Countdown to Opening your Practice
Running a successful medical practice is a business, initially made up of fairly equal parts of administration and medicine. It is only when the management of a practice becomes efficient that a doctor can afford to devote him or herself more to the medical side, with only a small portion of each day committed to the business side.
This article endeavours to direct the physician towards administrative proficiency from the first day in practice so that they can provide the best medical care to their patients at all times.
Some of the steps in this article are relevant only to physicians going in to solo practice, who may have to start from scratch.
Six months to two years before opening a practice
Long before you open your office, you must develop a philosophy for how you want to practice medicine. This will be integrated into your Mission Statement and will be the basis for establishing your practice. Everything you learn about yourself as a physician, and everything you do as a business person should have its roots in your philosophy. Your Mission Statement may change over the years as you settle into a style that you are comfortable with, but your basic philosophy will probably remain the same.
Keep a small notebook with you at all times -- even on social occasions. In this notebook, you will write down practice-related observations, thoughts and ideas that are generated in conversation with colleagues, family and friends. You should also include your personal goals.
Once a week, schedule 30 minutes to transfer your notes into a special binder – “Starting My Practice”. You should have two sections in this binder, one for Professional Goals and one for Personal Goals. This binder will become your testament to attaining your goals and will help you keep your perspective. Professional and personal goals may change over the years, but you need to ensure that any changes in one area don't negatively impact the goals you have in the other. Keep changes balanced with your Mission Statement.
Choose a date for opening your practice. Be realistic. It may take more time than you want, but you must be completely ready to open, and not have loose ends waiting to be tied up. Take a holiday first if you can -- it may be many, many months before you can take another one.
Develop your criteria for the type of practice you are interested in. Will it be solo, small group, large group, multi-specialty -- or are you interested in working in an academic setting? Think about these – do you want to be your own boss; who would you like to work with; will you goals be met; how much time do you want to spend on administration of the practice? Generate a list of questions to ask colleagues who work in the various types of practice. Find out the advantages and disadvantages to each type of practice to help you refine your decision.
Ask as many physicians in your specialty as possible the following questions:
Record their answers in your notebook, and learn from others' successes and mistakes.
The success of your practice and whether you attain your professional and personal goals is highly dependant upon selecting not only the right type of practice, but also the right community to practice in, so do the same exercise for choosing a community. Consider your ideal patient profile; career and educational opportunities that are available for your family; standard of living; and whether or not the community needs you. If you want a generally young patient base, you don't want to choose a community where most of the residents are going to retire within the next few years. On a personal level, if you have or intend to have a family, you will want a community that caters to the social and cultural needs of you and your family.
Visit three or four communities that you are interested in. Go armed with your notebook and a list of questions you want answered.
Once you have selected your community, continue to develop your network of professional contacts in that community. Visit local physicians again to fine-tune your practice requirements and needs. Start learning as much about that community as possible through local newspapers. If you are interested in joining a group practice, visit local groups to check out their needs and where you can fit in. Also check out their philosophy, practice styles and opportunities available, keeping your personal goals in mind.
Learn as much as you can during this period about the successful running of a medical practice. Develop a game plan before you open your doors for introducing as many good ideas as possible. Get in contact with the College of Physicians and Surgeons, Physician Advisory Services, for the rules and regulations of practising medicine.
Four to six months before opening
Examine your net worth in terms of capital that you will have available for start-up costs. This will help you determine what type of practice you would like to work in. Things to take into consideration:
If you are not joining a group practice, check sites for leasing or buying medical office space. Check zoning ordinances to ensure that you are allowed to open a medical practice in a site of your choice. Plan to be able to move into your new office one month before opening your practice. Find out what other businesses are in your immediate vicinity, these can influence the development of your own practice.
Check on utility requirements for your office.
Hire professionals to help you make a smooth entry into practice. In many instances, the Ontario Medical Association may have a list of professional advisors whom you can contact.
Start developing a list of office and medical equipment you will need. Get quotes from at least two companies who are experienced with the needs of physicians who are starting on their careers. Compare lease and purchase costs and research the pros and cons of both well. Visit other medical offices to evaluate their satisfaction with the equipment they use.
Start assessing the technology you want/need in your practice. Visit established medical offices to answer your questions about their technological needs. Look at both high and low technology users so you can reach a decision. Talk to the staff as well as the doctors, as the former are the people who work with technology the most.
Reserve an office telephone number, if possible, at this time. Find out when the telephone book is printed and have your professional name listed. Decide whether you want a yellow page listing as well.
Two to four months before opening
Interview and select any professional advisors you haven't already hired. These include:
Obtain all necessary licences needed for practising medicine, such as narcotics licence.
Complete all forms necessary to secure hospital privileges.
Inform the provincial medical licensing boards of your new address.
Ask the College of Physicians and Surgeons of Ontario for their guidelines for advertising in local newspapers and other forms of practice opening announcements. Order the sign for your office, based on College of Physicians and Surgeons of Ontario guidelines.
Your accountant will need to establish your accounts payable, accounts receivable and payroll systems.
Notify pharmaceutical and business representatives that you are setting up practice.
Start preparing all pre-printed forms you will use in your office. Ask colleagues in your specialty for examples of their forms. Ask the doctors and their staff if the forms are adequate or if they would modify them in any way when they have them reprinted, and include any modifications in your forms.
Start the process for obtaining your billing number from the Ontario Ministry of Health if you don't already have one. Obtain the Health Care Providers' Manual and fee-for-service Schedule of Benefits from your local OHIP office. Ask an expert medical billing clerk from an office of your speciality to review it with you. Get acquainted with the codes that you will be billing the most so that you can start billing 100% of services from Day One.
Start developing your uninsured services program, along with all signs and handouts necessary to inform your patients of these services and fees. Ask the Ontario Medical Association for their Physician's Guidelines to Third Party and Other Uninsured Services booklet.
Order your clinical supplies with a guaranteed date of delivery. Purchase your office equipment and arrange a guaranteed delivery date. Purchase your computer system and plan for training sessions with the suppliers. A listing of vendors can be obtained from the Ontario Medical Association's Practice Advisory Services.
Obtain information on employment guidelines from the Ontario Ministry of Labour Employee Standards Branch and the Ontario Human Rights Commission. This will guide you when hiring staff and inform you of questions that can and cannot be asked of applicants during the interview process.
Decide on the number of staff you need, what qualifications they should have, and the hours of work and rates of pay. Start developing job descriptions for all staff. Refine responsibilities and tasks as you go.
One to two months before opening
Arrange for your personal and business insurance needs. Contact the Ontario Medical Association Insurance Department for details on their programs. You will want to consider the following insurance:
Contact Ontario Ministry of Labour, WSIB, OHIP and insurance companies for all available information on possible benefits and programs that may be available or critical for your employees.
Ask your accountant for the best options on opening chequing accounts for personal, business and savings.
If you are not joining another practice, select the date for telephone service installation. If you will be using an answering service, arrange a date to start using one after reference checking those available.
Develop your opening announcements for the local newspaper. Send opening announcements to physicians and local social agencies in the area.
Meet with referring physicians or specialists to whom you can refer in the community. Start developing a good professional relationship with them and their staff. If you are a specialist, notify other physicians when your staff will be able to start booking appointments. You may want to have your telephone connected two to four weeks in advance of your opening date for this purpose.
Place Job Vacancy advertisements for staff in local papers and begin the hiring process. Be sure to have job descriptions in place. This will reduce any staffing issues after opening.
Review tax requirements with your tax accountant and ask the accountant to define the procedures for paying income tax. Set up the appropriate accounting systems.
Plan your appointment scheduling system, and decide how many patients you will see each day and how long each type of appointment should be. You will need to review your scheduling system regularly as your practice becomes busier, so introduce some flexibility into the schedule from the start.
Arrange for the following services if needed or if not covered by your lease/landlord:
Order your business supplies:
Determine your office hours based on the needs of the community. You may want to offer early morning hours or evening hours if medical services are not available at these times.
Subscribe to magazines for your reception room.
Set up a business e-mail address and purchase a pager and/or cell phone.
Develop handouts for your patients such as:
Notify area pharmacies of your practice start-up date, and your prescription refill policy.
Mail out office opening announcements. Contact the Ontario Medical Association Printing Department to see how they can assist you in addressing your envelopes based on your geographic limitations.
Have utilities turned on:
Take delivery of all equipment and supplies, including computer equipment, and start setting up your office.
Hire your staff and have them start at least two weeks before you open. Ensure that they are properly trained in the following:
Establish a petty cash fund .
Put up your office sign and place your office opening notice in the local newspaper(s).
Start making appointments for your patients.
Take a deep breath and congratulate yourself! Schedule an extended two-hour break for lunch with your staff to celebrate your official opening. At the end of the day, provide each staff member with a special notebook and ask them to write down suggestions and ideas on a daily basis.
Never rest on your laurels. Constantly search out ways to improve any inefficiencies, and continue learning the art of practice management.
Meet weekly with your staff in the first few months to discuss ideas and suggestions to fine-tune your practice. Reduce the frequency of these meetings to once a month as you begin to feel comfortable with the way your practice is running.
Never hesitate to ask for help when you run into problems. Remember the immortal words of Duke Ellington: “A problem is a chance for you to do your best. ”