I started my practice in the summer of 2006 against all odds. I was refused any sort of business loan by four different banks. All four cited that I had a starting business and although I was a medical doctor, they still considered it risky. One of the lenders said, “Come back in two years”. I thought, “Okay, but how am I supposed to start something if I don’t have the money now?”

I briefly thought about getting a MBA a couple of years ago. Then I remembered that I had already been a perpetual student for so many years. Who wanted to be stuck in a classroom again? Not I. I also contemplated getting an online MBA, but those can be quite costly and time consuming as well. I decided that there was no reason why I couldn’t venture into a business using my street and academic smarts. Besides, I wasn’t about to start accruing another six figure student loan again.

The medical world is essentially divided into clinical, research and academia. I’ve never considered business to be a part of that world. Perhaps because doctors are associated with taking care of people that it’s difficult to envision them as business people. This is something that I’ve come to understand in my own practice. For me, it’s a medical business.

My own practice has a life of its own. I have an online appointment scheduler. Most of my patients are young and busy and express that it is annoying to be put on hold to schedule an appointment. Most like the ease of just logging on to my website and scheduling an appointment at whatever time of the day or night. Most appointment reminders are sent online. I have a billing company that is located in Massachussets. After I submit my claims electronically, this company is responsible for following up and making sure that I am getting paid appropriately by the insurance companies on time. Thus far, they are doing a good job.

The first year of my practice, I marketed heavily. I canvassed neighboring businesses and convinced them to send me patients. I did presentations on hypertension and diabetes. I brought in my glucometer and checked over two hundred fingersticks at a time. I designed postcards and flyers and created targeted mailing lists. I took out ads in various newspapers.

I was an employee for five years working in a community health center and subsequently a large private hospital. My first job really taught me how to do other things besides being a physician. Honestly, I wasn’t able to rely on my clerks to take care of prior authorizations or insurance issues so I would do it myself. When my patient was given an appointment with a specialist in two months, I would get on the phone and get the secretary to move up the appointment to next week. It made me tough and resilient. My second job was more tailored as a private office. I got hands on training about coding and billing and the world of private medical insurance.

When I initially set up my practice, it was part-time. I worked another hospital job to make ends meet since I really wasn’t pulling in too much dough from my business. I did this for about six months and then decided that I was turning into a workaholic. No fun and no play made me a very mean person.   I decided to take a big risk and go full-time into my practice. At first I expected that it would take about six months to really start making a decent salary. I was most surprised when the practice numbers increased sharply. I realized that by investing energy into one thing alone, it expanded faster than I expected.

The other things that I am learning more about are customer relations and dealing with employees. To be truthful, I fluctuate between being a sap to being absolutely unbendable. However, we don’t live in a black and white world, I’m learning. Most of my patients and I have a great relationship, but occasionally there are some that are not satisfied. I am learning not to take this as a sign that I am not a good physician. I am a human being and not all of us are meant to have a kismet connection. I am also learning to ask more from people who assist me. As someone who likes to do EVERYTHING, this is difficult for me to do. I don’t like to be bossy, but I’m realizing that in order to have a smooth running operation, delegating tasks is key.

Most people think it is really funny when they ask about my business plan. I never had one. Instead, my focus was what I wanted as a physician and person. I grew frustrated in the past with directives from non-physicians and working long hours. I knew I didn’t want to be hospital-focused and wanted normal hours so that I could still enjoy my personal life. This was and still is the plan. Everything focuses around it.

It’s almost year 2 of my business (August) and I can say that I still like doing all the mundane non-physician things. I like submitting the billing, I like doing account reconciliations. I like calling the insurance companies. I like doing prior authorizations. I like calling in the prescriptions to the pharmacies. I like calling my patients for appointment reminders (the ones that don’t have e-mail). I like scheduling appointments. I like drawing blood. I like centrifuging the blood. I like doing dipsticks and giving shots. I like doing EKGs. My doctor friends all laugh at me.

It’s sick, isn’t it?