Year One — Starting a Medical Practice
Starting your own business is really frightening/intimidating.
Starting your independent medical practice is even more so.
14 months ago, my wife struck out on her own and started her Women’s Health telehealth practice. Initially she spent 100% of her time going through getting her medical licenses here in Florida, in Washington State, and started the process for California. Investigating what was needed for a Nurse Practitioner (she’s a Masters graduate from Duke University, the top program in the country) to be able to practice in each state, and the rules are different and sometimes very restrictive depending on the state.
Malpractice Insurance, contracting a consulting Physician (FL needs that for the first 2 years / 4000 hours of the NP’s practice), setting up her website and all the needed software/systems that medical professionals are essentially required to use in order to track and keep records of patients, secure encrypted video calls, etc… Needing to find virtual office address for the legal PLLC was far more complicated than it needed to be — and then midway through the year the building the virtual office was “located” in was sold and we were “moved” to a new address.
The amount of time spent getting the practice set up was almost three months — before she could actually see her first patient.
Promotion is profoundly difficult as well. Google and Facebook Ads are actually quite expensive and not terribly effective for novices. When my wife pivoted focus from generalized Women’s Health to more tightly feature medical weight loss, periomenopause and PCOS — using trademark medication names or even the generic name was commonly disapproved and not being displayed. Editing the ad was very difficult because without providing even the generic name or the class of medication made the ad seem very “hand wavey” and vague. There are a TON of “med spas” which advertise weight loss but are simply doing non-controlled hormones and vitamins — which of course don’t have the same effect for patients.
The result of this is a slower uptick in the practice. Online discussion groups and anecdotal reading indicated some professionals who did start up and focus on this experienced a very fast growth and their own revenue reflected that. Over the course of 2023 learning SEO and iterating on information presented on the website, initiating TikTok, YouTube and Facebook/Instagram videos presenting in depth information, working on gaining visibility — it was a trial and error type situation. Ironically doing 10–30 second TikTok reaction videos for videos that already had a large following was one of the more successful strategies and she’s continuing to develop and refine her strategies to get better visibility and drive traffic to her website.
FF to today — the practice is coming up to its 1 year anniversary of seeing her first patient, and growth in her business has been modest but positive. The original growth target set was to gain 1 new patient/week — which would have put the practice at a healthy but still controllable 52 recurrent monthly patients/month. She’s at 26 recurring right now, so pretty good but below expectations — what was originally thought of as a modest target was probably somewhat overly aggressive in retrospect. Monthly income is in the black — covering expenses and able to provide a draw but not equal to her FTE salary from before. But we are seeing an uptick in scheduled appointments that provide a positive forward sentiment for the business.
Takeaways from the past year:
- start doing the legwork to set up your business before you leave your salaried job — it may sound slightly unethical, but if you work for a similar type of business there is a lot of domain knowledge you are just a few feet and a coffee away from. Its especially easy if the office is a toxic environment and people are one foot out the door — they’ll tell you maybe more than you care to hear.
- make sure your partner in life has a solid and reliable income! — two and a half months after she started down this path and we as a couple were investing money from our joint bank account into setting things up, I was laid off. Sure I got three months severance and reimbursed COBRA for medical insurance, but trying to set up the remaining infrastructure and handle the recurring expenses becomes significantly more challenging when there is no income stream anymore.
- be prepared to draw on savings of all varieties to cover off all the unforeseen expenses in the first year — we blew through stock grants, 401k, other investments, etc… to be able to stay afloat this year. It was unavoidable — be prepared to do whatever it takes if you are committed to making it successful.
- take on side hustles, negotiate contract gigs for your business, partner with other providers who focus on complementary areas of health — going it 100% on your own is profoundly difficult. A million years ago (not really, more like 54 years ago) my father was laid off from his foreman role at Kelvinator in London, Ontario, Canada. For the previous almost 10 years he had been running an electronics (television, radio, tv antenna, etc…) repair business evenings and weekends using his electronics technicial diploma from college and helping to pay off the mortgage much earlier than the contract was written for. When he was laid off, his repair business was already well established with a stellar local reputation and for that side hustle he even had a service contract with an electronics warranty company that brought in steady and good income on top of his normal customers. At the time he was notified of the layoff, he and my mom reviewed the options, and my mom gave him the encouragement to take his repair business full time given how well it was doing on a part time basis. They never looked back — with their work ethic and frugal lifestyle, they retired before age 60 and lived on a combination of Social Security and drawing the interest from their savings not just until my father passed away 3.5 years ago at age 91, but my mother is more than well taken care of as she continues to live well and the nest egg continues to grow. As for how I have learned from this? I have been doing my own side hustle mentoring people and preparing them for job interviews, reviewing and revising people’s resumes for the past 4 years. That has helped to stretch out the severance packages a little even during this really terrible period of layoffs in the tech industry. An aspirational side gig building and repairing guitars and basses doesn’t bring in consistent income, but selling the hand made guitars has also helped stretch the finances and helped us avoid needing to go on unemployment insurance. Do everything you can to ensure financial solvency during the down times and then set money aside during the good times.
- No matter what, support each other emotionally — encourage this effort and your partnership will only grow stronger — this is a very stressful time in your lives, and just as I teach in my Agile Scrum coaching of companies doing this requires 100% commitment from both of you. Not 50/50–100/100 since it will be a trying time and your nerves will be frayed and raw wondering if it will ever get better. Now, there is no guarantee of success in any attempt to go independent — I dont want to go get the statistic for businesses that fail vs succeed since that would be depressing, but even if it does fail you will have earned a TON of knowledge that makes you 10x more valuable to any employer you would choose to go work for, and earn significantly more $$$.
There are many more lessons learned, but I need to leave something for the next person to write about. We’re still going through learning all about entrepreneurialism, even with me having grown up since I was 6 years old in a family that lived off of their entrepreneurial spirit and whose income was variable throughout that time, I am learning continually from this startup as well as my side hustles all the ins and outs of it.
If you’re curious about the three businesses I’ve described, here’s the links to the websites:
Thanks for reading. If you enjoyed my writing here, please feel free to share and attribute it in your writing. Better yet — buy me a coffee! Thanks in advance!