The world that you are about to enter is both an exciting and challenging marketplace. Some aspects of setting up in private medical practice are simple and formulaic, for example, registering with certain bodies. Some are more complex, such as deciding on an appropriate business vehicle
for your nascent business, or how to set your own fee structure. The greatest rewards await those who, in addition to the pre-requisite of providing excellent quality of care for their patients, have a certain artistic flair, allowing them to see opportunities where others see threats.
We hope that the detail of this website will help you understand the complex and intricate business that is private medical practice. While your own practice will be different to your colleagues’, there are some key principles that we recommend you adhere to, in order to:
• Set up your business quickly and effectively
• Help it grow in a sustainable manner
• Stay legal and within regulations
• Maintain good relationships with your colleagues
Ten Commandments for private medical practice:
I.
Ensure that you have sufficient and appropriate medical indemnity
in place before
you start.
II.
Ensure that you have a discussion with an accountant / tax advisor
prior
to starting practice, in order to plan the best business vehicle for your medical practice. From a financial perspective, this step alone is the most important.
III.
Ensure that you have appropriate administrative support, in terms of book-keeping, invoice generation, appointment / diary functions and secretarial support, that is responsible and answerable to you,
not a third party organisation.
IV.
Apply early for admission rights
to at least one private hospital, but do not forget the possibility of practising privately at your NHS hospital.
VI.
Register early with those PMIs
that require it and also register with the Information Commissioner’s Office.
VII.
Engage in a wide range of marketing activities, and do not
turn down an early private referral.
VIII.
Do not let your nascent private practice interfere with your NHS practice.
IX.
Never denigrate your colleagues (love your neighbour as yourself!). Ideally you should find a legal way to work with them to grow your respective businesses together.
X.
Beware the temptations of ‘managed care’,
third party organisations that will effectively take a ‘cut’ from your doctor-patient relationship. You should concentrate on building your own name and business; if you are working for another organisation, you may simply be a mere worker bee.
While many of the above statements are legal pre-requisites for commencing in private practice, the greatest advice of all is the last: grow your own business, not someone else’s.
The drive to produce this web site stems from altruism for colleagues, but also an attempt to educate the profession regarding the increasingly ubiquitous and growing temptations of managed care pathways. In every case, an individual or organisation other than your own has the opportunity to dictate to you your fees and working conditions. Examples include:
• Healthcare organisations that offer to pay you a certain fee for your services, either on a case-by-case or sessional basis.
• All healthcare organisations will receive generic referrals (i.e. “Dear Consultant @ Greathealth Hospital”) rather than directed to a specific consultant by the referrer. Some organisations insist that such referrals are remunerated in a different fashion to named referrals: in other words, they ‘own’ that business, not you.
• Some healthcare organisations may try to insist that all referrals received at that organisation - even if directed to a specific consultant – are ‘owned’ by that organisation. Consider the potential conflict of interest if your secretary is employed by that organisation, rather than you.
• Healthcare organisations that have developed specific pathways for treatment with PMIs. Some patients have PMI policies that are directional, meaning that they have little choice regarding which consultant and / or hospital they can receive treatment from. The total payment from the PMI to the healthcare facility will include the consultants’ fees, however, the fees that are paid are decided by the healthcare facility, not the consultant.
• Established consultants who are overwhelmed with work can, on occasion, direct referrals to new consultants, although often via a financial arrangement. Consider whose business you are growing through such work: a lot will depend on the freedom that you enjoy in such a relationship.
As a new consultant, managed care organisations can allow a quick start to your private practice, which has clear benefits and is not universally bad. However, experience has shown that remuneration and conditions may deteriorate for those doctors whose practices exist solely within the managed care setting. To be fair, given that the organisations have generated the business/ referrals – and are businesses themselves – it is entirely reasonable that they should want to maximise their profits and minimise their expenditure.
If you can personally generate referrals and work through your own efforts, organisations will then court you and dance to your tune. This will lead to a happy, sustainable private medical practice, with you in control of your private business.
The autonomy that comes through self-employment is key to gaining the most satisfaction and financial benefit from your efforts: Don’t just be a worker bee.