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I haven't been here in a while and I'm sorry that I haven't added any of the new people that have asked to be added to the blog because I didn't see the requests until now.  I will say that you should have second thoughts about PA-ownership.  The reason is, it is becoming more and more difficult for small practices to exist.  I know of only one physician practice in our region that has not sold out to big health care (hospital groups). The reason is, insurance companies are making it more and more difficult to get paid.  I would guess that 60% of our time, cost and 90% of our emotional energy is completely wasted on dealing with insurance companies.

 

On top of this deck being stacked against you, you have these people, some are physicians, lawyers who work in government and executives at insurance companies who are totally committed to your complete failure and they will do everything in their power to fight against you.  It becomes battle after battle that you have to endure.  Why?  I honestly think it stems from their deep insecurity and self-esteem issues where it scares the hell out of them to think that a PA can own a practice and give better care than they can.

 

I'm at a juncture where I'm seriously considering selling out.  I love seeing patients.  I actually love being my own boss.  I'm sitting here right this minute in my large office on the water front looking over sailboats, snow capped mountains around me.  I couldn't have this if I were not the boss and have created this clinic here.

 

So, not to mean to offend anyone, I describe this ownership like being married to a supermodel , a supermodel who beats the hell out of you each night when you come home with a baseball bat.  It is the extremes.  Extreme love of being my own boss and doing things my way to bring the best possible care.  And then there is the loathing of talking to idiots day after day who want to refuse to do business with me because I'm a PA-owner.

 

I may stay in this or may not.  It depends on the offers I get to sell.  I will miss dearly being owner if that happens, but I will enjoy the sanity of not working 7 days a week and going home at night without giving work a second thought and never having to talk to idiots again.

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Totally agree. I am part of a small practice and we are one office of only a handful of independent practices in our area (called "Pill Hill" because it was once where 90 percent of Family practice and independent medical practices once were). Most of the offices here have either sold to Sutter Health or Stanford University Healthcare. We have 2 MAs and of course my doc and I. I have chosen to take a huge paycut to work here because of the opportunity to work with my good friend and the independence I enjoy but running the business is getting tougher. We might actually stop taking ACA (like many practices here) because of poor reimbursements with more cuts to come around the corner. I am not planning of leaving until it is absolutely necessary, I dont want to leave my friend out on a limb but lets just say my CV us updated and I am on the job websites and have 2 recruiters that stay in contact with me....just in case.

 

Sent from my SAMSUNG-SGH-I537 using Tapatalk

 

 

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I haven't been here in a while and I'm sorry that I haven't added any of the new people that have asked to be added to the blog because I didn't see the requests until now.  I will say that you should have second thoughts about PA-ownership.  The reason is, it is becoming more and more difficult for small practices to exist.  I know of only one physician practice in our region that has not sold out to big health care (hospital groups). The reason is, insurance companies are making it more and more difficult to get paid.  I would guess that 60% of our time, cost and 90% of our emotional energy is completely wasted on dealing with insurance companies.

 

On top of this deck being stacked against you, you have these people, some are physicians, lawyers who work in government and executives at insurance companies who are totally committed to your complete failure and they will do everything in their power to fight against you.  It becomes battle after battle that you have to endure.  Why?  I honestly think it stems from their deep insecurity and self-esteem issues where it scares the hell out of them to think that a PA can own a practice and give better care than they can.

 

I'm at a juncture where I'm seriously considering selling out.  I love seeing patients.  I actually love being my own boss.  I'm sitting here right this minute in my large office on the water front looking over sailboats, snow capped mountains around me.  I couldn't have this if I were not the boss and have created this clinic here.

 

So, not to mean to offend anyone, I describe this ownership like being married to a supermodel , a supermodel who beats the hell out of you each night when you come home with a baseball bat.  It is the extremes.  Extreme love of being my own boss and doing things my way to bring the best possible care.  And then there is the loathing of talking to idiots day after day who want to refuse to do business with me because I'm a PA-owner.

 

I may stay in this or may not.  It depends on the offers I get to sell.  I will miss dearly being owner if that happens, but I will enjoy the sanity of not working 7 days a week and going home at night without giving work a second thought and never having to talk to idiots again.

This makes me very sad because I have been thinking of starting my own clinic.  I already have my SP on board and am now working on the business plan.  Your posts have been very informative and I also see the changes where I work now with crappy reimbursements.  I hope you will make the big hospitals (or whatever other entity) pay up to wazoo to buy you out.   I guess at least I know now before I even get started.  

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I would like to read about your journey. I hear Cal makes it hard for any business. 

Your PM box is full.

 

stcharrj@gmail.com

 

Thanks,

Richard PA-C

Okay, I've added you.  I just flushed my mail box, so I'm sorry if there were messages there that I had not responded to. But it looks like it has been full since Sept  2013 and I thought it would be too late to respond now anyway.

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Mike, just wondering if you have considered something like a direct care model? Where you offer a subscription-based service, your patients pay you monthly and they can then bill their insurance, or some variation on that. I've seen it work for a lot of blue-collar direct primary care practices. I imagine it might be different and maybe more difficult for a specialty practice such as yours but if the insurance companies are giving you so much trouble that you're contemplating giving up, maybe cutting them out entirely is an alternative?

Best wishes to you.

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Mike, just wondering if you have considered something like a direct care model? Where you offer a subscription-based service, your patients pay you monthly and they can then bill their insurance, or some variation on that. I've seen it work for a lot of blue-collar direct primary care practices. I imagine it might be different and maybe more difficult for a specialty practice such as yours but if the insurance companies are giving you so much trouble that you're contemplating giving up, maybe cutting them out entirely is an alternative?

Best wishes to you.

I have thought about it a lot. A small, 2%, of our practice is cash only now.  I think the deciding factor about not going that route is discussions with my SP.  While he is willing to do anything I want to do, he is not in favor of this model.  I respect his opinions as he was one of the founders of a very large medical group and did the business end for a couple of decades.  I would love not to deal with insurance companies and that is what I envision Heaven is like. But he things that it would be really hard to support financially. I've listened to many lectures by experts on this or variations of this option.  Most suggest that you would loose 90% of your patients if you don't handle their insurances up front.

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This makes me very sad because I have been thinking of starting my own clinic.  I already have my SP on board and am now working on the business plan.  Your posts have been very informative and I also see the changes where I work now with crappy reimbursements.  I hope you will make the big hospitals (or whatever other entity) pay up to wazoo to buy you out.   I guess at least I know now before I even get started.  

 

Go ahead if this is your dream.  I knew that billing would be very important. However, I didn't know how hard it would be to find a good biller.  They are very rare.  My CPA (who takes care of several medical and dental practices) tells me that they all have had a hard time to find a good biller. The reason isn't billers are bad by nature, it is because the complexities in billing are growing rapidly. You need someone with a lot of experience, who is OCD and who really gives a damn about the business.

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  • 2 weeks later...
  • 1 month later...

Looking to start a cash only testosterone and ED clinic in Washington state.....would love to get your blog....

Send me your email via PM.  Maybe we can combine our practices into a "head and tail" approach. Actually, for a short time in the 80s when we still thought that migraine was a vascular illness, some referred to migraine as a "cranial erection." 

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  • 2 weeks later...

Hi All,

 

I am an entrepreneurial PA currently practicing in NY and NJ. I have a cosmetic/derm practice within a plastics office, but am technically an employee. As my SP is planning for retirement, I am planning for the future of my practice and would like to continue on as owner of my own entity. I have a lineup of SP volunteers, but am concerned with finding the type of business that is "technically legal" so that all parties involved are protected. I know several PA's have done it across the country, but I'm concerned with the NY state-specific laws. I felt I knew more about the laws governing PA's than a lawyer that I met with a while back and I don't want to waste money educating them. I by no means want to operate outside of the legal red tape, however, I'm sure that there are creative setups. FYI this is a 100% cash pay practice. Does anyone have any suggestions? Recommendations for lawyers well versed in PA practice ownership? 

 

Interesting side note...I certify and train MD's, DO's, Dentists, PA's and NP's to perform the procedures that I do nationally. Seems unfair for someone to say that I cannot own my own business with the proper PA/MD partnership IMO.

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