Getting Started

[Guest guest]

Greetings, Friends! I'm new to the list-- have loved reading your comments here

for the past month or so. Learned a lot. I'm a Family Practice physician,

practicing for the past 6 years in Truth or Consequences, New Mexico. I've been

working at a community health center but plan to open my own solo practice here

in November, 2009.

I am at the point right now-- well I'm taking my loan application to the bank

this coming week.

I have so many questions!

T or C is pretty rural and medical services at the local hospital are limited

and of pretty uneven quality. People don't really like to go to our local ER

unless they have to, and specialists like dermatologists are an hour away in Las

Cruces. My patient population here is primarily geriatric (last survey said

half the population here is over 65), fairly low income so unlike for many of

you, Medicare and Medicaid patients will make up most of my practice (except for

the people who have no insurance! For them I am real interested in your

subscrition/direct pay ideas.).

I have a pretty large practice now and many many patients will be loyal and make

the shift with me. I don't think I will have problems scheduling 15 pts a day

pretty quickly. That is about all I want to see.

I bought the building where I plan to open the practice several years ago

(2005). It was a chiropractor's office so it has ADA access most places, good

location, etc., but it is needing a lot of remodeling. I confess I want to

work in a beautiful place, not necessarily fancy but I love that the building

looks out with several big windows to Turtleback Mountain, and in the back it

opens onto a closed-in private courtyard (just cement now but I put in a well to

the hot springs which lies 6 feet below ground level here.) I'm going to spend

about $30,000 on remodeling this year-- expect the ambience will be funky but

elegant. Maybe this is stupid but I am going to spend most of my time here

and I want to feel GOOD and want my patients to feel good too.

I don't have much debt but I don't have much cash either. I'm going to see how

much I have left over after remodel to buy office equipment. Again, maybe that

is stupid but that is how things are going.

Mortgage payments are $800/mo, insurances $200/yr, taxes about $500 yr.

General Questions and Concerns:

1. STUFF! I don't know how I can do this!

I've read many of your comments about a stripped-down office. Here in this

rural community I think I need to be full service. So I'd like to buy an ekg

machine-- I just don't want to have to send my pts with irreg irreg hr to the ed

or Las Cruces. I'd also really like to get an autoclave (used seem to run

around $2000). Where I work now we are JAMMED with patients and patients have

to wait sometimes 2 mo to schedule enough time for a procedure whereas the

dermatologist-- if he takes their insurance and if they can get to Las Cruces--

can see them in a couple of weeks! But if I used open scheduling and some of

the other innovative practices I am learning about from you guys I could get

them in sooner and do maybe a couple of office skin bx's a week. Need to

rent/purchase (however you do it) nitrogen, oxygen.

The local hospital is improving its lab a lot lately so I don't think I want to

buy a lot of CLIA-waived lab stuff but I would like to do PT/INR and AICs in

my office-- now do at least 3 of each a day in my present clinic.

Wonder if those new little cartridges for AIC are accurate?

2. HELP!

I read about some of you doing your own billing, answering phones, etc. I'd

really like to spend my time doing what I was trained to do not that stuff. EMR

will save me some time, but not enough. I want to hire my current talented

Medical Assistant to work with me but also really want to have a nurse in to

help with diabetic education including getting people started on insulin,

immunizations. Unna boots, wound care, fielding calls from patients, etc, etc,

etc. I've contacted a retired RN in the community who would like to work full

time. I am thinking she could train me to do some of the above stuff.

I'm planning to hire a billing firm and a CPA. I am really not good at

accounting stuff.

SO does anybody out there have a nurse and a medical assistant and a billing

service and an accountant? It seems overwhelming!

I turn this over and over in my head and I just don't know if I can make it.

I'd appreciate anyone's comments on anything I have said.

Again, I appreciate all of you. I'm so glad you are out there. We seem to have

many heartfelt goals in common.

Best to all,

Haruhuani Spruce, MD

Truth or Consequences, NM

Email:

haruspruce@...