A 5.5 Year Update Growing My Medical Practice

Time for an update for the status of how the practice is doing. I’ve posted quite a few of these on Student Doctor Forum in the past, but that forum is not nearly as active as it was in the past. For this update, I will just post it here on my blog instead. For those of you who don’t know. I started my own private practice medical practice and have grown it over the past 5.5 years.

Backstory

I’ve posted the original here, and the second update here, and the third update.

Here we go! I missed year 4.5 but I’m back with a year 5.5 update!

I meant to do one of these updates yearly, but time got away from me. For those who might be new to my journey. Here is the TLDR for the background: I am the first in my family to be a doctor, I grew up not well off financially at all. However, all members of my family owns some kind of business. Currently, out of the 2 brothers and me, I am technically the least successful in business. I am an IM doctor who graduated, was a hospitalist for 2.5 years then opened my own practice outpatient. I did everything by myself and created everything from scratch (including my website). Lets check in to see how things are going.

Workload

I have scaled back in my workload. Growing my medical practice goes beyond growing my personal panel of patients. The last update I was seeing 90-110 pts a week. Now I work 3 days a week and average about 60 patients a week. I spend 2 days a week on doing admin tasks.

I’ve stopped accepting new patients this month Aug 2024. My wait list is about 3 months long. I don’t have the time or bandwidth to see more patients at this time. Also, I want to focus more on this blog, InvestingDoc. I now do about 5-10 consulting meetings a week at $100 per hour to help others grow or set up their practice.

I now have a reginal manager who goes between the 3 locations that we have. That way I can deligate tasks to her on my belaf.

Growing My Medical Practice With Now 3 Locations

We now have 3 locations. 4 docs and 3 PAs working for me.

I’m currently in the process of looking to add a fourth location in the coming 9 months.

Rough Start To The Year

My business partner, the other doc in my group, she took 4 months off at the start of the year to have a baby. I also put my foot down with my PAs and told them that their schedule has to change. They previously had 30 min appts for everything, meaning they only had 16 on their schedule a day. With no shows, they were seeing about 14 a day. Hard to grow a medical practice while your PAs hardly make overhead.

I changed their schedule to put 20 on their schedule a day which means they see on average 17-18 per day. Keep in mind many of these visits are simple UTI, pregnancy tests, quick med refills. Very quick and easy urgent care type visits that on average take them less than 5 minutes to do. Even after the change, every PA was still leaving early.

Well, with that change, all 3 of my PAs revolted that they did not like the change. As I predicted they all quit. I had to re-hire all 3 new PAs which means that for the first half of the year, we were grossly understaffed for a very long time. This, of course, negatively affected income and my stress levels.

This taught me a key lession. Once people get used to a baseline, changing that baseline will lead to unhappy employees. I should have changed their schedule much eariler. No primary care practice has their PAs seeing less than 14 patients a day including no shows.

Inflation

Inflation has calmed down and has been stable for us. Same salaries as 2 years ago for the most part. Our PAs are making about 10% more, everyone else is making about the same.

Insurance

We still are a traditional practice. Hard to do growing a medical practice, but we make it work by staying lean. We take everything but Medicaid. Talked to cigna and was able to get a huge boost of about 20% in our contracted fees. I tried to get a raise from United healthcare but they snuck a nasty clause in my contract that I can only negotiate for a fee increase 180 days to 90 days before my contract auto renewal. I tried to negotiate a raise with them less than 90 days from renewal so now I have to wait until next year.

Personal Life

We have two kids, one girl and one boy. My wife and I have the itch for a third kid. We will see if we are blessed with a third in our life in the future. If not, that’s okay. I feel very happy with our family the way it is at the moment too.

My mother in law had a knee replacement and about a week later was found down in the shower and unfortunately passed away abruptly. That was the low point in the past 2 years since my last post update.

My wife and I moved into a new house, this one has a pool that we all enjoy using in these hot summers.

My wife continues to battle with her skin cancers. This will be an ongoing issue that will most likely never resolve unfortunately since she was diagnosed with Gorlin’s syndrome.

Employees

I now have 23 employees, still with 2 full time billers. We do all of our billing in house.

I have 3 other MDs that work with me and 3 PAs

We are seeing about 500+ encounters a week.

We continue to offer full benefits, including PTO, 401k match, dental, vision, and disability to all employees.

Income

Well, this is all over the place. I’m spending a lot of money on growing my practice. Opening 2 new locations is not cheap. I have estimated that I have spent about $300,000 this year on opening these two new locations (so far).

I’ve gone 4 months in a row without taking any salary at all, mainly in an effort to grow my practice. Starting a new location is always going to be slower than you would like. It takes time and money to grow a panel.

Some months I don’t take a salary this year  (as I have mentioned above). Other months I have made >100k net profit during that month. My income is all over the place this year because I am spending so much on growing the medical practice. I plan on keeping my income at about $250k this year and re-investing the rest into growth. That means that I’m going to spend well over $500,000 on growth this year for my practice.

Every single month though we have been cash flow positive in 2024 and 2023.

This year we will come close to $3m in gross revenue for my practice.

Re-branding For Growth

I built my website myself 6 years ago. I did everything form photos to using fiverr for our logo.

Expanding to 3 locations I realized that I needed to advertise. While talking to a billboard company, they pointed out that our name, what we advertise as, and our website are all 3 different names.

For example our name is something like “Investingdoc Clinic”, we advertise as “Investingdoc” without the clinic word, but our website is “investingdoc pcp dot com”

They pointed out that this is confusing. They recommended that we make it all the same brand. I paid $22,000 for a new domain name so that we can be “investingdoc dot com” and advertise as just our main name.

In total I’m spending about $50,000 on rebranding if you add in the website costs and cost to build a whole new website. That goes live next month.

Future

I’m hellbent on growing my medical practice. I’m in the process of trying to possibly form an IPA to get better rates with some specialist in town.

This has not been easy, but for those of you wondering if its possible. It 100% is.