Start & Run a Medical Practice

Medical schools often don't teach the up-and-coming doctor how to establish an independent practice. This book will teach them how to run an office smoothly, while incorporating the medical elements of the practice. This guide is for every doctor, dentist, chiropractor, massage therapist, naturopath, or other health-care professional who dreams of opening a medical practice

NOTICE xii
PREFACE xiii
INTRODUCTION xv
1. CAREERS SUITED TO OWNING AND OPERATING A MEDICAL-TYPE PRACTICE 1
1. Medical Doctors 1
2. Allied Health Professions 2
2.1 Audiology 3
2.2 Chiropractic 3
2.3 Dentistry 3
2.4 Dietetics 4
2.5 Midwifery 5
2.6 Naturopathy 5
2.7 Nursing 6
2.8 Occupational therapy 7
2.9 Optometry 7
2.10 Osteopathy 7
2.11 Physiotherapy 8
2.12 Podiatry 8
2.13 Psychology 8
2.14 Respiratory therapy 8
2.15 Speech-language pathology 9
2.16 Veterinary medicine 9
2. IS THE HEALTH-CARE FIELD THE RIGHT CHOICE FOR YOU? 11
1. Good Reasons for Choosing a Health-Related Profession 11
1.1 You are a caregiver 12
CONTENTS
iv Start & run a medical practice
1.2 Exciting 12
1.3 Rewarding 13
1.4 You want to help people 13
1.5 You are dedicated 15
1.6 You are patient 16
2. The Wrong Reasons to Choose a Health-Related Profession 17
2.1 Family pressure 17
2.2 Money 18
2.3 Status 19
3. There Are Many Different Specialties from Which to Choose 19
3. IMPORTANT INFORMATION TO KNOW BEFORE YOU BEGIN 21
1. Licensing, Registration, and Membership 21
2. Continuing Medical Education 22
2.1 Additional Learning 23
3. Reviews 24
3.1 Peer reviews 24
3.2 Billing reviews 25
3.3 Licensing body review 25
4. Professionalism 25
5. Personal support 27
4. CHOOSING THE TYPE OF OFFICE PRACTICE 29
1. Solo Practice 29
2. Group Practice 30
3. Associate 32
4. Locum Tenens 33
5. Factors to Consider When Choosing a Style of Practice 34
5.1 Time commitment 34
5.2 Financial arrangements 34
5.3 Options for continuation 34
5.4 Possibility for change 35
5.5 Mobility 35
5.6 On-call 36
5.7 Flexibility 37
Contents v
5. DEVELOP A BUSINESS PLAN FOR YOUR PRACTICE 39
1. The Business Plan 39
1.1 Executive summary 40
1.2 The mission statement 40
1.3 History and background 40
1.4 Practice values 41
1.5 Operations and employees 41
1.6 Market research 42
1.7 Marketing strategy 42
1.8 Financial plan 42
1.9 Forecasts and predictions 43
2. Revisiting Your Business Plan 43
6. DECIDING ON A FACILITY AND LOCATION FOR YOUR OFFICE 45
1. Proximity to Ancillary Services 45
2. Group Environment versus Stand Alone 46
3. Building Facilities 47
4. Access for the Disabled 47
5. Washrooms 48
6. Public Transport and Parking 49
7. Other Factors to Consider When Choosing Your Offi ce 52
7.1 Square footage 52
7.2 Design of the offi ce 52
7.3 Adequate examination rooms 52
7.4 Adequate patient waiting area 53
7.5 Noise considerations 53
7.6 Storage space 54
7.7 Dedicated child play area 54
7.8 Security 55
7.9 Side entrance 55
7.10 Signage 55
8. Purchase versus Rental 58
8.1 Purchasing a house or condo for an offi ce 58
8.2 Renting offi ce facilities 59
8.3 Lease considerations 59
vi Start & run a medical practice
7. THE LEGAL, BUSINESS, AND INSURANCE ASPECTS OF RUNNING A PRACTICE 61
1. Hiring a Lawyer and Getting Legal Advice 61
2. Litigation 62
2.1 Consent to release information about a patient in a legal case 62
2.2 Expert consultant for a law fi rm or insurance company 63
2.3 Be aware of the possibility of negligence and malpractice lawsuits 63
3. Hiring an Accountant 64
4. Investment Advisors 65
5. Insurance 65
5.1 Offi ce insurance 65
5.2 Disability and life insurance 65
5.3 Liability and malpractice insurance 66
6. Incorporating Your Medical Practice 66
6.1 Professional limited liability company (PLLC) in the United States 67
6.2 Incorporation in Canada 67
7. Additional Information 68
8. EQUIPMENT AND SUPPLIES 71
1. Adherence to Guidelines for Equipment 72
2. Technology 72
3. Phone System 73
4. Furniture 73
5. Destroying Confi dential Files 74
6. Stationery 74
7. Offi ce Cleaning Supplies 75
8. Notices and Signs for Patients to Read While Waiting 75
9. General Medical Supplies 75
9. HIRING EMPLOYEES 81
1. Hiring Options 81
1.1 Contract services 81
1.2 Whether or not to hire staff with experience 82
1.3 Hiring family or friends 82
2. Where to Find Employees 83
3. Interviewing Potential Employees 83
4. Checking References 85
5. Salary 85
Contents vii
6. Benefi ts 86
7. Staff Contracts 86
8. Employment Rules and Regulations 86
9. Training the Staff 87
10. HOW TO GET YOUR FIRST PATIENTS 89
1. Advance Preparation 89
1.1 Word of mouth 89
1.2 Personal visits 90
1.3 Notice boards 90
1.4 Mass mailings 91
1.5 Presentation at relevant venues 91
1.6 Being available 91
2. Don't Rush Patient Visits 91
3. Daily Schedule 92
4. Dealing with Patients that Miss Appointments 92
11. ANNOUNCEMENTS, PROMOTIONAL MATERIAL, AND ADVERTISING 95
1. Business Cards 95
2. Announcement Cards 97
3. Introductory Letters 97
4. Flyers 97
5. Advertisements 100
6. Website 101
7. Open House 102
12. MAKING SURE YOUR OFFICE RUNS SMOOTHLY 103
1. Importance of the First Line of Contact 103
2. Avoid Long Wait Times for Your Patients 104
3. Medical Records 104
4. Dictation 105
5. Investigations and Results 111
6. Emergency Provisions 113
7. After-Hours Coverage 114
13. ADDITIONAL TOPICS TO CONSIDER 117
1. Offi ce Hours 117
2. Child Safety 118
viii Start & run a medical practice
3. Reading Material 118
4. Other Nice Things to Have in the Waiting Room 119
5. Retention of Files 119
14. BILLING OF SERVICES 121
1. Billing Practices 123
1.1 Fee-for-service 123
1.2 Salary 124
1.3 Contractual 124
1.4 Income splitting and commission 124
1.5 Associate or locum tenens arrangements 125
1.6 Block payments 125
15. EVALUATING YOUR PRACTICE 127
1. Direct Feedback 127
2. Indirect Feedback 129
3. Periodic Review 129
4. Self-Assessment Tools 130
5. Lectures and Rounds 130
16. TROUBLESHOOTING 131
1. What to Do When a Staff Member Phones in Sick 131
1.1 Family or friends cover the shift 131
1.2 Everyone in the offi ce pitches in 132
1.3 Contact temporary staffi ng agencies 132
1.4 Close until employee returns 132
2. Safety Issues While with a Patient 132
3. Management in the Event of a Fire Alarm 133
4. Prolonged Patient Visit 134
5. What to Do During a Power Failure 134
5.1 Ground- or low-fl oor practice 134
5.2 Higher fl oor offi ce 135
6. Outdated Patient Contact Details 135
7. Bad Weather 136
8. Staff Confl icts 136
CONCLUSION 139
CHECKLISTS
1. Deciding on a Facility for Your Offi ce 50
2. Other Factors to Consider when Choosing an Offi ce 56
3. Legal, Business, and Insurance Aspects of Running a Medical Practice 69
4. Offi ce Equipment and Supplies 77
5. Hiring Employees 88
6. Troubleshooting 137
SAMPLES
1. Interview Questions 84
2. Daily Schedule 93
3. Business Cards 96
4. Announcement Cards 98
5. Introductory Letter 99
6. Flyer 100
7. Follow-up Assessment 107
8. New Assessment 108
9. Standard Template for Surgical Report 110
10. Effi cient Management of Investigations List for Offi ce Staff 112
11. Medical Offi ce Emergency Provisions Checklist 113
12. Survey for Patients 128