Starting a new practice

[Feli]

The idea of working in a well run practice sounds great but if you are tied to a location, working for that practice puts you in a non-compete and you're locked out of that area.

Yep, if you want to go to an area where non-competes hold up, you go another state, another area of your goal state, or at least another city... or at least cross-town enough that your landing spot is out of the radius.

If you want to go into PP in an area where non-competes don't hold up, it doesn't matter much.

Either way, pick a group where you'll actually learn fairly good PP mgmt and ideas.

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[PatchAdamsFan]

Yes it is tough even with an established practice of less than 3 year to get a loan. I did not say impossible. There might a few banks that would take the risk. I am not sure what banks are worth a try, maybe ask on IPED.

I heard SVB and Credit Suisse are reputable and are willing to give new grads loans.

 

[NatCh]

Is it tough to get a loan for a practice after 1 year of associate position or does one typically need at least 2 or more?

You can also ask the bank if they can do a business line of credit instead of a loan.

Business Loan vs. Line of Credit: Which Is Right for You? - NerdWallet

Business loans are best for major projects, while business lines of credit make more sense for evening out cash-flow gaps or covering emergency expenses.

www.nerdwallet.com

 

[Feli]

Is it tough to get a loan for a practice after 1 year of associate position or does one typically need at least 2 or more?

It's quite possible to just save up with a couple years at a hospital job or a decent-paying associate job. Use those years to learn what you can about how you want to run your own.

And yes, you'd want the credit score for a potential LOCred, but starting a pod office isn't as expensive as one might think - esp if you already have some pts/goodwill in the area for refers. You're talking under 100k in most places (lower rural, or skip XR or u/s initially, just one staff to start, do more pound-the-pavement and less paid ads marketing early, cheaper instruments can always get upgraded later, etc). Many do it with half that... no joke. It's entirely possible to bank that amount of capital pretty fast with a job ~$125-200k and frugal lifestyle to achieve goals. Even a $100k job should be able to do it within 5 years.

The problem is that a lot of DPMs "can't save" since they are trying to support a family or a big lifestyle on that ~$150k or whatever. That usually will struggle and cause frustration, esp in combo with student loans. It always goes back to savings rate and reigning in spending... whether you make $75k or $575k.

A lot of the fear factor on starting an office is just from people who are afraid of doing anything "risky"... so they advise play-it-safe just as they do, large group or hospital employ pods who want to bash small PP or often don't understand it, and definitely from PP owners who don't want you to leave them or compete with them, etc. We forget that even a decade or two ago, in podiatry, there were really only two choices for grads: go solo or work for a PP. Now, we suddenly decided small podiatry PP is impossible.

 

[Pronation]

It's quite possible to just save up with a couple years at a hospital job or a decent-paying associate job. Use those years to learn what you can about how you want to run your own.

And yes, you'd want the credit score for a potential LOCred, but starting a pod office isn't as expensive as one might think - esp if you already have some pts/goodwill in the area for refers. You're talking under 100k in most places (lower rural or skip XR or u/s initially, just one staff to start, do more pound-the-pavement and less paid ads marketing early, cheaper instruments can always get upgraded later, etc). Many do it with half that... no joke. It's entirely possible to bank that amount of capital pretty fast with a job ~$125-200k and frugal lifestyle to achieve goals. Even a $100k job should be able to do it within 5 years.

The problem is that a lot of DPMs "can't save" since they are trying to support a family or a big lifestyle on that ~$150k or whatever. That usually will struggle and cause frustration, esp in combo with student loans. It always goes back to savings rate and reigning in spending... whether you make $75k or $575k.

A lot of the fear factor on starting an office is just from people who are afraid of doing anything "risky"... so they advise play-it-safe just as they do, large group or hospital employ pods who want to bash small PP or often don't understand it, and definitely from PP owners who don't want you to leave them or compete with them, etc. We forget that even a decade or two ago, in podiatry, there were really only two choices for grads: go solo or work for a PP. Now, we suddenly decided small podiatry PP is impossible.

My friend, with all due disrespect, a lot has changed in 20 years. Reimbursements aren’t the same. Just look at @heybrother crying about getting #metoo’d by insurance companies. You know where reimbursement is still good? RVU comp. Especially when I put 6 different codes in for a bunion or hammertoe. Yeeeeeehaw!

 

[icebreaker32]

We forget that even a decade or two ago, in podiatry, there were really only two choices for grads: go solo or work for a PP. Now, we suddenly decide small podiatry PP is impossible.

This is true. People would scan practices for sale instead of the bad jobs on BM News There was Medical Mavin listing practices for sale (think this still exists somewhere on the internet). Usually neither buyer or seller was happy from what I have been told.

A couple decades ago most family doctors were often solo. Now they are employed by hospitals or in groups. Most don’t do Hospital work now with hospitalists either. Midlevels have exploded over the last two decades also.

Solo PP is not impossible, but it is not getting any easier either and is not without risks. How long will it take to provide a good living? (could be 3 months, could be 3 years, could be never). How scammy will one become when they have risked everything and need to produce more income? One that goes into PP should be someone like Feli. He has some goodwill in area, money saved, and experience/confidences he will make it. It should not be the it is my only option to get out of associate hell.

Podiatry will not be an attractive choice for most students with what is is: either get one of the few hospital jobs or either expect to be screwed as an associate or open an office. If that is what this profession is then it makes little sense with options such as RN and PA etc.

If you are are confident you will be at the top of your class, have charisma and are geographically open…..you will likely get a hospital job or good group/Otho/MSG job and do very well.

For everyone else who goes into podiatry only go if you want a very long and expensive path to be a small business owner. Like all small businesses it is a lot of work and you make it big or fail. Not the safe ROI with a good job market like many other healthcare professions.