Anticipating pitfalls is a fundamental part of the clinical side of medicine, and physicians starting out in private practice should apply that same thinking. Find out what it’s like from a doctor who has done it.
The thrill of opening an independent private practice—and the speed bumps along the way—are still fresh memories for family medicine physician and obesity specialist Carolynn Francavilla Brown, MD. She is the sole owner of Green Mountain Partners for Health, in Lakewood, Colorado, which she cofounded in 2015.
Dr. Francavilla Brown is also the immediate past chair of the AMA Private Practice Physicians Section. (AMA-PPPS) Governing Council. The section seeks to preserve the freedom, independence and integrity of private practice so that physicians who choose to practice in that setting can provide compassionate personal medical care for their patients.
She had thoughts about going into private practice when she was in residency, and it took only a few years of employment to convince her it would be the right move.
“For me, it really came down to autonomy,” she said. “I felt that I was very well trained to practice family medicine, and I also had this interest in obesity medicine, but that wasn’t really a thing 10 years ago, and there weren't many opportunities to practice it. I was employed at a private practice, but I quickly realized that the only way I could take care of patients the way I felt they deserved to be taken care of was through my own practice.”
But like almost all newly minted physicians, she had no experience in the business of medicine. She wants to see other doctors thrive in private practice, so she identified six pitfalls everyone striking out on their own should be aware of if they want to enjoy long-term success.
Dr. Francavilla Brown coaches physicians on starting their private practices, and she will be a featured speaker at the AMA Independent Practice Accelerator Workshop, taking place Sept. 11–12 at the AMA headquarters in Chicago. The workshop is designed to give physicians the essential knowledge, practical skills and confidence to launch or strengthen an independent practice in a concentrated, high-impact format. Learn more and register now.
Don’t put off marketing
“One of the things that often comes up is marketing way before you may start the practice,” Dr. Francavilla Brown said. “Having a simple marketing strategy—an online presence, a reputation—before you ever launch the practice goes a long way. You can't start marketing too soon.”
Marketing is an uncomfortable topic for most physicians because it is unfamiliar, she noted. Many physicians assume it involves advertising, but advertising is just one component of it.
“The thing I try to explain to people is we physicians have tremendous value—we're making people feel better, we’re even saving lives—but we can't help people if they don't know we exist,” she said. “Marketing is just letting people know what you're good at and why it's important to you.”
Building a website should be your first step, Dr. Francavilla Brown said.
“It doesn't have to be a website for the practice—it can just be a website for you,” she said. “It can have your bio, maybe links to articles you've contributed to, or YouTube videos or podcasts with your ideas, such as: Who do you help? Why do you help them? Why is that important to you?”
A second step is spreading the word that you’re open for business.
“Tell your local community, your neighbors, people at your gym and, of course, other physicians,” she said. “Anyone who may overlap and want to share patients with you—don’t be afraid to reach out to them. These are things that are free or almost free.”
Don’t ignore your systems
“This may just be as simple as: What exactly do you want your medical assistant to do? How should they greet people? What should they have done before they leave for the day? What should they do every week? What should they do every month?” Dr. Francavilla Brown said.
“I've realized a lot of managing people is reminding them what their job is, and the more that that can be written down, the better everyone will do,” she said. “Take pictures of things so they know, ‘These are the supplies I want, and this is how I want them set up every time.’ That way, you're not having to teach things over and over. And if you get a new team member, it's very easy for them to get up to speed.”
Check out this episode of the “AMA Thriving in Private Practice” podcast in which Dr. Francavilla Brown discusses the steps she took to start her private practice shortly after residency and how other residents can prepare themselves for private practice setting in the future.
Don’t neglect admin time
“You’re going to need time to run payroll and pay bills, but also to look at the numbers and make projections and do a SWOT [strengths, weaknesses, opportunities and threats] analysis and other things that will help your business grow,” Dr. Francavilla Brown said. “If you're scheduled to see patients 40 hours a week and then you need another five hours to do the business side of things, then you may just be more frustrated and stressed out than being employed.”
She suggests setting aside at least a half day per week to work on the business.
“You probably need a protected afternoon or a protected day to be the business owner. You can't see patients 40 hours a week and run the business. I mean, you can, but that is going to interfere with your wellness, your balance, and be a recipe for burnout,” she said.
Don’t take payment for granted
“One mistake some people make is they may look at the rates that they got paid in an employed setting and think that they are going to get the same rates in private practice,” Dr. Francavilla Brown said. “But they may not be able to negotiate those same rates. They may not realize that their rates at a hospital included facility fees that they are not eligible for in independent practice.”
The upshot: You need a complete understanding of your payment model.
“You need to actually find out what your contracted rates are going to be,” she said, adding that private practice payment rates can also vary by state. “I have colleagues in other states who have much better contracted rates than I have in Colorado. Assuming the rates are going to be the same as your peers’ or what you had someplace else can be a big financial mistake.”
The AMA’s “Getting started in private practice” resource page highlights eight steps to starting a private practice and other resources for getting started, including expert guidance on payment and contracting.
Don't argue with the numbers
“I was part of a leadership conference recently, and someone there had the best quote: Don't bring emotions to a math fight,” she said. “Does the rent you're paying make sense? Are you going to be able to make a return on that? If you're taking insurance, what do you actually get from insurance companies? If that’s not sustainable, then you may have to take cash or be out of network.”
Taking insurance is a particularly important issue, Dr. Francavilla Brown noted, because it constrains how much you can charge for services.
“In another business, you’d set your own rates. But if you take health insurance, you can't raise them. So you really have to control your overhead,” she said.
The AMA STEPS Forward® podcast, “Private Practice: Attending to Business,” has expert guidance to help navigate business operations and efficiency solutions to create and support a thriving business.
Don’t try to go it alone
Physicians pride themselves on their knowledge, but there are some domains related to private practice that are well outside of their training, Dr. Francavilla Brown said. And doctors should not be tempted to try to take them on.
“You’re a doctor. You don't have to know HR [human resources], or payroll, or taxes. You can find specialists to do those things for you,” she said. “If legal questions and compliance things are keeping you up at night, pay a lawyer for that help.”
The AMA Private Practice Playbook introduces foundational terms and concepts that apply to private practice. It also breaks out the professional advisors who can provide invaluable guidance as you develop a business plan for day-to-day and long-term operations.
