When Nicole Ottens, D.O., joined Mattoon, Ill.’s Sarah Bush Lincoln Health Center in July 2010, setting up her practice was “incredibly easy,” she recalls. As an emergency room physician employed by the 128-bed rural hospital, she didn’t have to make many decisions.
The hospital’s recruiter and human resources department processed the paperwork for securing her credentials. She didn’t have to market her services, because sooner or later people use the ER. And because she joined a department already staffed with nurses, she just became one of the team.
Ottens, who will soon be dual boarded in emergency and family medicine, was delighted with the process and even happier with her choice of employers. “All I want to do is to provide quality care to my patients,” she says. “This is the perfect job and the perfect way to do that.”
Perhaps you’re looking for the same streamlined experience. You want to sail through the formalities of launching a practice so you can just take care of patients. But establishing your practice is as important as anything you’ll do in medicine. It usually takes time, patience and attention to detail to make the smooth transition from training to your first job or from your first job to the next. To launch yourself as a skilled practitioner open for business, you’ll have to focus like a laser on key tasks: putting your credentials in order, marketing your name, staffing your office and equipping it too.
Are you in this alone? If you’re flying solo, you’ll have to take care of every aspect—unless, of course, you’ve already tapped a business manager. It’s the nature of being a lone wolf. But if you’re destined to join a group or hospital staff, you’ll likely have lots of guidelines, to-do lists and helping hands.
Organizations are usually quick to help physicians navigate a practice setup. Depending on the size, you’ll have plenty of assistance for mastering the terrain.
As Dorrie LeForce, director of operations for the Dallas-based HealthTexas Provider Network (HTPN), the 500-physician Baylor Health Care System-affiliated group, notes of their extensive soup-to-nuts assistance they give new hires: “We’re the legs and arms to support them in everything they need to open their doors.”
Credentials first on to-do list
You can’t treat patients unless you have proper credentials. It’s that simple. The first order of business in setting up your practice will be to get licensed by the state, affiliated with area hospitals and approved by Medicare, Medicaid and the major payers your employer wants to bill for your services.
Some fundamental items—such as NPI (National Provider Identifier) and DEA (Drug Enforcement Administration) numbers—you’ve likely already presented as part of your application. If not, you’ll need to apply for them before you can bill and prescribe drugs. Likewise if you’re staying in the same state in which you trained, you already have your medical license. But if you’re moving to a new area, getting it will be a priority.
Once you have those basics, you can complete the paperwork for your group’s major payers and professional liability insurance. In terms of malpractice, you’ll likely have the same carrier and coverage as your colleagues in your specialty, but you’ll still have to apply separately. Educate yourself about the coverage limits, how any suit might be settled, and what happens with the tail.
Chances are very good that the group or hospital you’re joining will help you navigate the paper chase. Start dates are usually contractually contingent on having your ducks in a row so you can see and bill patients on day one. Most organizations have an office or function to handle the details and keep the process moving forward.
So what’s your responsibility?
• Make sure your information is complete. Leave no time span unaccounted for or stone unturned about your training and work history. A non-problem can become a problem if you answer “no” to a question that should be a “yes.” Even if hiding something wasn’t your intent, it looks like your intent if you can’t account for holes in your CV or explain a dubious episode, especially involving complaints by patients.
“The most important thing is to be careful and clear,” says Paul Sherman, M.D., MHA, associate medical director, strategic deployment, for the 1,200-member Seattle-based Group Health Physicians. “If you’re not sure, ask.”
• Be a stickler for deadlines. Most new physicians know about their first job a year in advance, so there’s plenty of time to submit relevant documentation. But that means responding quickly to every request. Credentialing can take up to six months, depending on the number of applications you’re submitting and the organization’s policies for processing them.
At Group Health Physicians, for instance, the general credentialing and privileging committee isn’t the only panel to sign off on a new doctor. Members of the applicant’s specialty also get to review the file, making sure that the physician has performed enough of a given procedure to be privileged for it.
New physicians recruited by the Surgical Institute of South Dakota, P.C., in Sioux Falls may have to allow time to get a state medical license. Most recruits need to check licensing off the to-do list first. Practice administrators get the paperwork rolling in February or March so it’s completed by the candidate’s summer start date.
“You need to start early and be diligent about completing the paperwork,” says Mark Hatting, CPA, CMPE, executive director of the six-physician general surgery practice. “The process can be laborious, boring and frustrating at times. But you have to be patient and accept all the help your administrative staff offers.”
When he first left training, Chris P. Lupold, M.D., now a Strasburg, Pa., family physician, had no idea that he’d have to get credentialed with so many insurance companies. But the practice manager at the Charlottesville, Va., group he was joining at the time was extremely proactive in sending materials and keeping him focused. When Lupold joined Lancaster General Medical Group, a 100–physician multispecialty practice, in 2008, the process slipped his mind until others reminded him two months prior to his start date. He had to play catch-up with the paperwork before joining his four colleagues at the Strasburg location.
His words to the wise: Take credentialing seriously. Know who’s in charge. Find out who will pay the costs. And keep copies of everything so documenting your past if you need to in the future is a cinch. For instance, because Lupold tracks his malpractice policies every year, when he had to provide proof of coverage back to residency, he was able to dip into his files. “It’s a lot easier than having to ask somebody else for it, especially if you’re leaving that practice.”
Marketing equals success
Letting people know that you’re taking patients is the only way to build your practice. You’ll likely have access to marketing professionals ready to make your face, specialty and skills familiar to everyone. But what should you do to toot your own horn?
Depending on the organization’s media savvy, your biography should be fodder for anything from an internal mailer and external news release to a website and even Facebook page. Since Googling is second nature to many consumers these days, most practices include a web presence among their marketing tools. Make sure you review it.
When Lupold learned that some of his new patients found the practice via various insurance websites, he made sure that he updated his material every three months, especially when he became board certified.
Even with today’s communications gizmos, the single most effective tool in your marketing arsenal is word-of-mouth. If you’re not going out into the community, developing solid relationships with colleagues and interacting well with patients, all the advertising in the world won’t make a dent.
“If you don’t get out there, people don’t know that you exist,” says Randy Buchnowski, chief operating officer, Physician Enterprises, the provider network affiliated with Centura Health, the Englewood, CO-based health provider. “They don’t know what sets you apart. What makes you different? What makes you special? That’s what you need to tell others.”
Whether you’re a specialist or primary care physician, meeting doctors and other health providers in their environments not only adds to your credibility with patients when you need to refer them, but can reap rewards for you, too.
As one of more than 200 orthopedists in the Dallas-Fort Worth metroplex, J. Scott Quinby, M.D., now co-director of Baylor SportsCare, head of the division of orthopedics, Baylor Medical Center at Uptown, learned early on that competition would be pretty fierce. He had to gain the trust of as many primary care doctors as possible so they’d refer their orthopedic patients to him. Quinby was persistent in knocking on doors, visiting clinics and giving orthopedic lectures to primary care colleagues, all of which “helped out tremendously.”
“The main thing, especially from a specialist’s standpoint, is that you must aggressively market yourself,” he says. “I’ve seen people fail because they just sat back and waited for others to help them. But you can’t depend on somebody else to do it. You have to be very assertive.”
When Luis Perez, D.O., opened his family physician office in Vermillion, Ohio, this past summer, he knew the territory. Because he had trained within the same system that now employs him—the Firelands Physician Group, a multispecialty entity affiliated with Sandusky-based Firelands Regional Medical Center—his name rang a bell. People who knew him recommended him to their acquaintances. Because he’s the only doctor in this office, however, he’s still doing his part to raise his community profile by giving speeches, doing interviews and helping with the local triathlon.
“Doctors shouldn’t be too bashful,” Perez says. “People have a better idea of what you’re like if they actually meet you in person or hear you speak at an event rather than just seeing your photo in the paper. Sometimes it’s a little intimidating to do those things, but I think it’s worthwhile.”
Staffing is an important ingredient
The people surrounding you will be instrumental in making your day flow seamlessly and your patients confident in your abilities. But how much input will you have on those decisions?
You’ll likely have no say in hiring administrative and support employees such as billing clerks or lab techs since they’re part of the general office staff. But you should have a big say in the choice of any clinical employees—your nurse, nurse practitioner, medical or physician’s assistant or other ancillary provider—you’ll oversee on a day-to-day basis. If you’re replacing another doctor, you may have to learn to work with the existing staff. But if your hiring means the department is expanding, you’ll probably be involved in those choices.
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