Starting Your Private Practice: Essential Insights and Tips for Success

Transitioning to a Direct Primary Care or Direct Specialty Care models requires wearing multiple hats simultaneously. If you're considering removing insurance intermediaries from your patient relationships, terms like Direct Care doctors, independent physicians, and cash pay doctors will become familiar. Additionally, you will start learning about the business side of things, such as how to run a practice.

Starting a Private Practice: Learning from an Expert

We sat down with Dr. Grace Torres-Hodges, a distinguished Podiatrist and a strong advocate for the Direct Care model. Committed to enhancing patient access and autonomy, Dr. Torres Hodges has transformed her practice to better meet community needs.

She is the author of the book "Private Practice Solution: Reclaiming Physician Autonomy and Restoring the Doctor-Patient Relationship", one of the winners of The Independent Press Award in the category Medical Nonfiction.

In this interview, Dr. Grace shares her journey and discusses her pivotal guide for healthcare professionals. The interview also delves into the tangible benefits and challenges of transitioning to a private practice model.

What inspired you to transition your podiatry practice towards a Direct Care Model, and how has this shift affected your approach to patient care?

I started my solo practice in 2001 and have loved being my own boss. I practice the full scope of Podiatry, from conservative treatments to surgical, and take care of children all the way up to grandparents - a very diverse group of people with varied pathologies. 

Over the years, new regulations were implemented by Medicare and insurance companies. Long story short, I went to a meeting by the American Association of Physicians and Surgeons because I was so fed up with having to do extraneous work and deal with codes, and you realize it was nothing that could take care of the patient. It was all just to get paid. But you have to do it, or else you'll go out of business. 

The first lecture I heard at the AAPS meeting was about how to opt out of Medicare. I didn’t even realize that was an option. As I started listening to that, and to all the other Direct Care Doctors there, I noticed there are DPC and DSC. I got hooked and started looking at my practice very differently. From that point on, I began to transition out.

How has the transition to a private practice impacted both your professional life and patient interactions?

Before the transition, business-wise, I had to look at what was actually paying me. I found out that some of my payers, the insurance companies, were actually paying me only $0.51 for every dollar I was charging. And yet, every year my costs were going up. From a financial perspective, you can't keep up with that unless you start seeing more patients. But then, you would compromise the amount of time you spent with each patient. I stayed up late at night, did all my charts at home, and would rather just leave it to the side and go out with my family. But you know, you get to a point where you're just done with it. 

When I found that Direct care was an option, I really focused on making it happen. It took me until 2017 to actually get out of all the insurances, but from 2013 to 2014, I started transitioning out. Every year, I dropped more, and everytime I dropped out of an insurance company, it got filled in by direct pay from patients, no longer was partial reimbursement which then increased daily revenue.

Since then, I've also dropped my overhead. So now my take-home revenue is much more even, and it is a win-win not only for my practice financially but for the patients. 

You know, when I was seeing 26 to 28 patients a day compared to now seeing only 10 and actually spending the time to listen and talk to them, it makes a big difference. I'm not feeling exhausted anymore. 

What challenges do doctors face when transitioning to private practice, and how do you address these concerns in your mentorship?

A lot of doctors fear going into Direct Care because they think they won't have enough patients, but they're under the mentality that they need to see X amount of patients in order to make this much money when they're not looking at the actual numbers themselves. 

Another problem is that they have never been taught how to look at the actual numbers themselves. A lot of what I'm doing now in my free time as I mentor, that's what I teach them how to do. 

I find that doctor's have forgotten that they can do more than they are used to. I'm a better doctor because I'm not only just focusing on one thing. A lot of the insurance companies just want you to focus on one problem at a time, but patients come in with multiple issues. So you want to take care of the patient completely, and we really try to do that. 

You give better service, the patients are much more satisfied, and it's about the customer relationship, you know, and our customers happen to be patients, so it goes above and beyond the just know, like and trust. It is important.

What motivated you to write your book, “The Private Practice Solution”?

Taking the leap is the hardest thing for a physician to make the transition due to a huge fear factor for several reasons. First, they are not familiar with it because they were never exposed to it. A significant part of what I'm doing these days is reaching out to medical students and residents because, had we known this earlier, it wouldn't be so hard to grasp. 

My book came about in the mindset of my transitioning. I was missing a book that really breaks through and explains the business aspects. 

It doesn't matter if you're in primary care or specialty care; it's just to get into the Direct Care mindset and understand why you want to do it. I was very intentional with my title: “to reclaim physician autonomy and restore the patient-physician relationships”. These premises are exactly why the title is structured that way, which influenced my writing. 

How is your book structured to guide physicians through the transition to private practice?

The book is written like what we call a SOAP note. It's divided into four sections.

The first section discusses the history of how we got into this mess and why doctors feel the way they do, as it came about very slowly and insidiously. 

The second section focuses on being truthful to yourself and looking at your numbers, which is more business-oriented. I learned in business school how to teach these concepts, I can explain this because there's a fear factor due to doctors not feeling that they are an expert. It's actually common sense from a physician's perspective if they know how to look at labs on a sick patient; they know how to look at their practice's numbers. 

The third section, known as the assessment in a SOAP note, asks what you want to do and where you are at the decision-making point. We either go this way or that way. 

The fourth section, if you decide to move forward, outlines the plan and goes through strategies for medical marketing, pricing, and writing your business plan. 

This book is business-oriented but should not scare doctors and instead make them realize that if they can manage a patient, they can manage their practice. They just have to treat it like their most important patient.

"As for mistakes, you're going to make so many along the way because every practice is different. However, the biggest mistake is not taking the first step. If you don't try it, you'll never know."

As an entrepreneur, you have to be willing to take on those challenges. These mistakes are not errors; they are challenges, and you have to find solutions to move past them.

What steps are necessary to integrate the Direct Care model effectively within the broader healthcare ecosystem?

Direct Care is not just about doctors; it's about the whole ecosystem. One of the examples I always use when introducing Direct Care to people who have never heard of it before is to think about how you do business in every other industry but medicine. 

If you're looking for a plumber, a mechanic, an attorney, or an accountant, the key thing is you ask around. You contact the individual business, exchange information, get pricing, and then the customer, or in our case the patient, decides what the next move is. If you notice, it's not the business that decides; it's always the customer. 

From that point, if the customer decides to proceed with that business, they move forward, already aware of the price set at the beginning. This is a very basic business model present in every other industry except medicine. So, Direct Care follows that business model. But you have to understand this: the problem is never with the patients or the doctors. It has always been with a third party that was involved.

Where do our patients come from? They come from the general public, but most of them come from employers who provide the insurance plans these patients have. The big movement forward is for doctors to become aware of where their patients come from, including that they come from employers who have their employees on certain plans.

We encourage those employees to talk to their employers about Direct Care benefits, looking for self-insured plans and direct reimbursement plans, which are completely different from traditional insurers like Blue Cross, United, Cigna, Aetna, and Humana. 

And that's the next step: we need to help our benefits community understand what we do because it doesn't work just doing it ourselves and it works for us in our business, but it doesn't work in the whole ecosystem. We need to get everyone involved and as more and more companies switch over to those types of plans, you get a healthier overall patient base with Direct Care.