AMA STEPS Forward® Series Announcement: Hello, and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today--solutions that help put the joy back into medicine. AMA's STEPS Forward® program is open-access and free to all at STEPSForward.org
Taylor Johnson: [00:23] Hello, and welcome to the AMA STEPS Forward®: Private Practice: Attending to Business podcast, a 10-episode series exploring the business side of private practice. In this series, we talk about how to navigate business operations and practice efficiency solutions to create and support a thriving and sustainable medical practice business. I'm your host, Taylor Johnson, manager of Physician Practice Development at the American Medical Association, and I'm joined by my colleague and co-host Megan Kwiatkowski, program manager of Private Practice Sustainability, also at the American Medical Association. Collectively, we have two decades of experience in private physician practice, and we continue to support physician practices in our current work at the AMA. Before we dive into our first episode, I want to share a little bit about why we're doing this podcast. Fifty percent of physicians are in private practice and are crucial point-of-care for patients and communities across the country. Yet very little is taught in physician training about the business aspects of private practice. Our goal for this series is to close that learning gap by covering business topics relevant to physician practice, and providing helpful resources aligned with each episode for a deeper dive into the content. Additionally, I want to emphasize that this episode is for general informational purposes and should not be relied on as medical, legal, or other professional advice. Listeners are always encouraged to consult a professional advisor for any such advice.
Meghan Kwiatkowski: [01:54] So to set the stage for our listeners today, Taylor, we're going to talk about your experiences in the area of starting a private practice. Could you please tell our listeners about your work and about your background?
Johnson: [02:08] Yeah, definitely. So I completed my undergraduate degree from Loyola University Chicago in health systems management, and I recently completed my MBA from Pepperdine University with a concentration of entrepreneurship. My health care experience is really in health care administration with small- to medium-sized practices. And I've worked on the business and operation side of these offices. So starting them from the ground up, coming in and reworking workflows implementing some digital health platforms. My focus in health care, really, all of the experience that I have is in small- to medium-sized physician practices. And that's been over the past nine years now.
Kwiatkowski: [02:54] Amazing. Could you share your personal journey, so how you really got started working in private practices?
Johnson: [03:02] Yes. So I started in my first private practice a week after I completed my undergraduate degree. So during my undergraduate education, we had exposure to several different health care settings. So things like community hospitals, clinics, large health systems, small practices, things like that. And so I knew that I wanted to begin my career in health care in a private practice. I just felt that the health system would be a little bit overwhelming for me just coming out of school. And so I laugh about it now, because I've come to realize that running a private practice involves a lot more than being involved by [sic] a health system. So I was hired by a multi-physician multilocation group of surgeons on the northwest side of Chicago. And I was so fortunate because this group really taught me the basics of operating an independent practice. I was exposed to things like clinic workflow compliance, hospital credentialing, insurance, credentialing, filling, coding, staffing, and human resources. I really think that that experience set me up to succeed when I moved into my next phase of consulting with independent physician practices.
Kwiatkowski: [04:13] So when the practice doors opened, did you feel that you were adequately prepared? I mean, did you feel like you were equipped from an educational perspective with the foundational knowledge and the basics that you needed to get a practice off the ground running all of that?
Johnson: [04:30] Absolutely not. I think kind of like anyone when they're doing something for the first time, there's always a little bit of hesitation and some nerves that you have to work through. So I was very nervous, because that was the first time that I was responsible for opening a practice from scratch. So the previous practices that I had been a part of had been up and running for years. There was already something there for me to work with, I just had to update it. So going into this, I really had to have some pep talks with myself about…you know…I have a good amount of foundational knowledge, I have a great network that I can reach out to, my education from Loyola really prepared me. Well, there's just always a fear, but I think you kind of have to get over it and just dive right in.
Kwiatkowski: [05:24] Absolutely. I mean, I think going into a situation for the first time for anybody, you know, there's that little bit of trepidation of the challenges that are inevitable, that are going to come along with starting something new. So in that vein, can you talk about some of the challenges that you faced?
Johnson: [05:45] Yeah. And so I think that we…we probably have this conversation multiple times a week, and we're not even in independent practice right now. But just trying to navigate the different insurance payers is the biggest challenge, I think, that anyone in health care has to deal with right now. This was a new practice that had just opened, so they had no credentialing in place. So first, we had to credential the practice. And then we had to credential the physicians. So it was a much longer process…I really had to take my time and make sure that everything was done correctly and in the right order, just because if something got messed up, and we saw patients on the [sic] that insurance where things were done incorrectly, then the practice is not going to get payment for their services. And that was so terrifying to me that like, if I make one wrong mistake, it could be extremely detrimental to the practice, and that could mean, tens of thousands of dollars that we're not collecting. Just because one piece of paper wasn't filed, or like the wrong box was checked on a form. So that was really, really challenging.
Kwiatkowski: [07:08] Yeah, I think that certainly is a challenge, the impact of which, as you said, really can't be underscored enough. And there's certain things that you can just sort of get over your nerves. But there are certain pieces of running a practice that you know really need to be done right, or else there can be some pretty important and intense ramifications. What do you think are the most important things to implement when it comes to building a successful and sustainable private practice?
Johnson: [07:38] Yes, so the very first thing is you need capital, right? You can't really open a business or do anything without the funds, you need access to capital when you're starting. And then you need access to capital as you're continuing to grow. Because there is such a delay in those insurance payments, you've got to prepare for that; you really, really need to get your staffing down. So how many physicians do you need? But then also, how much support staff do you need for each physician? How many technicians or medical assistants are you going to have? Also, with that, you have to think about your receptionist and front desk staff. Are you going to have your back office billing and coding and HR be in house? Or are you going to outsource those things? Those are also really, really important things to think about at first, and then your workflow. When your patients come in, what's going to be the process to get them from the beginning of their appointment to the end of their appointment at checkout? And then as you think through all of those steps, what equipment and what office structure are you going to need in order to make that happen? So these aren't just physical things, you know, like your exam, tables, and desks in the room and your diagnostic equipment. These are also things like your electronic medical record, and your phone system and your internet. All of that login. I know you spent a lot of years in physician practices. And so is there anything that you would add to that?
Kwiatkowski: [09:23] I mean, I don't think you missed anything. I think certainly it's unfortunate that when you're going into practice, the first thing you have to think about is how am I going to fund this because obviously you want to support your patients and care for your patient population. But as we'll talk about a little bit, in some of our later episodes, running a private practice is running a business. And so all of these things that go into running a business are things that you have to think about, but not just how can I best care for my patients but to that point, even doing these things, making sure that starting up your practice and getting it up and running on the right foot is the best way that you could actually care for your patients.
Johnson: [10:08] Exactly. And that's just so important. And you know, people always think like, Well, we don't want to focus on the business, we just want to take care of our patients. But like you said, that is part of taking care of your patients, making sure that all of this is set up correctly in the first place, so that there's no delay in their care or anything like that.
Kwiatkowski: [10:31] Absolutely. And to that end, I think when physicians are considering what setting is right for them, they really need to ask those types of hard questions of clinical care versus the business pieces. The answer to those questions may be that they want to go into a different setting and provide care for patients in a different setting outside of private practice. Do you think that the private practice setting is for everyone? How can a physician evaluate whether that's the right choice for them?
Johnson: [11:05] So no, I don't believe that the private practice setting is for everyone. When you're in private practice, yes, you do have more autonomy. And you do get to choose your schedule and the way that you care for your patients and all of that. But physicians in private practice are also running a business. So a desire to be involved in the business side of medicine should be present as well with the physicians that go into private practice. You and I authored the STEPS Forward® Private Practice Playbook, which really does a great job of going through some key questions that physicians can ask themselves when they're deciding if private practice is the right choice for them or not. We kind of talk about how much control do you want in your day. Are you interested in taking on financial and management responsibilities in the practice? How much financial risk are you comfortable with? How much time do you want off? What call schedule and coverage will you have? Those are just some high-level things. And like I said, the playbook goes into much more detail. But you really have to consider all of those things and how much involvement you want in them. Are you going to open this practice by yourself? Are you going to have a partner? Would you bring a partner on later on? How would you divide the responsibilities, between yourself and your partner or partners? It's not a decision that should be taken lightly. And it is not for everyone. And that's okay. You just really have to make sure that this is what you want to do, pick your place and be able to be there for your patients and really be comfortable in your decision.
Kwiatkowski: [12:47] Yeah, and I think alongside some really amazing physicians that you and I have worked with, who had some direct experiences in opening and working in their own private practices. I think the Private Practice Playbook, as you mentioned, is a really great resource for physicians who are either looking to start their own private practice, or who are in their own practice at the moment and want some insights into ways to sustain. I think it's a really great resource available for anybody who's interested. And I think physicians consider what their journeys will be, as they care for patients and go throughout their career. Do you have any advice that physicians probably need to hear when looking to start their own private practice? Really, can you tell us where…where somebody can start?
Johnson: [13:38] Make sure that you really do your research, and you really prepare. Read as many books and articles on private practice that you can. There are so many things online that you have access to now, and those are so important. And then also, I would say, talk with colleagues that are currently in private practice, or talk with colleagues that have left private practice. Find out what they liked, what they disliked. And just gather as much information and advice as you can from the people that have first-hand experience to make sure that it's right for you. The AMA has a lot of great resources. And Meghan, you are so, so familiar with that. And so do you want to share some of those?
Kwiatkowski: [14:24] Yeah, absolutely. I think to underscore your point. I mean, there's a lot out there on the internet from you know, your own network. But the AMA, as you mentioned, does have a lot of really great resources. Our team has the Private Practice Playbook. We also have a toolkit. It's a web-based collection of AMA resources that are relevant to private practice. And it's not just resources that are coming from our team, but it's from resources across the AMA. So that includes our Ed Center, that includes our advocacy department, just a number of really great resources that are helpful to physicians as they begin their journey, as they continue their journey, or potentially look to make a change down different paths in their journey. As we begin to wrap up our conversation today, Taylor, are there any other final comments or thoughts that you'd like to share as we close out?
Johnson: [15:21] No, I think that, you know, we have covered a lot of really important considerations in this episode, and really underscoring do your research, make sure that you are knowledgeable about private practice before you make the decision to enter or not to enter. Because it could be really great if you're fit for that. So I hope that this was helpful for everyone.
Kwiatkowski: [15:47] Yeah, likewise, I think certainly our conversation is not all inclusive; we'll just encourage you to take a look at some of the resources that we've mentioned in this episode. And there will be links to other relevant resources available for our listeners to look at as well.
Johnson: [16:03] Awesome. Thanks, Megan.
Kwiatkowski: [16:04] Thank you, Taylor.
Johnson: [16:05] The tools and resources mentioned in today's episode are linked in the podcast description and available on the AMA website. CME is also available for this episode on the AMA's Ed Hub, and linked in the podcast description. I'm Taylor Johnson and this has been Private Practice: Attending to Business. Thank you for listening.
AMA STEPS Forward® Series Announcement: [16:25] Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA STEPS Forward® program is open-access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, STEPSForward.org.
Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.
If applicable, all relevant financial relationships have been mitigated.