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Time-line for Starting a Practice

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Time-line for Starting a Practice
by Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM
One of the common mistakes students of acupuncture and Chinese medicine often make which keeps
them financially hobbled is not taking enough time to lay solid groundwork when starting a private
practice. Many of us graduate and sort of “fall” into practice without much in the way of planning and
thought. We do what seems “natural” or what everyone else is doing without thinking about fundamental
assumptions or questioning “conventional wisdom.” However, the more carefully you do your research
and the more you plan, the greater the likelihood is that you will be successful. So here is a suggested
time-line for planning and starting a practice. It based on a time-line created by the American Medical
Association and comes from their Starting a Medical Practice: The Physician’s Handbook for Successful
Practice Start-up (Coker Publishing Co., ISBN 0-89970-786-6). This book is a great resource for any
health care professional thinking about establishing their own private practice. I have modified the AMA
version of this time-line to make it more appropriate for acupuncturists and professional practitioners of
Chinese medicine. As you’ll see, this time-line starts one year before opening the practice and seeing your
first patient. That means that students who intend to go into private practice should begin actively
planning when they start their last year of school.
Not every part of this plan will be applicable to you, but even so, it is wise to take a careful look at this
list, possibly highlighting the parts that make sense for your personal practice goals. This will give you a
huge leg up on most other acupuncturists just starting out after graduation.
One year before starting practice
1. Make a decision on practice location in terms of state and community in which you hope to practice.
2. Begin examining your net worth in terms of capital available for start-up costs.
3. If possible, reserve office phone number or answering service number.
4. Find out the date when telephone books are printed and have your name listed in both the white and
yellow pages.
5. Visit banks and begin shopping for a loan. Pick up loan applications and meet loan officers. Determine
what information the bank needs to evaluate your loan application.
6. Open:
Checking account, personal
Checking account, business
Savings account, personal
Savings account, business
7. Write a business plan or at least draw up income/expenditure projection for the first year of practice.
Talk with several bankers about borrowing money, and submit applications.
Nine months before starting practice
1. Check sites for buying or leasing medical office space.
2. Check zoning ordinances with your local city hall and/or zoning board regarding signage and type of
businesses allowed in the area and ask about any expected changes.
3. Check on utility requirements for the office.
4. If leasing, see if any leasehold improvements are needed and when you can start making these
5. Determine office layout and design.
6. Determine office and medical equipment needed.
7. Choose advisors:
Insurance broker(s)
Management consultant
Real estate broker
Other (such as computer consultant)
8. Evaluate office lease and/or any partnership agreement contracts with your attorney before you sign
9. Obtain bids for any major office equipment or furniture you will need. Compare leasing versus
purchasing. Be sure to get a written guarantee of delivery date and in-transit insurance.
Intercom system
Exam room/medical equipment
Photocopy machine
Telephone equipment
Reception room/office furniture and decorations
10. Check with the local state agency who issues licenses to acupuncturists and make sure you can have
your license by the time you plan on opening your practice.
Six months before starting practice
1. Obtain the services of an answering service
Beeper service
Call forwarding
2. Select an Individual Retirement Account (IRA)
3. Obtain current ICD and CPT codes.
4. Order a medical record system.
5. Order sign for office.
6. Obtain insurance forms.
7. Notify acupuncture needle vendors, Chinese herbal suppliers, and other appropriate sales persons that
you are setting up practice.
8. Obtain county and city occupational licenses from county/city clerk’s office or city hall.
Three months before starting practice
1. Arrange for professional malpractice insurance.
2. Arrange for office insurance:
Business liability
Worker’s Compensation
Health. Major medical for yourself, dependents, and employees
Key person or disability for you
Life insurance for you
3. Arrange for telephone service installation. Consider purchasing telephone equipment.
4. Arrange for acceptance of credit cards in your office through your local bank.
5. Talk with your local newspaper about practice announcement ads.
6. Order office opening announcements.
7. Arrange to give talks to community groups on acupuncture and Oriental medicine.
8. Meet physicians who are potential referral sources. Send letters; arrange appointments.
9. Check on membership in local civic, social, fraternal, volunteer, and/or church organizations.
10. Arrange for movers if necessary.
11. Write your State Department of Labor for state employment regulations and wage and hour
12. Write preliminary job descriptions for employees.
13. Write policy manual for office employees.
14. Check local resources for personnel.
15. Start interviewing for office personnel.
16. Apply for your Federal Employer Identification Number through your local Internal Revenue Service
(IRS) office.
17. Apply for your State Employer Identification Number through your state Employment
Office/Department of Labor.
18. Obtain “Small Business Tax Guide” and your Federal Estimated Income Tax Form through your local
IRS office and/or attend a small business tax seminar at your local IRS office.
19. Write for your State Estimated Income Tax Form through your state Employment Office/Department
of Labor.
20. Obtain payroll withholding booklets (federal, state, city) through your local IRS office.
21. Review tax requirements with your accountant.
22. Purchase or order appointment scheduling book.
23. Arrange for as needed:
Janitorial service
Snow removal service
Laundry service
Grounds maintenance
Sharps and medical waste disposal
24. Order clinical supplies and set up inventory control system.
25. Purchase or order business supplies:
Appointment cards
Business cards
Patient recall system
Petty cash vouchers
Letterhead stationary and envelopes
Stationary supplies
Deposit stamp for checks
Prescription pads
Purchase order forms
Preprinted telephone message pads
Preprinted super bills
26. Determine office hours based on community need.
27. Determine fee schedule.
28. Select and order magazines:
For reception room
Medical journals for yourself
29. Purchase office equipment and furniture. Arrange delivery date.
30. Write patient information brochure or booklet and have it printed.
One month before starting practice
1. Start setting up office.
2. Have utilities turned on:
3. Start accepting appointments.
4. Hire and train office personnel:
Telephone techniques
Office policies
5. Decide on collection/insurance policy.
6. Hang out shingle.
7. Establish a petty cash fund.
8. Establish a change fund.
9. Place announcements in community papers:
Paid advertisements
News releases
10. Mail out announcements to physicians, chiropractors, health food stores, hospitals, health groups, etc.
11. Plan office “open house.”
Opening day
1. See first patient
2. Congratulate yourself. You are now in practice!
Copyright © Blue Poppy Press, 2004. All rights reserved.
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