Things no one tells you when you go into Private Practice


Article is written by  Dr Mark Silvert, founder of The Blue Tree Clinic.
I always knew that I wanted to be my own Boss and after working in the NHS for over a decade, I thought it would soon be time!
The first thing to say is I have no regrets about it. It is incredibly rewarding to be your own boss and set your own agendas for the week. There is no one to answer to but yourself, but also no one to pay you either, unless you are successful.
I thought that leaving paid regular employment would mean less stress and more free time. How wrong could I be! Now, if I don’t work, I don’t get paid. And I tend to work probably twice if not three times as much, my clinic is open 7 days a week, with really motivated staff.
You don’t have to adopt a clinic model, or run a whole clinic. I started off working for other private companies but decided I could try to do it better myself.
I would still say working for yourself outside of a clinic model is really fun. You can pick your clients (within reason), you can decide who to see and when to see them.
But working as a sole practitioner can feel quite isolating and I would recommend you find rooms in a clinic where others are around for company. One thing I do miss about the NHS was being part of a large team who all met every day, it’s something you take for granted and you will miss it when you leave.
I chose to start a clinic with one other staff member, a woman I saw on Facebook who was a therapist and I, as a psychiatrist, thought that would be a good start. When I approached her with the idea, she thought I was a bit fanciful and grandiose and she wondered if I just wanted to ask her out for coffee.
Three years later and we have over ten staff and a therapy dog, and she is so busy that I regularly have to beg her to work more days and hours. Something neither of us could ever imagine at the concept stage!
So if I can do it, you can too.
The things I did not imagine I would have to deal with are certainly things we never learnt at medical school. Some of them are:
– Managing the accounts of a busy clinic
– Learning how to effectively use digital marketing, such as Google Adwords and SEO
– Whether or not to utilise someone in PR
– How to build a good website
Then there is insurance.
We have GDPR insurance against a data breach, public liability insurance, group insurance, professional indemnity insurance and the list goes on and on.
Sometimes you feel like you were better off working for someone else as there was only a pay cheque at the end of each month, never dozens, and I mean dozens of bills to pay.
You have to make sure you satisfy regulators and check all your staff’s documents and accreditations annually. You need admin support, a 24 hour phone line, emails for everyone and to put on fun events to keep morale high.
No one is going to teach you these things at University. You have to learn on the job.
You’re also responsible for payroll – something that keeps you awake at night as now you have to make sure that every patient pays or you won’t have enough cashflow to pay your staff or invoices. This is a recipe for a disaster and a bad reputation!
My tip, something I learnt the hard way, the old ways of doing business on a hand shake and posting out an invoice after treatment are over.
People are happy to pay when they need your service but once they have had it they often don’t want to pay. You’ll be left chasing them for months, only to decide it’s not worth the grief.
We are health professionals who want to help people so chasing clients for money is contra-indicatory to our core feelings and principles. Avoid this and get the money before treatment.
How to pick your name for your practice is probably the question I get asked the most. I always say, the name is just not important. What’s important is the people in the team.
I made it my business, through my medical and psychiatric training, to make a note of every person I worked with that I was really impressed with. I then offered them positions when I formed the company, The Blue Tree Clinic.
Working with friends is another thing you are going to have to think about. Mixing business with friendship is actually one of the hardest things to do.
It’s important to be direct and transparent. To let them know what you can pay, where the money you make is going, (i.e. to get more patients, more PR etc) and that you are their friend, but this is a business. You need to make a profit at the end of the day.
I am lucky that I love my team and I love my job. The adage is true, if you love your job you will never work a day in your life.
If you are thinking of moving into private practice, good luck and go for it!