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Startup Spotlight | Jan/Feb '17

Starting from Scratch

Previously, over the past few years, I had been struggling with a goal: to work at a practice I love in a city where I want to live. South Florida is great, but it can be a competitive location for an ophthalmologist, especially one recently out of training. I searched for years to find that perfect setup and had been through several different positions in the process, looking for the next step that would enable me to move to Miami. I came across a lot of great opportunities, but each came with a compromise. I just couldn’t quite find the right fit.

Hear more from Will Christian, MD, here.

In 2015, at the ME Live meeting in Hollywood, I heard a talk by Will Christian, MD. In all of 15 minutes, Will changed my outlook on the path I was about to take. Hearing about his experience going out on his own, I realized, why should I settle? If there is something I want to do, I should do it. Will’s insights gave me the courage and inspiration to go out on a limb and do something I had long been interested in but was fearful to try, and that was starting my own practice.

Common knowledge had told me that it would be near impossible to have my own practice, especially as a solo practitioner. However, keeping in mind Will’s experience and putting my own doubts aside, I opened Loh Ophthalmology Associates 10 months ago. This article details some of the key steps I took over my yearlong journey to start from scratch.

Step One

Get a Practice Consultant

My first step—which I learned from Will—was to hire a practice consultant. When you are graduating from residency, a common piece of advice you get is to seek the help of a practice consultant, even if you are just accepting a position at an existing practice. However, coming out of training in a less-than-ideal financial situation, you understandably are likely not inclined to spend money on a consultant.

In the end, I learned that was a mistake, so this time around, I decided to do it right and hire a consultant. I worked with BSM Consulting, but there are many great practice consultants out there. A consultant can help you look at your choices objectively. They can help you identify and ask the tough questions about the practice you are joining, and they can help you ask the tough questions of yourself when you are looking to start your own practice. They can also provide benchmark data and the many different metrics you will want to measure along the way.

Step Two

Become a Leader

As physicians, we are leaders in patient care; however, being a business leader was an area I had little to no experience in. I realized that, by starting my own practice, my role as a clinician was quickly going to expand to the role of an administrator, a manager, and a physician. I wanted to get the appropriate education, and I found it in a wonderful program called Physician CEO. This course gave me the ability to look at my role as a physician in a different light and to learn not only how to be a manager but also, more important, how to be a leader. I learned that if you are going to take on the role of opening your own practice, then you become the representative of the practice and have to not only take care of your patients but also take care of your staff, your employees, and your brand. Devoting time and energy to these efforts is great for both professional and personal growth. I highly recommend completing this course or another program that will fulfill your leadership needs.

Step Three

Find Your Space

There are many different options to consider when finding a practice space. You can purchase your own space, rent a space, or participate in space sharing. Regardless of which setup you choose, you should know the pros and cons as well as the regulations of each. In the beginning, I decided in to go with a concept called space sharing, which involved finding an established ophthalmology office that had some extra time when it was not in use. In my case, I found a retina practice, so I felt like there were mutual benefits we could obtain by sharing the space. Also, the practice was already built-out. It was a beautiful, established location and would keep my overhead low.

At the time, I genuinely thought I had found the perfect solution; however, I learned that there can be some drawbacks to space sharing. You can quickly start to outgrow your space and then feel like you need more room, but you don’t have that option right away. Another piece of advice to heed—and this is relevant no matter what situation you go into—is to check the governmental regulations. I made the mistake of not realizing that there were certain restrictions related to space sharing in the city and township where I was practicing. I had to go through a couple of anxiety-ridden months working with attorneys and the government to obtain a license.

Every situation is unique. Be sure to do some background work before signing a lease or heading down a particular path. Luckily, everything worked out for me, and I am very happy where I am. Space sharing has saved me a lot on overhead and has given me a great place to work from while I focus on developing myself as a leader and setting my goals for the practice. Consider each available option because the best one for each person is unique.

Step Four

Create Alliances

No man is an island. A small practice is at a bit of a disadvantage in today’s world. Unlike large practices, they don’t have economy of scale. Thus, it may be harder to get on insurance contracts, and small practices lack the support system that a lot of the larger established practices have.

I was fortunate in that I figured out a system that worked well for me. There is a corporation in South Florida called Eye Physicians of Florida. This is basically an office without borders, where 26 ophthalmologists have banded together to create a company. Each retained his or her own individual practices but built under one tax ID, and they used their alliances to create economy of scale and build a corporate office. As a doctor and solo practitioner, I could buy in and become a partner. By doing so, I feel like I have the best of both worlds: I can retain my independence with my own practice, but I was able to jump into being credentialed instantly on insurances and acquire better rates and bargaining power. This may not be available in every area, but it is worth seeking out or considering starting in your area.

Step Five

Find Your People and Create Your Culture

Your staff members are your most important allies, so it is crucial to hire the right people. I have been fortunate so far in finding a great staff member who shares my vision, and she works just as hard, if not harder, than I do. As the physician-CEO, it is up to you to determine your office culture and decide where you want to take your practice. There are all different types of markets that you may want to cater to, but protecting your brand and moving your practice in the direction you want is essential. Remember that you are the role model and that all your staff members and patients are looking up to you.

Step Six

Expect the Unexpected

During this journey, there will be a lot of ups and downs, and you will probably feel like you are riding a rollercoaster half, if not all, of the time. Be prepared: You will experience a range of setbacks, such as technological difficulties, Internet outages, nonfunctioning phones, government regulations, human resources management issues, and even inclement weather. Regardless of the bumps sure to pop up along the way, starting your own practice can be an amazing ride.

Jennifer Loh, MD