Banner
banner

Fall 2015 (Volume 25, Number 3)

The Business of Rheumatology

By James Henderson, MD, FRCPC

Download PDF

This article is primarily for individuals setting up a fee-for-service practice. If you are joining an academic group, many of the decisions we will be talking about will be handled for you.

When one commences a full-time practice after residency, there is usually a noticeable increase in income. The obvious temptation is to immediately upgrade everything (e.g., house, car, clothes, etc.). My first advice is to temper the temptation! Most residents I speak to are carrying significant debt after their residency. They would be far better off to pay down their debt, starting with any credit card debt, followed by lines of credit and student loans. Being able to avoid interest payments will ultimately put more money in your pockets. I would prolong the “residency lifestyle” a year or two to get the debt paid off.

Some may not be ready to start a practice of their own just yet; a good alternative would be to offer your services as locums. This provides new practitioners an opportunity to see various practice patterns, as well as to see more of the country to get a sense of what locale and type of practice you would ultimately like to set up.

When one is ready to start a practice, you will need to assemble a team: I would ask colleagues to recommend a lawyer, an accountant, and a financial adviser who are familiar with medical practices. They will provide you with an overall financial plan, assist with leases, set up accounting procedures for the office, and help set up long-term financial goals for the business.

I feel the most important decision you will make early on is the selection of office staff. I recommend you advertise and collect résumés. Pick the top five résumés and interview each candidate, giving them a typing test with a short rheumatologic letter. These individuals are crucial to the success of your practice as they are the face and voice of your office! In my personal experience, I have usually shared a secretary with another rheumatologist. Over the years I have been fortunate, only having train two secretaries. My clinic now has an office manual with all businesss-related facts set down, to ease the transition to a new secretary if that ever becomes necessary.

The location of an office is important. Ideally, it would be near your affiliated hospital and close to home, provide adequate parking for patients, and have a good layout. The lease can be negotiated regarding rent, leasehold improvements, cleaning services, duration of lease, and other issues. I would have your lawyer assist you with these discussions. Optimally, the office would be accessible by public transit, and be accessible to patients with disabilities and mobility impairments. Over the 30 years I have been in practice, I have practised out of four different offices, each one suited to my needs at that time. Be aware of your needs, and adapt accordingly.

Make sure you have all the necessary insurance, including general liability, disability, Canadian Medical Protective Association (CMPA), office overhead, and a health plan for your family. Your family may even play a role in your practice: your spouse can take on a role in the office to allow for income-splitting. Many spouses of rheumatologists assist with billing and the scheduling of travel clinics. Moreover, if your spouse is trained to do patient counseling, so much the better. There is a book from the Medical Post called Succeed at Everything in Your Practice available on Kobo, Amazon, and i-books: I would strongly recommend this reading to any practitioner looking to open their own practice!

Good luck and enjoy the ride!

James Henderson, MD, FRCPC
Chief,
Internal Medicine,
Dr. Everett Chalmers Hospital
Teacher,
Dalhousie University
Fredericton, New Brunswick

Issue Skyscraper