"I need everything first before I start"

Dr. T:      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. T:      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. T:      0:53
Welcome to episode number 49. I'm so excited to be here. This year 2023, I really wanted to expand my reach. So direct care is really for all specialists. This podcast was designed initially for other podiatrists because that was the language that I use in my own podiatry practice. But looking at the processes, the concepts, the mindset behind developing a direct care practice, it's all very similar. So in this year, I want to invite all specialists to take a listen to this episode. And all of the others, of course, because it has some valuable gems that you can apply in your own practice in your own development of your direct care practice.

Dr. T:      1:37
So today, I'm going to address a concern slash question about an individual doctor who said that they feel like they have to have everything in place, before they decide that they wanted to have a direct care practice. Maybe this is you, maybe you've been listening, just to see what direct care practices are like, and you still feel like you don't have enough information. Despite being here for now. 49 episodes, plus probably all the information you've been googling or looking on Facebook and even talking to others, right? We always feel as physicians that we need to have as much information as possible before making a decision. And I want to give you another perspective, when you're a physician, when you're a surgeon, yes, you want to have all of the information in front of you to treat a patient.

Dr. T:      2:32
But when you're developing your business, sometimes you have to make decisions on the fly, you may not know what the outcome is going to be until you take action. So you may not know what your practice will look like, exactly. I mean, there really is no book that takes you from A to B to C to D, when you're developing a business, it's really trial and error. It's developing that muscle of experimenting, and looking at the results. It's being okay with exploring and trying different things, until you get it just right, just for you. And through this journey of business development, what you're going to find is that when you don't know exactly what you're supposed to do, the next best thing that you should do is to take action is to make a decision and commit to that decision, until you see it full out.

Dr. T:      3:21
So the action that you take will create clarity, I'll give you an example of what that means. I put together a lecture had it promoted. And when I gave the lecture, nobody showed up. The interest in this particular demographic was low, there were some people who registered for the live lecture. But nobody really ended up staying for the whole thing, or even participated in the q&a session at the end. So I could say that I successfully delivered a lecture. But I could also say that the outcome was not successful. However, the information that I gathered from this experience was that it wasn't that my lecture was bad. I had practiced this lecture time and time again in different audiences. And it has valuable information. But I just wasn't in front of the right people. And because I was doing this in a different format in front of a different audience, I really didn't know what the response was going to be like I kind of went in blind, because I didn't know who was going to be on the other side of the screen. This was a webinar that I was doing on Zoom. However, I took that information in that experience as a learning opportunity. I learned that the lecture was valuable enough, it just wasn't in front of the right people. And so do I have to tweak my lecture a little bit? Yeah, I'm gonna have to tweak it for the audience that it's intended for, or I just have to present it in a whole different arena.

Dr. T:      4:43
But you see what I did there. I didn't beat myself up in saying that lecture was a failure. I said, I committed to the process. I committed to creating the lecture delivering it and observing the results. That's it. And this is just a business skill that I developed over time. Had I done something like this, four years ago, delivered a lecture where nobody showed up or registered, I probably would have been devastated, I probably would have said, I will never do this again, right because of that one time that I did poor market research and didn't have the outcome that I expected. Instead, I chose to view it as an experiment. I really didn't know what the audience was like in this particular platform.

Dr. T:      5:23
I was doing it for, but now I have some data. Now I know, I should not be talking about this particular topic in front of this particular group, because it didn't interest them. It wasn't something that really engaged this demographic. So going back to the individual saying, I don't really think I have it all figured out. Let me pick up some more pieces before I decide to open my direct care practice. Listen, when you started medical school, did you figure it all out before you entered medical school, you probably had some idea that you were going to commit to making it work. But maybe you didn't know all of the challenges that you were going to encounter. Plus some of the life scenarios that kind of happened onto us that we had no control over. I mean, after all, medical school was four years, but it school is four years, we could not predict every single activity, every single life lesson that happened to us in those four years.

Dr. T:      6:19
But we did have the big picture, we did know that we wanted to complete the process with our degree, whether it be an MD a deal or DPM, but I bet you went into medical school with the intention of figuring out how you were going to get through it, you knew it was going to be hard. But you were also resourceful in ensuring your own success. That's how you should be viewing your business as well start with the big picture, wanting freedom in your medical practice. And then all the pieces start to come into play. And in order to know what the next pieces are, what the next puzzle is to solve is to really to take that first step, that first action.

Dr. T:      7:00
When I started my direct care practice, I wasn't sure if I wanted to do the monthly membership option or continue on with a fee for service. I tried both. And with both, I got to experiment, I got some of the feedback. And then I got to reevaluate exactly what I wanted to do, and take away things that I didn't want to do anymore. If you listen to the previous episode I did with Dr. Grace Torres. Hodges, she is mostly fee for service. And I shared with her my experience in offering a membership service for particular conditions that it kind of worked, it kind of didn't. And you know, go back to that episode, take listen to her, she has some brilliant ideas, some good feedback in in starting a direct care practice. So that's a really rich resource for you as well. So what I'm getting at with is, you won't really know what the end result of your practice is going to look like until you start taking the first move. And sometimes that first move is experimenting on whether or not you want to do a membership. Or if you want to do a fee for service, or if you wanted to implement some kind of retainer fee in your direct care practice. So how do we simplify the process of starting our direct care practice, when in the beginning, it probably seems very overwhelming because it's kind of crazy to do what the majority is not doing right to be the minority can seem a little bit mind barley a little bit insecure.

Dr. T:      8:22
And there's probably a lot of fear that comes from that. So here's my advice to you on how to simplify your direct care practice. Number one, just write out all the things that you need, grab a piece of paper and scratch it all out. It doesn't have to be perfect. or type it on your computer type of every possible thing that you will need to open on the first day of your direct care practice. Once you take it out of your brain, and you stick it on a piece of paper, you'll feel a bit of relief, because instead of it looking really messy in your brain, it's out on paper, it's tangible, it's actionable. So at the bare minimum, write down all the things that you need in a Word document or on a piece of paper to decrease the sense of overwhelm. Next is dealing with the legality of your business. So if you needed to, you might need to decide between an LLC a PLLC or the variety, work with an attorney or go to LegalZoom. For recommendations on how to start your medical business legally, then you want to see in the location that you desire to practice. Does that please also need a business license? What other registrations do you need cost for your DEA a controlled substance license?

Dr. T:      9:41
Other maintenance like hospital credentialing insurance contracts if you chose to do a hybrid first, get a biller and the billing software that they recommend and the EMR that you'll need to document your patient encounters and make appointments on now. Keep in mind in the beginning of your practice unless you have a wait list, the first few months are not going to be completely full, there's still going to be a period of startup. And if you are procedural, your surgeon, the first person you encounter may not necessarily need surgery. So in the beginning, you'll be doing a lot more consultations before you start doing procedures and surgeries. So keep that in mind as well. That means that you don't need every single piece of equipment ready.

Dr. T:      10:24
On the day that you open your practice, start really basic, what is it that you need to even offer a consultation, it's a phone, a laptop, a business card, maybe some diagnostics, like your hands and gloves, maybe some gauze and saline. If you think you're going to encounter body fluids, write all of that out on supplies that you'll need to refresh or purchase. Next, look at the things that you might be able to outsource for podiatry. A lot of us like having in house X rays, a digital unit is that really necessary though, in the first couple of weeks or months of your practice, that's kind of up to you and your budget. I personally did purchase an x ray unit, but I wasn't really using it not even on the first day that I opened. And could I have outsources likely because there are X ray facilities within the community that is easily accessible. So think about those larger equipment, things that you might need in your consultation and the possibility of outsourcing it. Before you make that big purchase.

Dr. T:      11:28
Other considerations, maybe you can share some of the equipment with somebody locally, now is the time to start developing those symbiotic relationships, I call it and see if there is opportunity to reduce costs and expenses early on. Back when I was printing paper, I'm now completely digital. But back then I had to get a shredding service, I had to get that shredding box in a place to store the thing, I had to get printing paper ink for the printer, I ended up having to rent my printer because I didn't want to pay for the ink cartridges anymore. And that maintenance and so on, you see how these costs add up. So maybe try to save a step by digitizing everything in your practice, from the intake registration to the consent forms the Adobe Acrobat Pro, I believe it's still free. If you download the PDF, you can convert that into a digital form that patients can sign digitally. And then you can just upload it in into their chart. Or maybe you have an EMR that already has that option. So try to digitize Next, think about ways you can partner with local businesses, you're going to be low volume in the beginning. And maybe you haven't set up your sharps disposal. See if there's any other dogs in the area where you can use their sharps container to dispose your low volume sharps, or even a local pharmacy that will collect sharps for free. I have a local pharmacy that does that. And so I did that in the beginning, they had an allowable of like one sharps container per month or something like that.

Dr. T:      12:51
And I wasn't using a lot of sharps anyway, so that was a really good option for me. Same thing with paper shredding, I have a local paper waste company, that if you're low volume, you can just drive to it and drop it off and they charge you by the pound. If you are a higher volume, then it might be more cost effective for you to have someone pick up the shredder instead. So those are just some options. Now some people think they need a huge fancy website in the beginning. And the reality is if you have a brick and mortar and office for people to go to websites are important, but they shouldn't cost you that much. You can easily create your own website online, there's a lot of how to build your own websites. And that's what I did in the beginning, you just need a place to park your name, your address and the services you provide and how people can call you. And you can even register your Google business. If you have an office address available, I really wouldn't go overboard with setting up your website in the beginning, because a lot of the marketing efforts are going to be word of mouth potential referring doctors like a primary doctor or even other specialist. So are we kind of take it really easy on the website development down the road as the budget allows, then you can look into doing SEO and optimizing your website. So it stands out on top on the Google search. And you can also do that organically by asking your existing patients to give you Google reviews, I think the most important thing here is that you don't need every single thing before you open your practice.

Dr. T:      14:19
You need to have a general idea of what you want to do with it. And you want to have the legal structure in place for protection. But as far as the detail goes, the supplies that you'll need, even the coaching that you want to invest in. Those can come a little bit later as you start to build and as you start to take those action and see what it is that you actually need. Because you might be surprised with what you think you need and what you end up not needing. So for example, when I first opened my practice, I ordered everything that I thought I could possibly need. All the wound care products, all of the casting material, the fiberglass, all of that not realizing that the first 30 days a may not be Suppose to those opportunities, I may not need to cast somebody, or I can outsource my X rays, for example. So every 30 days do a re evaluation of things that worked, things that could be improved on and things that you might need to let go of, and then look forward in the next 30 days, do I need inventory for an entire year? No, I don't recommend that at all. That's just sitting capital going to waste going to be expired.

Dr. T:      15:24
But you know, you can really simplify starting your practice with something as simple as getting your LLC opening a bank account having a place for you and the patient to exist. And I can even look like telemedicine. In the beginning, it's really easy to sit in procrastination, I guess, because you want everything perfect the first time around. But when you're building a business, you won't really know what you'll need until you start getting your feet wet. You start putting yourself out there, you start seeing what kind of patients are coming in what their needs are. So you see, it is the action that provides a clarity in how you want to develop your business. You don't want to have all this stuff lined up. And then 90% of the products that you buy or the equipment that you invested in not going to use, that is a really bad way to go about it.

Dr. T:      16:09
So if you find yourself saying I need to have everything in place before I opened my practice, I want you to take a step back and be honest with yourself. Is this really true? Or are you just kind of delaying the inevitable because it is very scary to finally open your practice and have your doors open on that very first day that very first week in that excitement slash fear can really paralyze us from taking the action we need to take in order to move forward in our business. So I hope that this information was helpful and you know if you are in analysis paralysis, or perhaps you want to sign up for my coaching program where I can help you create your very own personal roadmap so you know exactly what you need to do in order to get started in your direct care practice. The sooner you make the decision to do this, the closer you'll be to your dream direct care practice.

Dr. T:      17:03
Thank you so much for being here with me. If you enjoyed this episode, don't 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. T:      17:22
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time