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MEDICAL PRACTICE
STRATEGIES & ISSUES

Integral to an efficient and successful business model is where you locate
your practice. So, how do you decide?

The first issues are to determine what type of practice you want, The location became part of that marketing process as practices
and where in the city you want to locate. Those decisions should evolved from being in Ob’s to shopping centers.
be based on (1) demographics of the target population you propose So, are you a “retail” specialist or an “Ob” specialist? It varies,
to serve; (2) your specialty; (3) proximity to your home and/or kids’ and it depends on how you see yourself marketing yourself and
schools; (4) ability to negotiate equitable managed care contracts; your practice. Many practices today that are in Ob’s could do better
and (5) proximity to a hospital where you may admit your patients by having the exposure of a retail site. We are seeing movement
(if you’re not hospital based, then #5 isn’t applicable). nearly across the board in that direction. but, what’s the difference
in a retail vs non-retail building?
DEMOGRAPHICS AND SPECIALTY We all understand that an Ob is a big multi-story, multi-tenant
do you want to provide care in an underserved area of the com- type facility wherein you just select a box of a certain size, and then
munity, thereby taking on a heavy Medicaid load? If so, that will with a little help, just show up one day with your stethoscope (or
require a different location than if you’re performing procedures whatever accoutrement you use). Parking is far away in a separate
for a cash-paying crowd. Is your specialty such that you will be treat- building, and costs your patients money. but only the building
ing mostly Medicare aged patients? If so, you will likely want to be owner sees that revenue. Signage is very limited, usually to a direc-
near other specialists who have a similar demographic since there tory in the lobby. Patients have to know ahead of time where you
is a greater likelihood of referrals back and forth made easier be- are, and they learn of you slowly through word of mouth, adver-
cause of that proximity (i.e. multispecialty office building). tisements that you may undertake, and referrals from your col-
All practices would like to contract with the bUCA’s (bCbS, leagues (which, in many cases, you’re in competition with).
UHC, Cigna, Aetna), but will they want to contract with you? Your A retail location, on the other hand, is usually in a shopping cen-
location and specialty will have a lot to do with that. If they have a ter. You can find an “in-line” location near or next to a big box re-
plethora of your specialty in a given geographic area, there may be tailer, or possibly in a smaller outbuilding. In either case, your
a reluctance to add another person to their roster, or they may only visibility to the public is much greater, usually owing to drive-by
want you to come on board if you accept their low-ball offer. Re- traffic and signage. You still have to undertake some advertising,
searching this very important issue is fundamental to future success. but people who visit that big box retailer will likely see your sign,
A more detailed discussion about the process of contracting with and know you’re there. Your advertising costs are less than they
the bUCA’s is beyond the scope of this article, but remains a key otherwise would be because you have exposure to drive-by traffic.
factor in determining where to locate. Sounds easy, right? If you haven’t experienced it before, it's not!
Younger physicians with kids in school will want to consider the Retail is usually more expensive on a per square foot basis (but
proximity of those schools, as that dictates your commute time. not always), and there is normally an upfront cost to finishing out
Nothing new here. Just one more variable to consider. the space. The key issues are that the rent structure and potential
out-of-pocket costs to get a space ready for your use are significantly
RETAIL VS OFFICE different in a retail vs. office building. In order to navigate the po-
Fundamental to the decision about where to set up a practice is tential landmines you will encounter, hiring a good real estate agent
whether you consider your type of practice a “retail” or an “office” is the best way to minimize pitfalls. He/she can also help you work
practice. And that, in turn, depends on your specialty to a large ex- through the multitude of issues identified above to arrive at the ideal
tent. Historically, most physicians new to practice located in an office location for your needs, both personal and professional.
building (Ob) near, next to, or even connected to a hospital. And
with an announcement in the newspaper of your new office location, Dr. Swift is the Managing Partner of Texas MedClinic, an Urgent Care
patients just came. Some of you may remember how that worked… and Occupational Medicine practice, with 19 locations throughout San Antonio,
“if you build it, they will come”. And they did. Until they didn’t. It New Braunfels, and the Austin area. He is also a former Board member of
all began to change in the mid-1980’s with the “retailization” of med- the Bexar County Medical Society.
icine. It became important to more actively market your practice.

visit us at www.bcms.org 11