I help doctors open private practices and resuscitate failed ones. Here are the 3 biggest mistakes I see them make.

BI Graphics

An as-told-to essay is based on a conversation with Lisa McDonald, the founder of Integrated Connections, a national medical-practice consulting company. It has been edited to make it clearer.

Many medical schools overlook the business side of medicine, which can make opening a practice difficult.

I've worked with hundreds of private practice physicians and aspiring business owners since founding my consulting company in 2009. When doctors go off on their own, there are a number of challenges they face.

1. Unrealistic expectations

After opening a practice, many physicians come to me and discover it wasn't what they had in mind. They didn't put the right amount of time and effort into properly vetting the resources, the systems, or the software required to open a practice without sufficient capital or support staff.

A physician I worked with thought he could start a practice with just himself and his spouse working part time. The couple worked on a small budget and their spouse was busy with everything. They weren't able to build a patient list as quickly as they wanted because they didn't have enough money. The administrative burden negatively impacted his quality of life because he couldn't hire any additional support and he wasn't able to maintain a salary that would support his family and lifestyle. When he decided he had to close the practice, he came to me looking for a job.

2. Being afraid to spend a lot in the beginning

Spending money is seen by physicians as a hit to their bottom line rather than a necessary investment to fuel future growth.

I've worked with doctors who didn't have a plan. They couldn't decide between the best price and the best value when it came to marketing and staff spending. I've seen this mindset damage a business beyond repair and it's understandable that many physicians are swimming in student loan debt.

Doing marketing work, using social media, creating programming, writing articles or a book, and hiring the right support staff are all things that physicians don't immediately consider to be revenue generators, but investing in the right professionals to help get these aspects running smoothly sooner will help grow your patient base

3. Not hiring help or budgeting properly for staff

When opening a new medical practice, physicians don't understand how hard it can be to find quality candidates, and how important it is to hire quality candidates. This applies to both clinical and non clinical staff.

Many physicians attempt to open a practice with little to no staff. Trying to run a practice on top of treating patients is a fast way to burn out, even though they think they can do it all. If you have effective processes in place to hire the right people, it's a huge payoff in the long run.

The hiring costs are underestimated by many. Clinic owners are often excited to grow their practice and want to hire an advanced-practice provider to help see more patients, yet they aren't aware of how much these professionals can earn elsewhere.

Here are a few key strategies for dealing with these mistakes before opening a practice

1. Define your objectives: Some physicians may be particularly focused on making as much money as possible, while others may value the autonomy and flexibility that can come with being self-employed. Physicians need to prioritize which factors are most important to them so that they can build and shape their practice around those priorities. The highest-paying practice opportunity may not be the one with the three-day work week located in your hometown or on your favorite beach or ski resort, for example.
2. Do your research: There's a plethora of information online regarding the challenges of owning and operating a medical practice in today's environment. Physician professional associations, local physician meetings, and online healthcare-networking groups on LinkedIn and Facebook are also great places to find practice owners or vendors willing to share their knowledge and expertise. When setting a budget, think about all the costs involved in starting a business — things like office space, staff, IT, marketing, and administrative tools, among others.
3. Hire based on character and loyalty: You can teach new skills, but you can't teach personality, emotional intelligence, or purpose. You also want to hire for tenure, as significant turnover can be detrimental to a private practice. To gain insight into how candidates think, problem solve, and interact with patients and peers, I use open-ended and behavioral interview questions like: "How do you adapt to working at a new practice?" "What do you believe are the three most important aspects of a successful patient encounter?" "What do you think are the top challenges in healthcare now, and how do you overcome them?" and "Where do you see yourself in five years?" One client I work with likes to ask office-support candidates: "What would you do in the last 15 minutes of the day when all of your work is done?" Some candidates reply with answers like, "Just hang out," while others answer with examples demonstrating initiative like, "Clean around my work area," or, "Ask my colleagues if they need help."