Should I start with telemedicine or rent an office first?

Dr Tea:   0:01
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise, the doctor gets full autonomy in how they care for patients and how they get paid. They have chosen this path with a love of medicine. This is the direct care way.

Dr Tea:   0:24
By listening to this podcast, you may even start to believe that you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the pandemic, and the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice. I'm your host, owner of a direct care podiatry practice Dr. Tea Nguyen.

Dr Tea:   0:52
Hey there, welcome to the second episode of the year. We're in 2023. And we've got some new goals and new ambition to start working on our dream practice. And I'm here to do that with you today. By answering some questions I get about how to start. Before I get started, I wanted to share with you I am opening up the coaching group program, which is going to be a huge booster to what you need to start your direct care practice. In this group coaching session, I do weekly conversations around how to prepare opting out processes how to increase cash flow. And you'll be doing this amongst a community of people just like you. Now in the beginning, you're going to feel like you're having one on one coaching with me. Because I tend to keep these programs really small so that you can get the attention that you need to get started. In your practice, it might seem easy to get started. Or it might seem really hard to get started. Wherever you are in your journey. Whether you're a student, or resident, a fellow an employed position, or you are already in private practice, but you want to start opting out, this is a really great way to get started, details are in the links below. membership includes monthly option or an annual option. Because I want to be there with you throughout your journey through the ups and downs and the hardships that come along with owning your own business. The process could sound very intimidating. And the idea is really to help you through that process.

Dr Tea:   2:18
This coaching session starts this Friday, January 13 2023. We meet at 12 o'clock at lunchtime so you can bring your lunch. That's Pacific Standard Time. And I really look forward to meeting you and helping you along your journey. Okay, so now moving on to a question that I just got that I thought was worth elaborating on. The question is I'm looking to start my practice in an area that is mostly health systems, and wanted to know if I should start with telemedicine or get a rental place. First, I like this question because this is probably a question I should have asked, when I started my private practice. I'm also in a community that's predominantly health systems run. So most of the docs around here are employed or contracted. I started my own practice in 2018. And that was from the ground up, I opened a rental space and built everything from scratch.

Dr Tea:   3:15
And that's how I started my practice, mostly because I didn't have the foresight to think about what could be in the next couple of years after I open, I only had the impression that once you open your practice that you can anticipate some groundedness or some level of predictability by year three to five. And that's in the insurance based practice. But I also believe that's probably similar in the direct care way while you're practicing without insurance reimbursement, because the growth of your business does have a lot to do with your relationships that you build within your own community. And I've asked a lot of successful practices, where do they put their money in marketing, and most of them will say it really gets generated by word of mouth.

Dr Tea:   4:01
And ofcourse, these are folks who are decades out in their practice. And so the landscape of marketing looks a little bit different for them than it does for us in the newer generation. Those are those of us who are in practice in 10 years or less. And so just kind of pencil that in the back of your mind that no matter where you end up spending your money, your dollars, your marketing dollars, that the one that gives you the most traction is still word of mouth. That means you can't ignore the daily task of meeting people creating relationships and gaining their trust. That's just part of the equation. The other part is going to be stuff like social media, having a decently run website with SEO that's properly aligned to get you in front of your potential patients.

Dr Tea:   4:45
And so if I had asked myself this question, Should I have started telemedicine or get a rental space first, I probably want to just dive into both. So my experience has only been to get a rental space first, because with the prior consulting firm that I He was asking about what I should do that was the traditional model. Now we want to talk about the benefits of getting your rental space first versus the disadvantage. So the benefit of a rental space is that it's your own space to claim. Initially, when I was in the insurance based practice, when you contracted with insurance, you needed to have a business address, so that they can send your bills and establish you as a business.

Dr Tea:   5:25
But this modern age where a lot of us are moving more towards virtual visits that may not be necessary, you can have a peel box or an alternative professional business address, there's a lot of services that offers that as well. So that you don't have to have a rental space. The other advantage is if you anticipate building out your practice, you have the space to do that. So in the first three to six months, you might be a little bit slower in building your practice, whether it's insurance based or cash in as you build up, you can start generating revenue that can pay into your lease or your rent. And that's kind of a nice window of opportunity to look at having a rental space. As an advantage, it's an investment, you put money out month to month to have the space that's dedicated to yourself, where you can have everything you want exactly how you want it. And if you're anything like me, or you know, you're a little bit neurotic about having things perfectly where you want them to be. The rental space makes sense.

Dr Tea:   6:25
Now, the disadvantage of that is you're gonna have to pay somebody else the landlord that monthly rent, whether or not you have business. And so there is financial investment that goes along with having that rental space. The disadvantage that I had in my rental space was that I didn't really get the clear picture of the parking lot situation. And this is kind of a minor but important detail. I rented a space within other medical units. But the parking spots were kind of limited. At first glance, it looked like it was spacious enough to accommodate all of the different businesses in the facility. But as time went on, and people started to move in and out of the structure, one of the doctors who moved in was very busy, and they were double triple booked, and the parking lot was always packed. And so that actually affected my business because my patients weren't able to find parking.

Dr Tea:   7:12
So they showed up late or they showed up annoyed or whatever the circumstances are right. And that wasn't really ideal for me. And so that was something that was kind of a little oversight, the parking situation that you may not be able to predict until things start to happen. So side note, you know, the rental space, just things to look out for if you were to start with a rental space, I think number one, if you are starting lean, you don't want to spend a whole lot maybe consider subleasing from another doctor. Oftentimes primary care doctors or alternative medical doctors like natural paths. Oftentimes doctors aren't in their office five days a week, and they could probably offer a half day or full day once a week for you. That's something that could work out as a nice cooperative relationship. If you are going to sublease, just make sure that you aren't violating any anti kickback laws that exist, which means just pay the rent for its fair market value price.

Dr Tea:   8:10
And you might need a real estate agent to help with that, or even a lawyer who would know more about your area. So those are the advantages and disadvantages, you know more money upfront, but at least it's the space of your own that you can claim. And all of your stuff is where it needs to be, which was my reason for getting rental space. If I were to do it over again, I would definitely consider subleasing because that would have been a nice way to save money until I built up the practice to it's full time potential. But in my area, I couldn't really find anybody. And so you know, you kind of just work with what you have. And hopefully you don't get locked into a long term lease that you can't get out of which was my situation. And so I'm hoping to prevent you from going through the same mistakes that I did. So don't lock yourself in a long term lease, if you don't really know what your practice is going to look like in the next two to three, even five years, it may look really like a good deal upfront, but you might get stuck with something you can't back out of. And plus commercial leases are not as at least in my area, they're not as much as in demand as maybe some other types of properties. What that means is,you know, just kind of pay attention to your landscape, I had noticed a couple of businesses that were available for lease some open spaces that were available for lease for like two to three years.

Dr Tea:   9:27
And so knowing that the turnover rate for commercial lease is really low, might help push you towards one direction or another in regards to rental space. Now if you want to own property, that's a whole nother nother conversation, which is a good consideration. If you are into real estate, you want to invest, you don't want to pay rent to a landlord. You want to pay into yourself and have those types of tax benefits but that's a whole nother discussion. So the question we're going back to should you start with telemedicine or get a rental space first I think the answer is just do both. telemedicine is offering a consultation by phone or even by a zoom.

Dr Tea:   10:04
And if you have a cash practice, there are no regulations as to what platform you use other than it being HIPAA compliant. And to be HIPAA compliant means the program that you're using that might obtain personal information about your patients, their name, their first last name, their email, things like that, then you want that business zoom, for example, to have a be a business associate agreement. And you can Google this online as to what that looks like every business that I've encountered usually have their own template with their name, and you just plug in your name. That just means that you both will do your best to protect your clients private information.

Dr Tea:   10:44
I am currently using an EMR simple practice that has a built in secure telemedicine option, it's a feature that's added on on top of the documentation. So look around to the EMRs that may offer telemedicine platform in a secure way as well. But if you're really wanting to make it very simple, a phone call may be good enough for the consultation, a Zoom meeting might be good enough for the consultation, and then just find a way to get payment. A secure way to get payment might be something like PayPal, or just have the person mail you a check. There's a lot of different ways you can go about that. Whatever payment system you have in place, make sure that that's also secure by obtaining a business associate agreement. I'm currently using Stripe and square for payment.

Dr Tea:   11:34
And that's been working for me so far. So if you wanted to start your telemedicine practice, I think it's excellent because you might be the first encounter that a patient has, because of your accessibility. Being able to talk on the phone and get paid for that is a really nice way to get started in your business. So I don't know if if the question is really either or, you know, have telemedicine first and then get to a rental space or get the rental space and then add telemedicine like incorporate all of it, you have the freedom to choose either one. And I think that's for you to explore, I can't tell you which way is the best way. Only you will know what you would want to do and what makes sense for you and what your ideal clients are looking for.

Dr Tea:   12:17
So some key points about this question is, number one, start with the end goal. How do you perceive your practice in three to five years. If you're not interested in having telemedicine in three to five years, then you don't really need to start in that way. But if you think it is viable for what you do, then certainly start incorporating it right now. To get started in telemedicine. All you really need is a platform to offer the video conference something like zoom, or go to connect. And then number two a payment form how are they going to pay you after the consultation if you trust people, and you want to invoice them, and hope that they pay that that's reasonable. But for me, I'm a little bit more of a stickler, I like to have credit cards on file first, before having a consultation. And that is built into my EMR. Number two, if you want to start lean telemedicine makes sense. And it's something you can do right away. 

Dr Tea:   13:15
And it's really great that it's becoming more and more acceptable an acceptable way to get your medical care. Alternatively, you can sublease from another doctor, maybe a half day a week or a full day a week until you start to get your feet into the ground. And then you can decide once you get the capital, whether or not you want to move into a rental space and what that rental space will look like for you. In either scenario, whether you have an office or you're doing telemedicine, you have to ask yourself this really important question. And that is, where will patients be coming from, because simply having a beautiful website, or a door to knock on doesn't guarantee that people will show up and demand your services? So you have to go back as to how am I going to market myself so that people are on my books so that appointment slots are filled.

Dr Tea:   14:06
And I'll continue on this conversation in future podcasts, episodes about how to market yourself so people actually show up. So look at your potential referral sources like your top 10 strong referral sources. What does that look like? It might be a primary care doctor. It might be a specialist who you work with on a regular it might be from alternative medicine doctors or even community centers, or even large corporations. Those can be your referral sources depending on what you offer and how you sell your offer. Now if the word selling makes you cringe, I think we need to talk I think we need to get on a phone call and talk about how selling is a good thing people want what you have to offer. It's not a bad thing. And that's what my coaching program is all about. I'm going to help you through some of these mindset drama that you might be having that's holding you back from your dream direct care practice.

Dr Tea:   14:58
Now number four with rental spaces I talked about considering subleasing from another doctor, it can also be another situation that might be symbiotic and non competitive, you don't want to be in a space that can be perceived as competition for patients. And so find yourself in a symbiotic situation, so that you minimize conflict, and essentially stress. And number five, if you were to go all out starting the rental space, just know that this is going to have a high cost up front. And if you want to do that, just make sure that you're going to have a return on investment, which means also learning the language of marketing, so that you don't leave your business up to chance for people just kind of coming through their door, once the door is open.

Dr Tea:   15:44
The saying of hanging a shingle and they will come is really outdated, you actually have to do some footwork to get those people coming in. I've known doctors who had a waiting list of people who want to see a cash practice, a direct care practice, before they even open the door. And this was not an accident. This was a specific technique that they use, and that they did to ensure that their books were filled before their doors were even open. If that's something that interests you, and you want to learn more about, hop on a call with me and I'll share with you what their secret was to getting their books filled before they even open the door. In direct care, there really is no one right way to do it. There's just the way that you want to do it. And this is an experiment, you design experiment, you collect some data, and then you make a conclusion with the results you have. And that's it. Oh, yes, I wanted to point out one last thing, that just because you're opening a practice a private practice, in an area that's dominated by health systems, that doesn't mean the health systems is your competition. In fact, because you are independent, you offer something very unique that the health system does not offer, which is personalized care, and fast access. So if you leverage your offering your value proposition on those key points, you shouldn't have to worry about opening up a practice in a place that is predominantly physician employed. In fact, that uniqueness is what's going to help drive patients into your direct care practice.

Dr Tea:   17:16
If you're listening and you're like, hey, I have a telemedicine practice that's been very successful, or I have a rental space. And these were the things that I learned that I wish I knew before I started, I would really love to hear from you. Send me a message down below. And if you want to share some comments about this episode, I would be happy to share it on future episodes. That's all for now. Take care, and I'll see you next week.

Dr Tea:   17:41
Thank you so much for being here with me. If you enjoyed this episode and want to hear more, please like, share and subscribe so more people like you can have access to another way of practicing medicine, that direct care way. Let's connect find my info in the show notes and send me your questions. That might be the topic for future episodes.

Dr Tea:   18:00
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time