It isn't easy being self-employed! From the burden of self-employment tax to shouldering all the responsibilities for generating an adequate monthly "take-home", the physician entrepreneur faces many challenges.

Well, it apparently just got harder.

An article appeared two days ago in the Los Angeles Times titled "Health insurance options dwindle for self-employed". The author pointed out that many of the group plans that self-employed individuals have relied on, through organizations such as their professional associations, are being dropped by the organizations, or are becoming unaffordable.

From the article:

Although no one tracks association coverage to know how many plans have disappeared, the experience of Marsh Affinity Services is telling. A decade ago, Marsh, which brokers and administers the health plans, had 142 such clients. Today, all but three have shut down. (emphasis mine)

Over the same period, the nation's uninsured population, now estimated at 45 million, rose dramatically, fueled in part by the dearth of affordable options for the self-employed, experts say. Among uninsured workers, nearly 63% are self-employed or work in small firms, Todd Stottlemyer, president of the National Federation of Independent Business, told Congress recently.

...... Fewer than a quarter of 1,020 professional and small-business associations surveyed in February offer medical coverage, even though a majority of the groups said they would like to. The American Society of Association Executives, which commissioned the survey, views the issue as a crisis.

Yes, indeed, this sounds like the beginnings of a crisis to me!

What this means for you, the physician entrepreneur, is that you cannot rely on getting group rate health insurance through the professional associations many of you might belong to.

In the not too-distant past, as a family physician in Los Angeles, I could purchase excellent health insurance at affordable group rates through the American Academy of Family Physicians, the Los Angeles County Medical Association or the California Medical Association.

Now it appears that the best I could do is sign up for a Health Savings Account and a Catastrophic High Deductible Health Insurance Plan through any of the three organizations.

In his thoughtful and helpful book Free Agent Nation: The Future of Working for Yourself, Daniel Pink (of A Whole New Mind fame) devotes a sobering chapter to "Roadblocks on Free Agent Avenue" and writes about the difficulties of obtaining satisfactory health insurance coverage at rates that won't sink the business. In his later chapter on the new politics of "free agency", he proposes that self-employed persons be able to buy into a plan resembling the existing Federal Employees Health Benefits Program that covers Congress and over 9 million federal employees. This would be a viable option for the millions of self-employed entrepreneurs who represent a huge pool of workers and across whose vast size the risk could be spread.

Imagine - as Dan Pink implies in the book, all those insurers might even be eager, even hungry, to compete for this business!

Back to current day reality....... it seems prudent to make a thorough assessment of your and your family's health insurance coverage needs, and the availability of plans, before you leave a practice or organization group plan, and leap into entrepreneurship. And be sure to factor the new expense into your financial projections for your business plan!

I'd love to hear from anyone with suggestions for your colleagues as to how you have managed your health insurance needs as self-employed professionals. 

Time to toot The Entrepreneurial MD's horn a bit about a new program I'm offering!

Physicians tend to be hard-working, bright and narrowly-educated professionals - a bit of a generalization I realize, but I think this holds true for most of the physicians I know.

Those that succeed as physician entrepreneurs have done so because:

1.) they have first-hand knowledge and experience of problems for which they have devised good solutions.

2.) they have skills, innate talents and passions for ideas other than the delivery of clinical services that they are trained to offer.

3.) they have asked excellent questions and have pursued the answers relentlessly.

4.) they have stumbled by accident upon ideas or opportunities that have caught their imagination and held them mentally and emotionally captive, until they have committed to pursuing the idea.

But what if this isn't your experience?

What if you would really love to start something entrepreneurial, even if it is just to spiff up your medical practice, and you can't come up with any good ideas for your business?

At last, there is a new option available to you.

Here at The Entrepreneurial MD, I have been listening to you and your physician colleagues describe how hard it is to want to do something and not to know where to start. As physicians, we do not like the experience of not knowing!

It took me three years of building a coaching business before I hit my bull's eye - discovering the work I was really meant to do, that was in line with my experience, skill and passion (being a physician entrepreneur and helping other physicians succeed in business). I disliked not being absolutely clear and distinctive in my offering, and being just one of the burgeoning number of general coaches out in the world.

In response to the frustration I have heard and even felt, I have created a solution - a focused practical guide to getting you to the point of knowing how to make a sound decision about what your ideal business should be.

I'll be presenting my solution in a 4-week program, The Entrepreneurial MD BizIdeas^TM Teleseminar, starting on April 26th. In four 75-minute teleclasses, I'll share with you the tools and exercises I use when working with my individual clients. I'll also walk you step by step through the process of identifying your passions and interests, your skills and abilities and how to find out if there is a viable market for your business idea. The group will be limited to only 20 participants as I really want this to be a personal and intimate environment in which to accomplish something valuable. All classes will be recorded for you, and you'll get a workbook for your notes, thoughts and exercises. 

To learn more and to enroll, click on the What's New page here. 

I'd love to have you, or someone you know who needs this help and coaching, join us on our 4-week adventure. My fondest wish is for you to leave the program energized, clear, and ready to take action --- to embark on the next part of the journey towards living your most creative and fulfilling professional life as a physician entrepreneur. Don't miss out on this affordable and rewarding opportunity!

Imagine my delight when I came across a most inspiring article yesterday about a special physician entrepreneur, Dr Jeffrey Segal.

Dr. Segal is the founder of Medical Justice, a business dedicated to the vigorous and relentless defense of physicians who are hit with frivolous medical malpractice lawsuits. Know anyone with that experience??

This excellent article describes the anguish experienced by both Dr. Segal and all our physician colleagues when named in baseless lawsuits and faced with hungry "personal injury lawyers, unreasonable plaintiffs, and unethical expert witnesses".

Medical Justice's service plans work by doing the following: 

-- Deterrence: Keeping physicians from being sued in the first place through a patented infrastructure in which patients, as partners in the healthcare process, agree not to initiate or participate in frivolous lawsuits against the physician.

-- Early Intervention: Notifying personal injury lawyers who file lawsuits, file "Intent to Sue" documents, or wave other red flags, that the physician is protected by Medical Justice against frivolous lawsuits and the company will commit resources and expertise as an offensive remedy if a frivolous case moves forward.

-- Prosecution: Funding and providing countersuit services for physician members victimized by frivolous lawsuits.

The results speak for themselves - 10 to 15% of Florida physicians are sued each year. Conversely, less than 2% of Medical Justice's 300-plus Florida members are sued. As a result, both the Florida Medical Association and the Florida Neurological Society have endorsed Medical Justice.

The company's future looks equally bright:

Medical Justice has accumulated an unprecedented body of knowledge on a major factor that drives physician behavior. Concern over potential litigation forces physicians to practice defensively, ordering tests and referrals which do little more than protect the physician if indeed he is sued. The only purpose is for the doctor to be able to say on the witness stand (if that fateful day occurs) that he did everything possible, and more, to prevent an improbable event. It is estimated that such behavior, while entirely rational, adds over $100 billion to our nation's annual healthcare bill.

Medical Justice recently filed a patent application for a process called HealthCare 2.0 which eliminates the need for practicing defensively. Those funds can be redeployed for patient safety, to lower healthcare premiums for patients, to lower professional liability premiums for physicians, and for faster, more predictable remedies for patients who are injured.

HealthCare 2.0 is the only comprehensive program addressing almost all of the problems defined by all stakeholders in the healthcare system without increasing the cost. Importantly, lower healthcare premiums will translate into fewer uninsured Americans. As Dr. Segal stated, "We are passionate about tackling the problems of our healthcare system with a solution that is sustainable, and more than just the band-aids that have been proposed in the past. Fixing just one problem in isolation will do little more than buy time. Our country pays for a system that should deliver the best healthcare on the planet. HealthCare 2.0 might very well get us to that goal."

I have had the privilege of interviewing Dr. Segal, and his two entrepreneurial stories are recorded and available as audio downloads and PDF transcripts in Conversations with Trailblazers Volume 1.

He is a truly inspiring hero whose personal challenges led him to refuse to lie down and take being sued without merit. Instead he fought back in the most effective of ways - addressing a real source of pain and suffering for physicians while building a successful business.

Isn't that what creative, resourceful physician entrepreneurship is all about?

A quick update to my post two weeks ago about convenience clinics! 

It appears, from an article in today's Philadelphia Inquirer titled "New Standards for Convenience Clinics", that the newly formed Convenience Care Association is keeping apace with the critics by announcing new safety and quality standards.

It is refreshing to see an organization act swiftly (or so it seems) to forestall any serious criticism, by composing and agreeing to a set of standards designed to address the most legitimate and serious concerns.

The standards include several quality measures, such as:

• peer and physician review
• use of evidence-based treatment guidelines
• collection of patient-outcome and satisfaction information
• building relationships with other health-care providers with a view to sharing patient information as appropriate

Watching with fascination how the delivery of medical care is evolving through different business models, I am once again made aware of the inventive, creative nature of entrepreneurship at work. I hope that the end result of all of these disparate efforts will be an integrated, affordable, "commonsensical" continuum of care that capitalizes on our greatest strengths - knowledge, technological skill, and the desire to do good!

By the way, I am bummed that what I thought was my own cleverly made-up term - convenience medicine - was thought of long before I got there!!

If you are in the market for funding for your new physician business, and yours is a healthcare service or a medical device company, you are in luck!

In an article today in the San Francisco Chronicle highlights the leap in investments made in healthcare ventures by angels in 2006 - up 10.8% in the year, to $25 billion dollars!

Angel investors are typically wealthy private investors seeking a good return on their investments, and unlike venture capitalists, are less likely to need to insert themselves into the operations of the company in which they are investing. They do need to be satisfied, however, that their risk is being minimized by being assured of a sound business plan, a viable set of financials and a solid management team!

I noted this trend in a blog post last year and am happy to see it sustained through the remainder of the year, per the recent report by the Center for Venture Research at the University of New Hampshire.

According to the article: 

Dennis Fernandez, managing partner of Fernandez & Associates, a Menlo Park intellectual property law firm, said he has also seen "a modest unleashing of early stage capital," including funding for health care startups.

He said the aging of the Baby Boom generation and the growing reliance on information technology in health care has prompted entrepreneurs to explore new business opportunities.

He cited the trend of making medical records digital and more easily accessible to patients and their health care providers.

"There is an opportunity here to automate and integrate," he said.

"I think there is a screaming need for streamlining the management of patient information." (bolding all mine!)

It strikes me that now is the time to strike, if you are a budding physician entrepreneur with an idea that will serve the Boomer market or the need for seamless medical and personal health information integration and transfer.

With that in mind, I encourage you to take advantage of the complimentary monthly teleclasses I hold for any physician who is eager to acquire the skills and discipline to start a new venture or grow an existing business or practice.

Tomorrow, Wednesday March 21st, our class topic will address how to prepare yourself financially for a new business venture as well as what your funding source options are.

And next month, I will be interviewing Jim Horan, author of The One Page Business Plan, on how to begin the business planning process and how to write a well-thought out plan, on one page. 

Come join us and prepare yourself to claim your share of the huge "angel pie"!