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Starting a Medical Practice

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A Countdown Checklist for Medical Professionals

This guide has been developed for all medical professionals in any part of the world. Whether you are a medical physician, dentist, nurse practitioner, physiotherapist, chiropractor, optometrist or any other health professional looking to start a practice, this document has been developed to help guide you through the process.

You have worked long and hard to get to the end of your medical training. As you approach your final year, thoughts start to turn to life after your training. But you discover however, is that all the long hours on the wards have taught you to be an excellent clinician, but you do not know the first thing about the business of medical practice.

You are not alone. The fact is there is very little time devoted to your training on how to run the business of medicine. Most training programs do not provide any courses on practice management. Furthermore, many of your preceptors practice in academic teaching centers and university-based clinics where they do not control the medical business decisions.

Even if you spend a fair amount of your time training in community-based practices, few preceptors will open up their business practices in order to teach you the finer points of running a small business. In fact the business and regulatory environment is becoming very complex. Very many medical professionals find the maze of regulations too challenging and decide instead to work in established clinics or hospital environments.

Launching your own medical practice may be the most significant professional decision youʼll make since you settled on your specialty. You need to seriously consider your options, and proceed carefully. While there is a lot at stake, getting it right yields enormous rewards. Any project requires a plan. You need to construct your practice as deliberately as an architect would design a building. Before you begin construction, youʼve got to be sure it will rest on a sound foundation.

Having the Right Stuff

There are several things to consider before one even starts to build their practice.

  1. Are you willing, and does your family situation allow you, to devote most of your hours toward the new practice for at least two years?
  2. Are you prepared to finance your practice knowing it will leave you thousands of dollars in debt for many months?
  3. Do you have the drive and personality to market yourself in order to build a patient base?
  4. Will you be comfortable not having your colleagues readily available to confer with?

As a medical practice owner you will be wearing several hats. The administrative requirements of running an office is greatly underestimated. A clinician who practices medicine for 40 hours a week will spend another 20-30 hours handling administrative tasks. This includes dealing with staff and suppliers, working with your regions billing departments, working with your accountants to ensure accurate accounting for tax purposes, responding to complaints from patients and queries from the government. While an office manager can assume some of these responsibilities, many matters still require your attention. Medical professionals with a high need for control and autonomy often do best in solo or very small group practices. Running any business is risky. You need to assess your own tolerance for risk.

A Word about a SOLO versus GROUP Practice

If you are planning to open you practice with one or more partners, now is the time to make sure that you are a good match. Not everyone is temperamentally suited to practice together. While you may have trained together, you have not had the opportunity to run a business together. You each should share a similar business philosophy and vision of the practice. If your approach to the business side of practice is very different from your partners, consider going solo or look for another partner. This cannot be over emphasized. Youʼll be spending more time in your practice than you will with your spouse. If you cannot get along, then a divorce will be inevitable. And like any other divorce, it will be painful, disruptive, and very expensive.

The following checklist will help you identify issues that need to be considered when starting your practice, along with a reasonable timeline for implementation. Each of these tasks can be handled over short periods during your final year, between preparation for your certification examinations or after your graduate if you decide to locum or join another clinic on a temporary basis. Each task builds on the results of completed tasks. If the tasks are completed in this order, you will have a controlled rollout of your practice.

A more complete discussion on many of the checklist items will be available in the Practice Guides section of

Starting a Practice- Things you should think about

  • Practice Strategy
    • Number of Physicians in the office
    • Patient volume and size
    • Hours on operation and on-call arrangements
    • Clinic services, special procedures and offerings
    • What is you vision of success
  • Support Items and Services
    • Types of Equipment needed
    • Location and Building space (rent, lease, purchase)
    • Phone, Internet and EMR
    • Staff requirements
  • Professional Services
    • Accountant Selection
    • Lawyer Selection
    • Website design (see Rates and Plans page on for more information)
  • HR and Staffing
    • Job descriptions, interviews, hiring
    • Labor standards
    • Do you offer benefits to employees
    • Performance management practices
    • Compensation and performance evaluations
    • Payroll
  • Insurance
    • Malpractice insurance
    • Personal, home, auto insurance
    • Business insurance

A Checklist to Guide you Through the Process

11-12 months before opening

  • Decide on a practice location, issue to consider:
    • Traffic issues
    • Visibility to the public
    • Surrounding referral base
    • Commute time
    • Distance from a hospital if you will have admitting privileges
    • Parking for patients and staff
  • Select a practice management consultant
    • Select an attorney
    • Select an accountant to develop a startup budget
  • Check the deadline for submitting yellow page advertisements (online and offline)
    • Decide on a business structure

9-10 months before opening

  • Arrange for startup financing
  • Find office space
  • Negotiate a lease
  • Reserve an office telephone number
  • Contact hospital about applying for staff privileges
  • Contact local Ministry of Health about applying for business arrangement
  • Select a practice name
    • Apply for business and municipal licenses
  • Decide on an Electronic Medical Record Vendor if you want a paperless office system

7-8 months before opening

  • Establish a benefits package
  • Set up a retirement plan
  • Reassess adequacy of malpractice coverage
  • Apply for business owners and business continuation insurance
  • Arrange for an employee dishonesty policy
  • Get disability coverage
  • Purchase an umbrella insurance policy

5-6 months before opening

  • Hire an architect and designer for your new office
  • Layout office to ensure comfort and ease of workflow
  • Seek bids for remodeling, if need be, and hire a contractor
  • Determine your needs for furnishings, clinical equipment, and supplies
  • Shop for furnishings, equipment, and supplies
  • Determine your need for information technology
  • Choose IT vendors and negotiate a deal
  • Make a plan for IT installation and training

3-4 months before opening new paragraph

  • Determine how many employees you need
  • Develop job descriptions
  • Create an office procedure manual
  • Creative personnel policy manual
  • Determine staff salaries and benefits
  • Place newspaper advertisements
  • Review resumes
  • Interview potential employees
  • Hire first employees
  • Hire a professional medical website designer to develop your personal and/or clinic website (see Rates and Plans page on for more information)

1-2 months before opening

  • Install a phone system for your new office
  • Hire answering and transcription services
  • Determine your needs for sending and receiving mail
  • Contract with laundry, janitorial, and security companies
  • Establish a fee schedule
  • Put billing and coding procedures in place
  • Set up a system to handle collections
  • Complete application for billing arrangement with Ministry of Health and/or Insurance companies etc…
  • Obtain license from regional regulatory bodies
  • Obtain business number
  • Coordinate employee’s work schedules
  • Assign someone to order supplies
  • Establish protocols for reporting test results
  • Review your bookkeeping procedures
  • Hire a company to do your payroll

Getting ready for opening day

  • Place announcements in community newspaper, local publications and online resources
  • Mail announcements to patients, physicians, and pharmacists
  • Finalize your practice website if not done yet (see Rates and Plans page on for more information)
  • Select and order magazines and other publications for the reception room
  • Create patient informational handouts on the common conditions that you see to help educate your patients
  • Assemble patient registration packet
  • Prepare practice brochure and have it printed
  • Stage 'dry runs' to iron out operational problems
  • Begin accepting appointments
  • See your first patients

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