General practice, and what it means to be a general practitioner, has evolved a great deal from the 1980s. The “family doctor” concept has transitioned from solo and group practice owners to a degree of corporatisation, to the point where now only 25% of Australian general practitioners are currently principals or partners in their practice.1 The identity of a general practitioner has also had to shift focus from being the “one-stop shop” for healthcare to: “Not just a GP, but your specialist for life.” But while the general practitioner may be rebranded and repackaged with a shiny slogan, practice ownership continues to be a frightening pipedream for a vast majority of young GPs. GP registrars are still interested in practice ownership, as a recent study shows,2 and, indeed, there is difficulty accessing general practice care, especially in the rural and regional areas of Australia. But clearly there are significant barriers stopping GPs from taking the leap. “A lot of the time, it’s the risk involved and the fear of the unknown. Why take on the headache of running a practice when you can work for someone else and still earn a good income?” Dr Kam Ghatora, an independent general practitioner who recently opened a practice in Rosehill in Sydney’s inner west with the help of his medical and pharmacy colleagues, told The Medical Republic. “It’s a whole new learning curve setting up a practice, and it is quite different to the skills you learn in medical school.” Given the challenges, why do GPs do it? “It started with my colleagues and I looking above and beyond just medical practice to something that was more flexible, but also a business model where we could have more of a say in the way a practice was run and managed,” Dr Miriam Grotowski one of the co-founders of the Smith Street practice in Tamworth in country New South Wales, said. “I remember jokingly saying maybe we should start our own practice, and this was to three female GPs with seven children under the age of 10. Within six weeks of that we were looking at premises for our new practice.” For Dr James Liang, co-founder of Myhealth Medical Centres, starting his first practice stemmed from an early interest in running and owning a business combined with a passion for general practice. “It seemed like a logical next step. My parents were business entrepreneurs in their own right and we often get a lot of invisible learning through our parents. It just so happened that my training and passion lay in the medical field, so I decided to just say ‘yes’ and start the process of setting up a practice in a shopping mall in Baulkham Hills (in Sydney),” Dr Liang explained. Taking a risk is a common theme among most practice owners. “We had just started discussing opening a practice when an opportunity presented itself within a busy shopping area and it was either say ‘yes’ in a few weeks, or wait for the next big opportunity,” Dr Ghatora said. Being prepared to take a chance is one issue, but most owners also agree that it’s important to do the homework in terms of finances and setting up a business plan. So what goes into the planning for owning a practice? While there are several toolkits available from both the AMA and the RACGP, having a well-informed and competent accountant is key. It’s also important to establish whether you want to start your own practice, or buy into an existing one. Another aspect of running a small business is who you are going into business with. Inevitably most owners will have at least one business partner or more. “They don’t have to be your best friend necessarily, but they need to be someone with whom you can have open, respectful and robust discussions about the practice,” Dr Grotowski said. Dr Grotowski and her colleagues also had similar core beliefs of providing excellent evidence-based care to patients in a business model that was sustainable and flexible for their busy families. “It is important to have similarities in mindset about the scope of the practice and the fiscal nature of the business. For example, when it came time to upgrade our facilities we all agreed as owners to take a small cut in our take-home billings in order to fund it,” she said. For Dr Ghatora, having a shared ethos of always aiming for excellence was critical. “In the beginning, I had set out very clearly the main ethos of the practice. I wanted our practice to aim for excellence – in the way we treat fellow staff members, patients and registrars and medical students,” Dr Ghatora said. “It was a passion of mine to help set up and manage a practice where the staff members were just as much the ‘customer’ as the patients.” This passion is echoed by Dr Liang and Dr Grotowski. “For me the idea of MyHealth stemmed from my own experiences of starting a practice – all the wins I had and the mistakes I made,” Dr Liang said. “I wanted to make the experience easier for another GP wishing to run their own practice and that is where Myhealth comes in. Our customer is the doctor. Keeping them happy and motivated which, in turn, benefits the patients and staff.” The focus is on empowering GPs to take that first step into practice ownership. For Dr Grotowski and her colleagues, it was about setting up a practice that not only provided holistic care to a rural community, but also provided in-demand services, such as for mental health. As a practice, the partners made the decision to employ a specialist nurse in mental health and this move has paid dividends, not just in financial terms but also for the quality of care the practitioners can provide. It was these factors that led to the Smith Street facility being awarded “Practice of the Year” five years after opening. In terms of the nitty gritty, once a practice has council approval and finances in place, what happens next? The question of staff hiring is an important one, and just as most owners learn how to establish a workable business plan on the job, most also learn about staffing from early hiring mistakes. “It’s important to consider the type of GP you want working for you. A bad GP can cause irreversible reputational damage in what is usually a small area that the practice serves,” Dr Ghatora said. “Also we learnt to never underestimate the impact of a competent receptionist.” Delegating and trusting good quality staff is an important aspect of practice ownership. Dr James Liang recalls how his journey evolved from being a practice owner doing everything, including sometimes manning the front desk, to becoming a business owner of Myhealth. For Dr Liang, recognising and rewarding competent staff was crucial to the successful running of the business. “We learnt early on to recognise exceptional registrars and offer them the model of Myhealth, which is to have ownership and run their own practice under our mentorship. “It means that I can now focus on the bigger picture of moving the business forward collectively.” Employing a competent practice manager has also freed up time for Dr Grotowski and her colleagues to focus on other areas of interest, including medical education and the future of their Tamworth practice in terms of mentoring a younger generation of doctors to start working at the practice. In terms of recruiting doctors, there are several resources on employment available on the AMA website. But practically speaking the contacts made during medical school and networking events, such as conferences, can be invaluable in terms of attracting GPs to the practice. For Dr Ghatora, networking was one of the important aspects of hiring GPs. All the doctors he now works with, he either studied with or knew through working as a medical educator. A major advantage of a GP-owned practice is that there is usually more opportunity to recognise where practice changes are needed to improve patient care and then have those changes implemented. Every practice owner interviewed by The Medical Republic talked about the importance of regular meetings with proper agendas and minutes to allow for collaboration and improvements in care delivery. But also, sometimes, just to vent frustrations or discuss complex cases. Being able to collaborate with like-minded GPs is why Dr Ghatora decided to start his own practice. Having now set up successful businesses of their own, there are several tips these practice owners can offer. “Take the plunge. Even if you might not have the perfect plan,” suggested Dr Liang. “Find a mentor – someone who has done this before and learnt while on the job – don’t be afraid to make mistakes,” Dr Ghatora offered. And was it worth it? “Definitely! Nothing compares to seeing your vision in action. We grew from three part-time practitioners and one staff member to now having 22 staff members on board,” Dr Grotowski said. For Dr Ghatora, the changes he has seen within a year of opening has made all the difference. “The growth has been exponential. From being accredited in our first year to now having our practice open to registrars. As a team we can see the impact this has on improving health outcomes for our local community,” he said. For Dr Liang, he could not envisage doing anything else. He is also able to now focus on another passion of his: innovative technologies for general practice. “I want to establish connections between the GPs at the various practices so we can ask questions and have discussions in real time using an app I am developing.” Despite all the challenges ahead for general practice in terms of billings and sustainability of GP-owned practices, the GPs interviewed did not feel that business would slow down. “I want GPs running their own practices to be the norm,” Dr Liang said. “I want to be able to improve the care we provide through improved databases and communication models.” For Dr Grotowski its upwards and onwards in the expanding Tamworth district. “Now we have a subset of patients and families that have grown with us, but with the expanding population in NSW we are seeing several young families also moving into Tamworth, so as a business we will keep evolving with the demographic that we serve,” she said. Dr Ghatora wants to now build on the teaching aspect of his business. “We will start having registrars from next year and are hoping to be a practice of excellence, not just for the care we provide, but for the quality of mentorship and education we provide both registrars and students,” he said. Dr Aajuli Shukla is GP Editor for The Medical Republic and practises in Blacktown in Sydney’s western suburbs References 1. Joyce C, McDonald H, Lawlor-Smith L. General practitioners’ perceptions of different practice models: A qualitative study. Aust J Prim Health, 2015;22(5):388–93 2. Sturgiss E, Anderson K, Liedvogel M, Haesler E. To own or not to own How can we best educate general practice registrars about practice ownership? Volume 42, No.7, July 2013 Pages 503-506 Source
