Viewpoint
2017; Lippincott Williams & Wilkins; Volume: 39; Issue: 8C Linguagem: Inglês
10.1097/01.eem.0000524416.67993.57
ISSN1552-3624
Autores Tópico(s)Primary Care and Health Outcomes
ResumoFigureFigureMost troubles start on an idle Sunday afternoon. It was on one that my husband and I felt too relaxed and complacent for our own good. Our 8-month-old had finally started sleeping through the night, and all of a sudden, we felt rested and bored. So we started thinking about where we want to be in 10 years. Within seconds, we had agreed on an answer—retired! The next question was how to get there. Nobody has ever gotten rich on a payroll. To misquote Spider-Man, with big rewards come bigger risks. Our sailboat could be some kind of business. What business though? We only had exposure to medicine. It had to be something related, so we landed on the thought of owning an urgent care center. Urgent care centers are mushrooming all over the country. Is it a natural foray for the fast-on-their-feet EPs? After all, who better than an EP can manage urgent medical needs and understand the forte and limitations of such a center? Or is it a bite too big to chew? A business is a business, and an EP might not have the financial and business expertise to lead the managerial and operational aspects of this venture. I will let you decide for yourself. The Scope The urgent care industry has grown tremendously in the past decade and continues to do so exponentially. More than 8,100 urgent care centers are operating in the country. (BMC Health Serv Res 2009;9:79.) Urgent care centers basically cater to the urgent health needs of the community like coughs, colds, sprains, and small fractures. Such conditions happen unexpectedly, and primary care physicians usually do not have the openings to cater to these needs. These are minor cases that do not need an emergency department visit, where the wait times can be up to eight hours. The average cost of an emergency visit versus an urgent care visit for similar complaints have shown to be 10 times more. (Ann Emerg Med 2017. pii: S0196-0644[16]31522.) The average wait time for a well-functioning urgent care center is under 30 minutes. This means a lot of money and time saved for the public! With almost all EDs running full and most of the patient population not needing ED-level care, the market potential is obvious. “What do we gain from it?” the wise among us might ask. Obviously, the aim and ambition is to support our livelihoods, or to be crass: money, money, money. Now this goal can pan out in hugely different ways, and the pendulum can swing from losing all your savings to becoming a millionaire. It's all about calculated risks, so let me take you through the calculations. The Pros (The Good) Now that we have established a demand, let's examine the positives of being the supplier. As EPs, we definitely have the medicine down! What can be more attractive than a job needing no additional training? If anything, many of us will smirk at the professional requirements of an urgent care center; however, do not forget that to know the limitations of your resources and to utilize them efficiently is not easy. It is always easier to practice in the abundance of an ED, which brings me to my next point. Most practicing EPs are already hooked up to the resources, especially the human resources. With our working knowledge of EMRs and medical supplies, we are definitely better equipped than a nonmedical person to choose and buy these resources. As EPs, most of us are already embedded in the community and know the patient population well, including their needs and eccentricities. Like any other business, knowing your clientele can be highly beneficial. Advertising is, broadly speaking, an extension of knowing the community. If you know and understand your clientele, you can have good insights into how to reach their ears, hearts, and brains. (Yes, you need to grab all three to reach the fourth—their pockets). By the time you have reached your comfort level with the medical side of things (generally about five to six years), you are likely to be financially ready to undertake such a venture (having hopefully paid off your student loans and a zero-balance account, not a negative balance). Plus, who are we kidding? Our long years of extremely expensive training has acclimated us to a life of limited money and frugal joys. And lastly, contract negotiation with the big bad wolf—the insurance companies. It's difficult to put a “pro” spin on this one. But you can prove your worth in a more eloquent way than any outsider can. You just have to make the insurance companies see the ED expertise you will bring to urgent care. The Cons (The Bad) Now that we all have an idea of the scope and an understanding of our pros, let's just hold on to our early retirement dream for a few more minutes, and consider the flip side and the magnitude of this undertaking. You have the training down, but do you really? You are medically trained but not really a businessman. Running a business profitably entails much more than just knowing medicine. There will be literally a thousand and one things that have nothing to do with medicine that you will need to figure out. Businesses speak a completely different language, and you will need to devote months to learning this before you even talk to a bank. We spent about six months understanding, researching, and preparing our business narrative and business proforma. You have to think about everything that you will need for your center, from big to small—x-rays to soap dispensers. Everything needs to be written down. Costs need to be examined, pay scales need to be researched, vendors need to be compared. Go to local urgent cares to get some insights, and think about how to cut costs. You also have to project the number of patients your clinic is likely to see and the amount you will be compensated based on your area of choice, competition, and population. Unless and until you have a complete business proforma projecting every possible expenditure and income, you are setting yourself up for some unpleasant surprises. The same goes for resources. Honestly, what do you know about medical supplies except what you need and which Pyxis to get them from? You will need to make a list of all the possible resources, from human resources to local referrals, household items, medications, equipment, and supplies. Everything! Your six months of work and research for your proforma will help. Go to the local urgent care center and check out what they have. Think of innovative ways to cut corners. Start contacting vendors. Try to go local; usually it is cheaper, and this will help you build community ties. Talk to other business owners; they need not be urgent care clinic owners. You will be surprised by how much useful information you can get from chatting with them. We recently had a casual conversation with our daughter's dentist (yes, by the time we reached this stage, our daughter was 1 and had her first dental visit), and he ended up becoming a huge resource for us on construction and advertising issues. Also consider whether your local community is really the ideal location for your million-dollar venture? It might already be overpopulated with urgent care centers or EDs. You need to find a location that is underrepresented by such institutions, and if that place is not your local community, then woosh goes your knowledge of it. Our chosen location ended up being about 30 miles away from where we live. Do not look for convenience of commute when you are choosing your location; look for competition. If a place is already crowded with established urgent care centers, yours will likely not prosper as much as you would want it to. Once you have found a good spot, start investing your time in learning about the local community. Go to the grocery store; talk to local physicians. You will get some local insights and form good relationships for future mutual referrals. Find out about the local community centers and schools, and give free health talks to make the community aware of you. In general, your pockets (or bank) should have about a million dollars for such a venture. The expenses can vary a lot depending on your location, rent, buildout, and bargaining powers. Bring your “A” game to bargaining. Make cutting corners your mantra. It can be small things like not going for expensive cabinets and making Walmart drawers do the job instead! It can also be big things like choosing an office that is already built as a doctor's office and saving on construction! Remember the life of ED abundance is easy. Welcome to the simple life. Advertising is really an extension of how well you know your community, but there is a lot more to it: cost effectiveness, what sticks and what does not, and how to identify real from fraudulent vendors when their job is to sell. More research is needed, like finding out your target groups and the local population's age distribution, education level, and income. These things will help guide your advertising resources. If the community is older, opt for mailers and local newspaper ads. If it is a younger, college-aged crowd, spend most of your bucks on online ads. Start working on your website, and have it up and going. Never underestimate the grassroots-level advertising: Remember that health talks and camps in schools and community centers can go a long way. Just knowing yourself does not necessarily make you a go-getter in contract negotiations. You have to be thick-skinned and persistent, repeating your selling points over and over and over until you get the reimbursement you think you deserve. This might still not happen depending on your location and competition. Make a list of all major insurance companies in your area, and check out their percentage distributions. Decide whether you will be taking Medicaid. Start working on this early. This is usually your slowest step. It takes approximately nine months and never-ending paperwork to get credentialed by the major insurance groups. The Ugly There actually is no ugly. This heading is to satisfy the Clint Eastwood fans among us and to remind the pessimists that you will still have your qualifications and training even if you lose this game, and you can always go back to earning a decent livelihood by going back to the never-an-average-job of an EP.
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