Thursday, September 19, 2013

First Things?

I have no good idea about how to start a concierge medical practice.  Numerous corporations online will help you with this, and I am looking at some of them for ideas and guidance, though I don't want to contract with any.  I wonder how many more days will pass, however, before I find myself laughing at the absurdities that today seem like great ideas.  C'est la vie!

So, what needs addressing?  Here is my initial punch list:
  • Establish corporate structure:
    • corporation, sole proprietorship, other?
    • get tax ID
    • malpractice insurance
    • contract and fee schedules
  • Location:
    • primarily floating (out of car?)
    • get PO box
    • consider sublease from clinician friends
      • home for autoclave, microscope, centrifuge, etc.
  • Communication infrastructure:
    • hardware & software
    • paper back-up option
    • credit-card reader (iPhone or computer app)
  • Transportation:
    • Tesla (I wish)
  • Core tools:
    • stethoscope
    • sphygmomanometer
    • otoscope
    • ophthalmoscope
    • thermometer
    • reflex hammer
    • neurosensory tools
    • camera
      • disposable rulers
    • ECG
    • Holter monitor
    • spirometer
    • ultrasound
    • scale
    • head lamp
    • portable exam table, paper
    • cloth gowns
    • speculae
    • Rx pads
    • Triplicate pads
    • medication bottles/containers
    • carrying cases for all portable materiel
    • autoclave
    • microscope
    • cover slides
    • slides
    • specimen droppers
    • pill cutter
  • Medications:
    • Pain/nausea:
      • ibuprofen 800 mg, #100
      • APAP 500 mg, #100
      • APAP/hydrocodone 325/500 mg, #30
      • meperidine 25 mg/mL, #1 mL, #5
      • promethazine 25 mg/mL, #1 mL, #5
      • ondansetron 4 mg dispersible tab, #5
    • Antibiotics
      • amoxicillin 500 mg, #90
      • amoxicillin/clavulanate 875/125 mg, #90
      • azithromycin 250 mg, #18
      • TMP/SMX DS, #60
      • minocycline 50 mg, #60
      • fluconazole 150 mg, #5
    • Cardiovascular
      • ASA 81 mg, #30
      • ASA 325 mg, #30
      • NTG 0.25 mg, #10
      • clonidine 0.1 mg, #30
      • lisinopril 10 mg, #60
      • amlodipine 5 mg, #60
      • furosemide 20 mg, #30
      • HCTZ 12.5 mg, #30
    • Gastrointestinal
      • omeprazole
      • Maalox, viscous lidocaine, Donnatal
      • dicyclomine
      • loperamide
      • polyethylene glycol
      • bisacodyl
    • Allergy/anti-inflammatory
      • cetirizine
      • diphenhydramine
      • Epipen
      • steroids
        • prednisone
        • triamcinolone
        • triamcinolone
    • Psychotropics
      • alprazolam
      • diazepam
      • sertraline
      • zolpidem
      • melatonin
    • Miscellaneous
      • insulin, regular
      • glucagon
      • Mircette
      • testosterone cypionate
      • rizatriptan
      • dihydroergotamine inj
      • metoclopramide tab, inj
    • Vaccines
      • tetanus toxoid
      • pneumococcal
      • flu
      • portable cooling unit/device
      • certified refrigeration device at office with temp audit
  • Wound care
    • Kerlix rolls, pads
    • Army battle dressings
    • Hypoallergenic paper tape
    • Silk tape
    • Normal saline
    • Hydrogen peroxide
    • Betadine
    • Elastic bandages
    • Instruments
      • scalpel, blades
      • Adson forceps with/without teeth
      • hemostats, curved & straight
      • scissors, iris, standard, bandage
      • Weitlaner retractor
      • periosteal elevator
      • needle drivers, two sizes
      • ringed forceps
      • ear spoons and/or loops
      • punch biopsies
      • towel clips
    • Silvadene
    • Antibiotic ointment
    • Silver nitrate sticks
    • fenestrated and non-fenestrated drapes
    • Blue pads
    • green cloth towels
    • gloves, sterile and non-sterile
    • kidney basin
    • large basin
    • syringes, large
    • suture
      • Vicryl 3-0
      • Nylon 5-0
      • Prolene 4-0
    • needles
      • butterfly 23
      • 18 gauge, 1"
      • 27 gauge, 1.5"
      • 23 gauge, 1.5"
    • syringes
      • 1 mL with 27 gauge needle
      • 1 mL
      • 3 mL
      • 5 mL
      • 10 mL
      • 60 mL, Luerlock and standard
    • lidocaine with & without epinephrine
    • loupes
    • IVF normal saline
    • IV tubing
    • IV needles, assorted sizes
  • Specimen collection:
    • Vacutainers, assorted, with needles
    • Thin prep containers
    • Urinalysis containers
    • Urine collection bowl
    • Formalin specimen containers
    • Dry specimen containers
    • Culture swabs (aerobic, anaerobic)
    • pregnancy tests
Likely there are other things that I have not included in this otherwise reasonably thorough list.  Adding in pediatric care changes things a bit, but will likely be necessary.  My vision has a brand essence that is contemporary old fashioned:  a modern-day James Herriot might epitomize my ideal.  Thoroughness, privacy, affability, and dignity are to be the hallmarks of my trade.  A servant's heart at the bedside, a shrewd businessman at my desk.

I imagine a tiered remuneration structure with a free introductory consultative visit, hopefully at the individual's/family's home, where the terms of our relationship are clearly outlined and questions answered.  I would offer a contract for their review over the next several days.

"Good fences make good neighbors."  While Frost's eloquence argues that this is unnatural, I believe it to be excellent advice.  There are limits to my capacities.  I cannot do appendectomies on the kitchen table (ah, for the good old days!).  Some issues necessitate referral and/or medical facility admission.  With the proper connections, those transitions can be fluid and painless.  I will not write some medications at all (e.g. amphetamines like Vyvanse, Addrall, for adults; or opiates like MS Contin).  Some offerings will be outside the anticipated tiers, such as botulinum toxin for cosmesis.

So, a lot of ground to cover.  Lots of regulations to review and relationships to reforge.  In the end, will it work financially?  I'll leave that analysis to a future post.  If you've read to this point, and have a moment to spare, let me know what you think.

Always,

Dr. P

No comments:

Post a Comment