10 Steps to Starting a Concierge Medical Practice While You’re Still Employed
“Moving into the concierge medicine or say its lower priced and typically cash-only sister business model, direct primary care (DPC) is an important decision for anyone considering such a route. However, it’s our observation that peer pressure and enthusiasm from peers is more pressurized than say your transition sales teams conversations. ”
Article (Below) By Editor, Concierge Medicine Today, Updated for Jan 2024
Disclaimer: This site does not constitute legal, healthcare, medical, financial or other professional advice. Please note, an interview/story is not an endorsement of any particular model, company or individual. For complete terms and conditions, privacy policy and more, click here.
What do we mean by that?
Well, let’s say you attend a conference and everyone at that conference is enthusiastic and strongly opinionated about their success and achievements in the model. That’s great. I think we need more Physicians and providers in today’s culture excited about what they do. That said, it is our observation over the many years of reporting and observing the subscription-based healthcare delivery marketplace that enthusiasm and napkin scribbles can lead to disappointment. Eventually, enthusiasm subsides and upon further research on your own, the numbers may or may not reflect what is possible for you.
One husband of a concierge medicine physician in Alabama recently told Concierge Medicine Today, “It’s so easy to impress patients. If you just show up on-time or write them a handwritten note for coming into the office, they love us for it!”
So, you may want to take some of the advice you give to your Patients and ‘exercise more’ — meaning, exercise your ability to do your own research. Don’t let peer pressure, enthusiasm or a conference promise lead you into despair. No matter how much pressure you’re getting from a peer, a consultant, your staff or even your patients to on a deliver subscription-based healthcare offering right now, be prudent and don’t rush into any big decision. Take stock and inventory of your responsibilities first and exercise your ability to learn more about what this business model may look like for you in the months and years ahead.
Now, with that said, take a breath, start writing down your questions and start asking for more time and don’t stop until you get the answers to your questions. This is a big decision for every Physician. It’s a lifestyle and time equation which also may impact your family, your staff and your Patients. You need to feel confident and should only move forward with certainty and more importantly, wise counsel, both professionally, collegiately, financially and legally.
Concierge Medicine Today has put together a number of resources, articles and insights which can help you in five ways.
Our trade publication, Concierge Medicine Today;
Our annual national/international industry conference, the Concierge Medicine Forum;
Our online educational social network community, the FOR DOCTORS FORUM;
Browse our updated educational resources (updated weekly);
Listen (free!) and download our weekly industry podcast, The DocPreneur Leadership Podcast.
With all of that out of the way, how could you or should you prepare if you’re still working your day job? Well, we’re glad you asked.
A little background.
Concierge Medicine Today has been interviewing, writing, observing and operating in this industry for well over a decade now. A lot of things have changed but optimism about this space is still pretty high. Add to that, Patient satisfaction with most of the Physicians and programs out there are pretty great. Moreover, Physicians remain confident and job satisfaction is pretty high as well when you compare Physician career satisfaction scores in other plan reimbursed areas to concierge medicine and other membership medicine models operating today. However, at the same time all of that is sunshine and rose, we have seen many doctors struggle. Particularly concerning are those Physicians that are younger in age and whom have little to now business and medical experience in their chosen community or local area. Often we observe that they undervalue their services and price themselves well below what they are truly worth to their Patients and their local community. Over the years, many Physicians we’ve interviewed have informed us that operating and starting a membership medicine practice was not easy. In fact, it took a whole lot more time, research and money than they initially thought it would. In the end, for those that made it through the rough patch, they have found these business models incredibly rewarding.
The Patient-Physician relationship has eroded for most Patients to the point today where Patients have been under-served, over-charged and underwhelmed by their primary care or family Doctor. They lack trust in you and now, it’s up to you to rebuild that relationship and exceed their service and relational expectations. But here’s some encouragement, it’s easier than you might think.
Over the past several years at Concierge Medicine Today, we’ve reported on a number of doctor’s who’ve struggled to find their place in the concierge medicine and direct-pay marketplace in the first two years. Yes, they’ve announced their new private-pay or retainer-based medicine practice service offerings might have been priced right and when opened their doors they had some success. But about a year later, thirty percent of surveyed doctors we interviewed over the years were still unsure of their decision and we found that one in ten doctor’s in 2011 for example, said they were worse off than before. Any good friend or a trusted advisor may tell you and me the same thing which is … ‘no matter how hard you work, there are only 24 hours in a day and you’ve got to sleep during eight or nine of them.’
So based on these interviews, CMT’s interviewed sources over the years and insights shared, what are some of the do's and do not's you may want to consider if you’re in the research and information gathering phase and potentially working a day job and seeking to start up your own practice?
1. Don’t be afraid to reach out for help.
Howard Schultz said “There are moments in our lives when we summon the courage to make choices that go against reason, against common sense and the wise counsel of people we trust. But we lean forward nonetheless because, despite all risks and rational argument, we believe that the path we are choosing is right and best thing to do. We refuse to be bystanders, even if we do not know exactly where our actions will lead.”
If you think you can do this alone, think again.
You and I need trusted voices around us that can help us see our blind spots. All too often we have seen over the years Physicians only go to peers and colleagues for business advice. That’s fine, however, we’ve interviewed Physicians who’ve made their own observations and realized that ‘Yes, I went to my colleagues for business advice. Then I realized I wasn’t going to the right ones. The ones I thought would be helpful got the same amount of business education and credit hours as I did in medical school … and they’re struggling professionally and financially too.’
It’s also been noted that you will need specific legal, accounting, financial and even business planning time and resources from experts that can help you put your own business plan together. They’ll also help you put the right guard rails around you and your business plan that may prevent you from driving your practice right into the ditch.
Staff is also an important consideration. But, it’s been said by industry transition consultant that the right staff is what you need around you. They need to support your decision be able to answer important questions Patients and family members will have about your program or new practice. In reality, they need to believe in what you are doing and what your new practice model is trying to accomplish. If you already have great employees, make sure they understand what you are trying to do with your new practice. Education and mental buy-in amongst your staff is key. If they don’t believe in what you’re about to do, you may need to make some tough decisions. They need to as the business world says "lean in” [meaning, emotionally and psychologically].
Finally, if you’re married, you need his/her support and advice.
More often than I can recall, Physicians over the years have informed Concierge Medicine Today and stated at our annual conference, the Concierge Medicine Forum, that if a supportive spouse thinks you should pause, you pause. If he/she wants you to move forward, move forward, etc. This one person, probably more than anyone, is going to be your cheerleader. So, if they're not on board yet, Physicians and industry experts alike have stated, 'Wait until they come around, then move into this.'
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2. Write your questions down first.
Usually Physicians find our web site properties, our conference, publication, articles or podcasts because they heard about concierge medicine in the news or from a colleague or more often than not, they know of someone who the business model is working really well for and they want to learn more. Now, they find us and usually are well on their way into an exploratory journey of their own. That said, we don’t recommend any one company, individual or consultant over another. That would insult your intelligence and our own and we attempt to provide as much unbiased and educational content to you as possible. So, we encourage Doctors to first write down their questions in a journal and get their hands on as much information as possible. Only then can you truly become informed, not sold or overcome with enthusiasm that you rush into a big decision without the facts. Then we encourage Doctors to interview every company, every consultant(s), every colleague and every trusted business advisor as carefully and thoroughly as you’d like. Don’t leave your questions unanswered. Do your homework as if you were researching news treatment options or vetting published, evidence based medical literature about a possible treatment option for a patient.
More importantly, take your time. It’s easy to feel a rush of emotion when you attend a conference and believe that you are behind somehow. You’re not. You’re right where YOU need to be, right now. And, that’s okay. After all, this is your journey, not someone else’s. Don't put more time, energy and research into which refrigerator or car you're going to buy than the future of your medical practice. Do the work. Put in the time. Ask questions until you get the answers you’re looking for. Plan your business on paper, on purpose and feel confident about the path forward you will take. If there's one thing we know about you (eg Physicians), it's that you have and can do hard stuff and you’re capable of making thoughtful decisions and learning new things.
At this point in your exploratory journey of learning, let’s understand that there are usually two paths Physicians take on their educational journey. First, the Physician “DIY-ers.” Second, the Physician “Delegator.” They are those Physician’s whom recognize their not a DIY-er and need help.
We have no issue with either path. However, it’s important to recognize that one path may take longer, cost more and require more education and resources than you think at this point. I’ll let you guess which path that might be on your own.
So, a word about industry consultants and companies that help Doctors transition their current patient-base and practice into a concierge medicine model. We have observed in this space the useful and thoughtful role they each play in a Physician’s career (and transition) for almost 20 years and have immense respect for the work and expertise they provide Physicians. They each have a lot of expertise, resources and transition experience which as we have observed for quite some time, will provide you with and teach you a lot about the business, marketing, public relations and legal side of this space that is so important for your long-term success in this type of practice model. Therefore, industry consultants in the private, subscription-based industry are a wealth of knowledge for any Physician. Not only have they seen it all (probably several times), but they’ve already helped countless Physicians like you, navigate so many unnecessary hurdles. We truly hope you see the value they offer and the countless opportunities they’ve given to Physicians, like you, who’ve chosen wisely to move into this space.
Usually two paths Physicians take on their educational journey. First, the Physician “DIY-ers.” Second, the Physician “Delegator.” They are those Physician’s whom recognize their not a DIY-er and need help.
Additionally, we encourage Doctors on either path, regardless of whether or not you choose to be a “DIY-er” or a “Delegator” or discover it’s just not for you … that you consider interviewing at least three or maybe even all of the transition companies. This way, you know what’s available to you in the marketplace. To help Physicians, we've put together a list of industry consultants and companies that you may want to connect with here. (Disclaimer, full disclosure: While some of these companies are conference sponsors and/or advertisers, Concierge Medicine Today, LLC., does not endorse nor recommend one company nor individual over another. It is up to you to make your decision. Concierge Medicine Today, LLC., does not receive any renumeration for Physicians it refers to these organizations. This content, web sites and it’s resources are for educational purposes only.)
Here are some sample questions you may consider asking …
How long does this process of transition take for most Doctors in my specialty?
Have you done any Physicians in my area?
What about my EMR System … will it change?
What if this doesn’t work out? What then?
What happens to Patients who don't continue with me?
What’s your fee?
How long is the contract with you?
What's expected of me and my team?
What about legal and Medicare and Payor contracts?
What’s your timeline and implementation strategy to help me do this?
Do you have a patient-practice or patient-physician service contract I can review?
Do you have a referral of another Physician I can talk to that has worked with you?
And More.
These are just examples. You should come up with your own list of questions. Our hope is that these questions will simply get your gears turning and you'll eventually, with a little effort, develop your own list of questions.
Announcing that your medical practice is now accepting subscriptions, memberships, retainer-fees or going strictly going to a cash-only payment system can be a scary and exciting adventure. And, we're not non-believers in the DIY-approach either. We’re just not evangelistic about it. A DIY approach can work, don't get us wrong. As we’ve observed and Concierge Medicine Today sources have informed us over the years, a DIY approach to transitioning your practice without the proper research and legal assistance, business advice, financial and accounting insight and other professional advice is as critical to your success in the years ahead as the heart is to our anatomy. So, do yourself (and your staff, your spouse and your patients) a favor and do a little homework first. Most of the Physicians that we’ve interviewed over the years will tell us it’s a challenge at first, but one adventure they are SO HAPPY they chose for themselves.
3. Find A Great Accountant and Fight The Battle on Paper First.
Skipping this step before you start your concierge-style or direct-pay practice could cause you a lot of frustration.
According to industry ‘practice conversion’ consultants and our Physician sources over the years, making a to-do list, crunching the numbers and reviewing your current human capital and operational resources prior to announcing any pricing or business structure change is key. It’s always easier to fight a battle on paper (or a computer spreadsheet) than to promote first and ask questions later.
No matter how much pressure you’re getting from your consultant, staff or even patients to deliver new services right now, you need to take stock, take a breath, feel confident and certain that you've sat down with your business partners, spouse, accountants, attorney or staff and mapped out a strategic business and marketing plan complete with your own goals, costs and an achievable timeline that you're comfortable with.
A concierge-style or direct-pay operation will have to estimate how many additional employees (or in many cases, how many less employees) will be needed to service the expected influx of new faces taking orders on a daily basis over the course of the next year. According to our sources here at Concierge Medicine Today along with multiple Physician and transition consultant interviews over the years, the average concierge-style medical office employs 1.5 to 3.5 employees (2010-2022).
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4. Communicate with your patients often and early, but set your expectations accordingly.
One of the best pieces of advice I heard one Physician at our industry conference tell a group of her peers was "You're not the center of nor as important to your patients as you think you are."
Wow.
That’s a humbling statement. What came next from the Physician who said that was "Stop putting so much pressure on yourself. You haven't had the time nor the opportunity to be that type of Doctor or person for your Patients, until now. Don't expect this flood of interested Patients right away. It will happen gradually. It needs to happen over time otherwise you'll become overwhelmed and burned out, again."
What a great speaker.
You may think that on day one, your practice will suddenly become overwhelmed with interested patients, phone calls and discovered locally or even nationally by the media as some great story. That would be every doctor’s dream come true, right? Yet, too often, that overnight success can quickly become a doctor’s worst nightmare. Typically, day one expectations like that can be a let down. You see, the popular movie line "If you build it they will come." is a great movie quote. I love that movie too. But it is a terrible business strategy. An overnight success is a myth. If you have these lofty expectations you'll always feel like you're behind. So, surround yourself with the right people, possibly the right consultant(s), accountant, attorney and advisers to help you.
What you should actually expect she also noted is a little local media criticism, a few skeptical patients who misunderstand what you are saying and skepticism in all that you’re trying to accomplish. Why? Well, in reality, the Patient-Physician relationship has eroded for most Patients to the point today where Patients have been under-served, over-charged and underwhelmed by their primary care or family Doctor. They lack trust in you and now, it’s up to you to rebuild that relationship and exceed their service and relational expectations. But here’s some encouragement, it’s easier than you might think.
One husband of a concierge medicine physician in Alabama recently told Concierge Medicine Today, “It’s so easy to impress patients. If you just show up on-time or write them a handwritten note for coming into the office, they love us for it!”
One of the best pieces of advice I heard one Physician at our industry conference tell a group of her peers was "You're not the center of nor as important to your patients as you think you are."
5. Don’t Go Into Debt By Leasing More Office Space.
While it’s only natural to want to follow your colleagues advice they scribbled on a napkin or journal page at the last conference and suddenly celebrate your new practice idea with a new medical office with some new-to-you and maybe a few new toys it is so important to remember that concierge-style and direct-pay physician doctor’s office’s usually end up reducing the amount of leased office space [and staff] they actually need in those first couple of years. It’s not to say this is true for everyone, but it is more typical than you might think. While it might seem like downsizing your office space is a bad thing, according to our physician sources, leased office space is the most expensive annual expenditure for concierge doctors and direct primary care physicians followed by staff payroll.
6. Prepare your staff.
Before you go on a hiring binge and prepare for the influx of phone calls, concerned or enthusiastic patient inquiries and get one or two of those unavoidable angry or tearful conversations, it’s important to figure out how much working human capital you’re going to need to meet your local markets demand. Your conversion consultant and/or business advisors and business plan should be able to help you answer and address all of these questions. Plus, they can also help inform, coach and educate your staff on how to address common FAQs and answers that will undoubtably.
Pro Tip! Don’t commit to hiring full-time employees with payroll taxes and benefits until you’re sure your medical office model and strategy is here to stay.
7. Don’t apologize to your patients for the business changes you’re making.
The planning you did early and the time you spend toiling and searching for answers during your educational journey is about to pay off. You see the planning you did will now as Jerry Maguire “Help me help you!”
You see you’re about to use what you’ve learned in the months or years prior to help inform people that your confident in your decision and that this is a positive change that will help you maintain a more secure patient-physician relationship, enhance communication between you and the Patient and you’re actually going to be able to finally deliver care on a timely basis!
What fun, right!?! Well, hold your horses because once you’ve worked with your team or your consultant to formulate the proper communication strategy, according to our sources, the biggest mistake a doctor can make is failing to explain the value, features and benefits of this new business model to his or her patients clearly and simply. For example, a patients immediate response might be one of great acceptance and they will sign-up with your right away. On the other hand, there will be patients that might feel like you’re abandoning them after years of service. Or, perhaps they are just skeptical of the promises because they’ve heard these promises before at other offices.
So, be prepared for questions. Be prepared to respond with kindness, patience and humility. Wrestle with the tough questions before your patients have to make big ones. They might feel this decision is a dramatic change and need time to think about it. That’s okay. Don’t write them off. Talk to them. Talk to your team about what went well. Ask your team and your patients questions. This is especially important in the first year or so.
You should also definitely talk to a trusted attorney before doing anything or making any promises about important offerings.
Talking with Patients can be one of the most scary aspects of your conversion but it is one that is absolutely necessary. Many conversion consultants can also help coach you and your staff through various conversational scenarios that might occur. Sometimes, consultants will even place an outside person to help you and your staff explain the new model features and benefits in your practice for a few weeks.
In closing, if you only remember just one thing, we hope it is this. "It’s no longer about being the best Doctor in the world anymore, it’s about being the best Doctor FOR the world, FOR your Patients and FOR your local community.”
Got thoughts you would like to share? Email us at editor@conciergemedicinetoday.org or attend our industry conference, the Concierge Medicine Forum each fall in Atlanta, GA USA.