Leslie Saltzman, ACP Member, was still an internal medicine resident when she started planning her own practice. As the daughter of a Philadelphia family physician who had had a home-based office, Dr. Saltzman understood the demands of being a solo practitioner.
“I literally grew up in a doctor's office. It was such a normal part of life,” Dr. Saltzman said. “I used to do my mom's billing,” and sometimes she even went along on house calls.
But nostalgia wasn't enough to go on when Dr. Saltzman got down to the details of planning for what would become the Rittenhouse Women's Wellness Center in the heart of downtown Philadelphia. She needed a business plan and, just as important, a vision of what kind of doctor she practically and philosophically wanted to be.
To her advantage, her husband had experience in medical device marketing and start-up businesses. Not every practice has such a person on tap, but Robert Saltzman said he didn't have the knowledge required to start a medical practice. So he turned to practice management materials from four associations, including ACP.
“The ACP Web site was our bible as we wrote the business plan,” said Mr. Saltzman. “We downloaded every document from the Center for Practice Improvement and Innovation (CPII) and specifically followed the Marketing Manual for Internal Medicine Practices, “ as well as CPII's 12-month checklist and a guide to hiring consultants.
“The only thing that is necessary for a physician starting out is to find a competent, credible business consultant who can take all of those ACP materials and do the research, create the business plan and choose which of those marketing tools or which of the advertising tools they want to use,” he said. “It's like having a cookbook and all of the ingredients, and just needing a chef.”
Mr. Saltzman next hired two MBA graduates to research Philadelphia market demographics for existing practices in gynecology, women's medicine and internal medicine. He consulted others: a physician who had a medical spa and had previously run a primary care practice for 20 years, the administrator of a hospital-run women's wellness center, an attorney, an accountant and a financial analyst.
After a three-month study and many discussions of business and medical philosophy, Dr. Saltzman and her husband chose to found a practice for women modeled on the concepts of the patient-centered medical home. Dr. Saltzman spends an hour with each new patient and follow-up appointments are a minimum of 15 minutes. She hands out her cell number so patients can call or text her at any time.
“My model included my desire to be able to teach my patients how to lead healthier lifestyles to prevent many chronic illnesses by incorporating better eating habits, exercise and stress reduction,” Dr. Saltzman said. “It was the desire to provide these services that led me to include registered dieticians, personal trainers, and psychologists in my team.”
Dr. Saltzman runs the internal medical practice, and employees or contracts with a broader team of two registered dieticians, two psychologists, three personal trainers, and two aestheticians to provide ancillary services that meld with women's care, such as preventive services, a full spa, nutritional and psychological counseling, a fitness studio and dedicated space for health seminars. All the services are in the same building, one that Mr. Saltzman already owned. (Again, most starting practitioners won't have a building on tap, but Mr. Saltzman said leasing is an effective option.)
The practice still faced about $100,000 in start-up costs, so Dr. Saltzman kept her first year's expenses down by doing some things herself, such as drawing patients' blood samples, giving immunizations and billing. She had a receptionist, but no nurse. Now that she has more than 1,000 patients, she is looking for another physician and has hired a medical assistant.
About 40% to 50% of the practice's current income stems from internal medicine, and the rest comes from the ancillary services. Margo Williams, a senior associate for ACP's Practice Improvement and Innovation Center in Washington, D.C., said many young doctors understandably are hesitant to start their own practices, especially given the overall economic climate and insurance reimbursement trends that have made it difficult for primary care doctors to give patients the time they need.
“You hear how hard it is to make ends meet, that the economics are more difficult when you're in a solo or small practice, and there is truth to that,” Ms. Williams said. “But for someone who wants some autonomy and is a hard worker and has an entrepreneurial spirit, I think there are people out there doing it successfully.”
Ms. Williams added that ancillary services, such as spirometry and other diagnostic tests, skin biopsies, travel or weight loss clinics, and Botox and laser hair removal, can provide the added revenue doctors may need to operate the kind of medical practice they'd ideally like.
“Some purists find it offensive. I think it's good business,” she said.