Growing The Practice, One Patient At A Time

Wow, what a year 2020 has been! At the start of the year I thought that the hardest thing I would have to do is to finish the build of my new clinic. Little would I know that life would throw us all a curveball. The ups and downs have been dizzying so far. For now, things have at least stabilized and our growth continues. I started the year with 4 employees and one physician part time employee. I currently have 10 employees, 2 of which are physicians. I am also brining on 2 more midlevel providers which will also need more staff too to support them. I suspect we will start 2021 with somewhere around 15 employees. Lets see some of the highlights of how I grew my clinic in 2020.


PPP Loan

Luckily we were able to get the PPP Loan to keep our business afloat during the pandemic. Since every employee except me has contracted COVID-19, we had to close our clinic for almost a month. The PPP loan helped keep the practice afloat and keep my employees paid during this time. It also allowed me to keep everyone on the payroll without having to fire anyone. One of my employees had a fever for over 2 weeks and didn’t get her strength back until 2 months after initial symptoms. The PPP loan allowed me to keep paying her so that she didn’t have to worry about not making rent or paying her bills. Once we could open, we jumped right back into practicing medicine.

As of November 2020, I received word that the entire loan amount has been forgiven. However, it seems that I most likely will have to count the income as taxable income even though it 100% went to my employees. The rules for how taxes will be dealt with for the PPP seem to be still in flux a bit. We will have to wait and see what happens to the income.


Focused On Growth

Date night on Lake Travis

Being small is great….right?

I quickly realized that there was a huge downside to being small. The economics of size were working against me. The larger I continued to get, the cheaper each unit of goods costs.

I’m paying the same cost for my internet, website, and fax line no matter if there are 1 physicians or 5. Same can be said for air conditioning, taxes for the space, and for HOA fees. Might as well spread that over as many people as I can seeing patients in the clinic.

A good example of buying in bulk making me money is vaccines. All of a sudden I’m buying 4,000 flu vaccines instead of 400 when I started out. The unit cost goes down each time I give a flu vaccine. So far, I’m saving about $5 by buying in bulk. Might not sound like much but $5 per vaccine sure does add up when we are talking about 4000 of them.

There also is a matter of being on call. When it is just me, I’m in charge of call 100% of the time. As I grow, I can put others in charge of call.

Soon after starting my clinic I realized that there are two types of successful long term practices. Those that are niche and stay small and those that grow big. I could have just stopped right where I was. Seeing my small panel, being on call 100% of the time, and be okay with that.

To me, if I’m going to be on call 100% of the time, I’m going to either charge a lot of money or make money off other people working for me.

I decided to go big and focus on growth.


The Best Way To Grow

I’ll let you in on a little secret. The best and fastest way to grow is to keep your patients healthy and happy. Actually, healthy is not always a prerequisite but happy sure is to grow quickly.

Some of you may want to know how much I spend on advertising on average every month? $400. Yup. That is all I spend on advertising each month for 3 doctors.

Almost all my referrals come from people who tell all their friends about how much they love our office. How well we treat them and make them feel more than just a patient who is in and out of the office as quick as possible.

Come to believe in the “loss leaders.” The things that do not make you any money up front or even cost you money but potentially return 100x what you put in.

Kindness, hiring a bit extra staff for amazing patient service goes 100x more than a huge advertising budget. Spend money, time, and effort where it counts.

This is how we accumulated almost 10,000 new patients in the past 2 years. Good and happy go together.


Avoid The Negativity But Listen To Feedback

There are some people who will never be happy.

Give this type of person a $100 bill and watch them complain that it was not all in $20 bills. These people should be ignored. To engage them will only bring you down to their unhappy level. ignore these people and get them out of your clinic as quick as you can. The toxicity will rub off on your employees and bring your work culture down.

Knowing how to separate these chronically unhappy people from people who give you valuable feedback is key. If someone tells you that your clinic sucks, your MA is rude, your website has lots of spelling errors, listen carefully. If the person complains about a process or worker issue, deal with it asap. No person or business is perfect, but perfectly correcting errors is perfection.

Addressing these concerns often times leads to happier patients long term. They feel listened to and that their problems are being addressed as quickly as possible.


Buying Advertisements

Spend a few nights watching YouTube videos on how to set up Google and Facebook ads yourself. Instead of paying someone hundreds or thousands of dollars, you can constantly tweak your own ads for far less money. For most primary care ad words expect to spend about $1.20 per person who clicks on your link. For plastic surgery or more cosmetic driven procedures, expect to spent upwards of $5.00 per click.


Be sure to set an audience, a location, and time line. Do A/B testing. Run two ads at the same time to see which one runs better and which one patients respond better to.


Avoid high cost advertising. ZocDoc for our clinic was a total disaster. After they switched to a pay per new patient, we found that our cost to acquire a new patient on their platform was higher than $50. On google, it is as low as $4. ZocDoc and Yelp offer same day bookings but often times the patients are not the long term type of patients you want to attract.


Follow The Golden Rule

Treat people like you would want to be treated. Be available, kind and practice good medicine and your practice will be very busy in no time. If you forget all else above, follow the golden rule and you will do just fine.


Thanks for stopping by.




3 thoughts on “Growing The Practice, One Patient At A Time

  • November 29, 2020 at 5:26 PM

    Thanks so much for your inspiring post. I am glad that your practice is expanding and running smoothly. I have started (going in 3 weeks) my own home-based practice as a palliative care specialist for the sickest here in Baltimore MD metro. The past 2 weeks has been hectic but I was able to manage. It is not a lucrative practice but I believe it will pay off. When I see my patients and families understand and accept their permanent progressive condition and making better/realistic goals, my hard work for the day is all worth it.
    Looking forward for your next post.

  • December 14, 2020 at 4:07 PM

    Hi I just want to say – who is advising you on the PPP? The forgiveness of the PPP debt will NOT be income to you. However, you will not be able to expense the PPP expenses either, which does put a haircut on the benefit. Just let me know if you want to discuss further.

    • December 18, 2020 at 8:57 AM

      Hi, thanks for reaching out. I continue to have ongoing discussions with my CPA since the PPP has been a bit unclear until only somewhat recently for how the government is going to deal with forgiveness. Have a great day!


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