Practice what you preach (Walk Your Talk)Krystal Plonski, Bastyr student, shares her journey as a naturopathic medical student on the path to becoming an ND.
I have been in Naturopathic medical school for 4 years now, and during those 4 full years, I have not had the opportunity to take a vacation during any break between quarters. But, this spring break, I decided to make a much-needed exception.
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Would you put a goldfish in a gallon of Gatorade and expect it to live? Krystal Plonski, Bastyr student, shares her journey as a medical student and role model for those coming after her.
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Preparing for Business without Losing Focus in School
Written by Jennifer Bahr, SCNM ND Candidate
When you are in school it seems like you have so much you have to do – many projects to complete, tests to study for, patients to follow, organizational meetings to attend, and heaven forbid some attention to your personal life. It’s much easier to say that you are going to learn to be a good doctor now and worry about the business side of things later. While I doubt anyone would disagree that the primary focus of anyone in school is becoming the best clinician you can be, I would argue that it is possible and crucial to keep business in the forefront of your mind. Naturopathic medicine is about not separating focus on things when they are inherently related. We don’t give painkillers for headaches and carminatives for gut discomfort – we treat the food allergy that causes both. Being a good doctor will be your business. Remembering that the two are intrinsically related while you are still learning both will help make your life easier once you have a bustling practice.
Keeping business in mind while in school doesn’t have to be daunting. There are some simple things you can do to save yourself time in the long run and help you get into the practice of being both a business owner and a physician.
1. Practice time management skills. In my humble opinion, this is the most important thing you can do to help you stay in a business frame of mind. Too often as students we get into time consuming habits with our new skills that will be hard to break when our time actually converts to money. Try determining what time you want to allot to your new patient and follow up visits when in practice. Double that and use it as your starting point in the clinic, gradually working toward your goal by the time you graduate. Similar efforts in studying patient cases and for exams can be helpful, although not as easy to set up specific parameters for.
2. Keep a budget. Start with a simple personal budget using Excel, tools through your bank, or a Smartphone app. Be realistic or overestimate your costs. Having a good handle on your personal finances will make it easier to learn how to manage your business finances. Look into the future with your budget as well. How much will you need to take the NPLEX? How much for licensing? Association fees? What do you plan to do for funds in the time between graduation and getting your license? Having a budget will help you prepare for all of these things, mentally and fiscally, and will help alleviate the stress that comes with having to scramble to make it all work.
3. Network. Even in medicine, business can be about who you know. Networking early will allow you to refine your skills if you aren’t very comfortable with it. It can also help you build your referral network, find business opportunities, and give you a chance to explore what has and hasn’t worked for others. Take advantage of student rates for conferences in areas you are interested in. Go to the free conferences you aren’t interested in. Go with a goal of talking with a certain number of people. If you are less certain about it, consider joining a school group such as NMSA, N-ACT, philosophy clubs, service clubs, etc. These groups can give you a reason to work with others and help increase your confidence in networking.
4. Make use of your classes and assignments to create personal protocols and handouts. I am not a fan of wasted time or duplicated effort. A task done well once opens up so much more time for the more pleasant things in life. Keeping business in mind when doing these assignments can make it easier to put genuine effort into it, even when you really just want to get through it.
5. Approach things you are required to do with a business mind, specifically class and preceptorships. As I mentioned above, use your time as a student to figure out what has worked for others and what hasn’t. Save yourself some time! In class, keep notes on protocols that will be particularly helpful for your intended practice format or business model. Keep them in a separate file that you can easily access.
6. Keep abreast of health trends in the area you intend to practice in. When you visit home (or the area you intend to settle in) pay attention to the concerns of those who live there. Think about the specific location you would most like to have your business and walk around. How many others in the area are doing what you want to do? How many could be good allies or a referral base? These questions can help you to build your protocol file and give you direction in your networking or preceptorship goals.
7. Write a 5-year and 10-year plan. Keep on track by seeing where you want to go and then establishing steps back from there to determine how realistic your goals are. Include a vision in your plan. Knowing what you are working for and why makes it easier to stay focused and on task, both with the business and education side of things.
This is by no means an exhaustive list and not all of these things double as both school and business. The things that you have to set aside time for outside of things you would already do are the budget and the 5- and 10-year plan. Both of these will probably require a one-time commitment of an hour maximum. These should then be revisited from time to time for 5 to 10 minutes of tweaking as necessary. Everything else can be done in the process of doing things you are already engaged in anyway.
Business can be daunting, especially for those of us who just want to help people. But business is important. Start nourishing your business mind as a student with small steps such as I suggested above. Take additional classes if you are so inclined. I believe wholeheartedly that with a healthy business you can better care for your patients. With healthier businesses, collectively we can better care for our profession and ourselves.
Thank you to Emerson Ecologics.
Facing New Grad Challenges Head On
Written by Megan Schlick, ND, Bastyr Grad 2011
When I decided I was going back to my home state to start my career without doing a residency, I knew it was going to be challenging. Without advertised openings for “naturopathic physicians,” overwhelmed was an understatement. Although I was confident in my education and training, I wanted to be in a situation where I could continue to learn from colleagues while building a client base. I realized that practicing in a state that was unaware of naturopathic medicine, gaining respect from traditional practitioners was key. Those circumstances led me to pursue hospitals. I was approaching unchartered waters, but I thought my efforts were worth the challenge.
I initially drafted a letter that I sent to several area clinics with multiple practitioners. In brief, I explained my education, my passion for collaborating with conventional practitioners and my interest in offering naturopathic medicine to my new community. After several unsuccessful pursuits, I received a call from a well-respected local hospital and within a few weeks I was meeting with the chief operations officer, medical director and my future clinic manager. I had 2 weeks to prepare for my initial interview and spent that entire time drafting my vision for a hospital employed integrative practitioner. I tried to answer questions I knew they would have. “How would I fit into a conventional framework?” “How was I to gain respect from the physicians?” “What was my expected salary?” I created handouts to provide at the meeting, as I knew I was fortunate to be given this interview platform and therefore made sure I did everything I could to impress. I was professional, yet had a sense of humor about our profession-which I found to be helpful. As naturopathic doctors, we are the experts in holistic, natural medicine and by the end of my first interview, they agreed. By the end of October 2011, I was seeing patients in an outpatient branch of the hospital.
Benefits of working in a large hospital facility:
1. Daily learning opportunities: access to specialists, continuing education opportunities, medical library, frequent speaking opportunities.
2. Able to help patients you normally might not see in private practice, good variety.
3. Work under a community known organization, instant branding and leadership opportunities.
4. Opportunities to network with conventional minded practitioners and with that, able to dispel any common misconceptions of “alternative medicine” providers (my favorite!).
5. Job satisfaction: truly making a difference on a larger scale without much worry on the business side of medicine.
Words of advice to upcoming graduates:
1. Don’t get discouraged or take it personal, plan on getting numerous unreturned phone calls and “nos.”
2. Be willing to feel uncomfortable. Cold calling is never easy but the more you do it, the better you become.
3. Set a time frame and have a back-up plan. I gave myself 2 months to figure out my path and I didn’t allow myself time to worry about my upcoming student loan debt. I was also realistic, I knew it might not work out and I had a plan of action if it didn’t.
4. Practice confidently communicating what you offer as a naturopathic doctor. Most of my patients are coming to see me because they heard a lecture I gave, were referred by other physicians, or were recommended by another patient. All of these avenues came down to me effectively communicating my services. Don’t assume naturopathic medicine is as easy as a 15 second elevator speech.
Good luck to all the upcoming graduates! I have been in your shoes, and understand the stress you are all experiencing. We are a small profession, but opportunities are out there, you just have to be willing to propose them.
Thank you to Emerson Ecologics
Getting a Successful Start in Practice
The Six Tenants of a Naturopathic Startup
Written by Jaclyn Chasse, ND
It’s such an exciting adventure, starting a practice. You’ve done the hard work to get through school, pass the boards, decide where you want to live, and now it’s going to be easy, right? For a lucky few, yes. But for most of us, a new practice comes with a lot of learning opportunities.
Let’s discuss the 6 philosophical tenants of successful practice startup, naturopathic style!
The healing power of a business plan
It might not seem natural at all to you, but a realistic and thoughtful business plan is crucial for startup success. There are many resources (books, websites, templates from small business associations, etc.) available to guide you through this process, but most of us don’t take advantage of these. Rather than feel overwhelmed about writing a perfect business plan (which you’ll need if you intend to get a loan from a bank), think of this business plan as a tool to brainstorm all aspects you’ll need to consider for your business (dispensary management, marketing, startup cost, 1-year, 3-year, and 5-year goals, etc). You don’t know what you don’t know, but now’s the time to learn!
Identify and treat your potential patients
One key to success, in my opinion, is knowing yourself and what kind of practice you want to create. If you are practicing in an area with a lot of NDs, you may be tempted to try to fit a certain niche that you think will be most successful. While this is an important consideration, identifying your potential patients involves knowing both who is out there that may want your services as well as knowing who YOU are and who you want to work with. This is an important step not only for a financially successful practice, but also for one that is emotionally successful for you.
First do no harm
One big mistake I see is doctors taking on too much too soon, be it space, overhead carrying cost, or one-time costs associated with fitting up an office space, etc. Take it slow–find an existing office that will rent you a room, or a small space if you want to be on your own. You can always grow into the office of your dreams. Don’t make the mistake of getting in over your head!
Doctors as teachers– partnership or not?
We learn a lot from one another, and that is definitely the case if you are in partnership with another doctor. Having a business partner may seem like a great idea, but remember, it’s like a marriage. I’ve seen a lot of practice relationships (and unfortunately, friendships) change due to a challenging business relationship. If you are planning to work with someone, which can be a fantastic setup, make sure you’re very clear from the beginning what the expectations are around working together. If you’re not on the same page to start, keep talking until you figure it out!
Treat the whole practice
We usually focus on what we’re good at. For you that may be patient care (hopefully!), business financial planning (if you’re good at this, please call me- I’d love to have you join MY practice!), marketing, web development, etc. But being a small business owner means that you have to wear all of those hats. If this is not something you’re good at, look for a practice situation where you won’t be responsible for that aspect of practice. If you are in business for yourself, don’t neglect your blind or sore spots. They WILL get bigger if left untouched. And a successful practice requires work in all areas (whether you are the responsible party or not). For example, you could be the smartest clinician in the country and if you don’t have a marketing plan no one may walk in your door and you’ll be in trouble!
Just as it is with patient care, prevention is the best cure. This loops me back to the importance of a plan. Thinking your practice through on paper can prevent a lot of stress once you’re up and running. Use your resources, whether it’s a family member with business expertise, a preceptor, or a book or website! And understand that just like any healing process, there will likely be obstacles to cure and maybe even a healing crisis. But be persistent, make healthy business choices each day, and soon you will see your practice transform just like your patients’ health!
Thank you to Emerson Ecologics
Private Practice vs. Working in a Clinic
Decide What Is Most Important to You
Written by Jenee Kautzer, ND
Throughout school I wanted to practice independently after graduation. My goal was to find an established clinic that I could join as an independent contractor. I thought I would be renting office space, access to electronic medical record keeping, and office staff.
After all my options fell through, I was contemplating whether I should start my own practice or find a job somewhere. I soon realized that I had no desire to spend most of my time and energy for months on business related work rather than patient care. I realized it was more important to me to gain experience in patient care, continue learning about medicine and to become a good primary care doctor. Not long after focusing on my intention I found a great job.
I am now working for an Indian Clinic in an integrative setting. I see five to nine patients per day and manage an in-office dispensary. Owning my own business would definitely have benefits but there are also some nice perks when working for a clinic. I get paid hourly so if a patient cancels or doesn't show it gives me time to inventory supplements, read research, and update patient handouts. There is always a NP, MD or PA around if I have questions, the patient needs urgent care, or if I want to adjust a patient's medication.
The best part of working in a clinic–
I don't have to spend anytime marketing. Most the patients I see are referrals from other practitioner's in the office. Many of the patients I work with could not afford to see me in private practice, even with a sliding scale. So I get to work with populations that would be difficult to serve in private practice. I get to do a lot of diabetes care, cardiovascular care, weight loss management and primary care. Other perks include retirement benefits, health insurance, free CE courses, paid vacation and holidays, malpractice coverage through the clinic, and qualification for IHS loan repayment. While I still want to start my own practice, my current job is allowing me to work on the goals that are most important at this point in time.
Building a Medicinary with JIT Inventory
Written by Jamie Oskin, ND
Operating an efficient medicinary inventory can be stressful and a huge drain on a business. New business owners often make gross errors in stocking their medicinaries costing thousands of dollars in products that unnecessarily sit on the shelves, don’t move, and tie up cash flow. Many NDs think that their medicinaries are a big source of revenue only to take a look at the books and realize that they are a significant drain on cash flow due to ordering inefficiencies. Using Just In Time (JIT) inventory can help you keep cash flow available to fuel other areas of your practice growth.
Just in time (JIT) inventory is a production strategy that was made popular by Toyota. It is a strategy that strives to improve a business’s Return on Investment (ROI) by reducing the wasted inventory sitting on shelves and the associated carrying costs with shipping. It’s really simple: inventory is waste. Ryan Grabosky said it best that JIT is having “the right material, at the right time, at the right place, and in the exact amount.”
Here are some basic tips to run an efficient and cost effective medicinary with Just In Time Inventory:
1) Start Small and Focused.
If you are a new grad starting a private practice, then start your medicinary inventory small and focused. Pick one or two conditions that you are passionate about treating. Only stock the main products needed to treat the one or two conditions. For me, I started my medicinary very lean and it remains lean to this day. I see a fair amount of pre-diabetic and diabetic patients in my practice. My first medicinary order included a small order of multiple vitamins, fish oils, and a blood sugar support product – that’s it!
Purchasing products for the condition or two that you plan to treat will prevent your business’s cash flow from being tied up in products that just sit on a shelf. It is possible that you may not have the chance to sell these products before they expire. I’ve seen colleagues literally throw away upwards of $5000 of expired products because they couldn’t accurately predict the types of products they would need to service their patient’s needs.
2) Utilize Online Virtual Medicinary Models.
Companies offer online virtual medicinaries that patients can order directly from if given a unique password. You may make a smaller percentage of the profit, but you will save a lot of money. You will not need to lay out cash to stock your shelves and pay for shipping. Since the bulk of most NDs’ practices are treating chronic diseases, many of the necessary products for each unique condition can be ordered by the patients and drop shipped directly to them.
Don’t waste time buying every product under the sun for every possible patient that may walk through your door. Save your cash and let patients order directly from the distributor and drop ship to their homes. If you start to see a higher volume of patients needing the same supplements for a particular condition, then perhaps you can justify keeping related products on the shelf. You have to know the inventory will move if you are going to stock it.
3) Only order enough to keep on the shelf to have just in time before the next order without running out and without ordering too many.
I make about one order per month of diabetic related products. Since my distributor can ship products to my office within two days, I wait to make an order until there is only one or two bottles left on the shelf. That way, the next order will arrive before I’m completely out, but not too early so that tons of product wastefully sits on the shelf waiting to expire.
We do a lot of homeopathy in our group practice. Because we order so many homeopathic remedies, we are constantly checking our inventory need to make sure the shelves are stocked, but not over stocked. Our staff makes a weekly order to prevent overstocking. This way, we should be able to have four Sulphur 30C’s on the shelf at any one time and not need to worry about ordering 8 at a time. Four Sulphur 30C’s is enough that we won’t use more than that in a week’s time before the next order goes out and it also won’t tie up shelf space by needing an area big enough to stock 8 of that potency. If you order frequently and in large enough volume, often companies are happy to negotiate deals on the shipping.
4) Use basic spreadsheets in Excel or GoogleDocs to keep track of inventory and orders.
As your practice grows you will need to grow the medicinary. Keep track in an organized and methodical way. Your medicinary can naturally grow to keep pace with the growth of your niche. As you add more and more patients, you can slowly add more volume to each product order as well as slowly add peripheral products that are more commonly used for that niche group. If you follow this slow and steady model of growth it will protect your company’s cash flow and allow the medicinary to naturally expand to meet the needs of your practice.
In summary, you should focus on a niche area to build a small medicinary with specific products that you will see a high volume of patients. As I mentioned earlier, I see more diabetics in my practice so I started my medicinary with only the basics I would use frequently for treating patients suffering from diabetes. To this day that is the core of my medicinary and the inventory turns fairly quickly (within about a month). My supplement order arrives within two days of my order so I never have to order until I have only one left on my shelf. As time has passed and my cash flow has increased, I’ve slowly added a couple of other supporting products to the mix of core products. I have only added enough so not to tie up valuable cash flow that is needed to fuel other areas of my practice’s growth.
Birthing a Business
My LLC was born under the sign of Cancer in 2008. My accountant acted as the birthing assistant by organizing the paperwork, keeping me in check with what to sign, when to breathe, and what form to mail next. The federal government stepped in for the delivery of good news that my request to become an LLC as well as an S Corporation was granted. Thus began my new life as Business Owner - President and CEO of Emily Telfair, ND, LLC.
How did I arrive here? Everything seemed a bit easier when I was first starting out as a “sole proprietor” and working for several years as an independent contractor at a local wellness center. At that time I had one banking account, one major credit card and meticulously kept track of my miles and receipts to write off what ever I could on my taxes. And despite many new ND graduates complaining that they do not receive enough tools or guidance about how to start a business, I remember using several resources from Dr. Kasra Pournadeali’s Practice Management II class during those first couple of years to get myself organized. What I wasn’t quite prepared for was how much money the government wanted from me in comparison to how little I actually made as income at the time. FICA - or self-empolyment tax - was a rude awakening for a burgeoning young doctor just trying to pay rent and dreading the end of her loan deferment period.
One day, after much hard work in building up my practice, my accountant announced to me that I had reached a tipping point in regard to my FICA and income tax where the next logical step meant becoming an LLC. The thought of adding “LLC” after my name felt so official and established - like I was joining the club of starry-eyed Main Street business owners with big dreams and small payrolls. The reality of now being an LLC is that not too much has changed on my end - aside from keeping separate bank accounts and credit cards for personal and business use and paying my accountant more for my annual tax preparations.
My first piece of advice when trying to decide when and how to set up your business is to consult with both a good accountant and if necessary, a good lawyer. Ask colleagues or other local business owners in the area for referrals. There are a number of costs involved in setting up an LLC, but the advantage of being able to protect personal assets and keep them separate from any losses or damages that the business may encounter could be well worth the investment. If you are a new ND graduate without any assets to protect, there may not be a need to establish an LLC right away.
I have learned to accept FICA taxes as the trade off for not having to answer to a boss and being able to take a vacation or long lunch whenever I choose. Becoming an S Corporation in addition to being an LLC offers the opportunity to pay lower FICA taxes by reporting a moderate to low owner’s salary while still being able to access additional profits from the business as needed.
The Small Business Administration has an extremely helpful website
which outlines the various types of business models - from corporations and partnerships to LLCs and cooperatives - along with advantages and disadvantages of each. Consulting this site may be a helpful first step in determining which business model fits best with a new physician's practice. The IRS also has a site
which clearly explains the tax obligations for self-employed individuals with a link to the “Business Structures
” page that outlines the tax forms applicable to each business model.
Last week I received a call from a solicitor in search of my Human Resources Department. I had to laugh at the realization that I am the Human Resources Department, as well as the head of Billing, Dispensary Management, Scheduling, etc. This is the day-to-day life of a corporation with population: 1. We already wear many hats as naturopathic doctors. When it comes to the business aspect of our practices, out-sourcing to good accountants and lawyers can be well worth the investment.
Here’s wishing all new graduates about to birth their new businesses into the world a safe and prosperous delivery.