with drug seekers or other patients looking for special treatment. Set the stage early.

12.  Know the rules. Be an expert in coding and billing. You are responsible for any mistakes. And go through your accounts receivable on at least a monthly basis.

13. Never write off copays. Make adjustments for financial hardships. And this should happen rarely.

14.  Build trust in the medical community. Know the doctors you are referring to and vice versa.

15. Take time for yourself. If you get consumed with practice management and don't balance it with things you enjoy, you will burn out.

Private practice is not doomed as many predict. Many doctors remain independent and find success. Lack of business training in medical school should not be a roadblock, just a hurdle to overcome. It takes time and nerve, but starting a private practice is a great career path and there are many resources available to help along the way.

Linda Girgis MD, FAAFP, is a family physician in South River, N.J. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter's University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions.  Dr. Girgis earned her medical degree from St. George's University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University and she was recognized as intern of the year.  She has been a guest columnist and contributor to many media outlets. She authored the book “Inside Our Broken Healthcare System” and has been interviewed in US News and on NBC Nightly News. Dr. Girgis’ primary goal as a physician remains ensuring that each of her patients receives the highest available standard of medical care.