The Timeline: How to Start a Medical Private Practice in 9 months

Does the idea about opening a solo medical practice scare you? Do you feel as if there is too much to do? What about the timeline? Well this post is for you. Today we are going to go over the timeline from start to finish at how to get your practice up and running. We will talk about the dos and donts to get your practice up and running. And of course, I will share my insight from having started my own practice not too long ago. By the end of this post, you will be able to have the fundamentals to getting your practice started. You aren’t going to need a business degree nor consultant to navigate this journey, but I hope to lay everything else neatly for you to follow. I go into more depth in individual posts, but use this article as a reference.

Please note: this talk was featured at ASCRS 2023 and was one of their featured presentations!

Starting a medical practice can take easily up 6-9 months to leisurely set up a practice. But in under a more urgent time frame it can be done in less. I’ve seen a practice get off the ground in 2 months. The timing of what to do is less important than the order. For example, there is no point ordering equipment if you haven’t set up our business structure (LLC, S-corp etc). Anyways, let’s dive into this comprehensive guide.

The Timeline: 9 months before opening: Figure Out the Real Estate

One of the first things you need to do is to look for a potential office location. I think there are 3 important things that need to be addressed at this point: where do you want to open, what size office do you want, and what do you want to do in terms of buildout.

Where you want to open is one of the most critical things you need to figure out first. Do you want to practice in a certain city? Do you care about rural or urban? I will say as a solo practitioner, this is all personal preference. A solo practice can survive in any given location. I know many friends who have opened up in saturated areas and have done extremely well, so pick a location that makes you happy. As long as you are available and affable, you can have a significant impact on referral patterns.

Location is Everything.

Non-competes: Figure out if you have a non-compete you need to work with. For me, being from Atlanta, I knew I wanted to practice in Atlanta.

Market Analysis: It is important to find out how saturated the market is. I used Google Maps and Google places to map out every ophthalmology practice near me.  Some additional tips, stay near major highways. It’s much easier for patients to navigate to. Also keep in mind your potential referral network. It is important to look at potential Primary Care, Urgent Care’s, and other fields you commonly work with. In ophthalmology, we work with optometry and also endocrinology so I mapped all of those in my Google Maps.

For a more detailed look at finding a location and doing location analysis, check this post here.

Consider Your Office Size and Turn Key vs a Buildout

Check out LoopNet.com for listings. It’s easy to navigate. A reasonable size for ophthalmology is about 1500 square feet. This size gives you enough room for a lobby, diagnostic hallway, office, break room, and 1-2 exam rooms. At this stage, it is more important to see what the average price per square foot is, and this ranges widely depending on your location. In Atlanta, I saw prices varying from 15-30 dollars a square foot per year. And try to calculate the annual rent. Assuming 20 dollars per square foot per year and 1500 square feet, you are looking at $30,000 per year, or $2500 per month. In my case, my lease was advertised at $13 dollars per square foot but it was a triple net lease. The actual true price was closer to about $20 per sqft.

Also, if there isn’t anything that you like, you may have to consider a build out from an empty shell. I personally found that a build out requires a lot time depending on the scope of work.

My pro tip – look for something as turn key as possible. The MOST important element is the layout. There’s too many variables involved with knocking down walls. Even then, I looked at a place that required cosmetic changes and no new walls or new plumbing, and despite that, the contractor stated they needed at least 2 months to do all of the work. I thought that was too excessive. In many cases, by doing a lot of renovation work, your local county may take a long time to get everything approved. I had a friend who waited months before his local county to inspect and approve his business permit. This goes without saying: if you aren’t comfortable with legal paperwork, have a lawyer look over everything before you sign things. I will do a post on where a few of my colleagues were burned by their lease paperwork.

Another key tip – you can negotiating the tenant improvements so that the landlord pays for all or most of it. By looking at a place 9 months in advanced you can figure out if the landlord is desperate or not. I waited around 5 months before my target date and contacted the realtor. I knew it had been on the market for over 4-5 months, and I was able to negotiate all of my tenant improvements (in excess of 50K) to be covered 100% by my landlord. They will typically ask you to sign a longer lease or pay a higher dollar per square foot to cover the cost of the tenant improvements. However, I ended up not signing with them as I found a better office for my needs.

For a more in-depth look at how I navigated my lease and looked on LoopNet.com, take a look at this post here.

The Timeline: 6 months before opening: Paperwork and Licensing

Medical License: Start with getting your state medical license. This step can take weeks to months to do, so you definitely want to do this sooner than later. If you are fortunate enough to already have been practicing in the state you plan to open, this will save you some time.

DEA – same thing as your state medical license. All of these take much longer than you anticipate. The website for the DEA is here.

And start getting your NPI type 1, the website can be found here. These websites are all easy to use, but they all take time to get passed the review process.

ProForma and business plan. We talked extensively about this in another post, but these 2 things are essential for financing. It also gives you a realistic projection of your earnings. Lastly, you can begin to appreciate your overhead much better. In general, many of your costs are relatively “fixed” regardless of what part of the country you open. Your website maintenance, internet, EMR fees tends to be the same, but the rent tends to be a major difference between many practices, so that’s why it’s important to get the real estate process started earlier. Take a lookout my previous post on this subject for more detail.

LLC / Incorporation. Once you have your business address locked down, it’s nice being able to put the address to your LLC. I did not have my actual location locked down at this point, but I did still apply for an LLC. There are various benefits of staying an LLC vs an S corp, but I found it advantageous to stay as an LLC for now. For more information, on that, take a look at this post. Forming an LLC and Obtaining an EIN is easy. Take a look at my post and check out this link on LegalZoom.

Tax ID Number: After getting your LLC, you will want to get your Tax ID number. This serves as your social security number and is essential to a variety of things including setting up utilities, credit cards, and business bank accounts. For more information on that, you can check this post out. The website for applying for an EIN can be found on the IRS website.

The Timeline: 4 months before opening: Financing, Credentialing

Financing: Start the financing process. The cost to open a medical practice varies widely depending on the type of practice, but for ophthalmology, the cost is about 150-300K. Every bank has different rules, but in general, be prepared to show them your business plan and proforma.

Credentialing. Every insurance is variable, and the time frame generally spans from 3 months to 6 months. Some key ones to definitely be on include Medicare which you can register here. Medicaid can be state dependent. But start by googling “your state medicaid enrollment.” That should take you to your state’s application portal.

Commercial plans require your CAQH to be up to date. The CAQH database is a central database that contains all the information about the medical providers which the insurance companies can access to get the required information for credentialing. Check out this link here. 

Pro-Tip #1, if you are under crunch time, you can still see patients with Medicare. The reimbursement timeframe would be retroactive to the date of your application, so if you apply with only 1-2 months before opening, it is not the end of the world.

Pro-Tip #2, there are many healthcare networks you can join. In the Atlanta area, the Emory Healthcare Network is huge. It would have saved me so much time had I just joined them directly. More importantly, since it is a larger entity, your fee schedule is often higher. There are many credentialing experts and they didn’t even know Emory Healthcare Network was an option. I had to find out from colleagues in the area.

The Timeline: 3 months before opening: Naming Your Practice, Website Design, Malpractice Insurance, Phone Numbers and so much more

Naming your practice. At this point, consider naming your place. Once you come up with the name, that allows you to move to the next critical steps in getting your solo medical practice up and running. I went with Stratus Eye, as I had not settled in on a final location yet. My current office is Suwanee, GA, but I plan to move in town in the future. I did not want to take “Suwanee Eye Surgeons” as I felt this would have limited my geographic location.

Your LLC can be different from your actual practice name. Again, think about Alphabet and Google. Your “doing business as” is what your practice will be named. Once you get your business name locked in you can start with website and logo design.

Logo Design – My Pro Tip is to try to crowd source your design. I absolutely 99Designs is a great way to get your logo design, and after inputing my information specifically with my design preference, I was able to get my logo designed. Lastly, you can then use Fiverr for other creative help. I was able to get a simple business card design for 10 bucks. It would have taken me a few hours to do a nice design, so I appreciate the time value aspect. “Shout out to worthy-pixelia” for getting my design done in 24 hours. I ended up re-doing my card always, but under a time crunch, it was nice having someone do it for me.

Website Design and Domain Name. There are various groups and websites that will help you with SEO and website design. I ultimately went with PatientPop as I felt they had the best way to manage my website and focusing on search engine optimization and review management. However, learning to design your own website actually isn’t that hard. Here is an amazing youtube tutorial I used to learn how to create a the solopracticedoc.com blog. If you want something more turnkey, check out PatientPop.

Malpractice and Personal Business Insurance. Try to find out from your current hospital / clinic if you your malpractice insurance is per occurrence or per claim. An occurrence policy has lifetime coverage for the incidents that occur during a policy period, regardless of when the claim is reported. A claims-made policy only covers incidents that happen and are reported within the policy’s timeframe, unless a “tail” is purchased. Therefore, if it is a claims-made policy, find out who is purchasing the tail insurance. Don’t forget that business insurance is different. Business insurance coverage protects businesses from losses due to events that may occur during the normal course of business. There are many types of insurance for businesses including coverage for property damage, legal liability and employee-related risks.

Phone number – Also at this point, start locking down your business phone number. You can always purchase a vanity number, but I did not find it very cost effective. I was able to use RingCentral, and they had free numbers that I really liked. I scoped out various combinations of the last 4 digits of a phone number like xxx-xxx-7000, and I found that -2020 was available. You want to do this around this time because you will need this number for insurance contracts and surgery center applications.

Business bank accounts and credit cards. I won’t recommend any particular bank. Just go with one that you are familiar with. I would recommend checking on NerdWallet for their credit card recommendations, but since I had been banking with Chase for years, I went with Chase and the Chase Ink Preferred card. You want to get this about 1-2 months before buying equipment to maximize those points and treat yourself to a much needed vacation to celebrate your practice’s successful launch. Some credit cards will ONLY ship to your business address, so if you apply for the Credit Card too early, it will likely ship to your office before you actually can pick it up.

Also at this point, apply for NPI2. Remember, NPI1 is your personal NPI number. NPI2 is for your medical practice. The website can be found here https://nppes.cms.hhs.gov/#/

Hospital / ASC Privileges – Many places require you to have your malpractice insurance in place. Every hospital is different, but expect to allocate yourself 60 days for the application at a minimum. I hope you have your Case Log saved up. And definitely try to organized. You will find yourself constantly searching for your CME, vaccine records, medical license etc so being organize allows you to be on top of things.

The Timeline: 2 months before opening: EMR and Equipment

EMR – Start locking down your EMR of choice. Ideally you want an integrated solution so you should have a clearinghouse that integrates with this software. In ophthalmology, one of the better EMRs is ModMed. No EMR is perfect, but I did find that the practice management side of this EMR was very strong.

Also around this time start thinking about equipment, especially if you are bargain shopping. In general, you can find reasonable priced equipment either used or demo.

Local Business License – Depending on your location, you first need to submit your Trade Name Registration in person at your local Clerk of Superior Court. Afterwards, apply for your business license. Every state is different. This process wasn’t to bad.

Also work on contract with a credit card company processing company to allow you to accept credit cards. If you stuck with ModMed, this process is extremely easy.

The Timeline: 1 month before opening: The Fine Details

Office Supplies – start looking at essentials like office supplies, furniture. There are many great options for nice used office furniture. I’m a huge fan of West Elm and I live near their outlet, and it was part of my aesthetic that I was going for.

Business Cards – Again, I made this as simple as possible. I went to Fiverr.com and found a guy who worked with me on the design and submitted directly to Vista Print. Moo.com is another option, but they tend to be pricier. I was actually shocked at how good the design turned out.

Update your address on Google Places, Healthgrades, and Vitals. Don’t forget to update Apple Maps as well. I have had many patients use iPhones and found it difficulty to navigate to my office since Apple Maps had the wrong website. Healthgrades/Vitals.com will follow you so you do NOT have to create a separate Google Business profile.

Staffing – start looking at potential staff. Start posting your job openings to Monster.com and be prepared for interviewing, background check, hiring. I will tell you how I found my first employee, but your first hire is pretty critical.

Utilities – Again, this is basic, but try to set this up once your lease commences. Try to figure out who is responsible for what. You need to have electricity, water, gas, and internet. This is extremely case by case. At my location, I am responsible for electricity, gas, and internet. Water, janitorial services and landscaping is done by the HOA for the community.

And with that comprehensive overview, you should have all of the basics to get a practice up and running. There is more stuff to be discussed. Checkout each of the above hyperlinks.

Opening up solo isn’t hard, but its a lot of work. And when you go through burnout like I did, you will likely feel the same urge to go solo as well. Check that post out to see why I went solo.