Monday, January 18, 2010

Melissa Young, MD: Planning for a partner... already?

So I opened my practice four months ago. The influx of patients has been steady. The schedule is pretty full each day. The wait time for a new patient appointment is a manageable two to three weeks. The no-show rate is fair, roughly one patient out of 15. I get about one new in-patient consult (oh, yeah, there are no consults, just “new patients”) a day on average, and the hospital census is relatively small.

So why think of bringing in another physician?
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Before I answer that, let me say that I am not planning on having anyone start before the practice’s first anniversary. But it takes so long to get a license in New Jersey. And then there is applying for a Medicare number, credentialing with the insurance companies, and getting hospital privileges. Plus, the new physician may have to move and look for a house, etc., etc.

I am hopefully optimistic (is that redundant?) that by the time the practice is a year old, that I will have a sufficient number of follow-up patients and a decent sized in-patient population to justify having a second person on board.

I have visions of being able to make the office even more accessible to patients by having more office hours, maybe even the occasional Saturday. I also look forward to having my first day off — no office, no rounds, no phone calls. Sigh. Eight months is a long way to go.

My original business plan called for hiring a nurse practitioner at the six-month mark. I loved my nurse practitioner at my old office and feel she was an invaluable resource.

Having said that, I’ve gotten a lot of feedback from my old patients, as well as from patients of other offices that have an NP. While most of them (but not all) respect NPs, and many were quite fond of mine, they really prefer to be seen by a physician. Their physician. Some of them have said that they are glad that I went solo because they want to see me every visit and not alternate with an NP.

So while hiring a nurse practitioner may make more business sense than hiring another doc, it seems that from a patient satisfaction standpoint, hiring another doc is the way to go.

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.


  1. No consults only for billing Medicare- it is still called a consultation and you can still bill it as one if it is not Medicare!

  2. It gives you a lot of flexibility with a partner, but again it depends on the partner too. You should hire someone you know and trust, who is willing to take good interest in expanding the practice .

  3. Have you thought about a midlevel provider?

  4. Melissa, before you start thinking of another partner, you have to think about how your practice is set up. There are many things that are not mentioned that are key components. If you want to have another partner, is the practice set up as a corporation? Are you solo, and want to pay another Dr as contract labor? Are you wanting to be a supervising Dr in the practice, that one day other physicians are in the practice and you work prn? If you seriously want another Dr,I suggest you get group numbers/TPI/NPI with the insurance companies first. Set up the practice, ready to go for future Drs. This alone will take several months. Once this has been established, hire a NP or PA to get consistent patient flow. After that, hire another Dr.

  5. Thanks for the comments.yes, I thought about a midlevel provider. That was actually part of the original plan. But, as I said in my post, my patients would rather see a physician. And quite honestly, I don't think I could comfortably leave the practice without a doc, if I were to go away. Maybe that's just me.
    The practice is an LLC. It has it's own NPI and the group number for most payors is our TIN.