From: "John Brady, MD" <drbrady@thevillagedoctor

From: "John Brady, MD" <drbrady@thevillagedoctor.hrcoxmail.com>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Wed, 6 Jul 2005 14:43:38 -0400
Subject: RE: [Practiceimprovement1] Things quiet, how about updates financially and emotionally
Reply-To: Practiceimprovement1@yahoogroups.com

Brent,

Sorry for the delay in answering, but I wanted to do some research into the actual numbers before I responded. I have attached the spreadsheet detailing the growth (and ? plateau) of my practice which opened 5/03. Included are the number of patients seen each month, the amount billed, and the amount collected. As was stated on my business plan (posted months ago), I ended up about $120,000 in debt at my nadir in 3/04. Since then, the practice has been doing relatively well and I currently sit about $86,000 in the hole. (Much of the indebtedness was my salary which I kept at $100,000/year so I would not go personally bankrupt). My accountant states that this is wonderful growth for a business, but I still hate being in debt. I am currently seeing 12-15 patients a day (4.5 days/week) and strive to see 15-18/day.

Lessons learned: 1) Moonlight to cover salary for the first few months the practice is open. 2) Market everywhere you go (church, children’s activities, luncheons, restaurants) and always keep business cards handy. 3) Tell people “if you like it here, tell a friend.” 4) Be careful which insurance contracts you sign

Biggest headaches: 1) Insurances—I have come to loath them. They serve no real purpose except to make money and they do this by creating loop after loop to jump through until we get tired of jumping, and then they blame us. 2) Isolation—I was always in big practices before making the leap and I do not do hospital, so my interaction with other doctors is minimal. This leads to some professional isolation. I fill the void with local medical society meetings, etc, but it’s still not the same. 3) Juggling financial responsibilities at home and at work (hopefully will get much better as the loans get paid off and my salary increases). 4) Trying to determine when to cut off to new patients—we are currently seeing 1 new patient a day which I hope will fill the void of those leaving the practice through moves or death (not my fault), but the balancing act between being too busy and not being busy enough is more difficult than I thought it would be.

Biggest benefits: 1) Freedom to practice medicine like I want. No bean counters (except my wife), no administrators. 2) Unfaltering patient satisfaction/loyalty 3) Being a small business owner. I know it sounds goofy, but starting something from scratch, nurturing it, and watching it grow is quite satisfying and a sense of great pride. 4) Scheduling freedom—If I need time off, I take it. Since opening the practice, I have only missed one of my kids’ performances/meetings/parties/etc and that was because I was in Richmond lecturing to doctors about the benefits of EMRs. I have also found time to train for and run a marathon, which would have been impossible in the previous office. 5) Being on the cutting edge of the future of medicine—computers, database research, evidence-based information at my fingertips. How cool is that?

Would I do it again? Without question.

John