Starting a Medical Practice: Contracts, Billing, Marketing and Your Personal Brand

A restaurant, a candy store and a medical office have more in common than most people think, Dr. Siddiqui argues. The basics of business are the same; only the rules differ. A restaurant answers to the health code. A doctor answers to HIPAA, and the penalty for getting it wrong can be a license. That difference, and the absence of the hospital's lawyers and insurance cover, is what keeps many young physicians from striking out on their own. Chapter 3 is his attempt to make the leap less frightening by explaining what is actually on the other side.

How to start a private practice: the bills come first

He begins with overhead. Payroll is the single largest line in any office, and he suggests ways to soften it without hurting service — for instance, sharing staff between part-time locations rather than hiring a full team for each. Ideally a doctor owns the building, so expanding a treatment room doesn't mean begging a landlord; if that isn't possible at first, the location has to make economic sense. Then comes the patient mix: will the conditions you treat in that neighborhood actually pay the bills? Buying supplies in bulk helps. And underneath it all, he asks, do you have the drive to carry the place?

The early days are slow, he warns, and payroll feels heavy because staff must be on hand before the patients arrive. The art is in managing "traffic flow" — knowing when to hire and when to add a room before the waiting room backs up, while keeping the quality of care at the same level or higher.

He is candid about learning one lesson the hard way. On a day his clinic was running more than an hour behind, he snapped at a front-desk staff member who came to ask about billing codes. Seeing her in tears changed the office. He hired a full-time administrator to run billing, staffing and the front of the house, and admits that handing over the business side of a clinic he had built from scratch was one of the hardest things he did.

Medical billing basics nobody teaches

"In medical school, we’re taught anatomy, physiology, and about the ins and outs of the human body – there’s never a class on business."Chapter 3, The Dark Side of Medicine

Doctors learn a careful protocol for taking a history, he notes, but not how to turn a visit into a claim: choosing the diagnosis and billing codes, completing the right form and sending it to the insurer. In his view, that gap is part of what makes hospital employment attractive — a whole department handles it for you. He compares two habits, coding right after each visit or in a batch at day's end, and argues that the real skill is building a system: reviewing the chart before walking in, so you can anticipate the codes and level of care before you leave the room. His own clinic used a third-party billing company, and he favors that route. The company's "initial scrub" may feel like nitpicking, but it catches errors in both the medical record and the bill before they cost time and money.

Negotiating a physician contract with insurers

When it comes to insurance contracts, he describes three situations. A specialist in short supply may be offered a good contract quickly. A doctor in a crowded field — he names primary care, internal medicine, family practice and pediatrics — may be offered a poor rate or turned away. And a physician with enough patients on one plan can sometimes use that as leverage. His central point is that private insurers' fee schedules are commonly benchmarked against Medicare, so in his view a physician should know the Medicare allowable rate for their services, understand their market position, and negotiate from there rather than accept the first number offered.

Marketing and your physician personal brand

A new practice can buy advertising or earn word of mouth; ideally both. He pictures a practice as a tree: clinical work is the trunk, and referrals, a useful website, community talks and press coverage are the branches that feed it. Early on he gave heart-health talks at RV parks, senior centers and golf tournaments, knew exactly which population he served, and chose deliberately memorable marketing. A good website, he adds, should make the next step obvious and let patients book online. Patient stories, though, need written permission before they appear anywhere, because privacy rules are unforgiving.

Word of mouth still rules. He recalls a heart-attack patient on a gurney protesting that the doctor looked too young. His blunt reply about what would happen without treatment earned the man's trust, and after a successful procedure that patient became a source of referrals. What won him over, the author concludes, was confidence rather than age.

The chapter closes on bigger questions: why higher-risk specialties pay more, the trade-offs of salaried hospital employment (which he respects as a valid choice), the due diligence needed before hiring another physician, paying staff generously, and weighing risks such as a long commute against family life. And he plants a seed for later chapters — the difference between active and passive income.

This companion summarizes the author's views and experience. It is not medical, legal or financial advice.