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  • #16
    saildawg, how is it going in the new office.? Sending good vibes to you and wishing you much success. If you have any other specific questions, please feel free to ask

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    • #17
      Originally posted by ROC MD View Post
      saildawg, how is it going in the new office.? Sending good vibes to you and wishing you much success. If you have any other specific questions, please feel free to ask
      Thanks! I ended up getting a good deal on all equipment from a fellow WCI forum member who is now a friend, so I am super happy I made this post. Opening my solo practice has been so amazing. It has been a great deal of hard work, but all the hard work pays off directly to me. I am happier than I have ever been in my professional life and personal life. I have taken back control of my life, and have developed a whole new perspective on my career. If anyone needs more info I am happy to share more (I haven't hung around WCO forums as I have been so busy).

      From a financial side
      About $100,000 investment (roughly 60,000 post tax)
      I opened in mid February, 3 months in already have profit 1.5x expenses
      My patients are thrilled with their experience, and I am happy to come to work each day with patients that have chosen me to provide their care.

      I couldn't recommend going solo micropractice more


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      • #18
        Congrats! You mentioned 2 yr and 3-5yr financial targets. Still valid? Did your startup costs hit close to your plan?

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        • #19
          Originally posted by Tim View Post
          Congrats! You mentioned 2 yr and 3-5yr financial targets. Still valid? Did your startup costs hit close to your plan?
          Thanks Tim. Looking at my proforma for year one I expected 65k of profit. I eclipsed that in the first 45 days.
          Year 2 I expected about 300k, so on pace to outperform that in year 1. Its amazing what a low overhead can do, but I am going to need some more redundancy at the front desk. My one employee has called out sick twice and those days are hectic to say the least. It will be worth it to pay for that convenience.

          Startup costs were about 50-75k under what I expected.

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          • #20
            Originally posted by saildawg View Post
            ... I am going to need some more redundancy at the front desk. My one employee has called out sick twice and those days are hectic to say the least. It will be worth it to pay for that convenience...
            Yes, it's good to start cheap, but you need to break the mindset now. Consider this above issue your first warning light. As you build, you should aim towards really only doing things that requires a doc to do. You are a procedure-based specialist, so you should not be buying the office supplies at Sams club and DIY payroll and wiping down the waiting room until you retire.

            Once you build a patient base, anything you can reasonably train assistants for (cleaning instruments, cleaning rooms, rooming patients, eye chart, etc) will make your income grow. This is not psych... you are a procedure-based specialist. The micro-practice is a fine start for even the procedure specialties like ENT or derm or yours, but a practice with long term viability without MA staff is basically just for PCPs or solo psych or non-procedure docs who just write Rx and don't have the procedure and $$$ power that you do (or mess up the rooms as you can). Your specialty can double or triple or 5x their gross with some help.

            I would strongly consider an assistant as soon as you avg 10pts per day and then additionals as needed (like the front desk, one is too close to none... and you start over with training again also). Again, your long term goal is to only do what absolutely requires a doc: new patient decision making, test interpretation, procedures, etc. Even the PMH and post-op checks or Rx refills can be 90% completed by a well trained MA who knows what to ask after they room the patient... look at any successful ortho, plastics, etc group. It isn't "abandoning your principles"... it is making jobs for motivated people and allowing yourself to be more productive in the process. Win-win.

            Even if you decide you do want to stay with the micro thing, you will need 2 check in/out persons minimum for reasons you stated above... one of them can be MA/front if you are still slow. Missed phone calls cost you a ton. That second girl can help with phones but also room patients for you and put the chart up at the very minimum. The people who say they did micro without assistants for decades missed out on many millions of revenues in that timespan (again, unless they were psych or FP). GL and good work thus far.

            https://www.shortform.com/blog/48-la...ke-the-credit/
            Last edited by Max Power; 05-24-2021, 07:31 PM.

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            • #21
              I am so happy for you! Congratulations!
              Our passion is protecting clients and others from predatory advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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              • #22
                Originally posted by Max Power View Post
                Yes, it's good to start cheap, but as you build, you should really only be doing things that it requires a doc to do.

                Once you build a patient base, anything you can reasonably train assistants for (cleaning instruments, cleaning rooms, rooming patients, eye chart, etc) will make your income grow. This is not psych... you are a procedure-based specialist. The micro-practice is a fine start for even the procedure specialties like ENT or derm or yours, but a practice with long term viability without MA staff is basically just for PCPs or solo psych or non-procedure docs who just write Rx and don't have the procedure and $$$ power that you do (or mess up the rooms as you can). Your specialty can double or triple or 5x their gross with some help.

                I would strongly consider an assistant as soon as you avg 10pts per day and then additionals as needed (like the front desk, one is too close to none... and you start over with training again also). Again, your long term goal is to only do what absolutely requires a doc: new patient decision making, test interpretation, procedures, etc. Even the PMH and post-op checks or Rx refills can be 90% completed by a well trained MA who knows what to ask after they room the patient... look at any successful ortho, plastics, etc group.

                Even if you decide you do want to stay with the micro thing, you will need 2 check in/out persons minimum for reasons you stated above. One of them can also room patients for you and put the chart up at the very minimum. GL
                Good points,

                In my situation I can do the work of a tech in 1/4 of the time, and 10x the quality so I am in no rush to hire clinical help. I am going to add some front desk help, and cross train them to do basic tech work (like check visions, and perform visual fields, or imaging). I am seeing 8-15 patients a day already. Average wait time in the waiting room is -5 minutes (they show up early), so the clinic flow is going well. Surgeries are up from last year, but I do mainly OR based surgeries and in office procedures are easy for me to do without help.I will probably hit a ceiling for income this way, but I am already at the highest marginal bracket and would value time off more than maximum profit. Really I value maximum use of my time. If I am being compensated well for my time I am happy. Right now with the micro practice model I am on pace to be >75th percentile for compensation, while taking less risk (pt encounters), and with a more favorable and customizeable work schedule. Not sure I need to make any big changes as of now. Just need to eliminate risk of not having an employee show up.

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                • #23
                  Originally posted by saildawg View Post
                  ...I can do the work of a tech in 1/4 of the time, and 10x the quality so I am in no rush to hire clinical help...
                  Well, that is always possible, but you might not be 4x faster than a youngster and might not want to be stocking supply drawers, emptying garbages, mailing out bills, autoclaving stuff, etc as you get older.

                  In reality, you have the potential to produce $300-$500+ per hour as a procedure-based specialist (depending on payers, efficiency, billing, etc). Medical assistants cost $10-$20 per hour based on seniority and skill and COL area. So, even if you are 4x as fast and 10x as good, you'd actually need to be at least 15x as quick and good for it to make sense for you to do those MA tasks once you have enough patients... which you are clearly on the cusp of.

                  Like I said, any procedure doc who practices that minimalist way might enjoy it with DIY, but if they keep going on that route (again, assuming they're not psych, therapist, PCP, etc), then they also miss out on millions of dollars during a career and could've helped many more patients. The reason docs are typically fair or poor entrepreneurs is because they can't give up the control. In private, it is all about finding talented people, training them, letting them do their job, and trying to keep them awhile. It is not about you being the engine that does it all; while you are the talent, the staff enable your efficiency. Now that the startup year went well, consider the "DIY" aspect to be training assistants well... even doing the interviews to select them if you like that aspect? Take it FWIW and kudos on your success thus far.

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                  • #24
                    Glad to hear you are doing well in your practice!

                    One suggestion from a PCP: please be sure to send your notes to the referring physicians. This is especially important for diabetic patients because annual diabetic eye exams are a HEDIS measure which any PCP will tell you is essential. It also helps us capture any MRA (Medicare Risk Adjustment) codes which also helps reimbursement with some insurances. Not to mention it is good for patient care.
                    Last edited by ROC MD; 05-26-2021, 05:38 AM.

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                    • #25
                      Originally posted by Max Power View Post
                      Well, that is always possible, but you might not be 4x faster than a youngster and might not want to be stocking supply drawers, emptying garbages, mailing out bills, autoclaving stuff, etc as you get older.

                      In reality, you have the potential to produce $300-$500+ per hour as a procedure-based specialist (depending on payers, efficiency, billing, etc). Medical assistants cost $10-$20 per hour based on seniority and skill and COL area. So, even if you are 4x as fast and 10x as good, you'd actually need to be at least 15x as quick and good for it to make sense for you to do those MA tasks once you have enough patients... which you are clearly on the cusp of.

                      Like I said, any procedure doc who practices that minimalist way might enjoy it with DIY, but if they keep going on that route (again, assuming they're not psych, therapist, PCP, etc), then they also miss out on millions of dollars during a career and could've helped many more patients. The reason docs are typically fair or poor entrepreneurs is because they can't give up the control. In private, it is all about finding talented people, training them, letting them do their job, and trying to keep them awhile. It is not about you being the engine that does it all; while you are the talent, the staff enable your efficiency. Now that the startup year went well, consider the "DIY" aspect to be training assistants well... even doing the interviews to select them if you like that aspect? Take it FWIW and kudos on your success thus far.
                      Thanks, I will keep those valid points in mind, still need to iron out my processes etc and a ton to work on making the current model the most efficient.

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                      • #26
                        Originally posted by ROC MD View Post
                        Glad to hear you are doing well in your practice!

                        One suggestion from a PCP: please be sure to send your notes to the referring physicians. This is especially important for diabetic patients because annual diabetic eye exams are a HEDIS measure which any PCP will tell you is essential. It also helps us capture any MRA (Medicare Risk Adjustment) codes which also helps reimbursement with some insurances. Not to mention it is good for patient care.
                        Great points, I am staying on top of that and have made some good inroads with PCPs near my new office. If I can capture some of the middle aged demographic via diabetic exams etc it will be good for my practice.

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                        • #27
                          Solo practice has proven to be profitable but if I only had those sweet high reimbursement contracts you have I could retire by next year

                          Glad you made that post as well since I'm in this situation having been inspired by your original post to look for the soloeyedocs group and go from there. Talking extensively with you over the past 6 months has been great and it's fun to see us both succeed in a solo oph practice. It's wonderful to have a friend to bounce ideas off of and reach out to directly when hurdles arise that I know we are both facing.

                          Some days are still a struggle and the hours are often longer, but I also could not be happier to be working for myself and ultimately answering only to myself.

                          Thanks for partnering with me to help me buy all that equipment which allowed me to stay where I am and go solo after the hospital cut our department!

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                          • #28
                            Originally posted by Yowza View Post
                            Solo practice has proven to be profitable but if I only had those sweet high reimbursement contracts you have I could retire by next year

                            Glad you made that post as well since I'm in this situation having been inspired by your original post to look for the soloeyedocs group and go from there. Talking extensively with you over the past 6 months has been great and it's fun to see us both succeed in a solo oph practice. It's wonderful to have a friend to bounce ideas off of and reach out to directly when hurdles arise that I know we are both facing.

                            Some days are still a struggle and the hours are often longer, but I also could not be happier to be working for myself and ultimately answering only to myself.

                            Thanks for partnering with me to help me buy all that equipment which allowed me to stay where I am and go solo after the hospital cut our department!
                            Awww - another WCI success story! Glad you posted!
                            Our passion is protecting clients and others from predatory advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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