Is Private Practice up your alley?
As we approach the back half of the year, for many this is also means approaching the finish line, the light at the end a long tunnel, the finale – qualification as an Accredited Practising Dietician. The scope of what we can do is enormous – hospital clinician, food service, public health, education, research and for some this means the leap into private practice. Daunting as it may seem, if being in the drivers seat of your own career makes your heart skip a beat (from excitement as opposed to downright dread) then private practice could be for you.
Lori Evangelista from Feast for Health Dietitians knows a thing or two about starting out on your own. From the humble beginnings of a consulting room at a GP clinic, Feast for Health has grown exponentially to host a fleet of Accredited Practising Dieticians in multiple locations across Newcastle, Lake Macquarie & the Central Coast – even scoring the plum role of official dietitians to the A-leagues Central Coast Mariners.
Lori’s time is now spent building and mentoring a team of passionate dietitians (and dietetics students through clinical placement) to support and empower their clients with a positive and practical approach to their health and nutrition goals. Lori has a wealth of information to share about building a private practice from the ground up – not exactly on the list of subjects at Uni!
If private practice has been sparking your interest but you didn’t know where to begin or if you were made of the right stuff for the job then read on. Here at The Nutrition Press we are picking Lori’s brains on everything from building a client base to maintaining some work/life balance while you run your own business. If you are approaching that time during your studies when you have to decide what you want to be when you grow up, Lori offers some amazing insight into whether private practice might be the path for you.
Over the course of a degree in Nutrition & Dietetics we have the opportunity to gain practical experience in a range of environments. Why did you choose to go into private practice?
Lori: I didn’t plan too. I started and finished my degree with one focus – to be an inpatient dietitian working with kids with type 1 diabetes – that is all I ever wanted to do. My first job was at The Children’s Hospital at Westmead, working with kids with insulin resistance in an outpatient setting. Although it was a great experience in many ways, it unfortunately changed my mind about working with children. After 18 months there I started looking for a job closer to home. Out of complete chance, I got offered a room to consult out of at my local GP clinic. I started with no knowledge of private practice or business and just fumbled my way through. I started to like learning the business side of things, doing things my own was and the flexibility that I could have in working my own hours etc.
Hindsight is always 20/20 – what advice would you give to yourself now if you were approaching graduation? ( Is there anything you would do differently?)
I would be less afraid to make mistakes and less worried about people judging me (especially supervisors). I would just jump in and do as much as I could, not worrying about doing it perfectly first go, to get as much experience and feedback as I could. I learned the most when I made mistakes and stuffed things up. The more I did, the more confident I got, to the point where I now just say yes to anything, even if I don’t know how to do it, and I just work out how to do it later/as I go.
I strongly believe that good communication skills are the most important thing. If you are happy, friendly, positive and you can be confident with all people (patients and other health professionals etc) you’ll do well. It is good for someone who wants to work flexible hours. You should also have an interest in business as there is a fair portion of financial and bookkeeping type work involved. You also need to be willing to work outside of normal work hours (nights/weekends) and for very little or no money at times. The only income received is when patients are seen so on days when lots of patients cancel your income can be minimal. Sometimes the rent you pay for your consulting room and your other expenses can exceed your income, so some days you are basically paying to work (losing money!) So there can be a financial risk. But, if you are busy with patients then it can pay more than an average award paying job. Private practice is not for someone who wants the security of a 9am-5pm job with a steady income.
Nuts & Bolts Q’s – some of my fellow students were keen for answers to some of the more practical aspects of starting a practice such as, how to deal with Medicare/private insurance companies and any software that you might use. What are the top 5 things that keep your business running smoothly?
There is a lot to it but none of it is difficult. So that you can get started the first things to do are to get your APD membership (you need to be at least a provisional APD to work in private practice), then get a medicare provider number (so you can claim rebates for your patients from medicare and DVA). You should also get an ABN (Australian Business Number) and professional indemnity insurance. (Guild Insurance is supported by the DAA).
From there what you need or don’t need depends on how you practice is structured (i.e. whether you are using a room within an existing clinic and what level of reception assistance is provided, or whether you are only doing home visits etc). You may or may not need to do your own bookings (using a software program) or billings (software and/or HICAPS machine etc).
You’ll also need to develop a way of keeping track of finances. I use a custom made Excel spreadsheet to match all money received from medicare (for bulk billed patients) or from patients directly (private paying clients) with money I’m waiting for/expecting. Thanks to medicare it doesn’t usually balance!
Did you do anything extra during your degree that proved beneficial to starting your own practice? (I’m thinking any outside experience or business course).
No. The main things that helped me in the beginning were the other allied health professionals (working in the first clinic I started in) that gave me tips, the practice manager and reception staff there who kept having problems with my billings (which made me spend hours on the phone to medicare to find out what to do!) and just jumping in the deep end and figuring out solutions to problems as they arose. There is always someone on the end of the phone somewhere that knows the answer. My (now) husband was also a big help in the business/financial side of things as he has more of a business mind than me! Plus he taught me how to use Excel at an advanced level which I couldn’t have done without.
Where do your clients come from & do you have any strategies for building a client base?
The vast majority come from GP referrals. Very few come from other sources. Marketing to GPs is the most important thing to do to build a client base (which can be scary!)
How is the juggle between work life and home life? Any tips on how to maintain some sanity?
It can be hard to turn off, especially if you work a lot from home. Different things work for different people. Putting certain hours aside for work each day or having a ‘finish’ time can help.
What does a typical day look like for you?
I don’t have a typical day. When I was consulting those days were busy with patients booked every 30 minutes from 8.30-5pm. Other days when I wasn’t consulting I would spend time doing phone calls to set up meetings with Drs/nurses, doing other marketing activities, creating patient resources, researching, designing marketing materials (business cards, flyers, website, Facebook posts etc), going to conferences. Now I don’t consult anymore. I spend my days managing and mentoring the dietitians on my team who do the consulting, visiting our current sites and sourcing potential new sites. I also spend one day a week doing all the financials – chasing medicare for money owed, balancing accounts, pays etc).
You started your practice in 2009, how has the way you practice changed since then and where do you see it going over the next few years?
It changed a lot over the first few years as I found better and more efficient ways of doing things, better ways of marketing and building the business etc. Now it is fairly stable as I have put into place processes and guides for everything. All the new dietitians go through the same training processes etc. The main change for me personally that I don’t consult myself anymore so I spend most of my time working ‘on’ the business (building the business and managing it) rather than working ‘in’ the business. The business is growing exponentially so I think there is more growth to come over the next few years with more consulting room locations. We have also expanded to work with other Allied Health too (our other new business called ‘Allied Health Connect’) so we will build in that way as well.
Last but not least – do you have any stellar words of wisdom for those of us thinking of starting out in private practice? Any ‘must do’s’ or ‘whatever you do, don’t do this!’ pearls of wisdom?
If you start a private practice, do it for you, because it’s what you love. It may sound selfish but don’t do it for other people, because many of the patients you’ll see don’t care and won’t do what you tell them to do. If you help only one person out of the 39 or 40 you see in a month, that’s great because you have changed a person’s life. That should be enough for you because if it’s not it will all just seem too hard at times.