The questions to ask yourself before starting a spine practice, per Dr. Arthur Jenkins

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About seven years ago, Arthur Jenkins, III, MD, left his post at New York City-based Mount Sinai to open his own private practice.

Dr. Jenkins was part of Mount Sinai's orthopedic and neurosurgery faculty from 2001 to 2017. 

He discussed his own transition to private practice with Becker's and the questions spine surgeons should ask themselves before opening their own businesses.

Note: This conversation was lightly edited for clarity and length.

Question: You established your own practice after working with Mount Sinai. What was your tipping point that encouraged you to take the leap and establish your own practice?

Dr. Arthur Jenkins: I greatly enjoyed the time I spent at Mount Sinai, but I did feel that I was not really getting the support to take the department and the division in the direction I wanted. As one of the largest names in the hospital and in spine surgery at the time, I really felt that I had a voice, I had a lot of clinical and research experience, and there were more things I wanted to do with that. There seemed to be a general sense of, "We expect the spine surgeons to do the heavy lifting financially and we want the other subtypes of our surgery to be the research area." I didn't think that was the way I wanted to finish up my career. 

I had been thinking for a long time about when it would be appropriate for me to step outside the academic boundaries and do it on my own, or whether it was to join somebody else or join another academic group that maybe had a different vision.

In some cases, it's a more personal time that may be the straw that breaks the camel's back. For me, it was an opportunity to take a little bit more time with my family and focus on some family items. It would be hard for me to remain a full-time faculty member with the time commitment that I had to put into it at the time. So it was just the right timing for me.

Q: What advice do you have, do you have for spine surgeons considering opening their own practice? Is there anything you wish you had known in hindsight?

AJ: There is no kidding yourself with this move. You either are going to make it or you're not. There's more practices that are selling back to hospitals than going private at this time. It is definitely against the tide to go private right now. 

Having said that, if you can honestly answer these questions to the affirmative with a strong "Yes." 

Do you have the experience or the expertise to do this on your own? If not, join somebody else. If you want to leave where you are, you can join somebody else and maybe not be the boss, but you have to make sure that you have the reputation and the experience to do it all, and or to know that you're only going to do one area and you'll have the volume to keep it up. 

The volume is the second part. You have to look very honestly at where your patients are coming from, and if they're coming from other doctors within your existing network, some of whom you don't necessarily know well, they're not going to come once you leave.

Do you have the interest? Start with the interest in actually running the whole show by yourself. That means not just the financial aspects of managing, looking at spreadsheets and understanding balance sheets and what a profit and loss statement shows, and what the projections are and how important it is to follow that regularly looking at your collections. But you also have to do the administration. You are the boss, so you're also the chief administrative officer and you're also the chief HR officer. So you have to be prepared to settle everything for petty squabbles to, you know, understand when to hire or fire. 

Do I have the experience to do all of those as well? Maybe you've never run a business before. You've never run a group. You've never had people who work for you. Be honest about that, because that is harder than it looks. In many cases, it's the people who work for you that are so critical to making your practice successful or failure.

Do you have the money in the bank to start your own practice and survive for a minimum of six months or more? You're going to have a down payment on a space. You have to put money down one way or another for a security deposit or first month's rent depending on where you're going, you're also going to have to manage your own malpractice insurance independently. You're going to have a lot of expenses, and it takes a lot of money to start a practice on your own.

What is your business model? Are you going to be another me too physician and keep doing what you're doing as an in-network doctor? Are you already an out-of-network doctor or do you want to transition? Are you going to focus on one particular type of procedure? But those are really very important questions that every prospective independent spine surgeon has to ask himself. 

In hindsight, what would I tell myself seven years ago before I went into private practice? Not everyone who says they can help you are good at what they're doing or have your best interest at heart. Be very skeptical. Check out the bonafides. You want to hire slowly and fire quickly if an employee isn't not working out. Make sure you have all your ducks in order before you open your doors. Make sure if you're going to be in Medicare, that your Medicare application is completely set up before you start.

That's the advice I would have. Make sure you can have all your ducks in order. Make sure you have a mentor. Make sure you have somebody who doesn't feel threatened by you, but would want to help you. Definitely make sure that you have the stomach for it because it is a lot of work. 

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