Episode 55: Finding Success In Solo Pain Practice Straight Out Of Fellowship w. Dr. Shachi Patel

Jul 13, 2020

This Episode

Interview W/ Dr. Shachi Patel

You Will Learn

– Dr. Patel will discuss the joys of working in her fellowship. How her clients reacted to her, and what it was like to become a parent during this time.
– She tells me about the wild feeling of getting a bank loan. She talks about how it can be confusing at the outset, but with the right team it is absolutely doable.
– Dr. Patel talks about her experience finding the real estate for her practice. She gives tips on finding the right realtor.
– Dr. Patel discusses her relationship with her patients, and tips on how to build a robust referral network to get new patients in the door.

Resources & Links

Essentials of Physician Practice Management – https://www.amazon.com/Essentials-Physician-Practice-Management-Blair/dp/0787971898

Dr. Patel’s Practice: https://www.delmarvapain.com

Tina Rivenbark, Practice Consultant: http://advancedpracticesolutionsllc.com/

This week, I sit down with my friend, Dr. Shachi Patel to discuss how she started her own practice. Dr. Patel walks me through everything from getting a bank loan, finding real estate, gathering the right team, and creating a business plan. She also discusses the hardships of starting her own practice, the joys that make this her passion, and what keeps her going.

Justin (00:24):
This week is the first in a two part series dedicated to stories of pain, practice ownership. One is a solo practice. And one as a partnership this week, I’m talking to dr. Shachi Patel, who is the founder of the Delmarva pain and spine center. After reflecting on why discussion with dr. Patel. I really think that this episode may be one of the most important conversations that I’ve had to provide a real actionable insights for solo pain practice in the interventional pain community. I believe so strongly. This is no surprise. That position autonomy is something we need to protect and cultivate and equipping doctors to run their own practices is really important for the future of healthcare and patient care and or society in general, not to mention physician wellbeing, which obviously is near and dear to my heart as well. Dr. Patel in today’s episode gives us a play by play breakdown of how she started her own practice from scratch straight out of fellowship. And it’s my sincere hope that there are others out there listening right now who perhaps have this same dream of practice ownership and who just need a little bit of guidance and a little bit of context and are maybe going to dive in and take this journey themselves. So I hope that this episode is an encouragement and a resource I’m also excited for next week. When I talked to dr. George Hanna about his experience in merging with a few partners to start an interventional pain practice in Manhattan and everything that went into that. So these next couple of episodes I think are really special as always thanks for tuning in

Justin (01:51):
Hello and welcome to episode 55 of the anesthesia success podcast. I’m very pleased to be joined today by dr. Shachi Patel. Dr. Patel is an anesthesia trained interventional pain physician. She’s a practice owner and entrepreneur. She collaborates in industry. She does a lot of things really well, and she started doing it very early, straight out of fellowship. So I’m really excited to be joined by her today to have her tell her story. And for any fellows out there who are wondering, is it possible for me to conclude fellowship and then go straight into solo practice? Here’s a shining example of somebody who has done it, and we can hear from her today about how all that unfold. So dr. Patel, thank you for being here,

Dr. Shachi Patel (02:30):
Justin. Thank you for having me. I’m excited to be here with you today.

Justin (02:34):
So I’m curious as you were proceeding through your medical education and residency, and then eventually thinking about a pain fellowship, you probably had certain ideas about the way you assumed your career would unfold, the different opportunities out there that you thought, you know, I like this model or that model. At what point did solo pain practice sort of come onto your radar? Well,

Dr. Shachi Patel (02:58):
Yeah, it was, it was, it was an evolving journey. I will say that when I was finishing medical school and starting residency, I really thought I was going to stick around in academics. And then, you know, residency’s tough lots of call, especially anesthesia residency, lots of call, lots of long hours. And you start sacrificing the things you care most about, which is your family and your time with your friends and your weekends. And there was a shift through residency where I realized I didn’t want to live that life for the rest of my life cause I had other priorities that I valued just as much. And so I started to think about my career itself in anesthesia and in medicine and what did I, what I wanted out of it. And, and ultimately somewhere in the middle of residency, I was driven to realize I really enjoyed pain management. I liked that it was outpatient. I liked that it allowed me to do private practice and have a more balanced lifestyle. And, and so somewhere in residency that academic to private practice shift happened and then in fellowship is when I approaching fellowship. And then in the beginning of fellowship is when I really was more confident that I I’d be able to do this right out of fellowship and do my own civil, private practice.

Justin (04:20):
It’s funny you talk about you know, priorities and autonomy, the joke. So I’m a business owner with my financial planning practice. And the joke in our little corner of the world is entrepreneurs are people who work 80 hours a week for themselves, cause they don’t want to work 40 hours a week for someone else. And there’s obviously still a compromise in being with your family and your friends and having your weekends. And I’m sure that over the last few years, although you eventually do get to a place of, you know, stability, there’s a heavy lift on the front end and none of those benefits of mature entrepreneurship are enjoyed at the outset. So talk a little bit about how your expectations and desire for those things was sort of met with the realities of having to learn on the fly.

Dr. Shachi Patel (05:02):
Yeah. So, you know, you, you mean like with, with me now as a solo provider, I mean, definitely the hours can be quite long sometimes cause you’re bringing a lot of work home, especially administrative work, but it’s different because you get to do it out of the comfort of your own home and you get to do it after you’ve tucked your kids in, you know, into bed. And and it’s more manageable even though it’s what you said, you’re, you’re doing 80 hours of work, but because you’re doing it on your own schedule, it feels a lot less.

Justin (05:33):
So talk about the the people with whom you spoke as a fellow and you know, you’re probably pitching this idea probably at beginning, it’s like a little bit bashful, like Holy cow, you know, do you know anybody else who’s done? This is this even a good idea for me to be thinking or talking about and who was it in those discussions that was an encouragement to you or helped to give you the framework in which you eventually sort of constructed this endeavor?

Dr. Shachi Patel (05:55):
So it was actually a of factors. So what I was I’m in fellowship, looking at jobs, the prospects in the area that I wanted to practice, just weren’t looking that great. And at the same time I was keeping engaged with my friends from residency who are older two, three or four years out and seeing what their work experience post-fellowship was like. And I have to say many were just not happy with their, their, the first job that they took many switched to a second job, some to a third job. And then and then life got complex because at that point, because as physicians we’ve delayed having our families and our homes and all that stuff they, they have the extra burden or stress or, or factors of, of thinking about children or their mortgage. And so it just, it led them to kind of pursue jobs that they kind of felt like they were stuck in.

Dr. Shachi Patel (07:00):
And, and so knowing those two things I realized in fellowship that I really, what I really wanted was just the freedom to practice medicine, the way I, I want just what I want to do, how I want it. And at that point I was already living on a resident salary. I was fortunate enough to have a husband who is not medicine. So he had a stable career benefits and I didn’t have much debt. So I didn’t have to give up a whole lot because at that time I also didn’t have children. So it was easy to kind of dive in and say, if there’s a time to take this risk, it would be now. And then all the right people fell into place. So I was at Cornell for fellowship and, and prior to me there’s a graduate from Cornell.

Dr. Shachi Patel (07:50):
His name is dr. Corey Hunter. He’s lovely, amazing, but he, he had come and spoke to us when I was a fellow about his journey. And, and then he did it, he opened his own solo, private practice in Manhattan and he’s successful. And so I reached out to him and, and I had great fellowship directors, associate fellowship directors who were very helpful and encouraging, and all of that kind of fell into place based off my decision and wanting to pursue this. And so I then was more confident in my ability to do it.

Justin (08:27):
So you mentioned a couple of factors, so your husband was supportive and, you know, had an income that always helps you had the mentorship and you had the desire just from like a clinical standpoint to, to practice the way that you saw fit. Were there any other factors as you sort of did this self assessment to see, like, is this really right for me? Any other things you looked at, you thought, you know what, this is something that either disposes me to do this, or is something I’m going to have to like compensate for and adjust in order to still be able to pursue this dream?

Dr. Shachi Patel (09:00):
Yeah. I think debt is a big one. I didn’t have debt at the end of fellowship and during fellowship itself, I worked you know, I was done with anesthesia training. So I actually worked as an anesthesia attending moonlighting while at the same time finishing fellowship as a fellow in interventional pain. And so I was able to kind of eliminate my debt completely and actually create a little nest of savings. And so that having financial confidence, right. And, and not feeling like like having being locked down because of the intense amount of debt from, from all the training was, was a huge factor in wanting to do this now, because again, it goes back to like I was living a resident lifestyle. I didn’t have, I was not used to like a big home, big car, fancy things.

Dr. Shachi Patel (09:51):
And just, you know, I was used to living in the, with, within the salary that I made as a resident. And my husband was too. And, and if there’s any time to do it, it’s, it’s why not do it then when you have no debt, no minimal risks. I don’t have children. I need to think about at the time. And, and so that, that’s what really prompted the leap because two years later, my situation would have been different. I could, I’m not getting any younger, so I knew I wanted to have kids. Right. And, and then once you have kids, you kind of want to have a safe home. You wanna, you don’t wanna move from here to here and here to here. You don’t want to change, you know, locations too often and, and you want something that’s stable. And so having all of those factors kind of in place for me towards the end of fellowship really enabled me to, to feel confident that I was making, it was a challenging decision and an undetermined decision, but it was, it was the right or good decision financially speaking at the,

Justin (10:49):
Yeah. And it sounds like based on the conversations you had with some of your peers that you described, there were two, three, four years out. Like they probably didn’t have that same flexibility just because of the personal financial decisions that they made. And they found themselves having to say, well, you know, I got two kids, I got the mortgage, maybe I have car payments. And I can’t do the thing that might give me a little more clinical freedom and personal autonomy. I have to basically pay the bills and obviously try to do that and is a agreeable of a job as they can find, but certainly having less flexibility.

Dr. Shachi Patel (11:19):
Exactly. I have a co-fellow, who’s kind of venturing out and, and wanting to pursue a solo, private practice now, but, you know, he’s a perfect example. When, when, when I had discussions with him, it was these exact factors at the time when he was starting to think about it. I said, if you have debt, just stick around with your job one more year and pay off that debt, you know? And, and in that time, I’m like, he he’s a male, but I’m like, just have the kids that you want to have this way. That’s also not something that you’ll have to like take time off for the worry about. Yeah. And then, and give, give your spouse the opportunity to have stability returning back to work because the whole kid’s pictures is out of the way. And you have some comfort and Liberty and freedom to pursue this journey of starting a practice, because you don’t know how it’s going to go, but at least you’re not worried about the other things that really do matter, which is your family and your, your spouse and your kids and all those things. Right?

Justin (12:16):
Yeah. I’m interested. Cause you know, this is a common, it’s a shared question by any resident or fellow out there and something my wife and I have talked about is like, how did kids fit into the landscape of physician training? Do we, do we just go forward and residency or wait until, you know, a attending hood? And it’s funny because as you describe your own journey and the way that you’re thinking about this, it’s easy for me to imagine someone, another person who’s asking them, these questions of themselves could have said, Oh my gosh, I can’t start a practice because then I’ll be like nine months into the practice and then I’ll find out I’m pregnant. And then I’ll be like, you know, a year and a half in and I’ll have to take a month off or like, how am I going to deal with that? Or how has the business operations going to be sustained during a time of having a child? But clearly that didn’t dissuade you?

Dr. Shachi Patel (13:00):
No, I mean, I definitely had that worry. You had, you had a great speaker up previously, dr. Abraham. and she, you know this was something that I had discussed with her when I was a fellow. Okay. This was not even after I opened a practice, this was pre when I was thinking about all these things. And, and she said, she looked at me and she goes, that’s not a worry at all. You just, you just get, have a kid she’s like, on your first day, you open, you’re not even going to have a single patient. So what are you worried about getting pregnant for? And I’m like, that’s true. You know? So in the beginning, as you’re building your patient volume, it’s not like you’re seeing, you know, 40, 50 patients a day from the get go you’re, you’re building that volume and that takes time.

Dr. Shachi Patel (13:42):
And, and so you have gaps and so it’s actually easier to have a child and actually have more time to that you feel like you had with, with your child in the beginning when you’re just starting off, because you’re still growing that practice. Now that doesn’t mean it’s, it’s completely worriless and it was an easy process for me. It wasn’t, I, my journey was more like what you said. Like, I think it was like six to eight months into my, my practice when I opened is when I was pregnant with my first child, my, my first baby. And I, for me to have the security of having some time off, I had to find a locums physician to kind of come in to give me that comfort. But, you know, that’s the thing, like I never in fellowship. I never thought about that. Like, Oh, I just hire someone to replace me for a couple of months, but that’s what I did. I, for me, it was important to be home for a couple of months. I wanted the maternity leave. So I hired a locums position to fill my role and continue to do what I do at the practice while I was at home and used to oversee the administrative parts of, of the business. But the day to day, the, the execution of the clinical stuff, you could hire to do that.

Justin (14:52):
Yeah. That makes a lot of sense. And when you explain it like that, it’s like, well, we just, you know, hire someone to do the work while we’re not there. That’s the kind of thing that probably people don’t even understand could be an option that you just sort of, you thought, you know what, I’ll cross that bridge when I get there. And then you did, and then it worked and then you came back and your practice didn’t burn to the ground while you were gone.

Dr. Shachi Patel (15:10):
Exactly. And the patients love it. They love it when you come back and they’re just, and they’re happy for you. Like, Oh, she’ll get pictures of the baby. How are you? Like, did you get some time off for you and your family? And you know, it I’m in a smaller community, but they, they just love and support you. And, and I didn’t the way it kind of fell into place and the way it happened, I just, it couldn’t have been more conducive to what we as a society should do for women who have children.

Justin (15:37):
And I love how you built that for yourself on your own terms. I think it’s, it’s splendid. So I’m curious though, I want to rewind a little bit. You, you know, it sounds like you had the mentorship, you did this self assessment, you thought I’m wired to be able to do this from a personality standpoint, I’ve got a, you know, a stable home situation with my spouse earning an income. And we haven’t yet like ramped up our lifestyle. We don’t have kids, we don’t have debt. Like the pieces are in place, but there’s still the actual, you know, learning what you need to learn and then implementing, hopefully what’s going to be a well thought out strategy should take me to that, that sort of the beginnings, when you sit down with like a blank notepad and you’re like starting to make a list of all the stuff or, or even just the people who are going to give you the lists. Cause we don’t even know, you know, at the beginning probably what that looks like. How did that process unfold for you?

Dr. Shachi Patel (16:25):
Well, in the beginning I, I created a business plan. Really. It was just like thinking about location, location, location, which for me was just, where do I want to be in it? To me, it came down to, I want to practice where my family is cause I want my family. And then trying to understand and ascertain what the market of pain management is like in that area. Understanding the payer mix, the the, the established reimbursements that were happening. And a lot of that is not stuff like I knew, right. I was a fellow I’m still learning these things. And, and so that’s where like you need good people on your team, but a healthcare consultant can in a local area where you want to practice can really help give you some of that information and foresight. And, and so that’s where I started.

Dr. Shachi Patel (17:12):
I gathered some of that information and then and then it kind of just fell into place. Like it was like, okay, this is manageable. This is doable. I think, I think I have the person, like you said personality, but I do. I think I had the personality to really make this happen and execute this and, and and then it just started that way, but a business plan. And then eventually when you start thinking about, when you create the, the bigger picture, then you start thinking about the nitty gritty and then you, you will eventually create a performance statement down, down the road. But in the, in the very beginning, it was like, can I do this or can I not do this? And, and some of that is just personality. Like, do you want to do, or do you not want, that’s what my husband wants to do this? Or do you not want to do this? If you want to do it, I support you just do it. And, and and that’s, that’s really what it came down to, was wanting to do this. And now personality wise, I think it’s really important to like, if you’re outgoing and you, you thrive with other people, which is something that I just naturally need to be able to be happy. I think it goes a long way in, in this business, the medical business, because you’re in the service of other people.

Justin (18:18):
So it sounds like there was an integral relationship there that you sort of mentioned and then kept on going, w which is a qualified health care consultant to help you do the, you know, the SWOT analysis, strengths, weaknesses, opportunities, and threats for your business, evaluate payer mix and a geographic locale say like, who’s the competition. How many patients can you reasonably expect to bring on in a certain period of time, probably helped with contracting and giving you a lot of the questions that you need to ask and then help you answer them. So how did you find, I mean, consultant, we kind of joke, like that could mean literally anything and everyone could call themselves that. So how do you find someone who, you know, can solve the problems, which you found?

Dr. Shachi Patel (18:56):
Right. So, so, you know, I really need to figure out if I could be competitive in the market that I’m in. And I did use a consultant and the way I found her, her name is Tina is through dr. Corey Hunter, who I mentioned before. So he, again he came to talk to us when he was when I was a fellow as a fellowship talk. And he talked about you know, being a solo, private practitioner. And and he also mentioned a consultant and I reached out to him and just said, who was a consultant? You use, can you give me some guidance? And, and then I reached out to her and I, it was just her, I reached out to a few other consultants and interviewed them and figured out who was right for me, who wasn’t, who I enjoyed working with and then settled with her.

Justin (19:40):
Awesome. Yeah. So I spoke with Tina the other day and I’m hoping to have her potentially on a future podcast episode, we’re going to put her out her information in the show notes for anybody who’s interested. So anesthesia success.com/ 55. You’re going to find all the notes from our discussion with dr. Patel, including we’ll put Tina’s information there. So you hired a consultant and they helped you lay the groundwork. Talk about cost a little bit like, and the financing element, obviously starting a medical practice costs a lot of money, and most people don’t have the bank account to be able to stroke the check for that. So how did you, you know, how did you think about financing?

Dr. Shachi Patel (20:17):
Yeah, so, you know, that’s a really good question. It’s not as complicated as, as people think it is a consultant will definitely help you, but really you just need funding and you got to go to a bank and, and talk to them about like a practice startup costs and getting alone. And it’s like shopping around. You’re basically shopping around with different lenders to see who would give you the, the amount that you need at the lowest interest costs for you. But before you go and do that with, with the banks, you to make sure you have the stuff that we just previously mentioned, like, are you in a good market? Do you have a good paramedics or are you going to offer a competitive edge or is it saturated already? But interestingly enough, if you pick a good location the banks already have like lending divisions that are focused specifically on helping with like medical practices. And so they, they, they will put you in touch with someone that’s done this already prior. Like I’m not the first person to open a medical practice, you know, and they, they kinda take you, take it from there and you apply.

Justin (21:22):
So the bank puts you in touch with another physician.

Dr. Shachi Patel (21:24):
No, sorry. It’s someone within the bank itself that has done something like this. Like who’s, who’s given out a loan for a medical practice.

Justin (21:33):
Got it. So you mentioned that moment of sort of a realization when you’re like, Holy cow, like the bank is, is ready to wire, you know, a quarter million dollars or however much it is like into my checking account because they think that this is going to work. So tell me about sort of that, how, how that experience unfolds.

Dr. Shachi Patel (21:51):
It’s just so joyful. It’s when you’re, cause when you’re thinking about this whole process and your you’re, the uncertainty, it can be overwhelming. And and then when you collect all this information, you’re kind of drowned and just, Oh, can I still do it? I don’t know. It’s it’s like the paramix is good. It seems like the market is good. It’s not too saturated. I think I can make it there. And all of these are just, these are subjective opinions that you’re kind of coming up with, but when you put it on paper and you submit it to the bank and the bank’s like, Oh, we think this is a great idea. And we do think you have a market and we do think you’ll be competitive in this market. And, and here’s your bank loan to start this business. You’re like, Oh, like someone that who knows a lot more about finances and I do things that this is definitely successful. So why should I question it? Right. And so it, it really just changes the trajectory of, of how you go about thinking this will go because someone else now, someone being the bank thinks it’s going to bode well. And so you’re more confident that if someone’s willing to give you money, that they’re not, they’re also making sure that you’re not making a bad decision or poor decision,

Justin (23:05):
Right. Cause if you don’t make it, then the bank loses too. So they have a vested interest in your success.

Dr. Shachi Patel (23:10):
Exactly. And so, and then if they’re confident in giving it to you and, and the other part is if multiple banks want to give you money, that’s even more reassuring that you’re like, Oh, okay. Maybe I am onto something, you know? And that that uncertainly uncertainty turns into confidence, which I think was, was very pivotal for me when I was going through this subject.

Justin (23:30):
Yeah, absolutely. So you’ve done the, you did the business plan, you’ve done the proforma. You’ve talked to Tina, she’s given you all the, your, your, to do list. Now you’ve got a bunch of money in a checking in a business checking account, and you’re ready to go start spending some of it in order to get the, that you need to talk us through that process.

Dr. Shachi Patel (23:48):
Yeah. So, you know, you have to, there’s a couple of things you gotta do. You gotta go through credentialing, which I think, again, it comes back to like having a good consultant. They will start working on all that paperwork. Cause it’s an over a burdening amount of paperwork that you have to, you have to in your, your time is not worth doing all of that. There’s people who are better at doing all of that. And so I’m a consultant can kind of help navigate that. Or even your biller, if you’ve used a biller or have picked a biller, can help kind of navigate that or, or, or do that for you. And then and then you gotta get ready to have all the people that you need in your team, which is typically attorneys. Like you need a corporate attorney to kind of establish the business and you need a, you need some insight from an employment attorney and health care attorney.

Dr. Shachi Patel (24:34):
You’ll need to pick that biller that I mentioned having a management consultant is helpful. Having an accountant or a CPA is very helpful. And then just keeping open communication with the banker for the financing. But they do other lines of service too. Like making sure like the credit card stuff is, is figured out. And there’s just so many little tidbits, but that, that really the help the bank helps you figure out put into place for day to day practice. And so all of those individuals you need to kind of really start establishing yourself. And what’s, what’s fascinating is if you go into this thinking, Oh, I’m a physician and I could do it all myself, but that is not the right mentality. Like we know this much of what we need to know, but if you have, if you have the dry, but you have the right people who are advising you, it actually leads to more success.

Justin (25:30):
Yeah, absolutely. And I love the idea of building a team. I’m a big believer in that I have my own team and my clients have their teams, but I’m curious, you needed a team of experts, many of whom you didn’t even probably know that you needed a person in that slot, let alone know any people who could potentially fill that slot. So how did you go about sort of constructing your team?

Dr. Shachi Patel (25:49):
Well, when you, when you want to start first establish the business, you need a corporate attorney and the way, you know, I got very fortunate. I use a larger law group. And within that group, there’s also like an employment attorney and healthcare attorney. And so when questions come up, they don’t say, Oh, let me answer this. They’ll say, Oh, you need to talk to Joe down the hall here, you know, and he’ll figure this out. And then you realize when you’re, when you’re filling out one form to do one thing, like the 10 other things you need to figure out. And then but luckily the one person can kind of introduce you along the way. Yeah. But that kind of fell into place for me, because again, I used a larger all law group that had different types of attorneys within the practice.

Justin (26:31):
How did you learn how to strike a balance between delegation to experts and doing things yourself that, that, you know, maybe were things that you could have done.

Dr. Shachi Patel (26:43):
I still struggle with that. I feel like I want to double check everybody’s work all the time. But it’s just, you have to they advise you and then you realize like, Oh, I don’t know how to do this. And then they kind of instruct you or they’ll help you figure things out. And then you, you can not oversee it. So when you oversee it and you’re paying for, you’re like, okay, they’re doing their part and they’re doing it right. With time it definitely gets easier in the beginning. I wasn’t easy at all. And with time I’m learning to just, there’s certain things you just delegate off and cause you can’t do everything. There’s just not enough time in the day for one to do everything. And you get a sense of who you can trust and who you’re, you don’t trust and that’s innate, that’s your intuition. And so I think if you set up the right team, you’ll get introduced to the right people. And, and, and it really, it comes down to not so much wanting to do it all yourself, but like, is this worth paying for, and, and if the answer to that is yes, then you know, that the service that they’re going to provide is definitely one that you need that you’re going to write that check for. Yeah,

Justin (27:51):
Absolutely. Okay. So we’ve gotten the loan, we’ve got the plan, we’ve got the team, we still got a lot of money in the checking account and you’ve got to find space. You’ve got to start like getting the actual logistics in place. So take me through that process, the real estate and finding the office and getting outfitted.

Dr. Shachi Patel (28:09):
Oh, I think it’s so important to have a good realtor on your team. So I, I, again, I, I, I met with several, I started with one that I thought was going to lead to success and then pretty quickly going through different locations and just getting to know his, his personality. I realized it was, it’s not going to work out. So I, I said, I’m sorry, this is not gonna work out. Thank you for your time. And then I found somebody else. And that person is the best realtor I ever had. They understood my goals. They understood where I was like, they understood that I was doing something very unique and unchartered. Like I was finishing fellowship, starting a practice. And this was a huge deal for me because it’s a business venture that not many people do. Right. He was, he’s been in the community in which I practice for a long, long time.

Dr. Shachi Patel (29:07):
He had a lot of connections. Like he knew people from being in the community for a lot of time and was able to, to meet the needs I needed for my lease. Without, without sacrificing, like he understood what I wanted and was able to deliver that. And that included working with my landlord to get me like tenant improvement and things like that. And he took the time to understand what kind of space I would need. And sometimes it’s just, just simple as that. It’s not, there are realtors who will show you and say, well, this space is available and let’s meet at this address on this time, this space is available. And he was very unique in that. He’s like, well, let, what kind of space do you need? Explain pain management to me, what, what do you envision like space requirements looking like? And then he went that to showing me real estate that made sense for my needs. And it was just a very fruitful, successful process. And I’m very happy where I am. And I, you know, the only thing I would change is if I had way more money, I would, I built the space myself, so I wouldn’t have to rent it. But but that, those weren’t their circumstances I was given. And so I’m very happy with where I am and where my office is and how it all turned out.

Justin (30:20):
Awesome. And that shows, I think a lot of you know, it shows a lot about that real estate agent that he’s empathetic. He’s a listener he wants to understand. I think that’s probably, if you’re going to succeed in any profession, definitely medicine, definitely financial planning. What I do. Like you need to be good at asking questions and then just don’t say anything and then ask why two or three times in the process, and you’re going to learn a lot. And the solution that you would have came in with at the outset is probably going to evolve pretty significantly by the time that you understand really what makes this person tick. So that sounds like this person was really on point for you.

Dr. Shachi Patel (30:53):
Yes, he was great. So I think it’s really important to, to have a good realtor and it’s okay to say no to a realtor, move on. If, if you’re not happy with what they’re showing you or you feel like your time is wasted. And then after you, you find the space, I think it’s really important to think about all the, the state and local requirements. You’ll have to build out that space. So like, because we do pain management, there’s flouro, like x-ray requirements, there’s accreditation requirements. There’s you need a good architect to kind of help facilitate all of that. Right. Cause I’m not a physicist. What do I know? You know, so you need someone who, who can educate you on, on those state and local requirements. And then and then the part where you said where it’s like, how do you just let go and let them delegate what being on top of the contractor? I would say, you know, if you’re approaching this, just make sure you’re constantly engaged with the contractor to say, make sure they’re on time and they’re doing the right thing and they’re getting the right products and, and just everything is falling.

Justin (31:57):
Yeah. Make them be specific, make them, give you a timeline and make sure they adhere to it and create some accountability. You’ll probably get a much better result. I’m sure.

Dr. Shachi Patel (32:04):
Yeah, exactly. On the timeline that you want, if you don’t oversee it and you don’t present yourself as someone who’s like active in the process, then again, I was active in the process, so everything went by my timeline, but I, in my mind, I think it’s because I was just meticulous about making sure they were all tired.

Justin (32:21):
Absolutely. So I know one of the, a sort of black box type questions that would scare away. Other interventional pain practitioners from taking this step is Holy cow. How do I contract with payers? That just seems like this whole huge bureaucratic administrative that is designed specifically to make physicians miserable. How could I ever navigate something like that? It seems like an inaccessible hurdle. So talk through that process specifically in how it unfolded.

Dr. Shachi Patel (32:50):
Yeah. So, you know, credentialing and contracting, like when I was doing the market research, the first thing you want to find out is if the market’s saturated or not, if it’s a saturated market, insurers are going to come back and say, we already have all the doctors, we need a network. Right. And they’re not going to easily get you into network. Luckily for me I picked a market that wasn’t too saturated and then the credentialing process, it just takes time. It’s paperwork, it’s tons and tons of paperwork, resubmitting applications, resubmitting signatures. So for, for me, I was fortunate that, that the healthcare consultant kind of took care of a lot of that paperwork. And then saw through it the way I mentioned with the contractor, just staying in touch with the insurance companies to see the status of the application.

Dr. Shachi Patel (33:38):
If it’s, if it’s being processed, what the next step is, if they’re missing something and, and kind of reconnecting and getting those documents off. And and then it takes time. Some, some came in quick, you know, a couple months to six months and others took a long time, like a year. Yeah. And I have no control over that process, you know, but, but you have to be okay with that and you can’t control everything. So you have to just you kinda just have to let it play out the way where you need. And it’s kind of you when you’re seeing patients. I mean, patients have in network benefits and out of network benefits, if they, if they have cost prohibitive out of network benefits, if I was not in network with their insurance company, you just have to disclose that to them and let them understand that. And some people will still choose to see you because they want you specifically. And others will say, no, no, no, no. I need to find someone who’s in network. And that’s okay.

Justin (34:34):
Yeah. And I think that was as, as we had our previous conversation, this was a revelation for me where I thought, you know, what that makes a lot of sense is when you first start, once you get your space outfitted and the architects are done, and you’ve got all the stuff in order to practice that you need people come in and you’re just going to build them out of network under their existing insurance. And the, the payer credentialing doesn’t necessarily need to hold anything up. You just, you just start practicing. And as long as you’re disclosing the cost to the patients, there’s no reason that that shouldn’t work while you’re waiting for all of the three, six, 12 months for the paperwork to go through.

Dr. Shachi Patel (35:09):
Right. Exactly. And as long as, you know, the thing is, patients love honesty. Like they love people that provide full disclosure. So if you have someone on your team, who’s just looking at a patient’s benefits before they even come in, like when they’re calling and make that appointment and you disclose to them the current situation, if I’m out of network and they have, they don’t have out of network benefits or something, like just tell them. And they’ll, they’ll appreciate that. And, and what’s funny is like, I, I still remember this one distinct case of a, of a woman who we had this discussion with and she chose to go somewhere else. And then when I was finally in network, she came, she came to me. Yeah. Just kind of worked itself out. So, and I, I could say that now, cause it’s been three years later, but when it happened, then of course it hurts. You’re like, Oh, I wish I was at networks. I could see this patient. Right. But but it just kind of works out like life is just continuous and patients will come back. Yeah. If you’re a good provider, they’ll come

Justin (36:06):
Talk a little bit about how you’re thinking about sort of constructing clinical workflows and how that interacts with staff. And how did you decide like something as simple as like how many, you know, exam rooms that we have, what cabinets go, where with what things to make sure that everything is efficient and then who do we need to hire to help, you know, maybe there’s somebody at the front desk or a medical assistant and others, how did you just do the very nuts and bolts, like building workflows and then having people, parties, hiring people to participate in them?

Dr. Shachi Patel (36:34):
Well, you know, it kind of just I’ll tell you the, the, the real estate or the, the lease or the location you pay kind of navigates all of that. So you only have a certain amount of square footage once you decide, like, this is, this is the least that works for me. This is what to go with my loan. This is, this is where I’m going to be. Right. And then, and then you only have a certain amount of square footage. So you work with your architect to kind of say how what’s the best way to divvy up these spaces. So everyone needs a waiting room. Everyone needs a reception area. Everyone needs an office area where like physician or other providers can work. I needed a procedure room and I needed clinic space. So the architect then can kind of structurally look at the space and say, you’re allowed to build a procedure room here and like clinic rooms here, and you need this area for like an ADA compatible bathroom.

Dr. Shachi Patel (37:22):
And this one for an employee, you know, all of that kind of just falls into place. And they give you a good idea of how to use your space and best utilize it with different, different markups, but the there’ll be able to kind of show you that. So it really depends on, on the real estate you got. So meaning like if I’m practicing in Manhattan, the footprint of my office, the square footage would be so much different than where I am in Delaware. Right. So all of that has to be taken into account, but I did I did start with three, as far as staff goes, I started with three staff. Really the goal with the three staff was one person who is designated front office doing like phone stuff, insurance stuff, prior authorization stuff. And then a back office staff that was primarily a medical assistant who did clinic work. And and then a float person who kind of jumped to a one or the other, depending on what I needed. And it gave me the safety that if one person was sick or called out, I at least I had the minimum of two that I needed. And then it grew from there. Got it.

Justin (38:29):
So talk about how you raised the profile of your shiny new practice. You unlock the door for the first time at 9:00 AM on a Monday, the first day that you’re, you know, doing what you’re doing. And, and obviously there’s, there’s no one there to meet you. So you’re now a, a marketer, you’re a business development person. What we would call in the finance world, you’re you need to make people know that you’re there and make doctors know that you’re there and start to build patient volume. So talk about that process.

Dr. Shachi Patel (38:57):
You have to be outgoing and, and, and be, be able to talk to anybody and everybody when I first opened you’re right, like, it’s not like I had a million patients. So when you first opened, you have to present yourself to the community, go out to the providers and say, Hey, here’s who I am. And this is where my practices, and this is what I do. And part of that is providing some marketing material, but in a large part of that is just introducing yourself. And I can’t tell you, like, in the beginning, when I started to do this, it’s easy for me because I’m, I’m relatively outgoing, but the majority of the offices loved it. They loved that. They’re like, Oh, so you’re the physician. And I’m like, yeah. And like getting your marketing for yourself, like, yeah, that’s exactly what I’m doing, you know?

Dr. Shachi Patel (39:39):
And, and because you’re a physician, they’ll actually let you in the back and introduce you to the other providers in that office. And then they get to meet you face to face and get to get to know who you are and they’ll take your paperwork or your, you know, your, your, your marketing material. And, and you hope that that will lead to referrals and, and some did, and some didn’t. But I will tell you, it was just, it was the, of that phase of this practice. It was very well received. And, and now on the other side, like in my own practice, when I look at the people who come to market, I realized like, there’s only one other doctor I know in this community who self markets and he and I are good friends now, but not many people do that. So it’s a very unique position. You put yourself in, because you’re saying, Hey, here I am, look at me. I’d love to help you help your patients. And I think it’s well received. Now I’m, I’m, you know, several years in and the, the patients refer their own patients. It’s just a, it’s kind of, I don’t have to do that as much anymore. Yeah.

Justin (40:48):
I mean, obviously it was an adjustment. They don’t teach this in med school. They don’t teach this in residency, like the fine art of knocking on physician’s front doors and introducing yourself. So how did you, did you find any methods or any, how did you, how did you succeed?

Dr. Shachi Patel (41:02):
I mean, again, there were, there were definitely like offices that were while receptive and there were others that were like, okay, cool. I got the information. Thanks. Have a great day. I, I guess I don’t re I just, I, it was just natural to me and I, I think it’s because growing up, it’s kind of like when near Milla said to you in her podcast, like she had an upbringing where her dad kind of created this path for her. And I had an upbringing where my parents did that. Like, I, my parents were also entrepreneurs. They had gas stations with tells, things like that. And so I learned customer service at a very young age, and I had to continue with, through, you know, my years at home. And then talking to people, no matter what walks of life, they’re from, you just engaging them, listening to them connecting with them is just something I’ve learned through the years.

Dr. Shachi Patel (41:54):
And so knocking on a, you know, an office door and going up to the window and saying to the receptionist, I’m dr. Patel, it’s very nice to meet you. I open my own pain practice it’s level, blah, blah, blah. I’d love to tell dr. So-And-So about it. And, and get referrals for patients if, if I can help them. And, and I’m, again, I’m in generally in a very nice community and a majority of people were, well, thank you for visiting us today and let Patrick, I think the doctor actually has a few minutes to talk to you and, and they’d bring me back and I’d get to chat. And then that was it.

Justin (42:28):
Yeah. Yeah. So we’ve, we’ve mentioned this episode a couple of times now. So anesthesia success.com/ 48 was with dr. Normal Abraham. And she has a lot of great experience in all of these similar types of things. We talked about doing this in the HOPD context, in our discussion. But she, I know has been an instrumental mentor for many in the pain community. And I know that you shared that she has, has had a big impact on your practice. I want to sort of start to bring it home. Now, I know that in the last year or two, in addition to obviously your your clinical practice, you’ve done some industry collaboration that has sort of just popped up. I think, as you’re in the midst of doing what you’re doing at the beginning, knocking on doors, and then starting to treat more and more patients are then referring you to their, all their friends. Talk a little bit about the Genesis of that and what it’s like with regards to your experience in industry collaboration.

Dr. Shachi Patel (43:22):
Dr. Jessica Jamison actually said this where, you know, I was at Nan’s this year and she had made this comment where she was at the podium and she said, you know, my open my own practice. I have all these bills to pay. I’m still trying to grow the practice and, and here’s the industry. Who’s gonna pay me to talk to me about this or that or whatever. Right. And it’s just like, why I have, I have kids at home and I got a mortgage to pay, so why not engage them? And I think, yeah, I think that’s like a huge factor. I think in the beginning, it’s, it’s easy to collaborate with industry because they are helping you in a way that helps grow your practice, but also in a financial way. And so I think it’s, it’s kind of in the private practice realm, it’s something that kind of falls into place, but I will say my, I think my collaboration with industry really started from my networking with a lot of private practice physicians, like people who have kind of mentored me, advise me, and then who I look up to for advice or clinical help.

Dr. Shachi Patel (44:22):
And, you know, people like Tim, dear Jessica Jamison, you know, Metta, Corey Hunter, NIR, Malala Abraham, like all these physicians you meet over time and you meet them at conferences and you meet them at other conferences. And, and then in between you run ideas and, and clinical questions and, and Tufts situations by them and you build a rapport and they get to know you, you get to know them. And then with time, if someone that they work with in industry says, Hey, who’s a physician that we should work with. I think, I think your name comes up. And I think that’s how all of this kind of comes into play. Meaning I didn’t specifically seek my collaboration with industry. It, it found me, but I think it found me just by the natural progression of what it means to be an entrepreneur, a private practice physician and like a business person who networks.

Justin (45:14):
Yeah, well, you have a very diverse skill set. And I think some of those skills were sort of just dormant for awhile. But, but it’s clear that you have a lot of just disparate types of skills that aren’t inherent to all physicians, and it’s enabled you to prosper in ways that are not common, which is really, it’s really fun to be able to hear about and to see I’m curious, you know, for our listeners out there, are there any resources or any things that other things that we haven’t mentioned already that were, you would say, like, if you’re thinking about doing this, definitely read this, or look at this, or talk to this person to be able to just do part of the due diligence for this process.

Dr. Shachi Patel (45:56):
Well, you know, in, in fellowship, I definitely read a book called the essentials of practice management and it was great because it really explained budgeting the revenue cycle capital investment, how to Mo how you monitor the financial performance of your practice. So all so reading that was really a good foundation of like where I was going from the business aspect of this practice. And so I, I highly recommend that book. And then since then I found that the, the biggest source of information is your, your, your networking or your relationship or your collaboration with other practitioners like yourself. So private practice practitioners, and that happens in many forms. But I think the biggest thing is like go to meetings and, and present yourself and let people know you’re, you’re who you are. And you’re, you’re interested in, and with time you develop a network of like-minded physicians who could help you through things like COVID-19 no one really saw that coming, right.

Dr. Shachi Patel (46:56):
And like, how do you as a business or an entity survive this wave of, of changes in your business. And, and I think that the biggest asset to me and my practice was just my ability to reach out to all of these people that I’ve mentioned to you in this podcast, and many, many more who said, Hey, you know, this is what I’m doing, or this is what I thought about, or this is you know, this apply for this or this, that, and the other, and kind of the, the phases of, of going through this pandemic. It, it, it more, it didn’t make it a me problem. It kind of made it a a widespread problem that other businesses were also suffering and it allowed me to collaborate to find solutions. So, so I think having a network of people that you just meet over time and you stay in touch with is really important. And then a consultant is always, always, always helpful because they have done this more than you have. And so they have answers to questions that you’re thinking that they’re just like, Oh, this is this, this is what you do for this. And so I think like Tina is great to have along your side.

Justin (48:05):
Yeah. Not only the answers to the questions, but the questions themselves, which can be more important in many cases. Exactly. Right. Cool. So I want to wrap it up here and thank you again for your time dr. Patel and just closing with a story of a reflection of yours. You know, this is, I, I love what you’ve built and I love hearing the story and the entrepreneurship and the, you know, the clinical side of things and the marketing and the finance and business, and it merges altogether. And you have either picked up skills that you didn’t have, or you’ve learned to just delegate to experts. And you’ve been able to get a pain practice off the ground in a, just a pretty short amount of time. That’s just a very impressive story. So as you think about what you’ve accomplished, the patients that you’ve helped tell me just a short story or reflection on what is it like looking back, seeing, you know, thinking about the bright eyed bushy tailed fellow a few years ago, who had this dream, and now looking back and seeing that you have achieved practice stability, and you are living a life that is on your terms a story that sort of just brings all that home.

Justin (49:14):

Dr. Shachi Patel (49:14):
You know, that’s, that’s a tough question. I have to say. I don’t have, I have multiple stories of, of patient interactions that make me think this is worth it, but I’ll tell you that the journey with entrepreneurship and having your own businesses just there’s like, there’s this graph that’s around and it’s on online where it’s like, just waves of like, you feel like static. And then you’re like, why did I do this? And then you’re like, okay, think I can do this, or, Oh, I definitely can do this, or wait, why did I do this again? And it’s just waves of ups and downs. And I feel like that’s very true, like that graph or that pictorial is very realistic to what it’s like to run your own business. And I feel like what grounds me to wanting to do this and continue to do this is just this little bits of patient stories.

Dr. Shachi Patel (50:00):
So I have patients who have large, and I didn’t even know that I largely impacted them until they send like a gift basket or especially to me the card when they send a handwritten note. And I’ve kept every card that I’ve received since the first day of opening and any time where I feel overwhelmed, or I’m just like, what, what did I get myself into? Like, am I making the right decision here? I sit down and I look at either the memorabilia had been sent or like the, especially the cards and, and the stories and the thank you’s and how I, as one person was able to impact their life in such a positive way. And it makes me very it makes me want to do this and continue this. And so whenever I’m having those phases, I kind of take those out and I read through them and I’m like, okay, this is where, okay, we’re, I’m doing the right thing. This is totally worth it. The journey is hard. And you just gotta keep pushing. Awesome.

Justin (50:59):
Well, thank you for sharing that story and thank you for joining us today on the anesthesia success podcast.

Dr. Shachi Patel (51:04):
Thank you. Thank you for having me. I wish you guys all the best.