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What steps should I take now so that I can start my own private practice right out of residency? Any books/podcasts/mentors that anyone would recommend? I am single with $250,000 in student loan debt, does that make it impossible?

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What steps should I take now so that I can start my own private practice right out of residency? Any books/podcasts/mentors that anyone would recommend? I am single with $250,000 in student loan debt, does that make it impossible?
Read this blog. If you get nausea from all the steps involved to opening doors, then this is why most people dont open up right out of the gate. You are in debt and most banks are not going to finance a "start-up."

Your only job right now is to become the best podiatrist and surgeon. Unfortunately that comes with experience. Even if you get out and work for a year or 2 getting humble, learning the "business," honing on when to bill a 11719 or how to unbundle a lapiplasty, and cutting down that debt is not a bad thing.
 
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Yes, it's possible.

Start by looking at where you want to practice. Then do a value and demographic analysis of that area. Find out what the lease cost per square foot is in the approximate location, and find out what the going rate is to hire medical staff is. Decide how big of an office you need, and then look into how much it would cost to furnish and get equipment into that office. Look into the going rate for a fully functional EMR system, both hardware and software. Call some local billing companies there and find out what they charge to do your billing and ask them to send you some contracts and the various services they offer per contract. There are generally tiers associated with how much they charge you to bill. Expect anywhere from them charging you 10-25% of your receivables for their services. Lots more to that, though. Do you want them to chase your money? Tack on a bit. Send your patients bills and letters that they are deficient? Tack on more money for that, too. The reason to do this is that you won't have to hire your own staff to do that for you. Here's a tip though. NEVER let them take their money before YOU get paid. Tell them you want 100% of your receivables and that you will then send them their money after they bill you for their services. Much less chance they will rip you off that way. They may not agree to it. If not, find someone else. It's YOUR money.

Also, don't bother with digital x-rays. Since we only get $25 a pop to take and read them in the office, that $20K for a set up is better spent elsewhere.

Once you done all that, calculate how much it will cost you to open your doors based on the above numbers you've researched.

Don't forget you have your own expenses to pay, including your own salary. State dues, hospital dues, malpractice, etc.

Come up with a number for all of that. Then double it. That's what you will need to go to the bank and ask for a loan for.

If you want to chat more, I'd be happy to help you. Reach out via PM.
 
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You always hear "don't let anybody tell you you can't." That said, money doesn't grow on trees... and MA pay is all-time high, insurances aren't any easier, etc.

I found it to not be possible (to my standards/idea)... but that was ~2012-13 near finishing my residency, when most banks were reeling and had closed a lot of their lending programs (all kinds) after the 08-09 market crash. The guys I know who did it bigtime and got a sizable bank loan to buy out or start up a practice, improve it, market it, etc etc snuck in pre-2007. Fwiw, I had student loans a bit smaller than yours at the time but no appreciable credit card debt, no auto payment, no defaults or delinquencies, etc. I was told no without a co-signer, and even with my parent (tons of real estate and market assets) co-signing, I think I was offered $250k or $300k which was mostly line of credit at fairly high interest (would have been very dicey to pay staff and have any respectable office + equipment until payments started coming in for the city I was looking at... great insurance but very high commercial rents). Banks want to borrow money for sure things like franchise restaurants or gas stations... or collateralized loans like real estate... or at least home improve, cars, etc.

Make a business plan, tweak it, plan it more, find good office rental, etc... it will help you to run numbers. Talk to as many other DPMs as you can who have done bought an office or started one. Keep your personal finance impeccable. Still, be prepared to still be told by most regular banks that your debt to income ratio is too high or that they've closed their physician lending program. A lot of places will lend to existing businesses trying to improve or expand - but a startup is very tough no matter how good your plan is. Dentists would actually be the best to talk to since so many of them do it due to usually no other choice (just like podiatry 20+ years ago).

Assuming the big 4 banks and similar are a no-go, you are then stuck with "non-traditional" lenders like Kabbage (not even taking apps when I checked last year), hard money lenders, angel investors, credit cards, etc with substantially higher interest rates. If you go that route, since you are single, consider sleeping in the office to save money for awhile (wish I was joking) and live like a resident for sure. There is owner financing also, but that will typically get you into a very bad overpayment and needs a very good contract for the transition (owner will get greedy and want to raise the price once they see you hustling to grow revenues... and they control the financing if not well delineated).

People will tell you it's easier to get a loan for an existing practice than a startup, and that may be true... but 98% of established ones will be overpriced (usually grossly overpriced). Buying out a practice is highly valuable in that you can get onto insurance plans faster and have at least some amount of active patients... but you will almost always overpay for that - esp if owner financed. There is no easy road that I've found.

I continue to explore PP ownership from time to time but have not taken the plunge. I am just not willing to do the crap office with no staff, no xray, 2 rooms, etc... I have to have something I'm at least a little proud of and won't outgrow in a year (or worse, get complacent with a junk workspace). I will keep exploring it, but I have found jobs that are good enough and am actually not super far from retirement anymore just from frugality + investing (so buying/starting is not as viable and rewarding in the not-so-long term anymore). If you can make it work, I wish you all the success.

My classmates and buddies who've started their own had serious family help (grad zero debt and/or got the loan/gift for the practice in the family). Others did the associate or ortho/MSG thing for years, got rid of the student loans, built the credit, maybe got onto area plans and hospitals (has to be a place with no non-competes) and then did solo. That is a fine way to go. Pick a high paying job where you can bet board cert ABFAS and/or a place you'll learn a lot of billing and efficiency and prac mgmt skills (obviously you'd gain very little prac mgmt if you work for a MCA hospital or a VA or somewhere where you have zero involvement in the billing or marketing or hiring/training, no OTC products, etc).

The Medical Entrepreneur by Hacker is a good book. It covers a lot.
 
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Great responses everyone. Really appreciate it
 
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You always hear "don't let anybody tell you you can't." That said, money doesn't grow on trees... and MA pay is all-time high, insurances aren't any easier, etc.

I found it to not be possible (to my standards/idea)... but that was ~2012-13 near finishing my residency, when most banks were reeling and had closed a lot of their lending programs (all kinds) after the 08-09 market crash. The guys I know who did it bigtime and got a sizable bank loan to buy out or start up a practice, improve it, market it, etc etc snuck in pre-2007. Fwiw, I had student loans a bit smaller than yours at the time but no appreciable credit card debt, no auto payment, no defaults or delinquencies, etc. I was told no without a co-signer, and even with my parent (tons of real estate and market assets) co-signing, I think I was offered $250k or $300k which was mostly line of credit at fairly high interest (would have been very dicey to pay staff and have any respectable office + equipment until payments started coming in for the city I was looking at... great insurance but very high commercial rents). Banks want to borrow money for sure things like franchise restaurants or gas stations... or collateralized loans like real estate... or at least home improve, cars, etc.

Make a business plan, tweak it, plan it more, find good office rental, etc... it will help you to run numbers. Talk to as many other DPMs as you can who have done bought an office or started one. Keep your personal finance impeccable. Still, be prepared to still be told by most regular banks that your debt to income ratio is too high or that they've closed their physician lending program. A lot of places will lend to existing businesses trying to improve or expand - but a startup is very tough no matter how good your plan is. Dentists would actually be the best to talk to since so many of them do it due to usually no other choice (just like podiatry 20+ years ago).

Assuming the big 4 banks and similar are a no-go, you are then stuck with "non-traditional" lenders like Kabbage (not even taking apps when I checked last year), hard money lenders, angel investors, credit cards, etc with substantially higher interest rates. If you go that route, since you are single, consider sleeping in the office to save money for awhile (wish I was joking) and live like a resident for sure. There is owner financing also, but that will typically get you into a very bad overpayment and needs a very good contract for the transition (owner will get greedy and want to raise the price once they see you hustling to grow revenues... and they control the financing if not well delineated).

People will tell you it's easier to get a loan for an existing practice than a startup, and that may be true... but 98% of established ones will be overpriced (usually grossly overpriced). Buying out a practice is highly valuable in that you can get onto insurance plans faster and have at least some amount of active patients... but you will almost always overpay for that - esp if owner financed. There is no easy road that I've found.

I continue to explore PP ownership from time to time but have not taken the plunge. I am just not willing to do the crap office with no staff, no xray, 2 rooms, etc... I have to have something I'm at least a little proud of and won't outgrow in a year (or worse, get complacent with a junk workspace). I will keep exploring it, but I have found jobs that are good enough and am actually not super far from retirement anymore just from frugality + investing (so buying/starting is not as viable and rewarding in the not-so-long term anymore). If you can make it work, I wish you all the success.

My classmates and buddies who've started their own had serious family help (grad zero debt and/or got the loan/gift for the practice in the family). Others did the associate or ortho/MSG thing for years, got rid of the student loans, built the credit, maybe got onto area plans and hospitals (has to be a place with no non-competes) and then did solo. That is a fine way to go. Pick a high paying job where you can bet board cert ABFAS and/or a place you'll learn a lot of billing and efficiency and prac mgmt skills (obviously you'd gain very little prac mgmt if you work for a MCA hospital or a VA or somewhere where you have zero involvement in the billing or marketing or hiring/training, no OTC products, etc).

The Medical Entrepreneur by Hacker is a good book. It covers a lot.
A very good/accurate post

Almost everyone I know that started from scratch in a very nice state of the art office had family help. They still hustled like crazy and did nursing homes, worked a day a week at a medicaid clinic....you name it in the beginning.

The other way is some people find a solid part time job and sublet space. Not from a podiatrist and preferably from a specialty that might generate some referrals. You can get by without much equipment this way and just have your equipment in a tool box. With EMR and technology you need less physical space for charts etc and can be more mobile. As mentioned you do not need digital X-ray or power podiatry chairs in the beginning.

When you have been doing this a few years, you are more likely to be able to get a loan or you might even find a nice ortho or hospital job at that point. When you are established in an area and board certified in surgery these type jobs are easier to get.

Closing an office can be expensive also. The sublet type office is not nearly as expensive to close. It is also why some of these doctors trying to sell these low volume practices potentially have a liability and not an asset. If you have an interest, you should consider a low ball offer and they should consider accepting.

There are downsides and risks to everything. You could find yourself in a situation where you are not getting your numbers for boards if you sublet office does not ramp up quickly enough.

That is why a mediocre associate job where you can get your surgical numbers is still unfortunately a necessity in this profession. If you are not getting your numbers run. Once you are board certified, if partnership is not offered at a reasonable buy in, consider other options.
 
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