When starting a medical practice, or forming a small group, a LOT of customization needs to be done to avoid problems. Using a medical practice startup consultant can make life much easier than just using a startup checklist. A checklist is general in nature, and doesn't consider the unique factors of your personal situation. Medical practice startup costs vary widely by specialty, location, size, and business plan, but most can be done for under $100,000 including everything from consultants to attorneys to CPAs to furnishings, excluding specialist instrumentation like lasers or 'scopes or surgery suites. If you have to build-out a new space in an empty "shell", costs rise quickly, so its best to start your practice in an existing built space if possible, but that's not always possible. There are a number of specialty banks that will provide you a practice startup loan of 100% of costs while your AR builds up, which we can introduce to you.
There are hundreds of little steps to starting a practice (medical, podiatry, etc), and each one needs to be correct during the build-up. Goals need to be realistic, and financial projections reasonable. We are active participants in the top income-and-overhead databases, and include that vetted-data in our consults.
If starting your own concierge medical practice, it is often best to start with an insurance-based practice if possible to build patient loyalty, then convert by judicious elimination of plans, worst first. We can show you how.
Consultant Keith Borglum CHBC CBB has assisted with hundreds of medical practice startups, and over 50 mergers and group formations. You can call us for a free preliminary talk.
You probably don't need tens-of-thousands of dollars of consulting. Clients tell us that they like our straightforward, lean approach; without being a 'front' for other services like billing or accounting or insurance sales.
The vast majority of our clients need only one intensive day with us, one-on-one, and a few phone calls thereafter, at a cost of less than $2,500. And the banks will finance all of it. Give us a call at 707-546-4433 or email to discuss your plans or receive a written Agreement for review.
Professional Management and Marketing is one of the few consulting firms in the nation that have been cumulatively accepted by all of the following into their consultant panels, faculty, or referred us to their physician-members for a medical practice start up consult:
American Medical Association
American College of Physicians
American Academy of Family Physicians ( and state chapters)
American Academy of Ophthalmology
American College of Physicians
American Academy of Dermatology
American Academy of Allergy, Asthma and Immunology
American Osteopathic Association
We have given numerous seminars on the topic at national, state and local conferences, and have authored many articles on this and related topics.
Bountiful references are available, and we have worked successfully with many specialties to start practices.
You can see here a short video clip of consultant Keith Borglum speaking at ACOG.
Our consultants authored two national-standards-setting books published by McGraw Hill; The Medical Practice Forms Book; and the Medical Practice Pre-Employment Tests Book, both important to start-up practices (and included in a startup consult). Keith Borglum has also authored a book on practice valuation for mergers, purchases and buy-ins, available at PSR.
We also provide consultation on most of the problems and issues faced by physicians in private practice, excluding tax, law and financial planning. We also do not do coding and fee-setting, but refer those topics to very efficient lower-cost consultants that specialize in those areas.
A medical practice startup consult is ideally performed at least four months in advance of the start date, and the earlier the better (even though some practices come to us months after starting up!).
It involves an intensive full-day meeting with the doctor(s) making as many decisions as possible regarding practice start-up and operations.
Templates are customized for a business plan; an employee handbook; staffing and hiring: billing and collections; office brochure; general ledger/accounting; and most forms needed to run the practice.
Marketing strategies are discussed and a marketing plan prepared.
A checklist and calendar of pre-start-up activities are prepared and reviewed in detail, leading up to and through opening day.
The doctor is referred to pre-screened specialists for business loans (easy-qualifying loans available to $200,000, otherwise to $2M), fee-setting, tax and legal requirements.
A practice budget is established using reference data by specialty; financial/payment/collection policies determined; often a computer or billing service selected; and all physician-questions answered.
The one-day consult on practice start-up can be at your location or ours. Solo or two-physician practices usually come to us, but have us come to them if three or more physicians are involved.
We budget all day for the consult, but only bill you for the time used (if at our offices). If you have zero private-practice experience and are starting from scratch, plan on 8-10 hours in consult. If you have a lot of private practice experience, or have a lot of preparation already completed, it could take as little as 4 hours in consult. Every consult is customized to the needs of the client.
Physicians fly in from all over the country to meet with us for our one-day consult.
You will leave the consult with far greater confidence in the process of opening your practice, with a detailed plan of execution.
Past clients tell us that the consult reduced their startup workload to under 100 hours.
We recommend doing little-to-no advance preparation. Many clients tell us they wasted a lot of time studying the wrong things in advance. For example, you could easily spend hundreds of hours researching EMRs, when we might be able to reduce your choices to 1-3 within minutes! (our opinions on EMRs are published nationally in medical journals)
We are available thereafter anytime by phone, email, or visit for further support.
Lots of testimonials are at the Client Comments section.
Many airlines fly directly into nearby San Francisco, Oakland, Sacramento and San Jose airports daily. We recommend Oakland over San Francisco because of better on-time records (less fog).
Three airlines have direct flights into the Sonoma County Charles M. Schultz Airport (STS) in Santa Rosa:
-Horizon Air (Alaska Airlines) has daily flights from Los Angeles LAX, John Wayne/Orange/SantaAna, San Diego, Portland Oregon, and Seattle Washington;
-Allegiant Air flies in from Las Vegas;
- American Airlines flies in from Phoenix AZ.
The airport is also open to private planes, with a large private jetport (though we never yet have had a client come in their private jet!).
We can pick you up and bring you back to your hotel.
Santa Rosa is in the heart of the Sonoma Wine Country, and one hour north of San Francisco. We will provide lots of lodging and tourist connections.
Many clients book a consult on Friday and spend the weekend in the wine country or San Francisco "studying notes about practice start up", making much of the visit tax deductible, as activities in planning to open a business are generally tax-deductible (ask your CPA - or read the book Small Time Operator, an item on the recommended reading list for startups).
PRACTICE START-UP OR TAKE-OVER IMPLEMENTATION SUPPORT, occurs
after the Start-Up Consult or Practice Purchase and includes meetings
or calls with doctor and/or staff to make sure the practice is started and run correctly, in person or by phone.
PRACTICE PURCHASE or BUY-IN APPRAISAL Buying a practice is very cost-effectiveway to start, if the price is right. Appraiser Keith Borglum is also an IRS-Qualified and licensed appraiser. This is important because any transaction will flow to both the buyer and seller's tax returns. Keith does appraisals, second opinions, and expert-witness testimony for purchases and court-cases. He participates in the national Goodwill Registry and National Society of Certified Healthcare Business Consultants' statistical databases, and is a member of the National Association of Certified Valuators and Analysts. More info is available on our valuation website. Appraisals typically take 10-20 hours, excluding travel, which often can be avoided. A 'mini' 'calculation of value' can take as little as 3-5 hours, but is not meant to be fully educational and convincing, even though accurate.
PRACTICE SALE SUPPORT, to facilitate decision-making on all the details of transitioning the practice from one to the other is available. Terms of sale for the agreement should be negotiated and drawn by an attorney, to comply with state and federal law. Referrals available, and to specialty lenders for up to 100% financing.
MERGERS AND GROUP FORMATIONS: We offer a one-day intensive session with the merging parties to structure the transaction and how operations will function post-merger. This can be combined with a Practice Startup Consult if appropriate. Pre-merger practice evaluations & valuations are another option.
Fees are typically $300 per hour, but discounted for the Start-Up Day, or by project retainer. We have chosen to keep our rates modest and charge for all activities, including travel, rather than have higher fees and not charge for travel. Since we work on a national basis, we feel this is fairer to the individual client as local clients do not subsidize the costs of remote clients. Clients are usually given the opportunity to meet at our offices rather than theirs to avoid our hourly travel costs. Our location in the Sonoma Wine Country one hour north of San Francisco lends itself well to mixed business/pleasure trips for consults at our offices. The money saved by not having us travel to you will pay for a nice weekend here!
More information is available on our home page.
We can provide many, many references in addition to those posted on our website. Give us a call or email to talk about any special needs, or to schedule an appointment, at 707-546-4433.
Keith Borglum his CV
Professional Management and Marketing
3468 Piner Rd, Santa Rosa CA 95401-3954
ph 707-546-4433 fax 707-546-4437