Setting up private practice :
A route map

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Col(Dr) Mohan Kubendra

Introduction :
Although considered a challenging endeavor in the health care field, starting a medical private practice is also one of the most rewarding accomplishments for a physician or medical professionals. The ability to make decisions and provide treatment that directly influences the quality and standards of care delivered to a patient makes private practice an ideal career choice for clinicians especially for Family Medicine graduates. General practice throws a great opportunity and a personal challenge to excel which is really exciting. It gives you a great sense of independence and autonomy.

When one joins medical school, many would have probably dreamed of starting a private practice someday but the fact is that even after post graduate training, doctors are not confident of setting up their own clinics. It is desirable that the focus of any PG program should be to make physicians ‘Practice ready’ - having all the skills needed to practice on own, unsupervised, do everything that family-medicine specialist is expected to do. Unfortunately both under graduate course as well as PG curriculum in India does not cater for preparing physicians to acquire the skills for starting the practice soon after their training. Opening your own practice can feel intimidating. However, by taking things one step at a time and making smart decisions, you can set yourself in a position of comfort to establish a clinic and to run it successfully. The objective of this article is to sensitize primary care physicians with various options available and steps involved in setting up own clinic as well as to run it successfully.

Business Plan: One should remember that setting up practice is no less than starting a business and become an entrepreneur. The first step is to develop a thorough business plan which will be a guide to arranging finance, setting up the practice structure, buying the right equipments, defining the scope of professional practice and marketing your practice. Always have a clear vision as to how and when you are going to start the business, If you think you are practice ready start own clinic else it is better to join an established practice set up and start practicing part time which allows you to learn the nuances of building your own practice. Draw a business plan for your practice and show what you want to achieve, what services you wish to offer, why your service is different and why your clients will choose you. Set clear aims and objectives for progress of your practice rather than setting targets.

Start up costs: Every new business needs money to cover the initial start up costs and fund the early stages of running the business. Cost of establishing clinic depends on various factors like cost of hiring / leasing the property, furnishing, partitions, equipment cost and hiring the staff. You will need to identify your start up costs and find means of funding. Explore various options for raising fund- own money, borrow from a bank or a non bank borrowing like from friends, family or an outside investor. You may create a Personal Financial Forecast expected to cover your living expenses and a Business Financial Forecast which reflects the expected income/expenditure & cash-flow. Using self owned property allows you more control over the use and development of the premises however it requires available capital. Leasing or renting is often the most financially viable option.

Premises and facilities: There are a number of factors you need to consider when picking your location. One of the most important is demography of your target clientele and feeding population. Your clinic has a better chance of thriving if it’s located in a main road connecting to a residential area. The property you choose needs to facilitate a smooth workflow. Make sure you also consider things like ample parking and office space. You also need to consider the aesthetic of your office, providing an inviting atmosphere resulting in enhanced patient retention. Also, keep in mind this is where you’re going to spend a lot of your time too. Equipment needs depend upon the scope of your practice and range of services one wish to offer. It is always wiser to start with basic equipments and keep adding based on requirement. Your goal must be to create a ‘one-stop’ medical centre for all your patient’s needs like Physician consultation, Nursing care, Pharmacy, Phlebotomy, Physiotherapy etc as that’s the expectation of the current generation. Choosing the right name is also very important the one which is catchy yet reflecting of your services.

Permissions & licences: There are a few mandatory permissions and licences required to establish a private clinic which may slightly vary from one region to the other. General licence from Municipal corporation / Panchayat, Bio Medical waste management certificate, Clearance from Pollution Control Board and State Private Medical Establishment License are mandatory requirement for establishing a private clinic. Licenses for pharmacy and Laboratory services need to be obtained separately. Apply for these permissions as soon as you set up the clinic premises as it takes time to obtain them.

Running your Business: A clear plan for running a business is essential for success as an entrepreneur. It’s important to remember that one of your business’ primary goals is to deliver fast and quality customer service. Your patients know that, if they do not have a positive experience at your facility, they can simply go down the street to another one. It’s very important you choose staff members who understand your values and are on board with the overall goal of your clinic. In addition, good communication skills and a pleasant disposition are very important in the medical industry. Always cater for both appointment system as well as walk in patients especially in an urban setting. Patient registration system and Electronic Medical Record (EMR) will make your patient management more professional and streamlined. Digitizing records and streamlining communication is a high priority for the modern healthcare provider. Fixing your fees is another tricky business. The costs you need to cover, your clinical knowledge & skills, your time and other market influences determine your fees. Factors that have an association with high earning include providing more patient visits, practicing the full scope of family medicine and providing multiple services in-house like clinical lab, physical therapy, Pharmacy etc. Some of these services could be outsourced as well. Offering full range of services makes the clinic profitable and sustainable. The services offered should cover the entire scope of Family practice like chronic health care, Home health Care, Palliative care, Corporate health care, Insurance panel, School health, Occupational Health, Immunization. Recording your various expenses and sources of income is critical to understanding the financial performance of your business. Keeping accurate and detailed accounts also greatly simplifies your annual tax filing. Once your practice is established you may want to consider growing your business. It must be done at the right time for you, and based on the strengths of your business. If you regularly monitor your business performance, you will recognise the point when expansion may be a consideration.

Marketing your services: Being a good clinician or professional is not enough for a successful private practice. You must also develop a fundamental understanding of how to market and sell your services which should help you find and retain your clients. Developing a marketing strategy enables you to identify potential clients & their needs as well as to communicate the benefits of your services. An online presence is necessary, so consider investing in a professionally designed website. Make sure it’s mobile-friendly so people can locate you on smart phones and tablets. You’ll also want your clinic to appear in online Business listings and advertise in any online medical directories in your area. Sending out flyers through local newspaper distributer periodically is also an effective way of reaching the target population. When you’re closing in on an opening date, you’ll need to start marketing your clinic. Once the clinic becomes functional, the ‘word of mouth’ takes over other marketing strategies.

Networking & support: Working as a sole practitioner can be isolating, so it is important to create a network of support. When you start your private practice you should aim to create a network of professional contacts that have the potential to provide you with referrals. These contacts could include General Practitioners, Physiotherapists, Pharmacists and other service providers within your profession who practice locally. Private practice can be a daunting task and it is good to have someone experienced to guide you and they can have a positive impact on both you and your business. It is always good to have someone you know within your profession as a mentor- someone who has already established a private practice who can offer both professional and business advices.

Ethical & Evidence based practice: What will see you through in your journey as a GP is a clear ethical values. Don’t look at the short term gains and get influenced by what’s going on around you. You need to draw your own ethical boundary. Present day clientele is smart enough to gauge your practice intentions. Keep yourself updated and indulge in Evidence based management. This will absolve you from professional and legal problems. Learn to accept your limitations as your knowledge base is so wide as a Family Medicine doctor. You are bound to get tempted to do every possible thing on earth but be aware of the fact that you are working in a clinic set up and you do not have the backing like in a hospital setting.

Models of GP Practices: There are different models of General practice which one can choose from. You should consider what type of practice situation will best meet your personal preferences and career goals. Solo GP clinics are well suited for rural practice but not a very sustainable model in the long run especially in an urban setting. Group practices are typically divided into single-specialty and multispecialty practices. The defining characteristic of single-specialty practice is a group of GPs providing patients with one specific type of care while in multispecialty group practices offers various types of medical specialty care within a polyclinic setting. Some advantages of group practices are increased financial security and better control of lifestyle. In campus clinics catering to gated communities are in high demand and provide an ideal setting to practice Family Medicine. Integrated clinics, Satellite clinics transitional care clinics and Assisted living facilities are some of the other new options in urban areas which a family practitioner could choose from.

Conclusion: General practice throws a great opportunity and a personal challenge to excel and thrive which is really rewarding. Setting up private practice and beginning your own business can be an exciting and fulfilling journey. There is no universal formula for starting a medical practice. There are many factors to consider and hopefully the route map presented in this article will help the young doctors in taking up the rewarding challenge of setting up own practice.

Editor's notes

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