What is the best way to approach a potential SP?

[ventana]

So still slowly picking away at starting my own practice

 

to the point of incorporation and EIN and lining up an SP

 

Have a few in mind, but what do people think is the best way to approach them?

 

Telephone

Letter

(both the above followed up with a meeting)

then is the meeting at their office, my house, a restaurant, lunch or dinner??

 

I have a thought but wanting to see what other people think is the best approach

 

 

 

 

 

 

 

 

 

 

Another question - trying to do this as my own corp with out an MD/DO in an ownership role - will have a family member own 1% and the doc position will be a paid position However - have also toyed with the idea (The state of mass has some fuzzy laws about the 'Corporate practice of medicine' which means it would be best to have a doc as owner but I don't want that) of exchanging a 10% ownership stake in the company for the first 6 months of supervision free - then just paying them an hourly rate when they do chart review (and make it a high enough hourly that they are happy - i.e. $100/hour.) This has a lot of benefits legally, but ties me to one doc and if that doc starts to get jealous of the income that I am generating (have heard horror stories of this) they could really make my life miserable (and much more so as an owner versus and employee that I could replace).

What are peoples thoughts on this? (no matter what the decision is there will be some legal agreements with consequences and requirements that will need to be drawn up and signed to protect the company from a crazy doc)

[jmj11]

This, getting a SP, is the toughest part. I approached about 12 physicians. They all thought I was a nut case and what I was doing was illegal. The SP I finally got, well, because we were the only people in the region who saw headache patients. So, when I heard he took an early retirement I jumped at the chance. I went to his clinic (where he was working PT) and asked to go out to dinner, me buying, to discuss a business idea. We went out, I laid out my business plan and the rest is history.

 

 

I attempted to do the same thing, pay my SP in shares, 1 share per month for 10 months (in lieu of SP payments). He balked at the idea because he knew he could have 10% of nothing at the end. So I gave him 1% for the first month.

[ventana]

just learned that the local NP practice only pays $800 per MONTH to their SP for 2 NP's!! that is affordable

 

setting my goal a little lower - I am thinking 5% of collections.... I have a tough time with a flat fee as it hurts to much when I am slow, but they I am basically taking advantage of the SP when (if) I get cranking.... I want the SP to be happy and feel a part of the business and if I am making 150k and he is getting $800/month I could see them getting frustrated and I really want to avoid doc turn over.....

 

so have contacted my first potential SP and waiting on a return phone call. Broached the idea I have and that it would be a paid position (he had just been crying poor so timing was perfect) that would require very little time from him..... have #2-#5 docs all lined up in a list in case he says no.......

[Contrarian]

When I first started talking about owning a practice in 2000...

After my initial research... I found that MOST physicians would be hesitant practicing in this model simply because it was "non-traditional" and you know like I do that MOST physicians are, by nature... afraid/leery of anything non-tradditional. Simply put... providers... for the most part aren't innovators and/or "out of the box thinkers."

 

I found that Physicians don't put much stock into what non-physicians and/or non-lawyers think or say about the practice of medicine. Hell MOST can't even fathom the idea of starting a practice and simply "look for a job" upon completion of their training. So I endeavored to find physicians with extensive experience practicing collaboratively with top notch clinically sound PAs. As I figured they would be easier to convince.

 

I have several SPs.

 

My Medical Director is a friend, mentor and former SP at a previous addiction medicine clinic who has worked "with" PAs in EVERY practice he has started or joined since the 80s.

 

He serves as my SP on record with the state for free but didn't give me any slots to see buprenorphine patients because all of his slots were/are occupied. He served and still serves as a reference for me and as someone that other potiential SPs can talk to... to get the real deal info on PA practice and our ability. He told me that he would serve in this role indefinately for free and act as a "Liasion" to physicians for me. So now when I'm recruiting other physicians (have 3 now) I usually give them his phone number and/or set up a lunch with him (I pay), myself and the new recruit. He then assures them that the practice arrangment, while novel... is indeed legal, viable, carries low liability and can be lucrative. I usually talk to him by phone bi-weekly, by text weekly, and in person about once a month.

 

For my second SP, I asked my phamacist buddy for a list of all bup prescribers in town. I surmised that younger, big city docs would be a bit more "progressive"... unlike the "cloistered" closed minded small town, entrenched, good ole boy network here, that is decidedly anti-NPP.

 

Then I heard of a new doc in town who had come from the big city east coast who also had the required data waiver.

 

So, I simply "suited up" and sat in his lobby one afternoon (1245) with one of my clinic advertising packets and some business cards. It was a classic "cold-call." I felt comfortable with the "cold-call" technique because I had to use it quite a few times in PA school because we were required to find our own preceptors for required rotations. His staff thought I was a "Drug Rep" and initially started giving me the "pharm-rep" cold shoulder.

 

I gave them a business card and they softened up and made sure he had some time for me once they realized that I was a local provider and not a pharmaceutical rep.

 

When he came out, I introduced myself, apologized for the intrusion on his schedule, and gave him a abbreviated version of my business plan. I revealed "just enough" to pique his interest, but not tooo much for him to say no.

 

He agreed to meet with me later that evening at my clinic.

 

After he saw the place, and asked me some in-depth questions about my protocols and practice style to include a few patient scenarios... he said he'd think about it. He then called me a few days later and said yes.

 

My situation is a bit different because basically he pays ME.

 

Our arrangement is that he serves as one of my SPs for addiction medicine and pain management and gives me 20 buprenorphine slots. (guaranteed $3000/month from those 20 slots. Overhead is only $1,100/month)

 

In return, I take call for him 1 weekend/month... and randomly 1-2 days/month overnight. Thats it..!!!

 

My third SP is a older doc about to retire from the VA. I knew him from the hiring process at the VA. He interviewed me and took me to lunch back in 2006 when I was applying for a job at the local VA CBOC. I actually applied for that job 3 times, and was called for that job 3 times, but the process was soooo long that each time I they called... I was committed to something else (Iraq/Afghan/Sudan). Anyway... I heard that he was about to retire and simply approached him about collaboration.

 

He was hesitant, so I encouraged him to talk to JmJ11's SP since they work together daily at the VA... and JmJ11's SP and I used to work in the same circles, used to see the same patients and therefore work together and know the same key people in the local medical community.

 

 

I said all the above to basically say...

Be creative...

Network...

Dinner Meetings are a great place to put the word out about what you are planning and what you need.

Talk to a few trusted, ole-skool nurses. They KNOW who is retiring soon, who is disgruntled with their current practice arrangement, who is getting divorced and may be looking for other income opportunities, etc.

 

Keep in mind that its a lot harder to flat out refuse... in person than it is on the phone.

 

This also applies when approaching a physician to create a job in a practice that doesn't currently have any NPPs... or in a practice where a PA student wants to set up a clinical rotation/clerkship.

 

Good luck

Contrarian

[ventana]

so was turned down by my first doc the other night - no issues with the business or even being a PA - but instead that he was winding down his career, and does not want to take any more stress on. As he is a friend a believe him and he does only work 3 days a week to keep his stress low.

 

So onto doc #2 - today meeting

 

 

 

 

 

This is what I have come up with for a supervision payment

 

5% of collections capped at $1000/month or $12,000/yr

$50/month for cell phone

 

Profit share after one year (details to be determined - as I am the owner I get to determine them)

 

overall might give him about $13,000 income for a once monthly meeting - pretty good pay I would say.....

 

thoughts????

 

 

 

Also, to those PA's out there in practice for themselves - how did you handle the 1% co-owner that can't be the PA?

[Contrarian]

Just include the 1% in the "SP" reimbursement package... with the stipulation that they must sell it back upon termination of collaboration.

 

Getting yuor first SP is always the hardest... so You may need to "sweeten the pot" to secure your FIRST SP... then dial it down for subsequent physicians.

 

Good luck...!!!

[ventana]

oh man just had a great meeting

 

really nice doc - he is most interested in call coverage and vacation coverage as he is a sole practitioner and in need of these

 

He seemed to "get it" that this would be my company, not his, and he would be the medical director, but at the same time employed as such and not the owner - he seems very nice and encouraging. Went far better then I was hoping! Now a discussion with an attorney to see what is the best way to set this all up legally.