Single Older Female DO: How To Start Niche Private Practice Fresh Out of Residency?

[Tim]

“I know the easy answer would just be to take the academic job, but they lack clinical opportunities and I want to continue to maintain and improve my skills as well as help people now that I've seen how potent OMM can be in so many conditions. I also really don't want to live FT at any of the medical schools because they are all 2-3+ hrs from the beach. ”

Compensation, job, location are your variables.

Student loans $303k (high interest rates and difficulties refi).
Warning, blunt but intended as constructive. The reality is you need to objectively assess the income potentials. A non scalable occupation you show $165k gross. What is the net, the time, and certainly? Educating the other physicians and population demographics don’t payoff. Building your brand for referrals does. I question whether you will increase demand for ONMM. That is potentially fatal financially, and likely.

Compensation, job, location usually means only two out of three. Helping people and close to the beach is wonderful, but you need to get compensated. At 40 in a physically demanding practice, you may need to change some of your desires for the job and location. You already paid a for profit organization and need to make some money. Straight facts, not an opinion about which path or feasibility. The private practice option currently looks like you will be paying that debt for 20-30 years. Yes, to 60-70.

That is a huge personal burden for living close to the beach. You have to live and work where you can make sufficient money. Refocus on the dollars. Surf on weekends would be my suggestion. You might grow the private practice as a side gig and eventually transition.

[Random1]

I would recommend working for another physician who does something similar first , and then go out on your own. Academic medicine vs private practice are completely different from a business standpoint from finances and practice building. Understanding the complexities of running a business is a full time job. Understanding billing , coding, hiring and firing should not be taken lightly. The easiest part of running your practice is actually the doctoring part

[braindoc]

I think White.Beard.Doc is completely right.

You need cash if you decide to move forward with that plan. If I were you though, I would go get an employed position with a high guaranteed salary [read non-academic] for a year or two. Then when my finances were more stable I'd look at opening a practice.

[jfoxcpacfp]

OP - all of the above comments have very valuable nuggets that i recommend you sit back and reflect on. Put your emotions and desires aside. You can come back to them after you have taken time to ask yourself - what would I advise to my closest friend? Or my spouse or child if s/he came to me with this proposal? Would I back them 200% and tell them to go for it? Or would I have a concern that our relationship or our joint finances risk suffering? It is so easy for “wants” to cloud our judgment and lead us astray. And the Facebook culture is all about support and positivity and “believing in yourself”. It sometimes nauseates me. It’s so much better to get a reality check before you make an expensive and regretful mistake. You don’t always have to “learn the hard way”.

Not saying anyone above will be proven right, just that you have been given extremely valuable feedback from those who are (probably) older and wiser - and have no dog in the fight. I have nothing to add because they obviously understand what you are facing far better than I. And I still admire your tenacity and determination. It’s up to you to determine how you need to channel it. Good luck

[TXDoc21]

I know a person at work who does this. She worked as a Hospitalist and opened the manipulation gig on the side in someone else’s office. She waited for that to grow over the last couple of years and is now transitioning out of the Hospitalist gig and doing the other full time.

I worry about scalability. You have to see every patient yourself to do the treatment. Only way to make more money is to charge more per session.

if that’s your passion, I’d say go for it. Just try to be financially smart about it and get yourself a guaranteed income so you can pay your bills and surf on the weekends.

[familydocPA]

Very good question to pose. On the one hand, I want to commend you and encourage you. The group here tends to be very fiscally conservative and risk averse, but does not always adequately weigh the risk inaction.

On the other hand, there are some very large practical considerations with the plan that you outlined, which have been pointed out by others.

I was once facing a career crossroads and came here for advice. I ignored the stuff I didn't want to hear. That was a mistake.

I wish you the best in your pursuits, and regardless encourage you to post your progress through this journey.

[gap55u]

Several DO’s interested in ongoing OMT went to my FM residency. OMT isn’t 100% paying the bills but it tilts their mix as a FM sports doc sees a different spectrum too. I would wonder about adding acupuncture to your skill set — desirable skill, usually cash pay, would let you increase from a 1:1 ratio to running multiple rooms as demand rose.

[Sereia]

Thank you, everyone for your feedback. I will take it all into serious consideration as I move through this last year, learn more about the financial/business side of things and see how things shape out. I think there may be some understandable misunderstanding of my small specialty as I don't think I have the option (nor do I want to) do a 'traditional' practice since I will not be dual boarded, so my guaranteed income would be an academic one. I do also really enjoy preventative and lifestyle medicine, which I always planned to incorporate into my OMM practice anyway, but it still is a more niche than a traditional primary care / FM type practice.

So assuming I take the academic job and re-evaulate the private practice during or later, I am still wondering how I should allocate my mother's money...all to loans? I'm also still wondering if there's anything else I should be doing with my few investments? Someone mentioned Roth conversions - I thought residents should max out Roths over tax deferred accounts...what am I missing here? Thanks!

And to answer some other questions that came up:
- The commute would be 3 hrs 2 days a week (but also assumes I have pay rent to live in 2 places). Given typical commutes in CA, it's actually not that bad for a short time...
- OMM is quite different than chiro and other bodywork therapists, which is worth knowing as an MD or DO so you can refer appropriately (your patients will love you!). Chiros focus mostly on the spine with articular techniques, where as DOs also treat the extremities, ribcage, and head. OMM does include a modality which is similar to chiro, but also about 10 other modalities that ONMM boarded DOs can integrate seamlessly to affect bones, muscles, fascia, circulation, lymphatic drainage all at once for optimal physiologic function, therefore helping people with acute and chronic issues *if* there is a somatic component to their disease process (which there often is and is not addressed in 'traditional' medicine). Sequenced OMM tends to get the job done in much fewer treatments because it is so individualized to the patient.
- I do plan to look for office space with sports med, ortho, chiro, massage, PT because they are a great source of referrals both ways. Since we all do different things, it ends up being a win win for everyone, especially the patients.

Thanks again! I will share my updates once I have any.