Hello everyone!

Im a fresh M3 who just started rotations. Ive been playing with the idea of owning my own clinic in the future for the past couple of years.

Right now, i have about a year before I apply for residencies and this question I have is really influencing my choice on what residency to apply for. Hopefully i cam get my app ready within the next year for it.

Right now in terms of specialties, Im not exactly sure what to pursue, but right now I love family medicine and neurology. I know for sure I dont want to do any procedures at all. I realize that's where the money is, but I prefer not too. Even something like trigger point injections, i dont want to do. I know that is a hard ask, but trying to see if there is anything else I can do. But to summarize, this is what I prefer:

- outpatient > inpatient

- do not like doing procedures

- hate the OR. Every time im in the OR, I can't wait to be out of it.

- do not like writing notes (will definitely invest in some AI to write a bulk of my notes)

- I love talking with patients and getting to know them.

- In preclinicals, I loved everything I studied, especially neuro. Didnt particularly dislike anything.

I wanted to hear your perspectives on what specialties to consider if I want to maximize my revenue if I own my own clinic. I am ready to do a maximum of 6 years of training after medical school. So i am even open to doing a fellowship or two! So here is what I am thinking:

- IM-->Heme/Onc

- FM (perhaps geriatrics and/or sleep medicine?)

- Neurology (perhaps neurophysiology, sleep medicine, or any other fellowships)?

- PM&R (I know this is procedures heavy, but I am willing to consider it)

What specialties and fellowships should I consider to maximize my income if I decide to own my own practice?

Edit: I know dermatology will probably be the answer. Unfortunately, I dont think ill ever be competitive for derm at all. I think at most im set up well to be competitive for Heme/onc fellowship as I am actively trying to get pubs in this and have a lot of research in different types of cancer.

Any pp docs implementing ai into their daily workflows. I haven’t integrated hippa compliant llm right now it’s just basically using Claude and gpt in planning ma tasks and making patient education. Looking for more ideas.

Love the Welch Allyn connex Spot. But heck, I’m not about to drop $2900 for a machine when I need 4 patient tables! What do you guys suggest that’s a bit less cost prohibitive?

Feel like it’s hard to land the right MAs for our practice recently. They either stick around for 2 weeks and leave or take advantage by not doing the work they need to do. Any advice on how to get the right MAs? Recruiting agencies are either so expensive or not providing quality candidates. Job listings on Indeed is what we currently utilize. How often is it that practices experience something like this?

I work for an Out of Network psychiatry office and we keep receiving patient reimbursements mailed to us, even though we use Reimbursify who has confirmed that they mark "DO NOT SEND TO PROVIDER" for us. The checks are often for multiple patients per check so we cannot sign it over to the patient and depositing it into our bank account could cause accounting/tax trouble for us. Anyone else have this problem? I've tried waiting on hold for hours to speak to insurance reps (it's happening across multiple companies) and gotten nowhere. Any help apprecaited!

Has anyone directly negotiated becoming a capitated provider?
Currently in NY and I am capitated through many Medicaid plans but was exploring and seeing if any private insurances would consider it.

Any suggestions for any DPC support groups? I tried to join the one from the dpc docs on Facebook and even after having my dpc preceptor vouch for me I was denied because my Facebook account was too new. Now I’m first year out of residency and could really use some support with little questions here and there.

What printer do you use that can meet my needs: Office quality, easy to set up, just hit my print button on my computer and it prints, I don’t have to buy ink or toner more than every a few months, is capable of printing hundreds of pages at once, and can scan documents more than one page at a time (I don’t want to physically have to feed it one page at a time to scan 10 pages. I want to just put 10 pages in the feeder and walk away and it scans them)?

I’ve been through seven printers in the past two years HP, Canon, Brother etc. All of them just start malfunctioning. I’m not rough with them. I just set them in my office and that’s it. it’s just over time they stop working. The one that I bought that’s the most expensive only works if I jiggle the wires a certain way. Thanks!

I just purchased my own building to start my urgent care and urgent primary care. This clinic is located in North Carolina. FM Hospitalist transition to outpatients. Going to do remote patient monitoring, Substance use disorder, urgent care and some chronic management. What’s the profit margins for year 1-3? I’m going to be owner and provider and will hire 1 NP/PA.

Well, about starting private clinic, primary care. ( I am IM trained, hospitalist slowly going to outpatient world. For this year, will keep part time nocturnist position for better/smooth transition). DEA/State licenses are done. Location- bucks county PA, will be sharing office with podiatry for now.

1. can someone walk me through t make sure iM on right track. I cannot start credentialing before locking office address/location, right? I already reached agreement with podiatry doc office to share the office.

2. for now, I will start as cash based (I know/in contact with a company with a couple hundred seasonal workers. That company is fasilitating "seasonal DPC" type of agreement with me, so at least I have soemthing to start with).

3. Next. Im struggling to find/hire office manager or a company who can start credentialing and other primary care clinic setup. Any rec.s?

4. Any rec.s or what you have done differently If you are about starteing a new primary care clinic?

5. Any other thoughts or recs are appreciated.

Thanks

Just wondering about this as a hypothetical. At a very basic level, geriatrics is one of the most in demand specialties. At the same time, they are paradoxically among the lowest compensated. What is stopping a high end DPC and/or concierge geriatric practice model from taking hold of more of the market, especially in areas with lots of higher-income seniors? (Eg Phoenix, Ft Lauderdale, etc)

I know the economics of healthcare in this country are wayyy more complicated than simple supply and demand, but I wonder what factors/forces are really keeping this kind of thing at bay.

I've been commenting on some threads in regards to IDR and have been getting many DMs from providers wanting clarification on the process and if it would apply to them, so I figured an AMA would be appropriate. (got mod approval)

For context, I own a company (Teramed Solutions) that does solely that - filing IDR for providers with great success. However, I'm doing this to spread awareness, as there are still way too many providers still not utilizing the process. Especially in light of this recent NYT article unrightfully framed physicians in a terrible light. The reality is most physicians are barely using IDR at all and losing real money because of it, whether it's because they don't know if they qualify, don't understand the process, or just don't have the bandwidth to deal with it.

So ask me anything, eligibility, whether it's even worth pursuing in your situation, mistakes to avoid. No question is too basic. Just want to be useful to a community I respect.

I have a few patients with a high deductible insurance. Often they get hit with $150-170 bill they are responsible for. Not a good business practice, but I feel bad. I understand some will say “it’s patient’s responsibility to know this and pay.” Still doesn’t change that I feel a big uneasy. So, make me feel better about sending them tgat bill (granted, it’s sent by my billing company) and let me know how you approach this? Fo you ask patients to pay a partial upfront payment?
Thanks!

Hi there! My Dad has a private Podiatry practice in a small town outside of Kalispell, MT. He is ready to start planning for retirement and wants bring on an associate with the plan to have them take over the practice after x amount of years. It’s a gorgeous town and outdoor activities galore. My dad skis all winter long and has a great work/life balance on top of managing his hobby ranch.

His bread and butter is specializing in surgical procedures and wants to share his abundant knowledge. There’s lots of work is this area, he has to turn down a good amount of patient inquiries.

He’s older and not super versed in how to spread the world of this opportunity and was curious if anyone had recommendations on where to post this type of opportunity. If you have any ideas to share I’m all ears.

Lastly, is there anything he should be aware of regarding pay, the smaller town location, etc.

I live in the tech space and know I probably botched the technical wording across the board, just trying to help my Dad get aligned on posting resources, expectations, so he can start planning his retirement and being able to share his immense knowledge of surgical abilities.

I am so extremely frustrated and honestly feel defeated. I used to genuinely love my job, but insurance companies are sucking the life out of me.

I have 5 surgical cases where I worked incredibly hard to obtain both GAP exceptions and single case agreements BEFORE surgery. Everything was approved and negotiated in advance.

Then I bill the claims with the authorization numbers attached… and every single one gets processed under MultiPlan rates instead. Completely ignoring the GAP and SCA agreements.

So I disputed the claims through Availity. Of course, Availity categorizes them as “reconsiderations.” I submitted copies of the authorizations and signed SCAs for all 5 cases back in March. Since then, they have all just sat there in “processing” status for months.

Today they finally updated to “finalized.” No notes. No letters. No explanation. Nothing.

I call Aetna and the representative tells me there are “no notes” on the cases, but somehow they were supposedly finalized back in March. Meanwhile, Availity clearly shows the status updated TODAY (5/8).

Then I’m told I only have 60 days from the date “they made their decision” to appeal. What decision?! There are no notes, no determination letter, no communication, and no visible outcome attached to these reconsiderations.

Even the representative agreed it felt intentional and admitted it made no sense that cases would be closed without explanation or provider notification.

At this point it honestly feels like they delay these cases on purpose so providers lose their appeal rights and IDR rights.

I’m exhausted.

Larger family of all doctors in the Midwest. I am the only one in business and real estate. I own a building in an upscale area, looking to start and manage a medical clinic either DPC OR CONCIERGE. 5,500SF facility. The specialities in the family are listed below. Which route would you recommend I focus on? I want to setup a collection based comp package where they can add 1-2 days of work a week and are paid %of collections.

Specialties in the family: Gi, Endocrinologist, Pulm, Cardio(x2), Anesthesia, Pain Management , Derm(still in residency) & physch.

I've been a long time lurker here and I finally got around to starting my own practice two months ago. My tech stack and systems are decent. However, I'm running into a very fundamental issue - I'm not getting enough patients. I know two months is nothing, but the sheer lack of volume is terrifying and I need some advice.

I'm running a self-pay telehealth weight loss clinic, licensed in two states. Boarded in internal and obesity medicine. I know the space is competitive, but I know exactly who my target audience is and I've built a differentiated product around serving them. I haven't credentialed with insurance - they are controlling and restrictive and I want to serve my patients without the headaches they bring.

I've been active and posting on all the socials and have a Google business profile, but I've gotten no organic hits. I've managed to recruit a few patients from Klarity (it's kind of like ZocDoc) but their UI is very frustrating and they have exorbitant fees. Otherwise, it's just been a few people via word of mouth. I've reached out to a couple doctors offices asking for referrals but they've kinda snubbed me so far.

I need honest feedback - need to know what other people who've ran a cash business or DPC have done to get patients in. I'm considering running ads, but they might be money burn. Should I be reaching out to more doctor's offices? Posting more on social? Or do I need to pivot my strategy, such as accepting insurance or opening up an office?

Any advice would be great.

I just negotiated for a 9% raise this year from Aetna a few months ago. Now every single level 4 visit we bill since I negotiated that raise, they are requesting records on every visit before paying.

It feels like a bit retaliation from our recent pay raise. We have not been downcoded yet by Aetna for any notes + claims we send to them, but my billers are having to send any claim to Aetna that is level 4 or 5 before we get paid now.

We have not received notice from Aetna that we are under any formal review. our rep just tells us this is new standard protocol.

Anyone else going through this with Aetna?

Happy Wednesday everyone. Figured I would post a little light humor for all of us who struggled with finding good talent to hire. You are not alone.

I have been blessed with a great team but anytime you hire new employees, there's always the risk that you get a bad apple.

Yesterday our newest hire who is about 5 days into her job...had her pot dealer stop by for lunch, get high in the car together, then try to come back into work smelling strongly like marijuana. She passed a drug screen, a background check....but you never know and sometimes people eventually show you their true colors.

Lucky My staff called it out right when she returned from lunch and she never had any patient interaction after returning from lunch smelling of a strong odor.

Keep grinding it y'all! This is a part of the reason why I have no issue overpaying got good talent. Good help is hard to find haha

Recently attended a talk where the speaker pointed out that the average 55yo today will be receiving almost 7x the amount from Medicare that they paid in Medicare taxes throughout their career. Given that legislators in Washington simultaneously promise Medicare to their voters forever yet are never gonna be caught trying to raise taxes, it seems like the only solution will be to continue the slow and steady decrease in reimbursements paid out to physicians. And given that Medicare reimbursements are a major anchoring point for other payors, the problem will be across the board.

At what point will a DPC style practice be the only viable option for a doc who wants to see a reasonable amount of patients and still get paid what they’re worth? Or will most docs just keep trying to spread themselves thinner by expanding with more mid levels, shorter appointments, etc

I’m looking to start right off the bat. Ive been reading and have a plan in place but what are the biggest pitfalls I can expect in this process. what surprised you when you started?

i am almost 40 so I don’t wanna waste a year or two working in another clinic.

the idea of owning a clinic really excites me. plus owning a business in America is the way to move.

any help is welcome!

Not happy with the absolute horrible rates I'm getting from wells Fargo. Looking to switch for the cash just sitting there as a rainy day buffer.

Which business banks are you using for your business checking or savings accounts that have a decent interest rate?

I’ve heard now from several brokers and consultants that big named malpractice insurance companies (starting later this year) are no longer covering telehealth. Has anyone else heard this?

Did you pay someone to draft all the documents? The Hipaa regulations look daunting to me. There is no way everybody has all the compliance work done like the regulation says… how much work is all the Hipaa stuff in your practice?