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Starting a lean plastic surgery practice- is it possible?

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  • Avatar fiomi 
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    Status: Physician
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    Joined: 04/15/2019
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    Hi,

    I’m looking to start my own plastic surgery practice but want to be as lean as possible. I’ve read about the ‘micropractice’ concept, but don’t know if this is feasible for a plastic surgeon. I have a ton of questions and have been browsing the WCI forums and found really good information. Hoping anyone who has started their own practice (surgical or not) could weigh in on some of my questions below:

    Business Entity: Thinking LLC is more appropriate than Sole Proprietor. Anyone see an advantage to being sole proprietor (other than no fee and dont have to register with state.)

    Financing: I have a significant other who will be able to put forward about 50% of the start up costs, and I would get a loan for the other 50%. Trying to understand if it’s necessary to take out an actual loan vs just open a separate business checking account with a credit card.

    Space: Have looked into leasing my own space but have found a couple of good options renting space from other providers who already have an office/staff and would charge me a monthly fee based on my utilization.

    Employees: If I’m able to use the staff of a practice I’m not planning to hire any of my own employees (at least at the beginning)

    Privileges: Will get local hospital and ambulatory surgery center privileges to operate

    Billing/Coding: Need to find out if this is included with me using “staff” at the practice I’ll be renting from, or if I should outsource this to a company. I’ve also read that if you have a certain type of EMR/EHR there are billing/coding services within that.

    EMR: Would like to find something simple to use and low cost. Preferably that can include billing/coding services with it.

    Insurance: Will be obtaining my own malpractice insurance. Will be on my significant other’s health insurance

    Marketing/Website: Will do my own social media (free) but understand I likely need to pay for website design. I’ve seen some free/very low cost design your own website companies but I do not know how well these will be for being mobile compatible, uploading lots of before/after pictures, having videos, etc.

    In summary, I want to start very lean and streamlined and want to find out if this is possible for a plastic surgeon. Eventually once I cover my own costs, pay off medical student loans, etc. I want to grow/expand my practice but starting out want to keep costs low. Open to any thoughts or suggestions, thanks!

    #210940 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2690
    Joined: 01/03/2017
    In summary, I want to start very lean and streamlined and want to find out if this is possible for a plastic surgeon. Eventually once I cover my own costs, pay off medical student loans, etc. I want to grow/expand my practice but starting out want to keep costs low. Open to any thoughts or suggestions, thanks!

    Click to expand…

    I’m sure it’s possible but I don’t know if the way you’re going about it is going to be a great idea. For full disclosure, I have no experience/knowledge of running a plastic surgery business. From your post, you state you want it to be “lean”, but you’re basically going to be leasing everything you need (including man power) instead of “buying”. You’re going to run into a pickle once your practice expands. If you want to be a real practice, I would get your own space, supplies, employees, etc.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #210951 Reply
    Liked by Zaphod
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6068
    Joined: 01/12/2016

    What is the angle of the practice? If you’re talking billing/coding I assume you’ll be doing recon as well as aethetics. Do you have a transition plan or something in mind?

    I dont think you’ll like sharing employees, etc…you’ll want them trained for just your stuff, etc….and they will feel more loyalty to one or the other, they can leave etc….without much input control from you.

    I think maybe defining the practice and the first five years is a great start. Agree you’ll likely quickly outgrow this place and it will be annoying to move so early on.

    #211024 Reply
    Liked by q-school
    Avatar wideopenspaces 
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    Status: Physician
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    Joined: 01/12/2016

    I’m pretty risk averse and there was a very recent thread here which outlined how catastrophic it can be if your surgical practice fails ( and this person had paid off home and student loans before opening the business). So the fact that you have student debt, maybe mortgage debt and then your SO is the only investor? Makes me very nervous about this plan. But again, I’m afraid to open private practice psychiatry and there doesn’t get anything easier than that! Hopefully some folks here will give you good advice.

    #211032 Reply
    Liked by Tim
    ACN ACN 
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    Status: Physician
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    Joined: 01/08/2016

    In regards to WEBSITE:

    I used yourpracticeonline to create my personal website.  My group is now using them to revamp our website.  Pretty affordable and 100% customizable to your needs

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #211085 Reply
    Avatar Tim 
    Participant
    Status: Accountant
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    Joined: 09/18/2018

    “Space: Have looked into leasing my own space but have found a couple of good options renting space from other providers who already have an office/staff and would charge me a monthly fee based on my utilization.
    Employees: If I’m able to use the staff of a practice I’m not planning to hire any of my own employees (at least at the beginning)”

    If the other provider is in Plastic Surgery, you may have some built in conflicts. In some discussions, it’s a eat what you kill with expense allocation. The support staff works at the direction of the other provider.

    If the other provider is not in Plastic Surgery, you have issues with practice specific training and staff does not work for you.

    It sounds like you want the “lean benefits” of a partnership only until you no longer need the partner. That may be difficult from a business plan.

    Simply an observation, zero expertise.

    #211093 Reply
    Avatar fasteddie911 
    Participant
    Status: Physician
    Posts: 300
    Joined: 05/31/2016

    I have a older family member who runs what I consider a “lean” surgical practice.  It’s just them, their spouse and hiring help for in-office OR days.  They own their office, take insurance and cash, paper charts, do their own billing and overall seem to keep things simple w/ low overhead.  It seems insurance is the biggest complexity and hiring spouse can have many benefits.  I came across this blog, https://solobuildingblogs.com/ and it seems to have good stuff in it.

    #211111 Reply
    Liked by Tim
    hatton1 hatton1 
    Participant
    Status: Physician
    Posts: 3059
    Joined: 01/11/2016

    I started my own Ob/gyn practice after being in my hometown for a year. I had some patients. It is certainly doable. I think sharing space makes a lot of sense. So does sharing employees. As you build a clientele you can then leave I did this at first

    #211156 Reply
    Liked by Zaphod, Tim
    Phinance Phinance 
    Participant
    Status: Physician
    Posts: 8
    Joined: 04/14/2019

    Sounds really smart, stay lean, maintain shared space (so long as they treat you fairly), then open your own thing when you’re ready 🙂

    "Our life is frittered away by detail. Simplify, simplify." -Thoreau

    #211888 Reply
    Avatar fiomi 
    Participant
    Status: Physician
    Posts: 20
    Joined: 04/15/2019

    Hi,  Thanks for the response. Yes I agree… I’m hedging. I want my own practice but not yet ready/able financially to “go all out.” So I’m looking at how to keep costs low, lease/share space, etc. Appreciate your input!

    #212369 Reply
    Avatar fiomi 
    Participant
    Status: Physician
    Posts: 20
    Joined: 04/15/2019
    In summary, I want to start very lean and streamlined and want to find out if this is possible for a plastic surgeon. Eventually once I cover my own costs, pay off medical student loans, etc. I want to grow/expand my practice but starting out want to keep costs low. Open to any thoughts or suggestions, thanks!

    I’m sure it’s possible but I don’t know if the way you’re going about it is going to be a great idea. For full disclosure, I have no experience/knowledge of running a plastic surgery business. From your post, you state you want it to be “lean”, but you’re basically going to be leasing everything you need (including man power) instead of “buying”. You’re going to run into a pickle once your practice expands. If you want to be a real practice, I would get your own space, supplies, employees, etc.

    Click to expand…

     

    Hi,  Thanks for the response. Yes I agree… I’m hedging. I want my own practice but not yet ready/able financially to “go all out.” So I’m looking at how to keep costs low, lease/share space, etc. Appreciate your input!

    #212371 Reply
    Avatar fiomi 
    Participant
    Status: Physician
    Posts: 20
    Joined: 04/15/2019

    What is the angle of the practice? If you’re talking billing/coding I assume you’ll be doing recon as well as aethetics. Do you have a transition plan or something in mind?

    I dont think you’ll like sharing employees, etc…you’ll want them trained for just your stuff, etc….and they will feel more loyalty to one or the other, they can leave etc….without much input control from you.

    I think maybe defining the practice and the first five years is a great start. Agree you’ll likely quickly outgrow this place and it will be annoying to move so early on.

    Click to expand…

    Hi, Thanks for the response. My business plan and defining the practice is a work in progress! While things are slow at the beginning I’m hoping to make some income from doing injections (fillers, neurotoxins, etc.) Also considering taking some ER call and/or doing locums work..but I want my focus to be on building my practice. I know it’s a catch-22.

    I do want the majority of my practice to be cosmetic but plan to do some functional/reconstructive work and take insurance. You’re right about the employees- I’ll need to consider that. Given they are loyal to the provider who is employing them…not me.

    Thanks again for your input!

    #212372 Reply
    Liked by Zaphod
    Avatar fiomi 
    Participant
    Status: Physician
    Posts: 20
    Joined: 04/15/2019

    I’m pretty risk averse and there was a very recent thread here which outlined how catastrophic it can be if your surgical practice fails ( and this person had paid off home and student loans before opening the business). So the fact that you have student debt, maybe mortgage debt and then your SO is the only investor? Makes me very nervous about this plan. But again, I’m afraid to open private practice psychiatry and there doesn’t get anything easier than that! Hopefully some folks here will give you good advice.

    Click to expand…

    Thanks for your response. Yikes- I’ll have to look into that thread! Yes my SO and I are trying to find the right balance of investing in the practice without going overboard or “all in” at the beginning. What kind of practice model do you have currently?

    #212373 Reply
    Avatar fiomi 
    Participant
    Status: Physician
    Posts: 20
    Joined: 04/15/2019

    In regards to WEBSITE:

    I used yourpracticeonline to create my personal website.  My group is now using them to revamp our website.  Pretty affordable and 100% customizable to your needs

    Click to expand…

    Thanks for the recommendation- I’ll check it out!

    #212374 Reply
    Avatar fiomi 
    Participant
    Status: Physician
    Posts: 20
    Joined: 04/15/2019

    “Space: Have looked into leasing my own space but have found a couple of good options renting space from other providers who already have an office/staff and would charge me a monthly fee based on my utilization.
    Employees: If I’m able to use the staff of a practice I’m not planning to hire any of my own employees (at least at the beginning)”

    If the other provider is in Plastic Surgery, you may have some built in conflicts. In some discussions, it’s a eat what you kill with expense allocation. The support staff works at the direction of the other provider.

    If the other provider is not in Plastic Surgery, you have issues with practice specific training and staff does not work for you.

    It sounds like you want the “lean benefits” of a partnership only until you no longer need the partner. That may be difficult from a business plan.

    Simply an observation, zero expertise.

    Click to expand…

    Hi, thanks for the response. You’re right about the lean benefits- I do eventually want to have my own practice but going all in right out of training isn’t possible for me financially right now. I’m also fairly risk averse so trying to see if it’s possible to start small/lease space/share with someone until I’ve gotten more experience and savings to take the next step. Re: the other provider, they are a plastic surgeon so we will have some overlap but I will be doing facial plastic surgery and they will be doing body work. Thanks again for your input!

    #212375 Reply

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