From grapes to computer systems, these physicians are branching out

Brunno Ristow, MD, cultivates his Napa Valley vineyard, J. Paul Martin, MD, "dabbles in technology" and David Winn, MD, concentrates full-time on practice management software.

By Tyler Chin, Cheryl Jackson and Julie Jacob, amednews staff. Aug. 26, 2002.

Making sidelines pay
Doctors who branched out beyond running their practice tell why they did it, how they did it, and what you should know before you do it. Contribute

In this new series, physicians share their experiences with making sideline business ventures pay off. Our first three profiles spotlight the owner of a winery, a partner in a CME credit-documentation service and the founder of a company providing Web-based systems for medical practices.

Heard it through the grapevine

Name: Brunno Ristow, MD

Specialty: Plastic surgery

Location: Practices in San Francisco, but spends his weekends in Napa Valley, where he owns the Quinta de Pedras vineyard.

Business: Ristow Estate winery

Annual revenue: Dr. Ristow would not give specifics, but he said he sells about 2,000 cases of cabernet sauvignon wine per year. Bottles are sold for $65 each; each case contains 12 bottles, equaling about $1.6 million in sales.

Why he started the business: When Dr. Ristow bought property in Napa in 1992 for a weekend home, a neighbor suggested he grow grapes on some extra land. He sold the cabernet sauvignon grapes to a winemaker affiliated with the Beringer family, who said the grapes made the "most extraordinary wine he had ever tasted." That praise led Dr. Ristow to expand his vineyard by purchasing an additional 23 acres in 1992, then more land in 1995.

In 1995, Dr. Ristow and his family produced their first bottles of wine under their own label, Ristow Estate. The wine has been reviewed favorably in Wine Spectator and Wine Enthusiast.

"The enjoyment of owning a winery is just immense," Dr. Ristow said. "However, it is somewhat nerve-racking because as a surgeon you control a lot of the outcome of what you do."

In the winemaking business, however, Dr. Ristow noted, much of what happens is out of one's control, such as the weather. A good crop of grapes can be wiped out by too much rain or a heat wave.

Why he keeps practicing: "I absolutely love being a surgeon and I can't think of anything more enchanting to do. But I also like the wine business."

Words of wisdom: "[It] takes a lot more work than one thinks to begin with. You have to have endurance to persevere. There were moments when I thought it was too ambitious to produce a premium cabernet, but I persevered." Also, "my wife and stepdaughter run the day-to-day business. I could not, as a surgeon, run the business day-to-day."

--Julie A. Jacob

Credits to his profession

Name: J. Paul Martin, MD

Specialty: Family practice

Location: Asheville, N.C.

Business: Electronic Education Documentation Systems, an automated registration and documentation system used to keep track of continuing medical education credits. He and his partner, Barry Fox, a former CME director, began the business in 1997. Customers are CME sponsors, physicians and accrediting organizations. Doctors who pay an annual $35 subscription fee get automated reports.

Annual revenues: "It's a profitable business."

Why he started the business: Dr. Martin and Fox "worked together in an educational program. We met and said, 'Here's an issue with unmet needs in medical education. What can we do to fix it?'

"It's a lot of fun for me because it directly impacts the medical profession. We get to dabble in the latest technology and do something that's meaningful and useful.

"I did the outside business primarily as a creative outlet. It allowed me to use skills that I normally didn't need in the practice of medicine. I wasn't looking for an alternative career. That wasn't my goal.

"In trying to design a computerized system to handle an everyday problem, I had to deal with computers on a daily basis and it was an area of personal interest."

Why he still practices: "I love medicine. This is just a hobby. My real joy is my role as a physician."

Words of wisdom: "The first thing a person needs to do is to surround themselves with experts in business and experts in that area of expertise that you don't have."

"It's important to find something you have a passion for and a willingness to defer gratification for a long period of time."

--Cheryl Jackson

Out of practice, but in your office

Name: David Winn, MD, MBA

Specialty: Family practice

Location: Cedar Park, Texas

Business: e-MDs. The company sells Internet-based electronic medical records, billing, scheduling and document management technology to physicians. Each module costs $3,000, or $10,000 for all four.

Annual revenues: $2.5 million in 2001; projects $5 million in 2002.

Why he started the business: "It stemmed from having written my own system in [1990] to improve documentation and ICD-9 coding. I had seen enormous productivity improvement in my own practice from that system. Then I decided to expand its capabilities. I looked at the products in the marketplace at the time and they were very disappointing or very expensive. I knew that we could create a better mousetrap.

"Also, I knew that with increased government regulation, increased paperwork and managed care, that information systems would become a requirement for the practice of the future. Dictation was incredibly inefficient. I never saw it as a viable documentation tool. It still works for some highly paid specialties, but we don't believe that for primary care it makes any sense to dictate."

Why he stopped practicing: Dr. Winn quit practicing in 1997 to become a full-time entrepreneur because he thought the financial potential was greater.

"I'd never encourage doctors to do that per se. I think the financial security of medicine still exceeds the financial security of your own startup. But when you're successful in your startup, the rewards can be a thousandfold."

Words of wisdom: "Make sure you have some business background. Get your MBA. I think you need to have some business background because a lot of physicians are excellent clinicians, but they don't necessarily have the best business acumen."

--Tyler Chin