Time-Line for Starting a Practice

Time-line for Starting a Practice by Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM

One of the common mistakes students of acupuncture and Chinese medicine often make which keeps them financially hobbled is not taking enough time to lay solid groundwork when starting a private practice. Many of us graduate and sort of “fall” into practice without much in the way of planning and thought. We do what seems “natural” or what everyone else is doing without thinking about fundamental assumptions or questioning “conventional wisdom.” However, the more carefully you do your research and the more you plan, the greater the likelihood is that you will be successful. So here is a suggested time-line for planning and starting a practice. It based on a time-line created by the American Medical Association and comes from their Starting a Medical Practice: The Physician’s Handbook for Successful Practice Start-up (Coker Publishing Co., ISBN 0-89970-786-6). This book is a great resource for any health care professional thinking about establishing their own private practice. I have modified the AMA version of this time-line to make it more appropriate for acupuncturists and professional practitioners of Chinese medicine. As you’ll see, this time-line starts one year before opening the practice and seeing your first patient. That means that students who intend to go into private practice should begin actively planning when they start their last year of school.

Not every part of this plan will be applicable to you, but even so, it is wise to take a careful look at this list, possibly highlighting the parts that make sense for your personal practice goals. This will give you a huge leg up on most other acupuncturists just starting out after graduation.

One year before starting practice

1. Make a decision on practice location in terms of state and community in which you hope to practice. 2. Begin examining your net worth in terms of capital available for start-up costs. 3. If possible, reserve office phone number or answering service number. 4. Find out the date when telephone books are printed and have your name listed in both the white and yellow pages. 5. Visit banks and begin shopping for a loan. Pick up loan applications and meet loan officers. Determine what information the bank needs to evaluate your loan application. 6. Open: Checking account, personal Checking account, business Savings account, personal Savings account, business 7. Write a business plan or at least draw up income/expenditure projection for the first year of practice. Talk with several bankers about borrowing money, and submit applications.

Nine months before starting practice

1. Check sites for buying or leasing medical office space. 2. Check zoning ordinances with your local city hall and/or zoning board regarding signage and type of businesses allowed in the area and ask about any expected changes. 3. Check on utility requirements for the office. 4. If leasing, see if any leasehold improvements are needed and when you can start making these improvements. 5. Determine office layout and design. 6. Determine office and medical equipment needed. 7. Choose advisors: Accountant Attorney Banker Insurance broker(s) Management consultant Real estate broker Other (such as computer consultant) 8. Evaluate office lease and/or any partnership agreement contracts with your attorney before you sign them. 9. Obtain bids for any major office equipment or furniture you will need. Compare leasing versus purchasing. Be sure to get a written guarantee of delivery date and in-transit insurance. Intercom system Exam room/medical equipment Photocopy machine Computer Telephone equipment Calculator Reception room/office furniture and decorations 10. Check with the local state agency who issues licenses to acupuncturists and make sure you can have your license by the time you plan on opening your practice.

Six months before starting practice

1. Obtain the services of an answering service Office Beeper service Call forwarding 2. Select an Individual Retirement Account (IRA) 3. Obtain current ICD and CPT codes. 4. Order a medical record system. 5. Order sign for office. 6. Obtain insurance forms. 7. Notify acupuncture needle vendors, Chinese herbal suppliers, and other appropriate sales persons that you are setting up practice. 8. Obtain county and city occupational licenses from county/city clerk’s office or city hall.

Three months before starting practice

1. Arrange for professional malpractice insurance. 2. Arrange for office insurance: Business liability Worker’s Compensation Health. Major medical for yourself, dependents, and employees Key person or disability for you Life insurance for you 3. Arrange for telephone service installation. Consider purchasing telephone equipment. 4. Arrange for acceptance of credit cards in your office through your local bank. 5. Talk with your local newspaper about practice announcement ads. 6. Order office opening announcements. 7. Arrange to give talks to community groups on acupuncture and Oriental medicine. 8. Meet physicians who are potential referral sources. Send letters; arrange appointments. 9. Check on membership in local civic, social, fraternal, volunteer, and/or church organizations. 10. Arrange for movers if necessary. 11. Write your State Department of Labor for state employment regulations and wage and hour information. 12. Write preliminary job descriptions for employees. 13. Write policy manual for office employees. 14. Check local resources for personnel. 15. Start interviewing for office personnel. 16. Apply for your Federal Employer Identification Number through your local Internal Revenue Service (IRS) office. 17. Apply for your State Employer Identification Number through your state Employment Office/Department of Labor. 18. Obtain “Small Business Tax Guide” and your Federal Estimated Income Tax Form through your local IRS office and/or attend a small business tax seminar at your local IRS office. 19. Write for your State Estimated Income Tax Form through your state Employment Office/Department of Labor. 20. Obtain payroll withholding booklets (federal, state, city) through your local IRS office. 21. Review tax requirements with your accountant. 22. Purchase or order appointment scheduling book. 23. Arrange for as needed: Janitorial service Snow removal service Laundry service Grounds maintenance Sharps and medical waste disposal 24. Order clinical supplies and set up inventory control system. 25. Purchase or order business supplies: Appointment cards Business cards Patient recall system Petty cash vouchers Letterhead stationary and envelopes Stationary supplies Deposit stamp for checks Prescription pads Purchase order forms Preprinted telephone message pads Preprinted super bills 26. Determine office hours based on community need. 27. Determine fee schedule. 28. Select and order magazines: For reception room Medical journals for yourself 29. Purchase office equipment and furniture. Arrange delivery date. 30. Write patient information brochure or booklet and have it printed.

One month before starting practice

1. Start setting up office. 2. Have utilities turned on: Telephone Electricity Gas Water 3. Start accepting appointments. 4. Hire and train office personnel: Telephone techniques Collections Appointments Office policies 5. Decide on collection/insurance policy. 6. Hang out shingle. 7. Establish a petty cash fund. 8. Establish a change fund. 9. Place announcements in community papers: Paid advertisements News releases 10. Mail out announcements to physicians, chiropractors, health food stores, hospitals, health groups, etc. 11. Plan office “open house.”

Opening day

1. See first patient 2. Congratulate yourself. You are now in practice!