Re: Re: advise for a newbie

[Guest guest]

Tito, I started my own practice 4 years ago straight out of residency. I have done well but the IMP model is the real key to long term sustainability and living a good life. Any third party that you invite in(consultant, hospital, insurance company) WILL work against you with the IMP model. They all know one thing and that is whip the mule till the field is plowed. It is not their fault that is how they were raised. My real advise is to sit down and think this thing out yourself after reviewing the years of commentary on this list serve. The information you need is all in this list serve. I know I have been reading it for over 5 years. Think it out, compare, write it out, rethink it, repeat last four steps. Work some where to get you some money up to start. The more loans, staff, contracts and bills you have to pay will be what you have to pay before

you get paid. Lastly, when you get some patients--Lov' em!!!

Respectfully,

Beck, M.D.

Subject: Re: advise for a newbieTo: Date: Wednesday, December 24, 2008, 11:42 AM

Tito, my general thoughts: Income guarantees rarely come withoutstrings attached, so pay very close attention to the strings. If itmeans that they dictate your overhead expenses and/or patient volume,then you'll be stuck with those after the guarantee ends, and yourincome could drop precipitously. You'll have better long-term successif you keep your expenses tightly under your control. If the hospitalreally just wants you in the area, they should be willing to give aset amount for loans for every year you stay.And the expense concern applies to consultants, too. So many (95%?)are experienced only in a traditional model, and you can find yourexpenses increasing very quickly on their advice. You can do all theselittle tasks. But, no matter who does them, they do take time, and youneed income in the meantime. A big startup loan will pay you while youwait and pay for all the "necessary"

expenses...but that loan can endup being a big millstone around your neck. Are there options to dosome urgent care or something while you get these tasks done on yourown terms?Where will you be? You'll contract with all payers? What's the paymentlevel in your area? What's the PCP provider situation? You must knowthese to know how quickly the income will come.I think there is an advantage to getting over some of the medicinelearning curve before taking on the practice management learningcurve. An employed situation can do that. But then you have to decidewhether to do it locally so that patients can follow you to your newpractice or to do it somewhere else so that colleagues won't be angrywith you when you leave.You'll get lots more good (better) advice here. Haresch>> I am contemplating an IMP post residency and have the opportunity to be> supported by a hospital system in the area that I am looking atstarting my> IMP. They are offering an income guarantee (i.e. Income loan) for 2years> and 3 year loan forgiveness period. However, I am concerned about moving> forward in the current economic atmosphere especially since I am theprimary> bread winner for my family at this time. ( I have a family with 3 young> children cared for by my stay home spouse) I have significant amount of> student loans that will be coming due also which further heightens my> concerns. I was wondering would it be wiser to settle for an employed> position with prospects of starting an IMP later or just go aheadand jump> in the IMP river now? The

other concern is that I am feeling quite> overwhelmed by the sheer amount of information on what needs to bedone to> start a practice whether it is an IMP or not. Should I be looking at a> practice management consulting group to help with this initial phaseto help> ease the feeling of being in way over my head? I would appreciatesome wise> counsel on this issue?> > Tito Wion>

[Guest guest]

Thanks everyone who has pitched in some advice so far. It has been very thought stimulating amongst other things. In addition to the hospital that is offering a loan guarantee for start up practice, I have the opportunity to work for an urgent care but in a different location that is about 1.5 hrs away from the hospital location. I can moonlight for the urgent care starting out and they will cover my malpractice only. If I choose to work the urgent care full time they will offer benefits that include loan repayment. This is another option I have thought of taking. I have thought of working for the urgent care full time for a few years to take advantage of the benefits and loan repayment while I save money and plan my move to start up an IMP in my ideal location. I agree that the more people are involved in the process, the more expectations are included in my original plan. I would hate to become a servant to the lender by taking a loan that I am obligated to for 5 years and not even have the practice situation that I am looking for. I would rather wait and plan before setting up my ideal practice. I will take all the information you all have given and mull it over some more till I can come up with an ideal-for-now-till-I-get-what-I-want answer. Thanks a million again.

Tito Wion

Tito, I started my own practice 4 years ago straight out of residency. I have done well but the IMP model is the real key to long term sustainability and living a good life. Any third party that you invite in(consultant, hospital, insurance company) WILL work against you with the IMP model. They all know one thing and that is whip the mule till the field is plowed. It is not their fault that is how they were raised. My real advise is to sit down and think this thing out yourself after reviewing the years of commentary on this list serve. The information you need is all in this list serve. I know I have been reading it for over 5 years. Think it out, compare, write it out, rethink it, repeat last four steps. Work some where to get you some money up to start. The more loans, staff, contracts and bills you have to pay will be what you have to pay before you get paid. Lastly, when you get some patients--Lov' em!!!

Respectfully, Beck, M.D.

Subject: Re: advise for a newbieTo:

Date: Wednesday, December 24, 2008, 11:42 AMTito, my general thoughts: Income guarantees rarely come withoutstrings attached, so pay very close attention to the strings. If it

means that they dictate your overhead expenses and/or patient volume,then you'll be stuck with those after the guarantee ends, and yourincome could drop precipitously. You'll have better long-term success

if you keep your expenses tightly under your control. If the hospitalreally just wants you in the area, they should be willing to give aset amount for loans for every year you stay.And the expense concern applies to consultants, too. So many (95%?)

are experienced only in a traditional model, and you can find yourexpenses increasing very quickly on their advice. You can do all theselittle tasks. But, no matter who does them, they do take time, and youneed income in the meantime. A big startup loan will pay you while you

wait and pay for all the " necessary " expenses...but that loan can endup being a big millstone around your neck. Are there options to dosome urgent care or something while you get these tasks done on your

own terms?Where will you be? You'll contract with all payers? What's the paymentlevel in your area? What's the PCP provider situation? You must knowthese to know how quickly the income will come.

I think there is an advantage to getting over some of the medicinelearning curve before taking on the practice management learningcurve. An employed situation can do that. But then you have to decidewhether to do it locally so that patients can follow you to your new

practice or to do it somewhere else so that colleagues won't be angrywith you when you leave.You'll get lots more good (better) advice here. Haresch>> I am contemplating an IMP post residency and have the opportunity to be> supported by a hospital system in the area that I am looking atstarting my

> IMP. They are offering an income guarantee (i.e. Income loan) for 2years> and 3 year loan forgiveness period. However, I am concerned about moving> forward in the current economic atmosphere especially since I am the

primary> bread winner for my family at this time. ( I have a family with 3 young> children cared for by my stay home spouse) I have significant amount of> student loans that will be coming due also which further heightens my

> concerns. I was wondering would it be wiser to settle for an employed> position with prospects of starting an IMP later or just go aheadand jump> in the IMP river now? The other concern is that I am feeling quite

> overwhelmed by the sheer amount of information on what needs to bedone to> start a practice whether it is an IMP or not. Should I be looking at a> practice management consulting group to help with this initial phase

to help> ease the feeling of being in way over my head? I would appreciatesome wise> counsel on this issue?> > Tito Wion>

[Guest guest]

Tito,

Sounds like one good possibility for you

is to work part time at the urgent care while you start up. Any chance you

could do the same (work at an urgent care) in the area you plan on hanging your

shingle? Being able to recruit pts from the urgent care is a big plus.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of E B Wion

Sent: Wednesday, December 24, 2008

4:02 PM

To:

Subject: Re:

Re: advise for a newbie

Thanks everyone who has pitched in some advice so far.

It has been very thought stimulating amongst other things. In addition to the

hospital that is offering a loan guarantee for start up practice, I have the

opportunity to work for an urgent care but in a different location that is

about 1.5 hrs away from the hospital location. I can moonlight

for the urgent care starting out and they will cover my

malpractice only. If I choose to work the urgent care full

time they will offer benefits that include loan repayment. This

is another option I have thought of taking. I have thought

of working for the urgent care full time for a few years

to take advantage of the benefits and loan repayment while

I save money and plan my move to start up an IMP in my ideal

location. I agree that the more people are involved in the

process, the more expectations are included in my

original plan. I would hate to become a servant to the

lender by taking a loan that I am obligated to for 5

years and not even have the practice situation that I am looking for.

I would rather wait and plan before setting up my ideal

practice. I will take all the information you all have

given and mull it over some more till I can come up with an

ideal-for-now-till-I-get-what-I-want answer. Thanks a million again.

Tito Wion

On 12/24/08,

Beck <tsbeckmd>

wrote:

Tito, I started my own practice 4 years ago

straight out of residency. I have done well but the IMP model is the real key

to long term sustainability and living a good life. Any third party that you

invite in(consultant, hospital, insurance company) WILL work against you with

the IMP model. They all know one thing and that is whip the mule till the

field is plowed. It is not their fault that is how they were raised. My real

advise is to sit down and think this thing out yourself after reviewing the

years of commentary on this list serve. The information you need is all in

this list serve. I know I have been reading it for over 5 years. Think it

out, compare, write it out, rethink it, repeat last four steps. Work some

where to get you some money up to start. The more loans, staff, contracts and

bills you have to pay will be what you have to pay before you get paid.

Lastly, when you get some patients--Lov' em!!!

Respectfully,

Beck, M.D.

From: Haresch <newfloc>

Subject: Re: advise for a newbie

To:

Date: Wednesday, December 24, 2008, 11:42 AM

Tito, my general thoughts: Income guarantees rarely

come without

strings attached, so pay very close attention to the strings.

If it

means that they dictate your overhead expenses and/or patient

volume,

then you'll be stuck with those after the guarantee ends, and

your

income could drop precipitously. You'll have better long-term

success

if you keep your expenses tightly under your control. If the

hospital

really just wants you in the area, they should be willing to

give a

set amount for loans for every year you stay.

And the expense concern applies to consultants, too. So many

(95%?)

are experienced only in a traditional model, and you can find

your

expenses increasing very quickly on their advice. You can do

all these

little tasks. But, no matter who does them, they do take time,

and you

need income in the meantime. A big startup loan will pay you

while you

wait and pay for all the " necessary " expenses...but

that loan can end

up being a big millstone around your neck. Are there options to

do

some urgent care or something while you get these tasks done on

your

own terms?

Where will you be? You'll contract with all payers? What's the

payment

level in your area? What's the PCP provider situation? You must

know

these to know how quickly the income will come.

I think there is an advantage to getting over some of the

medicine

learning curve before taking on the practice management

learning

curve. An employed situation can do that. But then you have to

decide

whether to do it locally so that patients can follow you to

your new

practice or to do it somewhere else so that colleagues won't be

angry

with you when you leave.

You'll get lots more good (better) advice here.

Haresch

>

> I am contemplating an IMP post residency and have the

opportunity to be

> supported by a hospital system in the area that I am

looking at

starting my

> IMP. They are offering an income guarantee (i.e. Income

loan) for 2

years

> and 3 year loan forgiveness period. However, I am

concerned about moving

> forward in the current economic atmosphere especially

since I am the

primary

> bread winner for my family at this time. ( I have a family

with 3 young

> children cared for by my stay home spouse) I have

significant amount of

> student loans that will be coming due also which further heightens

my

> concerns. I was wondering would it be wiser to settle for

an employed

> position with prospects of starting an IMP later or just

go ahead

and jump

> in the IMP river now? The other concern is that I am

feeling quite

> overwhelmed by the sheer amount of information on what

needs to be

done to

> start a practice whether it is an IMP or not. Should I be

looking at a

> practice management consulting group to help with this

initial phase

to help

> ease the feeling of being in way over my head? I would

appreciate

some wise

> counsel on this issue?

>

> Tito Wion

>