The first step is to create a vision for your practice.
If you are considering opening a direct care practice, the first step is to create a vision. If you’ve always dreamed of owning your own practice, you might instantly know exactly what your dream practice looks like. But if not, try this mental exercise.
Imagine your ideal practice environment
Start by considering your ideal work environment. Close your eyes and imagine walking through your office – what do you see? Is the room big or small? Are there marble floors and water features, a clean and sterile-looking environment, or is the environment more homey and shabby chic? Is your practice full of patients and staff, or is it quiet and tranquil? Perhaps you want to make your practice child-friendly, or maybe you envision bringing your dog to work. Try to think of every little thing that would bring joy to your workday and jot down your thoughts in your bullet journal.
Think of your ideal work day
Now imagine your ideal working day. If you’re a morning person, you might prefer to see your patients at 7 a.m. and end the day early. Or maybe you value spending time at home with the kids (or sleeping!) in the mornings and prefer to start later. Would you like to work through the lunch hour and see as many patients in a row as possible, or are you more comfortable? Picking up pace, taking several planned breaks throughout the day? Perhaps you imagine working a three or four day week to have more free time. Again, write down your thoughts about what the “perfect” work day or week looks like for you.
Remember that you are just beginning to develop your vision and that your wants and needs will evolve over time. That’s okay! One of the best things about opening a practice is that you are free to experiment, and if you don’t like the way things are going, you have the opportunity to change them.
Consider your values and mission
Now that you have some ideas of what your ideal practice might look like, let’s explore your values and mission. Take some time to really think about what motivates and excites you about the medical profession. Is it important that you care for a specific type of patient or manage a specific disease process? Do you feel driven to be on the cusp of the latest technological innovations? Are you enthusiastic about social justice, research or pensions? Make a list of these intrinsic motivators as soon as you can think of them.
Some doctors may have trouble establishing a senior mission, especially if they have spent years being abused by the system. If you fit into this category, looking into your past is a great way to plan for your future. Start by thinking about the first time you realized you wanted to be a doctor and what inspired you to do so. Fast forward a little and see how to write your personal statement for your medical school application. What did you write? Think back to the moment you received your acceptance letter into medical school. What future did you envision?
Create a mission statement
Over the years, a variety of factors may have derailed your vision, but you can find your way back. A good place to start is to create a mission statement. It also helps to write down your values and ideas about services and office hours you would like to offer. Remember that you can always change these later. Here are mine, and feel free to borrow them if they appeal to you.
Mission: Delivering quality, evidence-based direct primary care at affordable prices by eliminating third-party payers and minimizing overhead.
I chose this mission because I am passionate about primary care. Studies show that treating chronic diseases and providing cancer screening saves lives. The direct care model allows me to offer this care cost-effectively and gives me the time I need to develop real relationships with my patients.
Values:Provide quality medical care that enables patients to improve their physical and mental well-being. Be accessible to patients while facilitating the doctor’s work-life balance. No gimmicks.
For optimal results, doctor and patient must work together as a team. Our job is to educate and provide tools, but only the patient can take the necessary steps to improve their health. I also remind myself here that I can’t take care of anyone if I don’t take care of myself. Finally, as a payments-based doctor serving budget-conscious patients, I find it imperative that I maintain trust in my patients by providing evidence-based treatments and avoiding unscientific practices, no matter how lucrative or popular.
Services:Basic care by appointment only. Telephone access and internet-based consultations when appropriate. Offer lab sampling and reduced lab fees. Minor procedures such as biopsies, ingrown nails are offered. and masseur.
I know I function best on a schedule. Patients who come to me with acute problems (especially minor, self-limiting conditions) bring my practice to a halt, so I discourage the practice. Instead, I reserve a few slots per day for same-day spending. I enjoy doing procedures, so I’ve learned to collect my own blood samples, a service my patients appreciate. And as a big advocate of mental health care, I’ve integrated inexpensive psychotherapy into my practice from practically day one. Seeing the need for additional services, I added an affordable nutritionist and massage therapist exclusively for my patients.
Business hours:Monday: 11 am – 5 pm, Tuesday – Thursday: 9 am – 2 pm.
When I first opened my practice, I saw patients Monday through Thursday from 8:30am to 5:30pm and used Friday for administrative time to run the business (and errands). As my practice filled, I switched to seeing patients only Tuesdays through Thursdays, and eventually changed my start time to 9am, which gives me more time in the morning to organize and meditate for 10 minutes – something that I’ve been working on making it a habit for years.
Because you are in control, your schedule can evolve to meet your needs and desires. For example, last year I planted a pandemic vegetable garden in the backyard, but was frustrated that it was too dark when I got home to check on it. It may sound silly, but watering the plants and picking lettuce leaves makes me ridiculously happy. Coming home earlier also motivates me to exercise in the evenings, which is something I need to do for my health. So, after consulting my office manager, we cut my Tuesday-Thursday afternoon hours and added Monday office hours back in.
Now that you’ve started to visualize your dream practice, are you getting a little excited? You should be because you can do it!In the next articles I will show you the steps to make your dream a reality.
Rebekah Bernard, MD, is a general practitioner in Fort Myers, FL and the author of How to become a Rockstar Doctor and Physician Wellness: The Rock Star Doctor’s Guide.