Starting Our Practice - 12 years later

One of the most frequent questions I get is how I started our private practice. It's not all that common nowadays to hang your shingle and own your private practice right off the bat. Most physicians, optometrists,

dentists, podiatrists will either choose to become salaried employees for a larger academic center, HMO or group practice. Some might even buy in to an existing practice. But, the thought of being your own boss, managing all aspects of running a private practice by yourself, fresh out of training, can be quite daunting.

It was for my husband and I. We were nervous and scared. We had absolutely no intention of ever working together nor of owning our private practice. Especially not in our early 30s.

We had absolutely no clue how to manage staff, apply for a business loan from the bank, do payroll or state and federal employment taxes, analyze key performance indicators for the practice nor how to build a patient base. These are all things that are never taught in medical school, residency or fellowship. Not even one small lecture or course. Nada. Zilch.

So, it stands to reason that hardly any of us would ever choose to enter this realm with so little knowledge. When my husband and I moved to Hawaii 12 years ago, we had no other choice. We called every ophthalmologist in town, no one was looking to hire another. We called the two largest managed care organizations on the island - they weren't looking either. We quite literally had no other option.

My husband saw the ad for Honolulu Eye Clinic in the back of one of our Academy journals. The owner wanted to retire and outright sell the practice. We met Dr. Edwards in May 2007, when we were on island to plan our wedding! We took one look at the practice and thought it was too fancy and too expensive for us. We never called Dr. Edwards back.

And, then we exhausted every avenue available to us - every practice, large and small and we came to realize that there was no other choice. We could have started on our own. But, we really wanted to be in the outpatient medical office building associated with Queen's Medical Center, the largest hospital in the state. We felt confident that if we were in that building (also where my sister-in-law had her endocrinology practice), we could secure referrals and build our practice.

But guess what? The building had a 4 year wait list for ophthalmologist. They chose tenants based on their specialty and they already had too many ophthalmologists in the three buildings. So, the only way for us to circumvent the waitlist was to purchase Dr. Edwards' practice and take over his lease.

It was one of the most terrifying decisions of our life. I had no one to guide us regarding negotiating the purchase price. We had hired an accountant to value the practice. But again, this was new to us. Words like "Goodwill" were thrown around and we had no idea what they meant. Dr. Edwards' employed a very large law firm and we felt outnumbered at the conference table negotiating the price. This all happened exactly 5 days before our wedding. It's the most stressed I've ever been in my life.

We sunk every last penny into the down payment and it was still not even close. We borrowed money from a local bank and Dr. Edwards' agreed to finance part of the purchase price at 7% interest (great ROI for him). But, we were desperate so we agreed.

But central to it all, was the belief that we would succeed. That we could work hard, deliver excellent patient care and we could take this practice that only had enough patients for 1 ophthalmologist and increase it to be enough for both myself and my husband.

We finally paid off the loan for our practice 2 years ago.

It was momentous. It felt amazing. The culmination that our belief in ourselves was not misplaced. We grew from a small staff of under 10 to the clinic we have today.

Along the way, we've received some accolades and awards.

We've doubled the number of patients we help. We've introduced new surgical techniques into the practice. But, I'm still grateful that circumstances conspired in the way that they did to force us to make this choice. If we hadn't taken over and built up Honolulu Eye Clinic, I could never have had a nursery in my office, learn that I enjoy entrepreneurship, or be able to integrate work and life so harmoniously.

How did I do it? I read. I asked everyone and anyone. My accountant told me I need to complete a general excise tax form and I didn't know how? I picked his brain, wrote it all down and did it myself the next time. Same went for every single thing. It is possible. You are capable.

So, take that chance on yourself. I know it's scary. But you're smart. You are capable of learning all that you need to succeed. Trust in that and the rest will fall into place.