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"I read your article and . . ."


Our cover story "Going solo" brought some other tips from readers who've left big groups to strike out on their own.


"I read your article and . . ."

Our cover story "Going solo" brought some other tips from readers who've left big groups to strike out on their own.

By Liz O'Brien
Associate Editor

The stories of the physicians we profiled in "Going solo: How four doctors are making it work" [May 9] prompted two readers to share what they learned when they also set out on their own. They didn't always follow standard wisdom, but in their own way they've managed to get their solo practices off the ground. Here's some of what they had to say.

"I'm in heaven! My lifestyle has improved 1,000 percent, my patients get more personalized attention, and my income per patient has skyrocketed," says general surgeon Alain J. Derzie six months after he left a 40-physician multispecialty group in Florida to open a solo practice in New Hyde Park, NY. "I broke even in my third month."

What's the key to starting a successful solo practice? Low overhead, says Derzie. "$15,000 for a consultant, $30,000 to $50,000 for an EMR, hiring a four-person staff—that's ridiculous! Put the money in your pocket, and figure out how to manage your practice and do things yourself," he says.

Tighten your belt for success

Derzie credits much of his early success to the tips he gleaned from reading Medical Economics over the years, which he combined with some cost-cutting measures of his own. For example, "Lease your equipment," he recommends. "You'll lower your start-up costs and get a tax advantage as well. After three years, buy it back.

"Pass on expensive computer software. Remember, solo practitioners are not required by HIPAA to submit claims electronically. With some smart privacy practices in place, you can be HIPAA-compliant with a password-protected word-processing program and locks on your filing cabinet and door. To store records, create a folder for each patient on your hard drive. Scan in each chart or reproduce it electronically. Down the road—when you can afford an EMR—importing these files into it will be a piece of cake.

"Share a nurse with another doctor. My nurse also works for the internist down the hall and answers both phones from his office," says Derzie. "She works in my office 10 hours a week preparing charts, going after accounts receivable, ordering supplies, scheduling visits, and assisting me in minor procedures."

Equally important to tightening your belt is to make sure you understand how your practice works. Get valuable advice from some experienced solo practitioners, and then take it a few steps further, says Derzie. For instance:

"Learn how to do your own billing and posting. Post your own checks and take them to the bank yourself. Nobody cares as much about your business as you do.

"Do your own coding. Read the CPT 2003 book." Derzie has created a database in FileMaker Pro from which he can create and print out claims. "I don't need to memorize codes because the program I've developed describes the procedures in plain English. Then, when I click on the procedure name, the program places the correct CPT code, Medicare fee, and patient information on the CMS-1500 form."

Does some of this advice sound a little extreme? "Maybe," says Derzie, "but for those of us starting out in solo practice, it's the economically sound way to go."

"Remember, everything is negotiable"

Budget considerations also topped the list of tips from FP Kevin E. Johnson of Clinton, OK, who left the community clinic he had joined right out of residency to open his own solo practice.

"Know where every dollar goes—down to the last dime," says Johnson. "Don't let consultants make financial decisions for you, but do hire an accountant who understands the business side of medical practice.

"Remember that everything is negotiable. When setting up your office, bargain and comparison-shop for everything from long-distance service and rates on credit card machines to supplies. When I fax supply requests to several different vendors, I make sure I include all their names on one fax so they know they're competing for my business. I hope this will motivate them to underbid each other.

"Set up a call group, ASAP. It may be possible—and temptingly Norman Rockwellish—to take your own call at first. However, you need to put mechanisms in place to protect your personal time—and better sooner than later," he says. "Also, covering for other busy solo practitioners will give you visibility among specialists and hospital staff. Otherwise, you may be 'out-of sight-out-of-mind' at referral time.

"Moreover, you'll establish yourself as a team player—and place a few deposits in the favor bank that will be remembered when you need a day off later. And lastly, don't underestimate how helpful the opportunity to bill a few extra hospital visits may be during the lean months.

"Find the best staff, pay them well, and keep them happy," he adds. "A smile at the front desk and a cheery voice on the phone can be the best way to defuse patient problems.

"Institute open-access scheduling. If you can get patients in, treat them courteously, make them feel better, and send them on their way in less time than the doctor next door, patients will come from all over to see you.

"Finally, make time for yourself," says Johnson. "Don't neglect your family as you juggle your various roles as doctor and entrepreneur. Set up a date night with your significant other. Plan vacations and take them. If you don't take care of thyself, Doctor, nobody else will."


Liz O'Brien. "I read your article and . . .". Medical Economics Jul. 11, 2003;80:45.

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