Option 1: Starting your own practice...
A candid interview of one of the busiest GI physicians in solo practice in south Florida
The scariest part of leaving fellowship is designing your own practice. The following is a brief interview of Dr. Karthik Mohan. He left GI fellowship and began his own practice right away. I am a sci-fi geek so allow me to introduce this article with my indulgence.
Star Trek, the Next Generation, is arguably the best in the series and definitely a fan favorite. But it is too far into the future to make you wonder, what did society have to do to do get there? It always bothered me when Captain Piccard said “fullstop.” This is after they had been going faster than light speed and bending space and time. How did they not get crushed under that many G’s? Another great sci-fi show called the Expanse somewhat answers that question for me. It is the time between now and Start Trek. A cocktail Epinpehrine solution injects into the character's veins before jumping to hyperspace. And then you learn about the come down from that cocktail that takes them hours to recover from. Every idealistic future has a story of how we got there. It took a long time for Dr. Mohan to jump to hyperspace in his career.
Dr. Karthik Mohan is one of my mentors who started his own practice as soon as he left GI fellowship. He graduated with a degree in Biochemistry from West Virginia University. He went to West Virginia School of Osteopathic Medicine for his medical school. His residency was in Internal Medicine residency at Chicago College of Osteopathic Medicine. His GI fellowship was at the Texas College of Osteopathic Medicine in Fort Worth, TX. During his fellowship, he received extensive training in therapeutic endoscopy. This included ERCP and Endoscopic Ultrasound. That kind of training during your fellowship is very coveted in our field. He prides himself in being a jack of all trades. He has made himself a cornerstone in many community hospitals in the south Florida area. He offered his insight via e-mail in the wee hours of the middle of the night when he had time from his busy practice.
How did you know you felt comfortable starting on your own out of fellowship?
I had a good experience during my GI fellowship. I was able to be exposed to a wide variety of patients that helped me gain confidence. I also had a great program director that was a great endoscopist, and I was very fortunate to work/learn under him to develop the skills I needed to give me confidence that I can work on my own. My parents, whom are physicians, also started independent practices from scratch, so I had their guidance and support as well.
Did you have an idea of how you wanted your practice to look? Or did you wing it as you went along when you started?
I knew from the beginning I wanted to start my own practice. I like managing things, looking at numbers, and building things from start. I’m also independent and like to make my own decisions for my business. I just didn’t know where until a recruiter called me one day to tell me about a community called Hialeah in Florida that was in desperate need of GI physician that does ERCP. Here I am 6 years later with a very busy practice working alongside GI fellows.
Did you need any capital to start your own practice?
Yes, capital is a must. I had the financial backing from my family, however, I opted to take an income guarantee from Tenet Corporation at the time due to a community need for GI to start my own practice. Basically, they provided me one year salary for my income with additional money for business/operating expenses. The money given to me for the operating expenses was used for office staff salary, rent, supplies etc. They supported me for 1 year. This was helpful as it took me that 1 year to get on insurance plans [and] establish myself in the community and I didn't have to worry about the business expenses since they covered it. In return, I was asked to stay in the community for 4 years and all the money they gave me for expenses would be forgiven with no repayment obligation. I have been in Hialeah 6 years now with a thriving practice.
What did day one of your practice look like? Just recount the day the best way you can.
Very slow, as expected! I remember sitting in my small office with zero patients on my schedule. My staff and I were filling out paperwork constantly to get on insurance plans and I also preparing carefully for Medicare's routine inspection of a new medical practice. I had hired a practice setup consultant at the time, and it was well worth it, as she helped set up my office including all logistics (licenses, inspections, getting on basic insurance plans, advertising). I also remember my first day thinking about when I would get my first consult for an ERCP, since I had always done them with someone supervising/helping me, and I was anxious to see if i could do it myself. I really had no partner to back me up or help assist me for ERCP since i was opening a practice myself straight out of fellowship. My first case was on my second day, and luckily successful.
Where does the majority of your revenue come from?
My practice has a slightly more inpatient coverage compared to most GI practices, so the majority of my revenue comes from the hospitals I go to (rounding on consults, followups, inpatient procedures). I would say my practice is around 55% inpatient based and 45% outpatient. My outpatient practice however, is busy and still produces volume similar to other solo GI physicians in the community who only do outpatient work. Combining all the inpatient hospitals I go to in Miami and my office practice, I perform approximately 3,000 GI procedures annually.
What is one thing you would have wanted to know when you started, that you know now?
I think one of the most important things in starting a new practice is hiring the right people for your office staff. My office manager, has been with me since day 1! She had a good experience working at a cardiology practice prior, and I thought that would be beneficial for me. She knew at the start how to schedule procedures, how to verify insurances and determine patient's benefits. I had a basic idea of how all of this was done, but I learned from her the fine details.
Did he provide some insight for you? Please comment if there is more that you would like to know, I can publish an addendum.