When I told my colleagues I planned to start a solo ophthalmology practice, the most common remark was a sarcastic, “Wow, you’re brave.” Why would I want to start a solo practice, they asked, when the trend in U.S. health care is for consolidation? Private equity and huge health-care systems are buying practices from all specialties, particularly in ophthalmology. Leadership in health care is transitioning from physicians to insurance companies, businesspeople and the government. What chance did I have to start a brand-new practice in today’s world?
For me, the decision to start my own solo practice was inspired by my desire to remove as many middlemen as possible from the doctor-patient relationship. Our patients put faith in us to provide them with the best possible care. It’s a sacrosanct trust, and any other entity that inserts itself into the doctor-patient relationship negatively impacts our ability to treat our patients with the utmost care. As physicians, our first obligation is directly to the patient, not to an insurance company, the medicolegal system or to CMS.
In this article, I’ll share how the right education, staff and advice helped me establish a practice of my own.
LEARNING ABOUT BUSINESS
Even though I was a well-trained physician and the director of the Cornea, Cataract and Refractive Surgery department at the University of Tennessee, I knew I did not have the business knowledge I needed to succeed. The single most important thing I did to prepare myself was something completely lacking in medical training today: I invested in formal business training. As physicians, we are very capable in many disciplines, but the standard medical curriculum does not include business training. That puts us at a clear disadvantage in a health-care system predominantly run by trained businesspeople. In academics, physician leadership is particularly necessary. Business training can help physicians to lead a department, collaborate with hospital systems, negotiate appropriately and make a positive impact in the health care of their community. For these reasons, I realized I needed formal business training.
Many believe that business is obvious and training is not necessary. This is incorrect. Lack of training in business and leadership leaves most physicians feeling incapable of running the business side of their practice, whether the practice is in an academic setting, multi-specialty group setting or even a solo practice. Most physicians tend to outsource the business and management of the practice to others who they deem more capable so they can focus on patient care. This results in non-physicians making decisions that affect the doctor-patient relationship. This scenario is all too common in the United States and has generally allowed the leadership to slip out of the hands of physicians. When businesspeople run health care, the purpose naturally shifts away from patients towards financial stakeholders. This is most obvious when insurance companies make decisions for patients that are clearly not in the patient’s best interest, such as not covering certain needed procedures or limiting access to providers.
To be a physician leader, it is absolutely essential to have some formal training in business. Business school is not only about accounting. It teaches leadership, strategy, entrepreneurship, marketing, finances, negotiations and the language of business. There are several good options for business education. Three years ago, I attended the “Physician CEO” program at the top-ranked Kellogg School of Management at Northwestern University in Chicago. The decision to dedicate time in my schedule to this program made all the difference. The program includes four modules over nine months. Each module runs five days and provides intense MBA-style training with some of the top business educators in the nation.
About halfway through the program, I realized that I would need to leave academic medicine and my job at the University of Tennessee in order to achieve my future goals and start my own private practice. The Physician CEO program gave me the business foundation I needed to have courage to make that leap. Our patients need physicians who understand business and can lead in today’s health-care system.
With proper training, physicians are more than capable of overseeing the business of their practices. The focus is on oversight. Physicians are CEOs, not managers. Our role is to lead the business, set the purpose, create the culture, drive the values and create the brand. Managers carry out the vision while physicians set the agenda. Health-care leadership in the hands of the physicians will always benefit the patients.
DETERMINING YOUR VISION
The next step in starting a practice, after investing in business training, is solidifying the vision. What will the business model be? Each physician has a distinct vision for desired practice style. Take this vision and equate it to the business model that fits it best. Consider factors such as:
- What aspects of ophthalmology you want to focus on
- What procedures to perform
- The amount of office space you will need
- How many employees are needed
- What kind of equipment to buy
- What insurances to accept
- How to handle cash pay
- How to differentiate from other practices
- How to attract patients
There are almost countless things to consider prior to starting a practice, but solidifying the business model is likely the most important step.
As part of the Physician CEO program, I developed the vision for my practice, Waite Vision, and wrote a formal business plan, describing my brand, personnel, financing, market analysis, competition, pricing, cash flow projections and more. For example, during my initial development of the business plan, I already had a profile for my practice manager in mind — someone I could trust and whose skill set complemented mine. I reached out to a close associate for this position, and she was “brave” enough to join me on this adventure.
PUTTING TOGETHER A TEAM
After presenting my business plan to a bank to secure financing and signing the lease on my space, I had my first real “freak out” moment. I had only a few weeks left before opening the doors, and I realized I had no idea how to assemble the team of employees I envisioned. I had never done it before and had no idea where to start.
My goal was to put together a team of people I could trust, who were genuinely kind and would be enjoyable to work with. My practice manager and I placed spots on a local digital classified ads forum and fortunately we had some excellent people reach out for interviews. None of those we hired had any training in ophthalmology, but all of them were genuine, kind, hard-working and trustworthy. We decided to hire based on personality (which we cannot change) instead of based on technical ability (which we can train). That philosophy paid off well for us and allowed us to develop a fantastic team. Each individual has been more than capable of learning the technical aspects of the job and has brought more to the table with their unique abilities than we anticipated. It is essential to find the right fit and not simply to fill a spot. Training our staff came naturally since they were so eager to learn.
Fortunately, after opening the clinic doors, the schedule was not too busy and our new technicians could take time to learn how to work up patients with direct physician oversight. They also learned techniques while studying JCAHPO texts in preparation for COA certification. In the first few weeks, the new team members had learned their roles and started to run the practice in an efficient manner.
MARKETING AND ADVERTISING
What is the best method to attract patients to your practice? Each practice model will have a different answer to this question, but each will need a solid marketing plan in place. That may include building a network of referring doctors, securing insurance contracts and/or even traditional advertising. Insurance-reimbursed surgical procedures such as cataract extraction can best be attracted through a referral network, whereas cash-pay procedures such as LASIK come more commonly through advertising. Waite Vision focuses on cataract and refractive surgery, so I have found it beneficial to both build a network of referring doctors as well as participate in advertising. It is constantly a work in progress since no marketing plan is perfect.
In all cases, a digital presence is necessary. In the digital age, consumers cannot take a business seriously if they cannot find it quickly on Google or social media. In medicine, we tend to be behind the marketing curve compared to other industries. Practices that focus on being easily found and easily accessible through digital formats will excel with present-day consumers.
Being found in the digital age requires a strong website with good search engine optimization primarily on Google, although Bing can be helpful as well. Social media, such as Facebook and Instagram, allow a practice to post content such as photos and videos to a potentially large local audience through targeted campaigns. Consider it a small digital billboard. This type of digital presence has allowed patients to find my practice and reach out to schedule an appointment online or through instant messaging.
The most important and organic form of marketing is word of mouth — it is also the most affordable and only earned over time. Earning word of mouth referrals entails patients wanting to come back to your practice and being willing to send friends and family members. This requires they have a good experience at your practice, along with excellent results.
Regardless of how strong a marketing plan is or how much is spent on advertising, if patients have a bad experience at a practice or feel no added value to their lives, they will not return or refer anyone else. So, ensure that patients have a good experience from the first phone call to the last visit. This means each employee must take the patient experience seriously with emphasis on good customer service.
For example, at Waite Vision, when patients call our number they reach a person directly instead of a call tree. The person they reach will always be kind and helpful. This first experience, although only the beginning of the process, encourages the patient to come in for a visit. Good outcomes will always grow a practice. Great patient experience with great outcomes will equal success.
It is essential to have a close network of business owners I trust, to whom I can turn with questions. Questions may be as simple as “What company did you trust to build your website?” or as complex as “How did you structure your marketing campaign to be visible in an already saturated market?”
This small group of mentors has made a significant difference in how I run my practice. They have saved me from making many common business mistakes and have offered encouragement through the ups and downs of starting a practice. For example, my network has helped me decide on specific equipment purchases, design the office flow and structure pricing for cash-pay procedures among many of things. Through their advice and encouragement, I have learned to trust my own business sense and follow my priorities.
Starting a practice is not easy, but it is totally doable and is extremely rewarding. My years of training were not a sacrifice — they were a foundation upon which I built my practice. My later business training also made this goal possible, and now I have a clinic that reflects my own values as a physician. During last two years of starting my own practice, I have found that being “brave” was totally worth it. OM