Reports on Private Practice Seminar held Melbourne June 2010
By Dr Mutlu Haksoz
3rd Year Advanced Trainee in Geriatric Medicine
Southern Health, Melbourne Vic
When I received the offer for tickets to attend this seminar on getting started in private practice, it came at an opportune time. I am now 2 months from completing my advanced training in geriatric medicine and although I now have work lined up for 6 months after completion of training, there are no guarantees of work in the public system in the metropolitan area after this. Therefore private work was an alternative I had to consider. In any case, it is an area that as advanced trainees we get minimal exposure to and I was interested in finding out more.
The course ran for three days and aimed at advanced trainees nearing completion, as well as junior consultants (generally up to 5 years post training). It was advertised as "A Course in Practice, Financial and Lifestyle Management for College Trainees and Fellows" and has been apparently run for several surgical specialties as well as dermatology for the past few years. This was run for the college of obstetricians and gynaecologists. It was attended by around 70 trainees and consultants from around the country and NZ.
The course director, Steven Macarounas, stated at the beginning that "Doctors are poor managers of time, money, human resources and lifestyle. Retiring doctors always state that they did not spend enough time with their family or have enough family holidays." The aim of this course is to address these issues near the start of doctors’ careers. I found a lot of the information very useful and would recommend that this course be offered to geriatricians in the future.
There were a total of 19 presentations over the three days. The presenters included a director of a medical consultant services group, a lawyer, financial advisor, an accountant, an obstetrician from a group practice and a representative from a medical insurance company. There were also IT specialists, business marketing experts, a broker, a billing service and finally a private coaching service. All the speakers appeared to be from leading companies in their field.
The session from the medical services group consultant was directed at how to set up private consulting rooms from the start including different structures (e.g. Sole vs group practice vs Company.) There was also glossing over multiple specific aspects to starting the practice; including choosing location, local government requirements and staff recruitment and management. A lot of the information was directed towards large practices with multiple staff. The overall message appeared to be the need to speak to the relevant professionals (lawyer, accountant, IT etc., as well as the medical consulting service) in a timely manner prior to starting the practice.
The lawyer had some very good advice on a variety of different matters. The focus was on minimising the financial risk arising from a private practice. There was information on the advantages of forming a trust in terms of risk minimisation. Also, in a group practice situation the importance of business succession planning with the use of a "business will" and insurance policy was stressed in case one of the partners is unable to continue working. The advantages of having a "low risk" spouse under which assets can be held was also mentioned.
The talk by the financial advisor was particularly useful. Practical ideas were discussed on ways to increase wealth. Examples were different ways mortgages can be manipulated for financial benefit. These include "First Home Saver Accounts," minimising capital gains tax, advantages of an offset account (over paying off the principal of the mortgage,) and positive and negative gearing. There was a dedicated session on superannuation including information about self managed superannuation and buying property for private practice rooms) using super funds (which also reduces capital gains tax).
The sessions from the accountant were also useful. The main lesson was that having an accountant experienced in dealing with medical accounts matters. Apparently hundreds of doctors go bankrupt every year, usually due to problems with cash flow, poor (non-medical) investments and inappropriate tax minimisation and investment schemes. We were told of frequent changes to the laws regarding taxation involving trusts and small companies, and that the current situation did not favour a company setup over being a sole trader or service trust.
We had a session from an obstetrician who is in a successful group practice and we were told about the practicalities of this setup including their cover arrangements. The advantages over sole practice were the ability to have dedicated times every week where the members did not receive calls, and easy leave arrangements. This would be particularly useful coming from a geriatric perspective.
The session from the medical insurance company was useful in that it gave some ideas about how to reduce and deal with complaints. The medical I.T. sessions gave useful tips about what to consider when setting up the practice, including remote access to databases, bill paying and EFTPOS, and also networking. There was also extensive discussion about choosing the correct software. Apparently the key questions are:
- How many sites are using the software,
- How long the company has been in business and
- How many staff they employ.
The answers to these inform on what level of follow up support will be provided and whether the software company will continue or fold, thereby effecting ongoing support and development.
There was a session on marketing with practical considerations when deciding on aspects such as websites, business cards and online directories. Ideas on how to get yourself known to GPs and proven marketing strategies were useful.
The session on billing gave very useful and basic information on the paperwork required when first starting as a consultant, Medicare provider number issues and details of what needs to be done in registering with private health funds to be able to charge no-gap. There was also detailed discussion about how to read MBS item number details and about AMA rates. This was particularly useful.
When I first looked at the program I thought 3 days was likely too long and things may have been able to be condensed. At the end, however, there was such a volume of information, mainly of a practical nature, that I think 3 days are required. Some of the information was more related to larger practices with multiple staff which are likely more prevalent in the obstetric setting than in geriatrics. Overall however there was enough useful information to make the time and money spent on the course worthwhile and I would recommend the college or ANZSGM look into having one directed at geriatricians.
Angela Liu, Staff Specialist Geriatrician,
Gosford Hospital, Holden Rd, NSW 2250
and
Consultant Physician/Geriatrician,
The Sydney Adventist Hospital, Walhroonga, NSW 2076
As a first year Geriatrician, I found the Private Practice course, held on behalf of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) in Melbourne, extremely helpful and informative.
The course, chaired by Steven Macarounas, Director of The Fintuition Institute at Double Bay, NSW, featured practical information on establishing, maintaining and optimizing the performance of a private practice.
After completing my fellowship training in December 2009, I took a part-time Staff Specialist position at Gosford Hospital and commenced my private practice at the Sydney Adventist Hospital in January 2010. I did not know how to set up my own practice rooms and it took me several months to learn the intricacies of billing and claiming. I also had no concept of how to protect my assets and most importantly, who to ask for help.
This well organised 3-day intensive course answered all my queries. In addition, I had the opportunity to speak to presenters from different disciplines including medical-legal, accounting and business structures, financial planning and practice management.
I feel it is crucial to plan ahead when starting private practice. After obtaining FRACP accreditation, specialist recognition needs to be applied through Medicare, which entails a $30 fee. When setting up a private practice, the location is extremely important as it affects marketing opportunities and travel time. Other considerations include staff employment of a practice manager and secretary.
The issue of billing was another aspect of private practice that I believe often confuses new practitioners. I found this course was particularly helpful in clarifying many of my questions. Although the details of billing methods and item numbers were tailored to the O&G speciality, I found the principles were also applicable to Physicians/Geriatricians.
Furthermore, often overlooked areas for new practitioners including asset protection, tax reduction and superannuation were also addressed in this course.
It would be very useful if the ANZSGM held a similar course for Trainees and New Fellows in Geriatrics, specifically for candidates considering private practice. I believe this would certainly ease the transition from working as a trainee to a junior consultant.