Transcript
YouTube English auto-captions.

========================================================================

Hey guys, welcome to another edition of Bootstrap MD, the podcast for physician and health care entrepreneurs. From time to time we love to spotlight physicians who are in the trenches and they're making it happen. And my next guest is no exception. She's a board-certified family medicine doctor, private practice owner, and advocate for physician entrepreneurship.

After launching her own successful independent practice in Alabama, she became passionate about helping other physicians start and grow their own practice. Through her podcast Physicians Hanging a Shingle, coaching programs, and speaking, Dr. Anderson teaches physicians how to move from employment to ownership and build sustainable physician-led practices. Oh, I love that.

In addition to her work with physicians, she is an active reader and advocate for the future of medicine, working to ensure independent practices remain a vital part of the health care landscape. I want to welcome to the program, Dr. Britney Anderson. Britney, I'm so glad you reached out to me and then I'm so glad to meet you for the first time.

Absolutely. I'm so great to have you. Thank you for the work that you're doing for all of us as physician and health care entrepreneurs. Love Bootstrap Bootstrap MD the at podcast that you put out and and just thank you for what you do and for giving me a chance to be here to chat with you guys today.

I I love it and for the longest time it seems each year I just see the percentage of doctors going into private practice seems to be dwindling. Not that there's anything wrong with working for being an employed physician, but number of coach clients that I have are in that and you know, they they feel kind of crushed with going on there. And private practice is not for everybody. I'm sure you would want to agree with that the same thing, but it is a viable option to practice the medicines that at least I aspire to when I was in medical school.

So, thank you for coming on to the program. Thank you for having me. I'm really looking forward to our chat today. All right.

So, I'm a big comic book nerd. I know it's surprising, but I'm a big fan of how Clark Kent became Superman or Peter Parker became Spider-Man. So, what was your origin story? What got you started where maybe you realized I can't stay employed anymore.

Let's talk about that. Yeah, absolutely. So, my So many residents, just before residency, I signed a contract. I did family medicine at a pretty large family medicine residency program here in Alabama.

We were then a It's a 3-year program, a 15 15 15 program. So, a big program. And like the other 14 of those in my cohort all 15 of us went into employed practice right after graduation. And a lot of that conversation just about private practice just wasn't there in residency.

And I think that goes back to the point you were making earlier where we're seeing the number start to dwindle of those who are going into private practice. I think it happens from the beginning, but so many of us don't get that in our training. So, I went into employed practice. My story is that I started off at an FQHC.

So, a federally qualified health center in rural Alabama. A position that had a really great mission to serve the underserved, but I it wore me out. There were days So, there were three people in my office. It was me, the receptionist, and our nurse.

There was some days that the receptionist wasn't there, and it was just me and the nurse. There were some days that the nurse wasn't there, and it was just me and the receptionist. And there were some days Mike that neither of the nurse nor the receptionist were there, and it was just me. I was answering the phone, I was rooming the patients, I was giving And that was not what I signed up for.

Needless to say, that was not sustainable at all. So, in looking for another position I ended up calling my previous residency director saying, "Hey, I want to stay around here. Is there something else that you can think of that I can do?" And like any good He was the dean then at that time. Like any good dean, he says, "Come on back." And so, I found myself back in academic medicine, the same place that I'd done my residency training.

And for any of your followers who are listening who are in academic medicine, and even you know this yourself, it is academic medicine is a beast of its own making and doing. And even though I was in a place that was familiar to me because I'd done my residency program there, there were so many things when you're in a big system, especially a university system, a hospital system, that you don't know where to work and you think, "Gosh, there's a better way to do this." Or, "Gosh, I wish this could change." But things do not change easily when you're in a big system. And my personality is one that if I see something that can change that I think would be to the benefit of me or the staff around me or my patients, I want to change it. And that does not That doesn't bode well when you're in an academic system.

So, I did that for a couple years and just really reached what I think is true burnout. I think sometimes we throw the term burnout out there, but there were times that I would have to sit in my car before going in the morning to give myself a pep talk. Like, I'd put the pep talk before I went in the morning, a pep talk before I went in after lunch, and it just wasn't sustainable. I booked a plane ticket, a flight to Honolulu.

It's a round trip ticket, but I booked that flight to Honolulu, went sat on the beach for a week, and before I left, I'd written my letter of resignation, and I'd started business plan for my private practice. And I went back to what were my roots, the docs that I'd shadowed growing up as a pre-med student, as college student, were all private practice docs. And so, it was, "All right, Brynn, if you want this autonomy that you're talking about, you want this freedom, you want to practice medicine your own way, then let's go out there and see if you can do it." So, that's the beginning of my story, and that's where private practice came from with me. Toes in the sand, may or may not have had a drink in my hand on the beach in Honolulu, and here we are 3 years later, just rocking and rolling in private practice.

Yeah, having flashbacks. I may have had a little cry in the car, who knows, but I just remember the minute 8:00 hit, like like 6:30 in the morning, that's when the phone calls would come in and then 8:00 when I came in and it just I felt like I was a fireman because I'm putting out fires all from 8:00 a.m. to 5:00 p.m. and we're on online call and it just just never ended.

I'm sorry, you're about to say something. No, absolutely. You're wasn't going to say anything. You're right.

Oh, >> [laughter] >> I'm so I'm getting a little bit flashback. So, you got your business plan written, what were the next steps you took? Yeah, so the next steps the honestly, the big next step was to come back and give the resignation which was the most daunting part of it. I had hyped myself up thinking that oh no, like they're going to ask me to stay instead and then I'm going to have to make a big decision, but it was okay, Anderson.

Good luck with that. Let's see how this goes. And though I devoted so many years and so much time to it, I knew that I was ready and so they accepted the resignation. I worked out the next three months which is part of my contract.

So, I had an attorney review my contract. That's so important. I tell docs that I work with you know, before you give that letter of resignation, know what your contract says, know that you can truly get out of it and know what the penalties would be for starting a practice in a similar area or nearby area. So, really understanding your contract.

So, I understood the contract. I gave my letter of resignation. I knew that I still had the next three months to to work and I would do the work during the day from 8:00 to 5:00, see patients, do the things I was supposed to do, but that second shift of the day, that 5:00 until 8:00 the next morning was 100% dedicated other than sleep to me planning my private practice and in hindsight, I tell folks one of the things that I regret was that I didn't either get coaching then or lean on docs who were already in private practice for the help, but so much of it was me figuring it out myself of how do I go about this path of starting a private practice and not just a private practice, but one that would be successful and really be sustainable and one that wouldn't be me creating the same type of burnout that I just given a letter of resignation to leave. And so I spent that time really building the practice, working on what the marketing plan would look like for the practice, and just how I wanted the practice to flow.

And it did in hindsight a pretty decent job of it such that we opened with a nearly full panel of patients. I mean, I marketed this thing like crazy. And the a month before we opened, the patients were lined up ready to come in the door. Our schedules were full.

And I think that gets back to any things I tell docs that I work with that you really have to focus on making sure it's one thing to hang a shingle, but it's another thing to to hang a shingle that patients actually come through the door. So, I'm going to get into a little bit of the nitty-gritty on it because a lot of our listeners want to start their own practice. And similar to yourself, I also coach with some physicians who want to start their own practice. Did you have a restricted covenant?

Were there a certain location you had in mind? Tell us about that thought process. Yeah, so the beauty where I am, I'm in Alabama, and in the state of Alabama, non-competes are not enforceable. And so I know that in certain states and several states that is not the case.

You And which is why I said it's so important but even before you give that letter of resignation that you know if there's a non-compete, what that non-compete looks like. And so many docs shy away from looking at their contract, especially at the end, but there's so much there that you need to know. You need to know if there's a non-compete. to know if there is there a certain radius from where you're practicing now that you can put your next practice.

You need to know what your malpractice insurance looks like. If you had tail coverage. And you need to know how long of a term you need to give when you give your notice. And for me, thankfully, there was not a non-compete that's enforceable in the state of Alabama, so that made it really free reign for me to say where I would want to start the practice, which ended up being in fairly close proximity to where I've been previously practicing.

And how did you So, did you find a location? Did you have somebody Did you hire somebody to do it? How did that work out for you? >> I didn't.

I loaded up in my car, with my dog in the passenger seat, and we drove around and looked at everything in the town that I knew I wanted to be in until we found some spaces. And And I found two or three No, let me be firm on that. I found three spaces that I was interested in and one that just really stood out. And one that it actually been a physician's practice 10 years before.

Nothing had been done in that space in the meantime. So, it was nicely The rooms were separated nicely for an office. was already there for sinks and things like that. But, it still required a pretty significant facelift to put a practice there.

But, that's what we did and it started lean. It was just me. I was the only physician provider in the practice. So, just me, four exam rooms, a triage room, a decent waiting room area.

And that was all we needed to start with. Little did I know that a year later I'd be buying another building right around the corner that was twice as big because we needed more space. And so, I think that my sights were set a little bit small when I first started, but not in a bad way. At least a place I made sure that I could build a patient panel.

And once I built that patient panel, I found another space that I could truly I found another space, demolished it, and built the clinic that I really wanted in that space because I already knew that I'd built a sustainable practice and that I could support the mortgage that would come from owning a building. Now, anytime that when I worked for someone else, I did it work for about 5 years, and then I Then there was a decade where I was out and about, came back, started my own practice. When I started my own practice, I would go, I know what I don't want to do. I don't want to do this.

I don't want to do that. How did it What was your kind of thinking when you wanted to form your own practice? Yeah, what were some things that maybe you took from other things that maybe you said I think we can do this a better way. Yeah, absolutely.

And that's so good. I think it's just as important to know what you want to do. It's just as important to know what you don't want to do and what you don't want to make a part of your practice when you're building it. Because again, the whole idea is building something that's sustainable.

And so you have to kind of yes, keep what you've learned and employed practices, what you learned in your training. But the beauty of private practice is that you get to pick and choose what you want to do. For me, one of the biggest is picking my hours. I am not a morning person.

I need the time to kind of I can get things done in the morning, but not when it comes to having conversations. So my practice starts at 9:00 in the morning. We start at 9:00 a.m. I don't see my first patient before then and it's been wonderful for me.

I'm less cranky, my staff feels better about it. So it's even little things like that. The other thing is being able to plan out what the schedule looks like. So I changed since then, but when I first started, I had this beautiful picture of I'm being a medicine, so I see kids and adults.

That Wednesday mornings were going to be all well child visits because gosh, that'd be a great way to spend my Wednesday morning just seeing well kids back-to-back. And even though that did not last for very long, it was at least still shows that ability to say, this is what I want my schedule to look like. And that again, beauty of private practice. So often we think, oh, I've got to build this out to look like how it looked in my last employed practice, but you don't.

That flexibility that is there so important. So the being able to build out the schedule has been huge for me. The other thing is that I'm really involved in leadership in our state. I serve on the board of our medical association for the state of Alabama.

I'm the immediate past president current chair of the Alabama Academy of Family Physicians. So I knew that the third week of every month, I need to be in Montgomery at our state capital for board meetings. Private practice gives me the ability to not say, oh, let me go ask somebody for PTO for this or time off or beg for some administrative leave so I can do these things. So it really the scheduling part is the biggest for me that it gives me that flexibility to build a schedule that fits what's important to me.

And sleep is Yeah, sleep that's important. Again, you're giving me flashbacks when I was like trying to coordinate my vacation schedule with 14 other doctors. Yeah. You talked about how you were able to get a a full panel or you you were busy from the beginning and you're doing marketing.

What what what kind of marketing were you doing? Were you boots on the ground? Were you doing online advertising? Absolutely.

>> you get people into your practice? Yeah, so all the above. And I took I decided I was going to have to commit to social media. I got off of Facebook probably it was when I was studying for one of my step exams.

Got off just cuz I was spending way too much time on it and never got on again until it came times that I knew I needed to market on social media for this practice. So in three, four, maybe six months before the practice started, I got back onto it. My niece then was 13 and she coached me on how to how to be social media and these things. And I built up a launch in a way I'll go and share the audience for those who are thinking about starting a private practice because I really encourage people to do this.

The day that I launched my social media page, my staff was already hired. I had me and myself, my younger sister and I said, "Okay, on the day that this launches, I have reached out personally to 50 people and asked them to share the post on Facebook." I reached out to 50. My younger sister, who's super active on social media, reached out to 30 people and each member of my staff reached out to 20 people and asked them to share the launch. In social media, especially Facebook, all it likes is a good a good quick dive onto something.

So immediately with very little work, I had 140 people who were going to share that post the minute that I sent it out. And by the end of that first week, the way just psychologically we work on social media is that I think you see something, you see all these people have shared it, you think, "Oh, let me share it, too." So, by the end of that first week, and even I can't go back, but I think probably in that first day, there were 700 shares of my post announcing the new practice. So, now it's at over 800, but it's 700 shares within that first week. And if we think about the average person, according to my Google search then, says that the average person has 300 Facebook friends.

And some people have 5,000, but 700 shares * 300 people seeing each of those, that's That's a ton of people. Let me do quick math here, so I'll mess it up. But that's a ton of people who are seeing that initial post the day it goes out. And so, it was immediate.

Go to the website, go ahead and click, get on our email list so that you can be the first to know when new patient packets are available, that kind of thing. So, day one, it took off like gangbusters. And again, that beauty of the non-compete or non-enforceable non-compete in Alabama, that my old patients who thought that when I left the practice, I was going to fall off the face of the earth, because my old practice is not advertising where I'm going. They don't want to lose those patients.

Now, all of a sudden, those patients knew how to find me again, and they were coming back to the practice. Those things with social media was huge were huge. The other big thing that I did is just what you said, boots on the ground. And I My dog and I My dog was everything to me.

She just passed away since then. I talk about her still lately. But my dog and we traversed most of this town. And I would go to places without the dog, but I'd go to places that were local businesses, especially around where the practice was going to be.

And I'd go in. There's a little restaurant right down the road, best hamburgers ever. I'd go in, meet the owner, take a picture of their burger, post it on Facebook, and say, "Have you guys been here? Have you had this burger?

Is this the best kept secret in town?" And then all of a sudden they were getting multiple shares. People were frequenting their restaurant who had not even known that they were there. So then you've got word out because now this business owner loves that I've made business for them, and you've got people who are still following and who like that I'm engaged in the community. Did the same thing at the public library, at the jewelry store.

It got to the point where owners of these businesses were calling me and saying, "People who have said that they never even knew our business existed are now coming into the business because you posted it on your Facebook. Will you drop off some business cards down here, some flyers, so we can start giving them out to people so they know about your practice?" And that was one of really good marketing strategy, but it was also a really good way to connect with the community and show the community that I'm here and invested. The mayor asked me if I wanted to head up the Chamber of Commerce. And I was like, "No, you know, I head up the Chamber of Commerce." He was joking, of course.

It's like, "I'm here to run a medical practice, but I've made sure that I was an integral part of the community, that everyone in the community knew that I was here and that I really wanted to be a part of business development here." So all those things together, the social media plus the getting out there to businesses, making sure I'm family medicine, making sure that the specialists knew that I was here, making sure that the urgent cares and the hospital ER doctors, people who could refer to me, the physical therapists, the pharmacies, all those people knew that I was here and they would send patients to me. Not just because I came in and dropped off a flyer, but because I'd proven that I care about the community and I'm a decent person. That's awesome. That's awesome.

I love hearing about your success, but as with any business on here, you're going to have your ups and downs. Looking back, were there any maybe missteps that if you could change it, you could, maybe cost you time or cost you money? Yeah, time and money, absolutely. And I think some of those some of the big ones is just thinking about the workflow, right?

So, thinking about initially, from the beginning, what that workflow needed to look like. And it was one of those things, Mike, that I obsessed over. I obsessed over it on the front end, when really I could have I needed to work it out to a degree, but I think I overdid it a little bit, so that on the first couple of few days of practice, the first week, it was wait a second, everything's not going like it went on paper when we planned this out. What do we do?

And it was just that need to be a little bit more flexible. So, I think I was a little bit too rigid in that. Now, don't hear me say, for your listeners, don't hear me say that you don't need workflows, because I believe in planning out a workflow, but I I have gone away from the part where I think need to be so rigid and tight in those workflows that you don't get patients in the door and get to see and be able to say on the fly, you know what? We said in our training that we were going to do things this way, but we're not going to do them this way.

We're going to change it. We're going to do it completely different way. Along those same lines, I think onboarding the staff is one of those things that I could have taken a little bit more time to do, to make sure that everyone was on the same page, to make sure that even though I'd worked out all these workflows in my head, that they knew the things that I was thinking in my head. Well, no, cuz it's a whole different thing when patients are coming in and something that you planned on paper isn't working the way you want it to.

So, in hindsight and now as I talk to physicians who are building a practice just like you do, I'm sure, it's really making sure that you're doing a good job of onboarding your team. Not to mention, picking a good team, but that you're doing a good job of onboarding them and make sure that you're building that culture that you want for your practice and the way you want your practice to be represented. One of the things that I don't regret that maybe I should is that I didn't slow walk into the schedule at all. So, on the first day, it was like full schedule, let's go.

We are not going half schedule, we're not doing this to slack it all. We're going full into it and then we're going to see how this works out. And so, maybe in hindsight, that's one thing that perhaps could have done differently because as we were all learning a new EHR system with real patients there, it would have made more sense to do. But, I don't regret it.

That first week was a lot. There were some tears shed that first week, but it was a good for me in the way my personality is. I needed it to be thrown fully into it in order to realize, "Hey, you need to make these changes. You need to make these changes to keep going." But, perhaps maybe building out a slower schedule the first day or week or so would have made for a lot more hiccups down the road.

I think I did a decent job of making sure that I had a good accountant and bookkeeper so that we were good from the beginning and knew how we needed to think about finances. One thing that I didn't do as an insurance-based practice, I did not shore up my biller before starting. I hired a biller I had to de-hire, fire, whatever you want to call it, within 4 weeks of the practice starting because I realized I knew more about coding and billing than she did and that is not okay. And so, that is one thing that I really regret because it did affected our cash flow right there at the beginning.

Thankfully, we had enough of a line of credit that we could cover it, but that that could have been really bad for us, especially if I hadn't been able to reassess quickly and say, "This is not something that I had time to teach you. I don't have time to get you up to speed on it. You're not right for me. You're a great person.

It's nice to meet you. I've got to find somebody else." So, that is absolutely mistake that cost me money from the beginning. So, now it's been 3 years. What does your practice look like now?

So, my practice now is it's only as physician and owner. I've got a physician assistant who we added 2 and 1/2 years into it. No, yet 2 years into it and then this past November, so you know we're recording in March, this past November added another physician to the practice as well. And I mentioned earlier that I moved out of space that I was leasing and moved into the space that was just our dream clinic, and we have already maxed out on space again.

So, I'm going to have to build another dream clinic here pretty soon, it sounds like. But, we've been on to 3 years into an insurance-based practice, family medicine practice, primary care, and at year three, we crossed the seven-figure mark. My goal beginning of that year was we are busting through seven figures this year, and we did it, and we are busting well past that this year, and that's the plan, and that is sustainable only because my staff has really bought into the my desire for the practice. The folks who started with me are still here.

We've added more staff, of course, but my staff has they have a feeling of ownership for this practice, and so I can share my big dreams for the practice with them. The land that I want I can literally look out of the window of our break room and see it, and everybody knows this is the goal. So, when days get long and we're tired or we're wondering why gosh, are we sure we want to add in this walk-in patient? This is why we're doing it.

We want that building across the lat or that space across the way to building a practice, so people can not we don't feel like we're walking all over each other in in the clinic space. It's been fun. I now see patients, so I started off seeing patients 5 days a week, and I now see patients 3 and 1/2 days a week, which gives me a half day where I am not in this clinic. I'm gone, I'm doing something else.

My staff won't even let me be in the clinic on Wednesday afternoons. They say you have to get out of here and go do something that's not work. But, on Thursday I I do. So, on Thursdays though is my true administrative time, and not administrative time like I'm getting notes done and signing paper paper letters that come in and and things like that, but administrative time where I'm meeting with the billers, I'm looking over the stack KPIs, I'm checking our AR, I'm doing those things, I'm casting vision for what I want the next quarter to look like, looking at our numbers, all these things that are so important because I had to separate being a physician and being an owner.

And that is important to take that time to put in that owner time. And I think that's one thing when I talk to doctors who are already in private practice that we just don't do as well as we should is take that time to truly be the owner and think about how do I make this business better as opposed to just putting out fires like you mentioned earlier. Yeah, 100% agree. It's hard enough being a doctor on there being full-time, but then adding becoming a business owner on top of it, you really have two jobs.

And then if you if you don't reduce your clinical time, unfortunately, it would really be very taxing on you. So, I'm glad you brought that up. So, what is one belief about private practice that you think physicians may have it flat out wrong? Yeah, that private practice is dead.

The and that is a is people say it, private practice is dead, private practice isn't profitable, all those things. And I think both of those things are just absolutely wrong. Private practice is not dead. I think that I hope that we are starting to see the pendulum shift back just a little bit.

And so, I think that private practice is not dead and private the myth that private practice is not profitable. I make more now in private practice than I ever did as an employed physician. And it is with this autonomy that now allows me to one day say, "You know what? I don't like the way we do this.

Tomorrow, we're going to change this." And so, not only am I making more money and we're profitable as a practice, but I'm able to make the decisions that really determine you know, what this practice looks like. So, I think those are two things that are just flat out wrong. >> Brittany, this has been a illuminating conversation and feel like we just scratched the surface, but if somebody listening to this right now, maybe they're in the working in the hospital right now. They've had this dream about starting up their own practice.

I know some of them been for years I've been talking to. They've never been able to take the leap. What are maybe like the first few steps that they should start taking this month to make me make that closer to their goals? Absolutely.

So, I think the first thing is look at your contract. Look at your current contract before you make any grand plans of thinking, I'm quitting this job and starting a private practice. Know what you're locked into in your current contract. I think that's the first thing.

The second thing is to sit down and like if you were to start a private practice, make yourself a list of things that you would do in your private practice, like you mentioned earlier, and things that you would not want to do in your private practice. Things that you were currently doing that if you had your own private practice, you would never do those things again. I like that because that's where we start to make a little bit of that mindset shift of this is if I were going to do this, this is what I would do. And that, if you make that list and you get that little tickle down inside that says, "Gosh, I like this list." And every morning you're thinking about that list or you're going back a week later and adding other things to that list, private practice is in you somewhere.

So, I think first looking at your contract, two making that list of things you would do in private practice, and things you would never want to do if you had your own practice and had your own say. And then the third thing is sit down and have a discussion with your accountant. All of us as employed positions, if you are, should still have an accountant, one that you trust, and talk to them about what it could look like. So, start to think about what your finances look like at this moment, and then start to think about, "All right, could I actually do this?" And then start looking through, "What are the steps to doing it?

What are the steps to getting off?" But I think that those are the kind of the three things to start with. I love it. I love it. Okay.

So, if somebody wanted to reach out to you, what's the best way to go find you? Yeah, absolutely. So, as you mentioned, I've got a podcast. The The is called Physicians Hiring a Shingle.

It's a twice weekly podcast that I put out. On Monday, it's all about how-to episodes. How to do this, how I did this. On Thursdays, they're all mindset shift episodes.

So, they're just really the Monday episodes are maybe 20-30 minutes, but those Thursday episodes are just 5-minute mindset shift episodes. And what I do is put on the table all those things that we're thinking, right? Like, what if what if Yeah, I don't make any money in private practice. What if people say I shouldn't do it?

All those things that we're thinking through our head, I talk through all of those things on the Thursday episode. So, you can find me at Physicians Hanging a Shingle or the podcast. The website is hangingashingle.com. It's our home base, so it has links to the Instagram, the Facebook, the podcast as well.

And for your listeners, I have a checklist. I love a good checklist. That is one thing I learned while I was planning my private practice, but it's called a private practice startup checklist, and it really does go through It's got maybe 100 things on it, but those things that when we're thinking about starting a private practice, we don't even think about. It goes into the entity.

You're going to be an LLC, an S corp. What are What's it going to look like? And really helps you think through that. So, your listeners can get that by going to hangingashingle.com/checklist.

And I'd love for folks to check that out because I really do think that it'd be helpful to them as they start to think through that process of launching a private practice. All right, awesome. We'll have that in the show notes as well. Dr.

Britney Anderson, thank you so much for coming on to the call today. Any last minute thoughts before we end today? Yeah, I just want to say thanks again for the work that you do and for being a a resource for physicians and just for those in health care who had that entrepreneurial side, who had that little bit of an itch that says, "Hey, maybe I can go start up something great." So, thank you for having me. I appreciate it.

It's been really fun. All right, Britney, thank you so much. And thank you, the listener, for joining us on the call today. Remember, as an an you're going to have your ups and your downs.

Do something each day to get you closer to your goals and keep moving forward.