Independent fee for service, often referred to as traditional medical practices, seem to be a dying breed. Go to any online forum and you will see doctors who advocate against starting a traditional fee for service practice. Most primary care doctors focus on DPC (Direct Patient Care). This is a type of practice where doctors charge a yearly fee to be a member of their practice. No bills sent to traditional insurance plans.
The argument to avoid fee for service and instead start a DPC practice is three fold.
- Traditional fee for service is potentially not as lucrative as DPC due to overhead
- Fee for service takes much more work compared to DPC practices
- Fee for service takes more money and effort to get started
Time is valuable and most people focus on time spent starting a traditional medical practice. Today I would like to focus on the time I spend on administrative aspects of my practice. I also will talk about how I manage my time in my practice.
The Startup Hustle
When I first started my practice, I did everything from creating my website to answering my phones. There was no task too small or menial for me.
Before I even opened doors, I would estimate that I spent well over 100 hours on behind the scenes administrative tasks to get the doors open. This ranges from creating an employee handbook, to creating my website, to working on credentialing. I wanted to be as lean as possible so I did as much as I could myself.
However, within a week of seeing my first patient, I clearly could not do it all. At this point I decided to sublease employees from the doctor I was subleasing space from.
His staff started to answer my phones, check patients in, submit bills and take messages.
My time spent on administrative tasks went from 40 hours a week down to I would estimate 30 hours a week within the first month or two.
My Cheap Mistakes
Some of the long hours in the beginning were a result of me being cheap. I’m not talking about frugal. I’m focusing on myself deciding to not spend a small amount of money and instead spend many hours on a task.
The best example of this was my bookkeeping. Instead of buying QuickBooks for $20 a month, I decided to log everything in Microsoft Excel. Payroll was even done manually where I manually calculated withholdings.
I had Microsoft Excel already on my computer, so it was free. I figured that I could keep logging my incoming money vs money spent this way for as long as possible.
Using Microsoft Excel, I ended up spending about 2 to 3 hours a week focused on my bookkeeping. Once I bought QuickBooks I then was spending less than 10 minutes a week on bookkeeping.
Lets assume the average physician time is worth about $100 an hour. I was spending the equivalent of about $1,000 a month in labor equivalent to save $20 on a QuickBooks subscription.
No other way to call it, I was cheap and it costs me a lot of hours for no other reason. Some of the hours I spent at the beginning were on stupid admin tasks like this.
Be Lean But Do Not Be Cheap
One could argue that maybe I should have paid a company to start my website. This is where I spent the bulk of my admin time before opening. I choose not to do my website 100% myself. If I would have offloaded this task to someone else, then I never would have learned how to update my website.
Now when I want to add something to my website, I simply log online and change it for free. No web developer has to get involved.
The average web developer is going to charge at least $50 every time you call them. Being my own website creator saved me a lot of money as I continue to update and change my website weekly.
Learning how to create a website also allowed me to gain an important skill learning the basics of SCO and web development. The same can be said about all my advertisement. I do it all 100% myself.
Know when to skimp on costs and when you are being cheap.
Being cheap will hurt you more than you realize.
Time Is Money
There is a reason why many people pay someone to mow their lawn.
The money that someone spends on paying someone to do the yard work is offset by gains and personal time with the family or hobbies. Realize that your time as a professional is worth money. In the beginning of staring a practice, it is nice to have control in your hand. However, as you continue to grow you will have to learn how to delegate these tasks.
You will always have the opportunity to make more money by working more hours. At a certain point, sanity and living life is severely sacrificed with the more work that you can take on.
Know what your threshold is to avoid burnout.
Learn To Delegate. Be A Boss
Most of my administrate time now is spent on growing my business. The majority of the daily task are set on autopilot by specific instructions that I have given to specific employees.
For example, instead of me being in charge of making purchases for the clinic for all medical equipment, I have one of my staff members buy what we need.
Whenever purchases are made by this employee, I automatically get an email from the purchasing website. If there is something egregious, I can simply log online and cancel the order. This has yet to happen. By giving this employee control of medical supply orders, there is a level of pride in doing that job well. I have found that delegating the right task to the right individual leads to good things happening for the clinic without me having to micromanage.
Find people who are reliable and want to grow with the practice. Give them a level of autonomy and responsibility over a part of the clinic. They will most likely surprise you on how well they do.
How Much Time I Spend On Running My Medical Practice
Before I started my practice, I was spending 30 to 40 hours a week getting ready to open doors.
Once a start of my practice for the first couple of months, I continued to spend 30 to 40 hours a week on the administrative task. This included being involved in all hiring’s and firings. I also was ordering all supplies, adding on phones as we expanded. Basically anything that the business needed to operate I was 100% involved in.
Once I hired my second physician and we had 5 total other employees working for us, it was easy to start offloading task onto other people.
I now spend about 10 hours a week on administrative tasks.
However, as stated above this is for different reasons rather than just running the clinic. I spent about 1 hour a week on actually maintenance or running my clinic.
The bulk of my time is spent on growth. I am in the process of hiring yet another physician to join me. I am also in the process of looking to open a second location even as we are about to move into a new office building to continue to grow my business.
We continue to grow at about 15 %per month. This type of growth takes a lot of work to sustain which is were all my energy goes.
The amount of time you spend on your practice admin work is up to you. I would estimate that it takes about a year to get things on autopilot. At that point, you should only be spending 1-2 hours a week on admin tasks unless you are growing your business.