From: "kleitzelmd" <keleitzel@comcast

From: "kleitzelmd" <keleitzel@comcast.net>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Wed, 26 Apr 2006 03:11:27 -0000
Subject: [Practiceimprovement1] getting pushed out of the nest
Reply-To: Practiceimprovement1@yahoogroups.com

I'd like to introduce myself after having lurked for a few weeks. Since finishing residency
(1998) I have been a hospital employee doing my best to give real small town (Indiana)
family care (with maternity!). Until recently I have been happy to not think at all about what
one might call the "business side" but just lately I have been thinking I could improve on
my employer. I happened on this group and then interestingly enough a couple weeks
later my employer decided to divest itself of all its physician practices over the next 2 to 6
months. So what was a fun academic exercise has rapidly become quite in earnest.

I can of course try to get a job with "the other hospital" where I am also on staff. I have
discussed it with them before and if I wanted to become a cog in a machine I probably
could...

Instead I am working on launching a new solo practice as soon as I can. The "ultralight"
low overhead model is what makes it seem doable as (1) personalized care is already
where I strive to distinguish myself (2) I don't want to be caught in a big financial
obligation that I would have to work like mad to meet. I am currently in the midst of
maternity leave for daughter#2--how's that for timing?

Currently in the works: getting legal and accounting advice for set-up, and looking at
locations. My first options appear to be
1) Take over the lease from my current employer on my current office space. Staying in
thesame spot keeps it easy to find for my existing patients, and has obvious convenience
appeal. It is about 1000 sq ft for just under $1800/mo. I've had two staff members and a
fellow physician with me in this space for the past couple years, and could make it work
with just one staff person. However, I don't see how I could operate in this space without
any staff employees (at least a receptionist for security reasons as I would otherwise
frequently be alone in the building).
2) Share space with small group of specialists across town (15 min drive from current
spot). One has suggested I might want to piggyback on not only services (cleaning,
utilities, etc) but staff--reception, possibly phlebotomy and even billing. The idea of
being able to share their (attractive, spacious) waiting room is great, not to mention
probably having waste disposal, autoclave use, kitchen use, and other perks is very
appealing. The space is not subdivided in such a way that I would be renting a room,
though. More like a time share.
3) Try to get space with the chiropractor or the PTs down the block, staying very close to
my current location while reducing rent compared with having my "own space", but
without some of the medical-specific staff and services provided.

So I'm wondering about the pros and cons of staying in the existing space at higher
overhead versus making the move to a different location. Sharing space with the specialist
group would let me bundle many services into my space rental--sharing the receptionist
seems great, but would I want them to do my billing?

This group has already been a great resource for me; I would welcome any comments on
the above. Any cautionary tales about sharing space with other physicians? General tips on
choosing a location...?

Regards,
Karen L.

From: roxywible@comcast.net
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Wed, 26 Apr 2006 03:31:51 +0000
Subject: Re: [Practiceimprovement1] getting pushed out of the nest
Reply-To: Practiceimprovement1@yahoogroups.com

I would vote for the lowest possible overhead. I was at 74% once and now down to 7%. I feel COMPLETELY LIBERATED!!! You can always add stuff later but starting out too heavy on expenses may limit your freedom and get you back on a volume treadmill. It is a really interesting exercise in frugality and business. Another thing you would want to consider is the type of services you want to provide and what else is availablein your area. I really love FP no OB myself. I like intermittent inpatient (couple times per year works for me) and I absolutely love psych, emotional, spiritual aspects of health. The cool thing about how I practice is people generally are coming for my brain.
The great thing about my brain is....

1) It is light and I can carry it everywhere
2) I do not need a refrigerator or an autoclave to store it or clean it
3) I do not need a lot of office space (280 SF in a wellness center)

so ya get what I am saying ? People come for you and why add extra bells or whistles if you do not have to. Keep overhead as low as possible so you can keep your volume manageable. Your freedom is inversely related to volume and overhead.

Asd far as other services.... why buy an MRI if you can send then down the street??Why do phlebotomy when you can send them down the street??? Unless you absolutely love something let someone else do it (someone else's employee). Just do what you absolutely love. I actually love billing now. It is sooo easy!!

I would go with the PT/chiropractic office especially if you like a holistic environment. You could probably get a great deal with them because you would add value to their office.

Alternatively you could do what my mom did in private practice psychiatry years ago when she rented an entire floor and then sublet all the offices and made money on the entire deal - rent free.... then you are sort of a landlord too if you want that responsibility.

I would otherwise never go for $1800/mo. That is more than my entire monthly overhead!!

Pamela

Pamela Wible, MD
Family & Community Medicine, LLC
3575 Donald st. #220
Eugene, OR 97405
541-345-2437
roxywible@comcast.net
www.idealmedicalpractice.org

From: "MEGAN LEWIS" <griffon@bresnan.net>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Tue, 25 Apr 2006 22:20:44 -0600
Subject: Re: [Practiceimprovement1] getting pushed out of the nest
Reply-To: Practiceimprovement1@yahoogroups.com

If there is one thing to learn from this wonderful group it is to keep your
overhead as ridiculously low as is reasonable for your patient load.

Be careful not to make the mistake of becoming "real-estate poor" by having
too much office space. You would be truly amazed how much you can get done
(and quite happily)in a small space.

If sharing space/services/staff with others, make sure the details are made
very clear and in writing. Small issues can end up being big deals.

Where are you in Indiana?

Megan Lewis, MD
Durango, CO
Residency in South Bend, Indiana

From: "lynn ho" <lynnhri@hotmail.com>
Sender: Practiceimprovement1@yahoogroups.com
Mailing-List: list Practiceimprovement1@yahoogroups.com; contact Practiceimprovement1-owner@yahoogroups.com
Date: Wed, 26 Apr 2006 21:30:35 -0400
Subject: Re: [Practiceimprovement1] getting pushed out of the nest
Reply-To: Practiceimprovement1@yahoogroups.com

Hi Karen-

I actually started my solo-solo office about 18 months ago, in a medical
office building near my house. Lease expense $1600 / month + about $150 in
utilities for 1000 square feet, a little too much space and too much rent
for me. My lease expires at the end of August and luckily I am able to move
next door in the same building to share the back side of a proprietary lab,
about 640 sqft, negotiated down to $1070 including utilities, which will be
MUCH better for me. No employees though I have often been the only working
office in the entire building at night which hasn't fazed me at all to date.
Although it is doable and I was able to swing the rent and pay myself
after about 8 months starting from 0 patients, I think it would have been,
and will be, easier to have less real estate burden, if you have that as an
option.
Currently, I also have the option of renting a room in a large 4 physician
primary care practice across the hall, for slightly less, but I actually
prefer to have me own space and identity instead of moving in with them-
I'm not crazy about their style.
Also what was important to me was that the current office building is about
4 miles from my home, I can run or bike to work, and get in and out easily
for commando weekend strikes, could be an important factor if you have young
children to be closer to home.
Can you share the current space with the physician who's in there now? That
would be a workable situation.
Good luck, I'll be interested in hearing what you decide.

Lynn
>