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
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
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