Dear Doctors and Chiropractic Students,
When I was looking for an office, I found it difficult to research and to pay for travel expenses, lending expenses, and simply have the time. I remember working at one office as an associate during the day, working at a restaurant to make ends meet at night, and then researching practices for sale until 3 am. I paid for plane tickets, hotel rooms, and car rentals. I spent not only thousands of dollars on research and travel, but also countless hours of effort and searching.
I found a practice I was interested in buying once. I purchased plane tickets to go visit the office only to have the doctor email me and tell me he didn’t want to sell his practice any more two days before I was to fly out. Once I found my practice, I paid for finding a lender and attorneys fees. Then, I had to find financing and jump through hoops to purchase the practice. Faxes needed to be sent on certain sizes of paper, items of personal information needed to be sent overnight, small business association reps may not feel like working on Thursdays or Tuesdays. It was horrible. Thousands of dollars later, I owned my own practice. This was eight years ago. It was much easier to obtain financing back then. Today is a completely different story. Do you think you have enough proof of income to obtain a small business loan? Probably not.
Currently, the company I obtained a small business loan, CIT, has filed for bankruptcy protection. They’re the largest small business lender in the country. They’re going to make it very difficult for someone to obtain a loan. Goodwill and blue sky isn’t enough. How strong is your business plan if you do not have collateral? You won’t get a loan if you don’t have money by yourself. If you even get a loan, there are certain criteria that the lender may demand you do that a seller may not want to do. In my case, the lender required the selling DC to stay for a month during a transition period. This didn’t make the seller happy. Overall, it cost me thousands of dollars to get up and running. Eight years ago I was in your shoes. I wish I had had some help and guidance. Business classes at school are helpful and touch on the basics, but real life is opening your doors and earning a living. Here’s your opportunity to get ahead in life without much financial commitment. You’ll also be helping me and my family. We both will win. Plus, if you are selected as the winner, you won’t need to set up a business plan.
This situation I spoke of above was a hardship for me and it will be for you if you go the traditional route. If you’re an associate, does this sound familiar? Work for a DC who you really may not like. The doc pushes their “system” on you. Work for a doctor who times how long you spend with patients. Work endless hours here, pay endless fees there. All patients get this and we must do that even though you may think otherwise. I’ve heard this before myself.
I was in the process of selling the practice, but the many doctors who have wanted to purchase the office could not get financing. They came to visit the office and spent some time there. They made offers but again, could not get financed. It was frustrating to both of us. You may ask why am I doing this. My reasons are simple and basic: I wish to move back to my home state because I have a family of my own and wish to be closer to our families. There’s nothing more to it than that. This is no joke. It may sound too good to be true, but things really are this simple.
First, let me address the issue of the commonly spoken issue of a non-compete clause. Schools talk about the fear of having a doctor sell their practice and then open up a new one down the street. The issue of a “non compete” clause is nil. I offer a 100 mile non compete clause. I can do this because truly I no longer wish to practice in the state of Colorado. I want to move back to my home state. I have no desire to “steal” patients from you. The practice and patients will completely and truly be yours. You will not find any practice or doctor that would offer you this large of a non compete clause.
Currently, it’s difficult for new graduates and associates to obtain funding to get a small business loan. We all know you have student loans to pay off. We know that will be about $1000/month. Plus, you may have a mortgage or rent. You need a place to live. You may have a car payment.
You may be working for another doctor who thinks you should work endless hours at personally, financially, useless spinal screenings on weekends while they’re at home or away. You know you can do better but what can you do when you’re just out of school? You have little, if any, business experience. You have little time and/or you don’t have the down payment for a business. That’s why I decided to own my own practice. I remember having to work at a Bally’s doing spinal screening on the weekends and over my lunch hour. For what? So the doctor I worked for could get a large percentage of my collections. Some docs just don’t have the personality to do screenings. That’s why I got sent out to do them. Financially, it’s more worth while owning your own business than being an associate. It also is more meaningful. But if you can’t afford to purchase a clinic or get financing, what can you do? Here’s your chance. This is the opportunity of a life time. You really can’t afford to not take a shot at this essay.
The office is completely viable and the new doctor will be able to step in and “run the show” without problems or financial burden. I will be providing all of my professional contacts: attorneys, bookkeepers, acupuncturists, massage therapists, medical doctors, physical therapists, etc. I will help the new doctor as much as I can and as much as they want. If the new owner wants, there will be a 30 day transition period I will help with. Some things don’t happen on a daily basis, such as billing, banking, etc. If you want help over the phone, I’ll help with that. If you’d like me to give you the keys and get out of your life, I’ll do that too. The amount of help and intervention you want from me is completely up to you.
Every office has different billing software. My office utilizes EZClaim. I have used this software for years. The company offers free updates, which many companies do not. I’ll teach you how to perform billing. I’ll also teach you how to enter the patient’s information into the computer. This includes not only how to perform billing, but how to bill patients individually and how to bill insurance companies for your maximum financial benefit. Another part of billing I’ll help you with is how to get paid for the work you do. I left chiropractic school with the question of “How do I get money in my pocket when a patient hands me an insurance card?” I’ll walk you through the steps of acquiring the right information from the patient, contacting the insurance company, if even necessary, and sending out HCFA forms. I also found it strange that we learn how to be doctors in school, but we never learn how to actually get paid for the work we do. What are CPT codes? What are ICD-9 codes? Do I have to use ICD-10 codes? Which codes do I bill? What are HCFA forms? Which insurance companies accept which codes? Some insurance companies pay for this CPT code and another company will pay for a different one. This information will be provided to you if you wish. This information could results in thousands of dollars of additional income for you. These are things that new doctors don’t know, only doctors that have experience in dealing with insurance companies can get you additional money.
If you think you are ready to run your own business this is the perfect chance. If you’re graduating soon, why not take the time to write and tell me why you should get this business. If you eventually think you would want to own you own business here you are. Why work endless hours for another doctor when you can work for yourself? Why do spinal screenings for the benefit of another doctor? $200 could get you a practice to support you for life. If you are working as an associate and you’re thinking, “I can do this on my own” why not give this a try?
The pictures should give you a vision of the office. I’ve also drawn up a floor plan of the lay out. The office is over 1,000 square feet. It is located in a shared, single-story building. The other office is that of an orthodontist. He works maybe once a week. He is the owner of the building. He’s been extremely helpful and responsive to any changes I’ve ever wanted to do at the office. (such as painting, changing the décor, he recently put on a new roof, etc.) There’s a large parking lot. There are about 20 parking spots. There is large signage both on the building and near the road. The sign by the road is shared with the orthodontist. My portion of that sign measures 26.5” by 69”. It is double sided so both directions of traffic are exposed to the information. The sign on the building is 36” high by 71.75” wide. They’re both illuminated at night. The office is located on a busy secondary road.
The office currently has two chiropractic treatment rooms. They’re both identical. I say currently because if you wish to move walls around and make the rooms different sizes or add walls to make more rooms, you simply need to ask the landlord. You could potentially have 5 treatment rooms. The chiropractic rooms have adjustable Lloyd tables that have cervical, thoracic, lumbar and pelvic drop sections. They’re both pneumatic and adjust vertically. See the equipment list to see the specific vertical height adjustments. Both rooms also have storage cabinets that contain supplies such as SOT blocks, headrest paper, oto/opthalmascope, stethescope, sphygomammogram, Biofreeze, FootLevelers foam casting kits, and such. The entire office has surround sound stereo which can be controlled with radio or CD. There’s an x-ray room. The office also has an additional room which has an intersegmental traction table and a massage chair. Another room is used for massage therapy. There is another large room that can be used as an exercise/rehabilitation room, a new patient examination room, or whatever you wish.
There’s a room with a washer and dryer. The bathroom has been recently remodeled. A back office area contains the patient files, cleaning supplies, microwave, storage area, stereo, coffee maker, and refrigerator. See the enclosed list for more equipment details and supplies that will be given to the winner. There is ample additional storage space in a large cabinet and book shelves. The office currently accepts Visa and Mastercard. There are two phone lines. The list does not include every office item of course. But if you see it in the pictures, it comes with the office.
Once the new owner begins paying the bills, with rent, phone, electricity your overhead will be roughly $1,200. Of course this depends on how warm or cool you want the office. But remember, I will be paying for most of the winner’s overhead for the first transitional period year. Once you start being responsible for paying overhead, if you do some rough math and you charge $40 a treatment for a cash patient, that means you would only need to see 30 patients a month to start making money for yourself. That’s one patient a day! The rest is money in your pocket. Imagine if you had a practice in which you saw 10 patients a day? 20? 30 or even more? $200 doesn’t sound like much at all anymore does it?
Also look at $200 this way. If you decide to open your own office, you’ll need supplies. You can cut corners at first, but have you really considered all of the items necessary to open your doors? I recently looked at the newest catalogue that Medical Arts Press sent to me. This is a great company that I recommend any student, future doctor, or current doctor doing business with. For $500 you can get:
1. A box of face paper, a box of CMS forms, and billing software.
-OR-
2. One x-ray view box and some patient gowns.
-OR-
3. About 3 or 4 reception room chairs depending on style.
-OR-
4. A CPT book, an ICD-9 book, and a two drawer file center.
You’ll need more than this right? This list of 11-12 items will cost about $2,000. Do you have that money? Will you have money left over for paper, ink, etc? I haven’t mentioned the start up cost involved in getting office space. If you’ve rented an apartment, you know there’s a deposit. Commercial space is the same. Do you have a few months rent ready to put down for a deposit? Got a couple extra $10,000-$20,000? That’s what you’ll need to get up and running to get supplies and office space.
The patients are an insurance and cash base. There are probably 70% cash and 30% insurance. Insurance companies I am in net work with are Blue Cross, UnitedHealth Care, American Chiropractic Network, Pacificare, Landmark, American Specialty Health Network. Again, I’m willing to help until the new doc gets a reply from the insurance companies as to whether or not they can be an in network provider if the new doctor wishes to do so. This process can take around 4-6 months. If you don’t want to deal with insurance companies, that’s up to you. You may not get paid by the insurance companies if you are not in-network with them. You may only be able to collect the deductible and/or copay. Remember in these hard times, the most common way for employers to continue to offer health insurance to their employees is to increase the deductibles. If you apply to the insurance companies as an affiliate of this office, you will more than likely get accepted as a provider. I don’t guarantee it, but it certainly will help. I don’t want the new doc to lose money as an out of network provider because they have to wait for the insurance company to do their jobs. It took me 7 months to get my Blue Cross provider number.
You certainly may be curious about the Denver area. According to MSN.com, Colorado was ranked the fourth fastest growing state in the country. Here’s some general information about the area where the office is located and some demographics to get you familiar with where your office will be. The area cities are Lakewood, Golden, and Wheat Ridge. The office is located in the city of Lakewood and the county of Jefferson.
For Lakewood, these numbers are taken from the City of Lakewood’s website. You can verify these numbers at www.lakewood-colorado.org.communityinfo/demographics.htm.
Lakewood is a western suburb of Denver. It has around 145,000 people.
The median home price for Lakewood is $237,000.
The population by age for the city is:
13.9% for 25-34 year olds
14.2% for 35-44 year olds
16.2% for 45-54 year olds
25.2% for 55+ year olds.
The median age is 36.5 years.
The employment industries for the county of Jefferson vary with manufacturing, wholesale trade and transportation, financial and real estate, government, construction, professional business services, education and health and entertainment and hospitality. Lakewood’s 2008 median household income was $53,333. The county’s unemployment rate was 5.2% in November 2008.
The people who live and work in the Lakewood area have an abundance of recreational opportunities year round. Lakewood puts you within minutes of the mountains to the west, the City of Denver to the east, and the City of Boulder to the north.
The City of Golden is across the street from your new office. It’s home to Coors Brewing. Golden has a projected population of 18,955 for 2010. The majority of Golden’s population is between the ages of 5-54. The largest percentage of the total city population is 60+. The median household income according to the City of Golden website at www.ci.golden.co.us/page.asp?navid=214 is $49,115. Major employment industries consist of: managerial/professional, sales, service, and construction.
The city of Wheat Ridge is located about a half a mile away. According to www.maps-n-stats.com/us_co/us_co_wheat_ridge_h.html, Wheat Ridge has a population of 32,069. It’s home to Lutheran Hospital which is only a few miles away.
The area is nestled against the foothills of the Rocky Mountains. The community is served by five major highways, including Interstate 70, Colorado 470, and U.S. Highway 6, which provides a direct route to Denver, Boulder and the mountains. Lakewood has over 1200 acres and 85 sites of city-owned formally developed and undeveloped parkland.
In the winter, the Rockies offer skiing in its most challenging forms. In less than an hour and a half, you can be at work renowned downhill ski areas such as Winter Park, Copper Mountain, Breckenridge, and Silverthorne. Cross country skiers may choose to try their skills at these areas as well, but cross country skiing is available near the city. Snowshoeing trails are also close by.
In summer, the mountains offer fishing, backpacking, and camping in glorious settings that rival any scenery in the world. Trails through Roosevelt and Arapahoe National Forests provide days of peace and quite in which to discover the Rockies. Estes Park and Rocky Mountain National Park is a beautiful 1 ½ hour drive away. There are plenty of “open spaces” which can be used for jogging and walking.
Jefferson County has 255 annual days of sunshine. That’s 70% of the year. The hottest month is July, with an average temperature of 74 degrees. The coldest month is January at 30 degrees.
Businesses close to your new office include Wal-Mart, Target, Coors Brewing, Wells Fargo, Colorado State Bureau of Land Management, Best Buy, and Colorado Mills mall.
Remember, I am completely willing to stay here, but I just want to go “home.” After the winner has been chosen, the winner is completely free to do what they want: stay and continue the success of the practice, take the files and move the office to a new location, take the equipment, sell it for a profit themselves…it’s up to the new doctor.
Again, all I am asking is for you to write a one page essay telling me why I should let you have the office.
Good Luck!
Mark Anderson, DC
