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Starting out: Courage, effort and capital part of framework
Rise of the Private Practice
By Michael C. Upton, Contributing Writer
Veronica Blum of MPN Realty, Philadelphia, specializes in retail leasing and relies on her expertise as a landlord representative. Physician-owned private practice is very much an option for today’s professionals.
“It’s one of the strongest career paths a doctor can pursue,” said Dr. Jaan Sidorov, former CEO of the PA Clinical Network, a subsidiary of the Pennsylvania Medical Society. “It takes a lot of courage, effort, and capital.”
Courage, effort and capital are just part of the framework for building a successful independent practice. While every practice and situation has its own needs, one of the universal first steps is acquiring a location and having a plan on what to do with that space.
Finding a location
Veronica Blum of MPN Realty, Philadelphia, specializes in retail leasing and relies on her expertise as a landlord representative. She leads MPN’s retail leasing division.
Her division has been busy this year placing medical practices in Center City locations. Doctors looking to start an independent practice need to take into account a number of items when considering a space, and those items all vary according to the type of practice; a dentist is going to need a lot more plumbing than a chiropractor, for example.
“There is a lot of infrastructure that is needed when starting a medical practice,” Blum said.
She believes it is helpful for practices to go into a space that was already a medical practice or similar facility. This will cut down any renovation costs needed to adapt the space to a new practice’s specific needs. Sites previously occupied by medical services move off the market quickly, Blum said.
Healthcare Facilities Today warns that even basic medical buildings use more electricity, heating, ventilation and cooling than a typical office building. When looking for a home for a new practice, doctors should consider the strength of the regional utilities and existing building facilities.
Also, the need for medical imaging technology may dictate what spaces can be used as a practice. Local and state codes may require certain vibration-generating imaging equipment be isolated from other parts of the building.
Architects note how the medical space is changing as large, lounge-like common areas are replacing tight waiting rooms.
Pennsylvania ranks fifth in the nation for the number of active primary-care physicians. There are a lot of doctors in a lot of spaces.
In Center City, Blum said new practices are moving into firstfloor spaces already adapted to meet Americans with Disabilities Act accessibility standards.
“You have to consider zoning and accessibility,” Blum said.
Outside of the city, real estate is much different. Suburban areas need parking, Blum said. Parking is one reason why strip malls are a popular choice among new suburban practices. Visibility is also a plus.
Patient perspective
When considering starting her own practice, Dr. Sue Kressly took the opportunity to innovate. In 2004 she started Kressly Pediatrics in Doylestown, a practice still flourishing today even as she enjoys retirement. Her vision was to focus on how health care works from the patient perspective.
“The second half of my career was about starting, building, and growing a practice,” Kressly said.
Kressly recommends private practice but, when looking back, she knows she would do a few things differently. She would plan more for the office’s future physical growth and spend more money on technology infrastructure.
Whether in the city or the suburbs every expert stresses the importance of demographics and knowing where patients are coming from. The practice will fail if the patients cannot reach the location. Conversely, if there is a need for services the patients will come.
Revenue streaming
David J. Zetter, a member of the National Society of Certified Healthcare Business Consultants, advises his clients to secure at least $100,000 to cover equipment and startup costs and a $100,000 line of credit to cover payroll and bills until revenue is streaming.
Zetter recommends addressing these needs in the planning stage: electronic health record system, practice management system, medical billing service, medical transcription software, background check services, a credit card processor and an office manager.
Kressly started by introducing technology as a more integral part of the patient experience. Her first task was to create a website where patients could access information without having to call into the office during working hours. This system may be rather commonplace today, but in 2004 a patient portal was almost nonexistent. When considering starting her own practice, Dr. Sue Kressly took the opportunity to innovate. In 2004 she started Kressly Pediatrics in Doylestown, a practice still flourishing today even as she enjoys retirement.
Dr. Sue Kressly started by introducing technology as a more integral part of the patient experience. Her first task was to create a website where patients could access information without having to call into the office during working hours. This system may be rather commonplace today, but in 2004 a patient portal was almost nonexistent.
Physician-owned private practice is “one of the strongest career paths a doctor can pursue,” said Dr. Jaan Sidorov, former CEO of the PA Clinical Network, a subsidiary of the Pennsylvania Medical Society.
This forward thinking and deep planning is important for starting a successful independent practice.
“The key to success is not replicating what is out there but thinking in innovative ways and starting from the lens of the patient and family,” Kressly said.
According to Sidorov, successful practices develop an intensely loyal patient base. He recommends practices perfect customer service and employ a strong administrator who knows billing, office management, and all the intricacies of the health care system.
Reputation advantage
Sidorov understands the benefits of traditional advertising, but he knows simple reputation is a great advantage for independent practices.
“Word of mouth among patients builds a practice,” Sidorov said. “It won’t happen overnight. The first few months to years are lean.”
Establishing community partners is another key to success. Sidorov worked for one of those partners, the PA Clinical Network, which allows quality minded practices — 130 member-physicians in more than 65 practices — to collaborate to better approach payors for access to value-based care and quality recognition programs otherwise unavailable to practices with a smaller number of patients.
“We help them report the quality, improve the quality and help them get paid more for quality by developing systems of care,” Sidorov said. “The doctors we talk to really treasure and enjoy the fact they are in control. By being in control, they can run the practice in innovative ways.” •
Michael C. Upton is a contributing writer to Philadelphia Medicine.
