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7 things I wish I knew before starting private practice

Dr Deepak Garg

Private practice is one of the common answer for, what after residency/ after  fellowship questions !.   Unfortunately, even though we become brilliant ( atleast hope to ) doctors ,we sadly lack  the exposure to the  business side of the  healthcare.   Many of us either lack guidance from the right people or more frequently take advice from the other doctors  which  is from  the same perspective  I personally think it is important to keep learning different things  beyond medicine  to improve productivity and efficiency while running a successful practice  Its been 10 years since my residency and i have certainly learnt few things over this period  some of them the hard way
When I look back, I wish I knew these things  when I finished my residency .!!

Location of private practice

We are doctors and we practice the art and the science  of medicine.  We also use super expensive equipment in the clinic and in our state of art operation theatres .  And we also exist in a bubble  imagining our business to be on a different plane compared to another business . SO while we deal with sickness and health and emotions  around them the reality is that at the end of the day    we are  sitting in an office waiting for a client to come and pay you for your services.   This is no different in any way than any retail business around you .  There are three important things in a retail business.  1) Location, 2) Location 3) Location.    So when starting a practice location is the most  important consideration  Don’t start at a location that your family has bought for you.  Dont start at a location where you can afford .Take a hard look at the location   Is it visible?  Are there many ophthalmologists practicing in that area?  how is their practice?  what is the population in the area and the paying capacity of these patients ?  Competence of the doctors practicing in the area is also a consideration   If you think that  you can offer better services and there is a need  for that service then look for a place in that area.  Location is very very important

Rental vs purchasing property to start a private practice

Several of us ,if not all are privileged in terms of family providing a space to start practice  Those who don’t have this luxury start looking for a place they can purchase to  start their practice.   To my mind this is a big mistake.  The calculation is simple.  Commercial rental yields today range from 3-5%.  This means that if you buy a place you will save 3-5% per annum of the amount you spent on buying the property.  On the other hand,  if you had invested that money in  let’s say Mutual Funds there is a very high chance that you will earn let’s say 8-12%.  Now if you go out and rent that same place which you were going to buy,  you will pay 3-5% of the money invested in mutual funds and still take home 5-7% extra cash.  Some people argue that there is appreciation in the price of the property.  Yes this premise may be true in certain situations but it may not be always true  The laws may change and more FSI may be allowed per plot which may lead  to a drop in valuation .  Another disadvantage of buying a property is your capital gets locked.   Instead if one is enterprising , capital can be used to start another center at a fraction of the cost of buying one single property.  If practice does  well your cash flow will increase and in business cash flow is a reality which is hard to ignore .

Marketing

As I mentioned earlier  ,that we are and we should behave like a retail business.   People have to walk into your premises / hospital to avail your services for a fee.  There is another rule in business,   VCP.  It stands for visibility, credibility and profitability.  This order cannot change.  If you want to be a profitable practice you first have to be visible and then build credibility and then and only then profitability will follow .   Marketing helps with the visibility part.  It lets people know that you exist in this world,  that you are located at a particular location offering a particular skill .   Doctors as individuals cannot market their services  but hospitals can.  Traditional marketing is very expensive and thus most of us ignore marketing .  But today with social media there are several ways to market.  There are many companies that do this for you but i dont think all of them know what they are doing and ofcourse not to mention the  cost involved which is a burden .  So learn to do this  on your own or through trainers. Later  when you hire a company to market for you, you can tell them exactly what you want and how you want it to be done.  Read about lead magnets, landing pages, autoresponders, newsletters and blogs and how you can use these to increase visibility and to IMPROVE credibility.  Read about google reviews, testimonials, patient stories to help in building credibility.

Networking

Networking means  meeting different and new people from different fields .   This is one thing i learnt sooner than others.   Networking helps with the V part of the VCP.  More people know you on one to one basis .  If you really wish to be known its important to  try and learn more about what the other people do   and help them if required .  Think of them as individuals who are as honest and ethical as you are.  Refer them to the individuals who are looking out  for their products or services.  I would like to share a true story here   One leading ophthalmic instrument distributor was chatting with me  regarding developing a software .   .  I connected him to a software guy i knew.i   helped both these individuals in the process   But i  went a step ahead and also looked at the agreement between  the software guy and the  instrument guy  I edited it to be MUTUALLY beneficial to both the parties  Both were happy AND SATISFIED AND I   I ended up building a little bit of  trust credibility for myself in return

 There are several organizations that help with netowrking   Rotary clubs, Lions clubs, building societies, your children's school parent committees, and of course a structured organization called BNI.  I was part of this for 7-8 years and LEARNED A LOT WITH THEM .

People person

I started off BY thinking that i was going to do whatever it is that i wanted to do on my own.   Unfortunately things dont happen like that.   You will be able to build successful practices because of a team.  The team in turn has to like you and want to work for you  If you cannot get along with most people, and if attrition rate of employees is high its time to introspect  , most likely the fault lies with you.  In any large company or hospital when they look for somebody in leadership position they look for interpersonal skill as an essential requirement   He or she  has to be a peoples person.

Partnership

We  keep thinking of starting solo practice and  many of us do .  But it comes with a huge investment of  time and capex risk.   Partnership is a great way to start.  Many from our fraternity say that partnerships dont work and focus on other negatives associated with partnerships But I do believe in looking at the positives.  I also look around and see that many people in many different businesses are partnering with each other to build successful businesses.  Ofcourse there may be problems, but then you may also  meet with an accident when you drive a car and a patient who undergoes cataract surgery may get endophthalmitis Does that mean THAT  we will stop driving or operating  ??   I guess not.   If each one of us is fair to the other then yes PARTNERSHIPS  will work.  When a young ophthalmologist joins your practice , he too wants to grow.  If you as the senior collegue cannot provide him that opportunity then that young doctor will leave and do his own thing Think of partnerships WHEN YOU ARE A YOUNG OPHTHALMOLOGIST raring to soar .  Here are the advantages that come to the mind   Less capital investment,  ability to provide more comprehensive services  and better quality equipment. And better utilization of that equipment and facility.  More brains means more  ideas grow  Partnerships also help in   Better work life balance ( this is very important in life.  I cannot stress enough )  and more opportunities to start a second and a third centre.

Learning

This is a very broad term that i use .  Learning can INVOLVE a  million things.  One has to make an effort to learn new things.  Best strategy to learn is to structure it  into your schedule.  It could be accounts, investing money, how to hire people, how to win people over, how to negotiate, how to write a purchase or work order, some tally usage, using technology (email, calenders, productivity tools, apps to help you plan meetings, apps that help you schedule whatsapp messages or emails) some basic networking ( computer networks).  If you are starting a second and third centre you may learn a bit about doing up a place, renovation, costs involved,  There are several other things that we can focus on  We can learn to eat healthy.  how to stay fit,  how to balance work and family life,  how to perform most efficiently and  how to meditate ( I am trying to learn this at this moment and i hope that this will increase my ability to focus.)  You could read about how to become more efficient, more productive... the list is endless.   But dont forget the order of your books.   First is Kanski, then all the other ophthalmology books and some of what i have said in the middle somewhere.


Dr. Deepak Garg

Dr Deepak Garg did his post graduation and pediatric Ophthalmology fellowship from Sankara Nethralaya.  He left in 2005 and started Eye Solutions in Mumbai.  Currently they have 3 locations in Mumbai.  He firmly believes that Sankara Nethralaya changed his life and he is extremely grateful for that.  He wants to become super famous, he wants to open many centers and he wants to be a huge donor as the years go by. He can be reached at drdeepak@eyesolutions.in