Are you tired of the hospital? Nurses and techs bothering you with their clock-in clock-out mentality? ED driving you nuts with “we pick em’, you stick em’ requests?” Those slow DR dinosaurs making you lose your hair as you grind out those RVUs between cases to justify your existence? Wouldn’t it be so nice to be in a beautiful office setting? You know, one with windows! No more DR obligations or hospital BS. Yes, the OBL dream. It is real. How do you make this your reality?
Here is what you need:
- Capital.
- Patients.
- HR
- Ability to bill insurance
- Hospital Privileges or a Transfer Agreement, maybe.
There are plenty of people who will loan you money, but how much do you really need? You can get by with 300-400k up front for a 1 million dollar valuation, which is about average. Not hard to save this much working diligently for a few years as a hospital IR.
I’m going to skip the patients part for now, because that is the focus of the post.
You can find someone to do your HR at the right price.
Being able to get on insurance panels can be very tough. It can take 6 months to a year in some circumstances and despite your best efforts you may be blocked out of certain networks. Networks exist to keep the bureaucratic healthcare system/hospital ticking. Big money and politics at work keeping the little guy/gal like you from thriving. Good consultants or even a managerial services organization (a post for another day) can help you navigate this.
Hospital privileges…yes, we’ve talked about this one before. Good luck. It may or may not be necessary depending on your state.
What I really want to focus on is patients. You need patients. How in the world do you get them without having to more or less financially incentivize someone to send you patients?
Referrals are the lifeblood of any healthcare practice. While getting referrals is by no means easy for any independent healthcare practitioner, I would contend that it is much harder for interventional radiology than it is for other fields because very few have a clue about what we do or who we can take care of. Hell, 10/10 interventional radiologists don’t even agree with each other about our mission and purpose. We have a huge marketing problem!
I’ve alluded to our marketing issue in a prior post and it ultimately stems from our history as a technical field born out of radiology trying so hard to differentiate ourselves as clinical specialists. The fundamental issue is we deal with pathologies across a variety of organ systems which makes it quite challenging to pinpoint what exactly it is that we do on a daily basis. I can barely even describe it to my own parents and I’ve been trying to do so for over a decade.
This is where subspecialization comes into play. The riches are in the niches. Most successful OBL practices run by IRs have niched down to two labels:
- The vascular specialist.
- The fibroid specialist.
When you take radiology and interventional out of the name, it becomes easier for patients and other physicians to comprehend your role in the healthcare universe. The “vascular specialist,” is very easy to understand by telling people you deal with “blood vessels outside of the brain and heart.” You then focus your marketing and education on peripheral arterial and venous disease (dialysis care too, though reimbursements make this a more favorable ASC procedure). The “fibroid specialist” is a nice way of saying you’re the UFE person. UFE is widely applicable for the majority of patients with fibroids. Since patients are looking for surgical alternatives, you can really focus your message on the minimally invasive nature of the services you provide as either a vascular specialist or fibroid specialist. Could you do both? Sure you can, but what you’ll realize is that you’ll likely end up doing one in more volume than the other depending on your market and interests. Hard having a waiting room with ischemic legs and fibroid patients. Very different demographics.
While there are new avenues that are exciting, such as the “prostate specialist,” or “musculoskeletal specialist,” these aren’t quite mainstream in high volume yet. More on future horizons in another post.
So in order to get referrals to your new OBL practice, you need to make it crystal clear what it is that you do for a living and how you can help other physicians and patients who may come to you directly. Your message needs to be concise. The moment you discuss more than two service lines, you lose people. It can become very challenging, though not impossible.
There are still three big hurdles you will face even with a clear mission and excellent marketing.
1. Medical Hurdles
Are you able to take care of an undifferentiated vascular or gynecology patient? For the vascular patient, are you adept in medication management? Do you do your own wound care or do you have a specialist you can rely on to help with this? Remember, you cannot rely on subspecialists to serve you “cases” on a silver platter. You are going to have to go direct to patients in conjunction with aggressive marketing to primary care to keep your clinics full.
For fibroids, do you do your own pelvic exams or are you simply relying on other practitioners to do some basic work-up first? Are you able to counsel patients on alternatives to UFE? Are you adept in gynecology and have a clear working knowledge of differential considerations for pelvic pain and menorrhagia?
2. Subspecialty Collaboration
Do you have a vascular patient who would be better suited for an open surgery? Who do you collaborate with? What are the politics regarding this? Would your vascular surgeon be amenable to working with an independent IR who may compete for referrals? Similar questions apply for gynecologists when it comes to fibroids.
3. Market Demographics and Competition
Can your market support your niche IR practice? Maybe a stand alone fibroid practice in North Dakota isn’t the wisest of moves. Perhaps you’d rather not enter a competitive market such as New York City or South Florida where there are OBLs on every corner, especially when you may not have a local reputation. At the end of the day, people need to know who you are which takes time, and more importantly, your market has to support your presence.
With all this being said, I think it’s quite naive for young IRs to think they can show up and easily build a practice overnight. You need the right market ingredients coupled with clear and consistent marketing to build a practice organically. It took me three months in my local market to get consistent referrals (and this was after 2 years of being present in the market as an attending IR), and I’d imagine it would take at least two additional years to really build the OBL to the level where I’d want it to be. There will be many months full of anxiety as you wonder if you can make this happen. I certainly felt that way.
So some questions I leave for you as points of discussion:
- Does our IR training support true clinical independence?
- Is there enough room for multiple IRs to have competing outpatient practices in any given market?
- Do new graduates have the drive to build their own practices organically?
- Am I completely off base and should we just accept our fate as a doctor’s doctor who is hospital based?
Honestly, I struggle with these questions and I would love to hear your opinions. Please comment below or reach out to me at linemonkeymd@gmail.com or @linemonkeymd on Twitter.
Until next time.