*This article was originally published as a guest post for Lisa at Integrated Connections! After the overwhelming responses (thank you!!) from it, we are reposting it here.*
Hi, I’m Tara, Co-Founder / CEO at Rupa Health. I’ve spent the past 12 years working in health, wellness, and functional medicine – from research at Stanford University to helping build Parsley Health in the early days to creating our own virtual clinic at Rupa, and more recently, building a lab ordering tool for functional and integrative practitioners. TL//DR, I have learned a lot over the years about what it takes to start and run a successful practice. I also have the firsthand perspective of starting and running a business on my own, from the ground up, as a female founder.
If you’re launching a new practice or thinking about it right now, I feel your pain – it’s NOT easy!
I’ve been where you’ve been. Debating jumping off on my own, but not sure where to start. Excited by the possibility, but nervous about the risk. Wanting to create a practice, but overwhelmed by all the details.
So, let me help you – here’s where you should start. Through my experience building Rupa & working with hundreds of practitioners, I’ve gotten a rare birds eye view into how some of the most successful practices operate. I’ve compiled a list of the 7 most important questions you need to ask yourself before you dive in 100%. The key thing is that you spend some time answering these questions beforehand. Thinking through these, and taking a firm stance can save you months of experimenting. I’ve also included tips about what I’ve seen the most successful practices do.
Existential Question #1: What is My End Goal?
Is it to create a global brand in the functional medicine world and oversee a large staff? Run an intimate one-(wo)man practice and be high touch with each of your patients? Or somewhere in between? Or is it something else entirely — is it not having a boss? Is it to be able to travel and see patients no matter where you are in the world?
Determining your “why” is the crucial first step that most people forget to do. It’s the single most important decision, because it will affect every other decision afterwards — from how much money you invest upfront to what marketing channels you use to whether you hire support staff or not.
Tara’s Tip: Write out what you want your practice to be in 10 years. How this business integrates with the rest of your life. In as crystal clear detail as you can. And then work backwards — where do you need to be in 5 years to get there? 3 years? 1 year? And then post these somewhere you see them every day. One tool I love is the Lululemon Goals Worksheet.
Existential Question #2: Do I Have the Financial Runway to Not Be Profitable For a Year or More?
I hate to be the bearer of bad news, but what we’ve seen, it takes most practices somewhere from 3-4 years to really hit their stride. (hopefully these questions can help get you there quicker!)
The reality is that starting a business is a huge financial investment — it can be tens of thousands of dollars especially if you are doing brick and mortar (see — Existential Question #7)
Things you’ll need to invest in:
- EMR / EHR
- Malpractice / Business Insurance
- Legal Support
- Website & Branding
- Telehealth Platform
But the biggest hit that no one talks about is perhaps your time. As a new business owner, you’ll be spending a majority of your time doing everything you can to build the business – in lieu of getting a regular paycheck or seeing patients for cash. It’s a real financial hit. Are you prepared for this?
Tara’s Tip: The biggest mistake we see new practice owners make here is to let money ruin their relationship with the patient. This happens in many forms – nickel and diming patients for every fee, being stubborn on pricing in the beginning (see EQ #6), cutting appointments off at the end of the exact allotment even if you’re not done discussing. The most important thing you can do in the beginning is….whatever it takes to get a word of mouth referral from your patient! This will likely mean spending more time with patients than they are actually paying you for — e.g. messaging, phone calls, check ins, going over on appointment time.
If you start charging for each of these “extra minutes’ ‘ – patients won’t be happy and won’t refer you to their friends. This will kill your business before you even get a chance to get off the ground.
Look at your finances and determine upfront how much money you are willing to invest in the business. Once you have decided that amount, set it aside, and spend it without worrying. Do the hard decision upfront – rather than just accumulating costs and feeling nervous about it every time a charge hits your credit card statement. Know that you will make losses upfront. Are you ok with this?
**BONUS** Also, get a really good business credit card like the Chase Ink – which will allow you to get a lot of reward points that you can use on travel, etc. (Let me know if you want a referral! firstname.lastname@example.org)
Existential Question #3: Am I ready to be a spokesperson for my business?
You didn’t get into medicine because you wanted to be a celebrity. (Or did you?! That’s fine too! 🙂 The #1 frustration we hear from practitioners running their business is…MARKETING. In the age of Instagram, it can feel overwhelming. Don’t worry though, you don’t have to be an influencer to run a successful practice! However, you do need to become comfortable being a spokesperson for your business. At the end of the day, you are selling your services, and no one – no consultant, no marketing firm, no FB Ad money – can do this for you. You must learn to get out there and promote yourself. If you don’t feel comfortable doing this – starting your own practice might not be right for you.
Tara’s Tip: Find one channel that works for you – and FOCUS on that. We see too many practitioners fail at marketing because their efforts are spread out over: posting Instagram stories, getting likes on their Facebook page, giving talks in the community, sending out a newsletter, etc., etc. This doesn’t work in year 1 because you’re doing too many things and not getting critical mass on any of them. So pick 1. My recommendation would be to build off your existing network and community. We see community involvement (speaking, etc) work really well in year 1 – much better than digital in fact. Your goal is to get word-of-mouth happening.
Existential Question #4: Am I ok spending 50% of my time not on patient care?
This is the reality, unless you have the money upfront to hire office staff, a patient care coordinator, a biller, an accountant, a bookkeeper, a scribe, a lawyer, a health coach…you get the picture. But to be clear — it’s not 10% of your time on “business stuff” or even 25%. It’s more like 50%. I’d go so far to say in the first 6 months it’s more like 80%. Your main job in the beginning is getting patients – it’s going to be a LOT of marketing. Even as your business grows, you will also have to hire and manage a team. Are you excited by running a business? I hope so! (and these “boring” pieces can actually be fun, trust me!)
Tara’s Tip: There’s a lot of tools out there that can streamline the operations of your business – install these upfront and spend time learning how to use them. It will make your life easier. Practitioners who implement these upfront rather than trying to patchwork them in later are more satisfied with running their business overall. BTW, we wrote a post on the 15 tools that will make your life 10x easier — check it out!
Existential Question #5: Do I want to have a niche specialty (fertility, auto-immune, IBS, etc.) or go broad (functional GP, family medicine, etc.)?
Ah, the classic battle. The nature of functional and integrative medicine means there is no “specialty” technically – as you’re treating the whole person and root cause. It’s understandable that many practitioners resist having a niche when they start out. However, from what we’ve seen, it’s important, if not vital, to at least state a specialty in the very beginning. This doesn’t mean you should turn away patients who don’t fit the bill. However, it’s in the patient’s psychology due to cultural conditioning to go to a doctor who is “the best at X”. (X being whatever the patient is experiencing.) If you’re “good at a lot of things”, the patient is going to have a harder time spending the money to fix a specific problem. Think of it this way: the patient will search until they find the practitioner who is best at X. If you’re not sharing that you are best at X, they will move on. If this one is a tough one for you, maybe consider growing a patient base at an established practice before starting on your own – that way, you can have some street cred and can build a general practice off of referrals, rather than starting from scratch.
Tara’s Tip: Trust us on this one, pick at least one niche when you start out. From what we’ve seen – patients who come for the niche, usually stay for life if they’ve established a positive relationship. It’s just a foot in the door. As you grow and have patients who are with you longer, you will be able to branch out more broadly. If you niche, your marketing can be very clear, and it is easy on who you are targeting.
Existential Question #6: What will my pricing model be?
Unfortunately, pricing is an art, not a science, and relies heavily on your patient demographic, your credentials, and your popularity as a practitioner. Most practitioners have to do a lot of experimenting to get started. Additionally, something to note is that your pricing structure will change over time as you grow your practice. There are three main questions to answer when you’re deciding your pricing structure:
- Should I offer a membership, packages, or pay per visit?
- Should I do free consults? If so, how long?
- Should I accept insurance or not?
Ultimately, no one can answer these questions for you – it’s up to the supply and demand forces in your area. It is incredibly important that you figure out as quickly as you can if there are enough people in your area with the willingness and ability to pay to support a full practice. If not, you will need to go virtual (see EQ #7).
Tara’s Tip: Don’t be afraid of asking your patients for guidance on pricing. To determine whether you should do membership, packages, or pay per visit — come up with one option of each, and ask your patients which one they’d like to purchase. Giving more than one option also psychologically helps the patient make a decision in your favor — since instead of deciding whether they want to work with you or not, they are deciding how they want to work with you.
Additionally, do the free consults as much as you can in the beginning. The more a patient understands how you think and how you’ll treat them, the more likely they will be to work with you (if they’re a good fit). It’s rare that a patient will drop a few hundred dollars on a visit cold, without a free consultation (the exception being a VERY strong word of mouth referral). A free consultation is a great way to get potential patients in the door, and also a great way to weed out the wrong patients.
**BONUS** We broke down the cost functional medicine MDs & DOs across the US are charging for their services in this blog post. Here’s the breakdown for naturopaths. It can also be helpful to look at people in your area to see what the competition is charging.
Existential Question #7: Do I want to work virtually or in-person?
Welcome to 2020! Telehealth is legal in all 50 states now, and it’s growing rapidly in popularity especially with functional and integrative medicine. Additionally there are tools you can use (like online dispensaries for supplements, Rupa for labwork, Zoom for video calls) that make it seamless to run a virtual practice. Convenience and low overhead are the upsides and loss of the in-person connection is the downside. Do a quick scan of your community — are there lots of integrative and functional doctors? Or very few patients with the ability to pay? If either is a “yes”, you’ll likely need to go virtual.
Tara’s Tip: Incorporate at least some virtual visits in your practice from the outset. You’re going to fall behind if you don’t. Telehealth is skyrocketing in popularity and we’re seeing more and more practitioners going virtual. If you choose to offer in-person, offer virtual follow ups for patients. That’s where we’re seeing the majority of virtual visits happening.
Wow, if you made it this far, I think you’ve passed the biggest test of them all – persistence! 🙂 Launching and running a business is a lot of trial and error – continuously figuring out what is working, what is not, & being willing to adapt. Always ask your patients what they want and what they need because in this field, we’re ultimately here to help people!
And remember, yes, it’s terrifying to take the plunge and start your own business, but it’s also incredibly fulfilling!
I hope this was helpful – shoot me an email and let me know!!