ASa part of my interview series with prominent medical professionals about “How To Grow Your Private Practice” I had the pleasure of interviewing Dr. Nisha Bunke, MD, FAVLS, RPhS.
Dr. Nisha Bunke is a venous disease specialist, who founded La Jolla Vein Care, San Diego’s only accredited vein center in 2010. She was the first physician in the United States to complete fellowship training in this specialty supported by the American Vein and Lymphatic Society and is a diplomate of the American Board of Venous and Lymphatic Medicine. She is also the author of the medical textbook, The Vein Book (Oxford Univ. Press 2013), numerous scientific publications, and CEO of Recova, Inc.
I am a venous disease specialist, meaning I treat the entire spectrum of superficial venous disease affecting the legs, including painful varicose veins, leg ulcers and blood clots. This is a niche specialty that has been growing over the past decade because vein conditions are so common. I was the first physician in the United States to complete fellowship training in this specialty, which is supported by the American Vein and Lymphatic Society. Venous disease is pervasive. During the early years of my private practice, I also served as a volunteer clinical instructor at UCSD, where I treated patients at UCSD Medical Center as well as the Veteran’s Affairs Medical Center.
Earlier on, I did not plan on having a private practice. However, while working in university and government medical settings, I saw obstacles that prevented patients from getting fast and convenient access to vein care. I liked the idea of being able to control the patient experience and creating a concierge-style, individualized and patient-centered practice. Being a physician and business owner allows you to exercise both parts of the brain. The medical decision-making, science and data-driven part of the brain is ingrained in any physician, but the business owner side allows one to be creative, making creative decisions from areas ranging from website functionality and design to how to effectively market and grow the practice.
As a provider and business owner, I tried to do everything myself for many years. That is a quick way to experience burn out. For balance, I’ve learned to delegate things that can be delegated. As a physician, I can’t delegate patient care and my judgment, but I can delegate business-related roles, which is why it is valuable to surround yourself with a strong and supportive team. The right team members will make your job a lot easier.
When I’m seeing patients, I’m 100 percent dedicated to patient care, not considering business at all. With a heavy patient load, I used to find myself working on the business itself on the weekends and evenings, until I eventually hired other physicians and nurse practitioners to help with the patient load. This allowed me to have more administrative time, which is important for accomplishing work related to quality of patient care like quality assurance reviews, overseeing our facility accreditation and allowing time to have team meetings, staff training and other marketing and business administration tasks. If you really care about your practice, it makes sense to spend time on things that count — from the quality of care you provide to patients to the attention and training employees receive.
Ultimately, it is the practice owner’s responsibility for the quality of care delivered and upheld within the practice.
The biggest hurdle that is prominent in my mind is the financial hurdles medical practices tend to experience. I think you have to be open-minded that it can take several years to really become established, especially when your business is heavily reliant on word of mouth referrals. There is so much to prove, and it takes patience and, of course, time.
I had to learn it was all simply part of the process. Without failure, there are no learning curves to grow from. One of the most important things a person should keep in mind if they’re hoping to start their own practice is realizing there are going to be failures, just like any other business will experience.
Know your patients. You know your patients and what is in their best interest. Use this knowledge to your benefit and market your business and experience to the audience accordingly. If you have patient reviews and testimonials, for instance, learn from them to improve a future service or to boost your practice’s credibility and reputation. Knowledge is power. Take what you know about your patients and use that to reach future individuals who may not have even been aware they needed your service.
Be involved with the management of your team. Patients tend to compliment my staff often, and they say that employee attitudes trickle down from the top. I agree with this, and I have noticed if customer service is not on par, it usually is tied to the top. If there is a staff member who tends to be a little less friendly, maybe it’s because their boss isn’t too friendly themselves.
Research EMR options. This is a must! There are many different types of electronic medical record (EMR) options, some are specialty-specific. I have seen EMRs that are touted but would not be right for my practice because of my documentation preferences and need to incorporate ultrasound and leg images, or inability to utilize text and email appointment reminders, or lack of billing capabilities. All EMRs are very different. I recommend trying different EMRs out before committing to one.
Consider outsourcing billing. I outsourced billing for the first few years of my practice, which is a cost-efficient option for practices starting out. If you choose to do billing in-house, your billing expert needs to be experienced and detail-oriented.
Consider outsourcing HR. For small practices, it doesn’t make sense to hire a full-time HR professional. Instead, we use a professional employer organization (PEO) company to offer employee benefits, facilitate payroll processing, provide risk management resources, human resource consulting, employee training and more.
Yes, this was huge for me. I never wanted to charge people for my services. Most physicians go into medicine because it is an altruistic profession. At some point you realize that you have a special skill set that most people don’t have and that brings value. And while you want to make things affordable for patients, you will not be able to offer any services if you can’t pay the rent or pay employees. To mitigate this struggle, I have designated personnel to handle invoices and payments from customers.
If possible, I put my work down and start fresh at another time. I’ll choose to go for a walk, exercise when I am able to or pull my senior staff aside to talk or brainstorm ideas. Anything that will give me a mental break for a fresh, focused start.
My mentor was Dr. John Bergan, who I trained under during my fellowship. He was a world-famous vascular surgeon known not only for his academic brilliance, but also for his great bed-side manner. I had the opportunity to work with him at his private practice. I was able to observe his approach, how he treated people and made them feel important — from his staff to patients.
Every day, he had a pearl of wisdom I could learn, especially about giving presentations to other physicians.
He also taught me you can’t make everyone happy all of the time. As a physician, if one patient is upset or leaves a bad review, it can be taken to heart. You need to focus on the fact that you make most patients happy. The same with staff, there’s always someone who’s going to complain. You can’t make everyone happy all of the time.
I relied a lot on interfacing earlier on, from conferences and face-to-face instructional dinners to webinars educating physicians on what it is we do. It was a way to get to know people on a personal level, while also giving them a taste of your extensive knowledge and experience in the industry.
I can’t remember specifically any very bad advice. I can tell you that everything has been trial and error, so some people give you suggestions and you have to be open and know they might not work for your practice.
The classic, Good to Great: Why Some Companies Make the Leap and Others Don’t. Studying business failures is as important as understanding business successes.
Thank you for these great insights!