A Look Back Of Growing My Medical Practice

Curious about the growth of my medical practice over the past 2.5 years? Lets take a look at exactly that in todays post. One of the most frequently discussed topics is how long it might take to grow a practice? I’ve spent a few hours collecting the weekly data for how many patients my practice has seen so that if you are wondering how long it might take to build your practice, you can see how long it took to build mine.

Growing My Medical Practice Over Time

In the picture above you can see how my practice has grown since inception. On the y axis is the number of patients seen during that 7 day week (Sunday-Saturday). Keep in mind, we have never been open on the weekend.

On the x axis is number of weeks since I started my practice.

The first 29 weeks that I opened my practice, I technically still worked as a hospitalist. This is why some weeks have pretty low numbers. During those weeks, I would go into the hospital to round at 5am or 6am. I would finish rounding sometime around lunch time then spend from 2pm to 5pm in my clinic seeing patients. You can see those weeks pretty well on the graph where there was a dip early on every other week.

Starting Low And Slow To Grow My Practice

The very first week I opened I saw 5 patients. I chose not to include that in this graph because all but one of those 5 people were my friends. In my business plan I figured it would take me 2 years to starting making good money.

One wrong assumption of my business plan on my path to making “good” money was that I assumed that I would be renting a full space by myself and not sharing cost of anything.

If it was not for Aetna screwing me over, read about it here, I would have been profitable basically from the beginning.  This is because I leased a space with a general surgeon and split the cost on everything. From staff salary to cost of ink for the printer, we split everything down the middle.

I kept cost low which allowed me to be profitable right from the beginning.

Lets Talk Advertising

I did not advertise until I went full time. Huge mistake looking back.

For the first 30 weeks, my advertising budget was $0 a month. What you see on the graph is all organic growth…word of mouth.

Once I went full time, I all of a sudden got a call from ZocDoc to try and advertise with them. I chose to try  it out and in the beginning it seemed to work out just okay. The reason I say it worked out only “okay” was that it was like a sugar high in the beginning. I was getting same day or next day bookings to help fill my schedule. However, the visits were often booked as “annual physicals” but it was really someone trying to get a free visit and ADHD meds from me.

It got so bad that we called every ZocDoc appointment ahead of time to tell them we do not prescribe ADHD meds unless they have a for sure diagnosis from a psychiatrist with documented testing. No, a script from some random PCP would not suffice and we required them to undergo testing again or we would refer them to psychiatry.

We left ZocDoc behind around week 50 and I finally dipped my toes into Google ads.

Wow did google ads work!

We immediately started to see a pretty big influx of new patients. Funny thing was that we also noticed that patients actually were nicer. They also tended to follow up with us in the future compared to ZocDoc patients doctor jumping to whoever is most convenient for them. The cost to acquire a new patient was much less than ZocDoc (more on that during the next post next week).

We attempted to advertise with Yelp briefly and that was slightly short of a disaster. Lots of patients came in for “worried well” visits. What I mean by this is lots of patients who come in for yet another opinion on why they are fatigued when every other doctor keeps telling them there is no medical reason for the fatigue and they should start on psych meds.

These people who came from Yelp also seemed to demand concierge level of care. Often times threatening us with a bad review if we do not drop everything and do exactly what they want. Once we ditched them, our lives got much easier.

How Much I spend On Advertising

As I said above, for the first 29 weeks I spend $0 on advertising.

The most I have ever spend on advertising is 0.4% gross revenue. The remainder of our growth has been organic, word of mouth, or simply from people searching for nearby primary care offices.

0-30 weeks = $0 a month on advertising

30-50 weeks: $300/ month on ZocDoc

50 weeks and beyond: Averaging about $400/month on Google and $150 / month on Facebook ads.

I’m a little bit blown away at how low these numbers are. I’m in a very desirable city and in a very saturated part of the city. There are probably 20 other primary care doctors within 5 miles from my office. I think it goes to show that if you provide good service, you are available, and kind you will have no problem filling up a panel of patients.

Our Shortcomings For Advertising

I am so embarrassed to say this but we have not once emailed our current patients to reach out to them for any services. This is something that will go live in January 2021, but to date we have not emailed or solicited anything from our current list of patients.

This means that every times we added a new service, had flu shots available, or added a new doctor….we never reached out to our current panel. The only thing that we have done is make one post on our Facebook group and add the doctor or service to our website. Our social media presence absolutely sucks. This is a goal that I have for 2021, to improve our social media.

Despite our shortcomings, it is exciting that we have had growth without trying to mine our current patient population.

Adding New Services

We started to add new services as my practice grew. First it was an EKG machine. Later we added vaccines, birth control injections, rapid flu testing, weight loss plans, and blood work in office just to name a few things.

I’m quickly learning that cash based services are so much easier to make money compared to visits for sore throats. For example, a quick visit for a sore throat after I pay my overhead might pay as little as $20 to me. It is no wonder most places are getting out of the business of primary care. You essentially are going to lose money on these quick visits. If you are not offering other services, you will be left behind financially.

COVID-19 And The Lockdown

If it was not for the paycheck protection program and change over to telemed visits, we would have had to fire most of our staff. The PPP allowed me to keep the doors open and keep people employed. It was frightening since I had no idea how long this would last, but so far we have made it through.

Our number of patients seen per week would have recovered more quickly, but towards the end of the summer we were limited by lack of space in the clinic. Right before the move, we had 5 doctors rotating through a clinic with only 2 exam rooms!

Things are starting to get back to normal. Our biggest problem now is patients who are lying about COVID-19 symptoms and entering into the office.

Future Growth Of My Medical Practice

In about 2 months we should open our second location with 2 more providers! This should help our numbers increase significantly over time. I also have one doctor who works with me that is only about 90% full most days and the other one that is only full 60% of the time most days (since they just started 3 months ago). There is room to grow for both of them.

I suspect that by the end of 2021, if we continue to grow at the current rate, that we will be seeing around 450 patients a week with both locations combined. This assumes that we do not open Saturdays, which I do plan on adding in 2021. If we open Saturdays, then the number may be 500 a week or higher.

In other plans for growth, I’ve already entered into negotiations to open a third location sometime in Late 2021 or early 2022.

Lets just see how big this can get 🙂

There you have it, the growth of my practice over time. I’d love to hear your thoughts!