Establishing a therapist practice - A checklist and what you need to consider

Having your own medical practice is a lucrative and at the same time an attractive professional goal for many physicians as well as therapists in a wide variety of specialties. Approximately 22,000 licensed medical professionals at more than 14,000 Swiss health care facilities¹ confirm that many physicians and therapists are ready to take this step. A higher degree of self-determination, self-realization and independence make self-employment so tempting for physicians.  

This step is obviously not a simple one, because medical training is not the only requirement. It also involves entrepreneurial thinking and additional responsibilities that need to be thoroughly considered in advance. In the following, we would like to outline the aspects to be considered and the steps to be taken when starting a medical practice.

The decision to become independent

You have certainly already given some thought to whether this step is right for you. The decision to become independent and start your own medical practice involves many aspects that you can discuss with others. Benefit from experiences in your private as well as professional environment and talk to colleagues who have their own practice as well as those who do not. You will gradually gain a complete picture of your own business, because in addition to medical skills, self-employment also involves dealing with issues like:

• Personnel management
• Marketing and communication
• Quality management
• Business financial management
• Infrastructure of your practice

These aspects take up a significant part of your time, which is not devoted to medical care and thus to your primary task. Once you have decided to start your own practice, you should begin a well-structured and systematic planning process.

Step by step to starting a medical practice

Let's say you want to open a practice as a psychotherapist or a physiotherapist. First of all, you need to ask yourself how you want to set up the practice. Generally, there are numerous options to consider which can differ greatly both in terms of finances and initial investment.  

1. Start-up or takeover?

Taking over an existing practice as a successor or starting up a new one makes a significant difference. With a new start-up, a considerable initial investment is to be expected, as well as an increased risk that arises from the choice of location, personnel search, and range of services. This is in contrast to taking over an existing, established practice with a specific range of services, experienced staff, excellent infrastructure and a patient base.

Both takeover and start-up have their advantages, which is why the decision is essentially based on personal preferences for risk tolerance, desired creative freedom, financial possibilities, as well as available takeover offer in your region. In addition to this, another issue is the form in which you would like to manage your practice.

     2. Group practice or individual practice? 

Although the financial aspect seems much more attractive in a group or joint practice², this is not the only criterion. Personal preferences are also crucial here, because professional, financial and personal benefits can be much greater in group practices. An individual practice, on the other hand, offers greater freedom and less potential for conflict when making practice-related decisions. Opening hours, however, can be arranged more flexibly in a group practice which tend to be more attractive for patients now that they are extended. Have you decided on the form of your future practice, and are you planning to implement it?

      3. Specify the realization

This phase can take about 6-18 months. This period depends on your current life situation. Are you planning the opening alongside your full-time job or do other factors influence a quick realization? To carefully study all aspects and handle them step by step, time is the most important asset and preparation is more than half the battle. You will have to deal with the following tasks:

• Practice location: This includes factors such as location, accessibility, competitors and proximity to other medical infrastructure such as pharmacies, laboratories, hospitals and so on.
   
  
• Workspace: Plan which rooms you need apart from the treatment room and reception and how you want to design them. Are structural changes planned and permitted? Also consider the quality of Internet access, location of bathrooms, sufficient storage space and barrier-free access. Rental agreements and terms should also be designed for a long-term tenancy.
  
  
• Equipment: Make plans for medical equipment, necessary furniture, IT infrastructure such as PCs and telephone systems, as well as generally required supplies for daily needs. In each case financially as well as spatially. 
  
  
• Permits and authorizations: Prepare all paperwork for various authorizations. These include the practice authorization from cantonal health department, central office registration number (to be applied for at Santésuisse) and the registration for self-employment.
  
  
• Financing: Investment planning and business resource planning provide an overview of the capital resources required to start up your practice. Talk to any financing providers in advance and obtain a financing commitment at an early stage.
  
  
• Insurances: For the best possible protection for yourself, your practice, and also your staff, insurance is mandatory in some cases and optional in others. Keep in mind: Retirement insurance, health insurance, household insurance but also disability insurance. If you have employees, you also need AHV,  BVG, KTG,  UVG and professional liability insurance.
  
  
• Personnel: Ranging from job offers, personnel management and communication to salaries and ongoing training, a basic level of knowledge should be developed here.
  
  
• Everyday work: Plan the work-flow and opening hours and bring them into line with each other. Patient services, administrative issues, substitution rules, patient records, reception work-flow must not be neglected. 
  
  
• Marketing and communication: How do you present yourself to the public? Where do you announce the opening of your practice and on which channels do you want to be present offline, as well as online? How do you want to communicate with your partners and most importantly with your patients? It is important to consider digital channels that increase your efficiency, from evaluations and communication to booking appointments.

Your practice is open - the rest is optimization

Once the planning and implementation phase is complete, you have already reached some major milestones.. In your daily work you now need to focus on acquiring patients through the right channels and on increasing patient loyalty. This requires ongoing adaptation. Talking to your patients and asking for their feedback can promote this initial optimization. Establishing automation and digitalization in medical practices is a key to their success.  

Digital solutions help increase efficiency for you and your staff, and also enhance the patient experience. Therefore, it is a key factor both from a financial perspective and for establishing you as a successful practice. Having your own practice means that you will not only make daily decisions based on your medical knowledge, but will always include a business point of view as well. A life full of challenges, responsibility, but also a lot of potential for self-realization begins.  

Cover image by Jason Goodman. Further images by Kelly Sikkema and Marina Raspopova.