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Episode 10

The business of practice ownership

Show notes

Welcome to Generally Speaking, the conversation for all GPs.

Join GPs Dr Gill Singleton and Dr Billy Stoupas as they discuss some of the most pressing topics and issues surrounding the operations of a GP.

This episode, Dr Stoupas and Dr Singleton tackle the intricacies of running a GP clinic with Dr Maria Boulton. Maria is a company director, GP, author and public speaker. She is also a member of the RACGP Private Practice Owner’s Steering Committee and the RACGP Federal Business Sustainability Working Group. This podcast features two conversations with Maria. One which took place at the beginning of 2020 and then a follow up recorded mid-year in the wake of the coronavirus pandemic.

15 July 2020 - 11:35 AM | 33 min 56 sec

(00:21) Dr Singleton and Dr Stoupas outline the recording time frame for the audience and set the scene for the conversations.

The first chat took place just as Dr Stoupas was considering setting up his own practice, so was perfectly timed for some pointed questions. The follow-up conversation detailed many of the sizable impacts of the pandemic on a general practice, and was just in time to get some feedback from Dr Stoupas’ on his first few months of running his own practice.

Introduction of Dr Maria Boulton

(01:38) Dr Stoupas gets a rundown on Maria’s career.

Originally from El Salvador, Central America, Maria came to Australia when she was only 11. She studied medicine and by around 2016 she decided to start her own GP clinic with a business partner. What started as a small practice, has grown into 19 consult rooms and plenty of happy staff.

(02:23) Dr Stoupas is inspired by the story and reflects on the fact that practice ownership isn’t for everyone, including Dr Singleton.

He wonders if by the end of the episode they can convince her to take the business on! And he reveals that he is currently looking at one himself and follows on with a question about Maria’s motivation for getting into it.

Dr Boulton explains that it was an organic process. She had listened to some inspiring business owners at a Telstra Awards function and then found herself complaining with a colleague the next day about something that had been an issue many times over. Together they thought, ‘Why not do it ourselves?’. So she and her now business partner Fiona just turned that motivation into a practice.

(03:53) Dr Stoupas follows up asking how they actually went about it. 

Dr Boulton outlined that the first step was to find the right location and that they spent a lot of time, about six months, to find precisely the right one. Part of the equation is of course the finances, so she emphasises that the business plan needs to account for appropriate figures, especially when it comes to rent. Dr Boulton has plenty of strategies to help identify the right location for the right clientele for the right price with the right branding. Oh and make sure that the place you chose is zoned for the business you want to run.

(06:23) Dr Singleton reflects on her time at medical school and didn’t recall doing any business management training. She asks if Dr Boulton needed any further education.

Dr Boulton ended up getting the extra insights she required through surrounding herself with a great team of people and some mentors. But the requirement to take on the business side of a general practice has sparked her passion for the RACGP Practice Owners Conference, because she admits that most colleagues she knows have not done any business training whatsoever. She and her practice partner, Fiona have done a some upskilling and management to make sure that they are doing the right things, but she figures you don’t need an MBA.

(08:01) Dr Stoupas, reflecting on the fact that he is hoping to take on practice ownership, sends a flurry of questions to Dr Boulton regarding clinic purchases versus rental, previous business figures and the scrutiny required of the books, etc, and whether these issues are covered at the RACGP Practice Owners Conference. 

Dr Boulton acknowledges that because of the size of the group in attendance, the details of a particular individual’s scenario may not be fully covered, but that the common and major issues are very well scrutinised. And for her, it comes down to the business planning. She says, ‘You have to let the numbers do the talking’. There are templates and plans available at the conference to help GPs know what to look for, what to ask and how to know if the numbers ‘sing’.

(10:07) Dr Stoupas follows with a question about financing, debts and the banks.

Dr Boulton said that they found it quite straightforward to secure finance as doctors are looked on as a pretty safe bet. So that’s not the hard part, but you have to make sure that you have the ability to pay the loans back. She calculates that most new businesses don’t make any money in the first 18 months to three years, so you need to put that into the business planning.

(11:27) Dr Singleton is particularly interested in how Dr Boulton balances everything. Between the clinic, her kids, organising the conference and even having written a book, how does she do it? And does she see fewer patients as a result?

Dr Boulton reflects on how hard she and her partner worked in the beginning to try and accomplish everything and see as many patients as possible. As far as balance went, it wasn’t. She was lucky that her husband was able to drop the kids to and from school and to get some other support from time to time. But initially she was very time poor – and with a new business that’s just the way it is. 

(13:01) Dr Singleton quips that sleep deprivation must be a part of it.

Dr Boulton concurs. She says that you need to be efficient and you’ve got to be able to make a decision and stand by it. If it’s the wrong decision, that’s fine. You just learn from it and move on. 

(13:23) Dr Stoupas asks about the pros and cons of going solo or as part of a group or partnership into business ownership. 

Dr Boulton figures that you must choose the right person. And she thinks it’s going to be someone who’s not necessarily like you but someone who’s going to compliment you, and someone who has the same values. Regardless of how well suited you are, however, you must have a legal partnership agreement which will include a termination clause, just in case it doesn’t work out.

(14:46) Dr Stoupas interjects with, ‘That’s a big motto of mine – plan for the worst and hope for the best.’

Dr Boulton agrees, especially given that she comes from an earthquake-prone country. She follows with more support of the partnership approach, recognising that she could at least have a week off in the first year, because she had someone to share the load with. That’s something that might not have been possible had she gone solo.

(15:26)  Dr Singleton asks Maria if she had any other mentors or practice owners that she looked up to along the way.

She said that she didn’t really, but she did work for a great practitioner in McKay who inspired her with the sort of clinic he ran. But her approach has been to put a quasi-board of directors in place to help steer the business. Her husband, who has his own business experience along with others from fields other than medicine, have been very valuable to her business.

(16:42)  Dr Stoupas asks if the college has any resources available to advise about buying or building a clinical business.

Dr Boulton replies, ‘Absolutely’. Depending on which state you’re in, some of the colleges are a little better resourced than others. But it’s a good idea to just approach the State Council and discuss what’s on offer.

(18:14) Dr Stoupas prods Dr Singleton to see if she’s interested in starting her own clinic.

(18:19) Dr Singleton acknowledges the great job that Dr Boulton has done in raising her curiosity.

Dr Boulton makes her final remarks and notes that since she and her partner have become business owners in the field, they have become much more active members of the RACGP and that it’s rewarding to touch base with everybody else who is in the same position.

(19:03) While Dr Singleton isn’t willing to commit yet, she asks Dr Stoupas for any key resources to add to Maria’s feedback.

(19:12) Dr Stoupas describes the RACGP General Practice Management Toolkit as a thorough resource that contains a lot of the information you’d need to know about running a practice, including different modules on business management, finances, clinical governance and staffing.

Second recording session 

(20:09)  Dr Stoupas describes that we are having to adapt to the time during the pandemic and expresses his interest in discovering what Dr Boulton has experienced over the last few months.

(20:42) Dr Stoupas welcomes Maria back to the podcast and asks how she’s going.

Dr Boulton explains that things have settled slightly and she’s hopeful that they will stay steady through to September when Jobkeeper starts to wind back. She’s heartened to have some patients come back face to face, and that patients are also coming back to get their screenings and check-ups done that may have been missed.

(21:18) Dr Stoupas asks how she went with the practice business and income went in the first few months of the pandemic.

Dr Boulton said that it was like being a new business owner again. Neither she or her practice business partner were paid for three months. All of the revenue had to be reinvested back into the practice to keep the doors open, because they experienced rising costs.

(22:04) Dr Singleton offers her sympathy and follows with a question about the mandatory bulk billing of telehealth and its impact.

Dr Boulton outlines her practice as a mixed billing clinic and that they found the mandatory bulk billing devastating because the incentive was not enough to cover her costs. Now that they’re seeing more patients face to face, it’s not as big an issue as it was in April when more than 50% of the consults were telephone or telehealth.

(23:12) Dr Stoupas asks for Dr Boulton’s thoughts on practice ownership now, since the pandemic.

Dr Boulton describes how it has been a very hard few months. But being in charge of her own clinic and ensuring the safety of her staff makes her feel that she wouldn’t want it any different. Although she would consider lobbying the government to treat mixed-billing clinics differently if it were to happen again.

(23:57) Dr Stoupas asks for Maria’s thoughts on investing in a clinic now – would it be a good time?

Dr Boulton comes back to her basics and says that it really all depends on the numbers. As well as the demographics in a particular area. Is there a need for more doctors there and what is the competition like? While she and her business partner were looking at expanding this year, they’ve put it on hold. She thinks it’s time to consolidate and to wait to see what happens in September.

(25:46) Dr Stoupas reaffirms Dr Boulton’s approach.  

(26:28) Dr Singleton summarises a recent college survey with its potentially bleak forecast and suggests that GPs are going to have to innovate. 

Dr Boulton offers her thoughts and she’s a bit more half-glass full about things. She recalls that more than half of the GPs surveyed were optimistic about the future. And she references what Dr Stoupas said, that ‘If we can make it through this, then we will be fine at the end of it’. But she does acknowledge that innovation will be mandatory for survival and that it will cost more to run a practice in the future, so ensuring that you know your numbers is more important than ever. Between extra facilities or equipment or PPE (personal protective equipment), all costs are going up.

(29:20) Dr Stoupas is awakening to the growing list of expenses required to run a post-COVID clinic. And that it is in fact, challenging and that people might not realise the true costs involved.

Dr Boulton says that the lack of acknowledgement of these costs by the government, amongst other things, has spurred many general practice owners, including herself, into advocacy lately.

(30:55) Dr Singleton thinks this advocacy is an example of how some GPs have innovated around the country. Many who haven’t naturally been in the advocacy space are really stepping up. She asks what we need to do in order to maintain the momentum and also to maintain quality, GP-owned practices for our communities?

Dr Boulton feels that the lovely thing about being a GP-run practice is that they’re responsive to the community’s needs. She thinks that now is the time for GPs to cement their place in the community. Some of her colleagues have found unique ways of doing just that, and her clients are very grateful. 

(32:15)  Dr Stoupas thanks Dr Boulton and she reciprocates with a plug for the podcast.

(33:01) Dr Singleton and Dr Stoupas reflect on the chat and the state of things at the moment and agree that they’ve all had to change the way that they practice in a short amount of time.

As a practice owner, the added stress of the financial considerations makes things potentially even more concerning. Dr Singleton takes the opportunity to mention the RACGP GP Support Program. And Dr Stoupas reminds everyone that it’s important to talk to each other and that it’s okay to not be okay. We’re all going through a really hard time.

  • For more information on the business of practice ownership, the RACGP website has some valuable resources
  • For information on the GP Support Program, visit the RACGP wesbite

‘You just have to be really efficient. I don’t know if you’ve ever built a house, but if you spend two hours deciding on the colour of the tiles, it’s not efficient. You’ve just got to be able to make a decision, and stand by it. And, you know, if it’s the wrong decision, that’s fine. You just learn from it and move on.’

‘To be perfectly honest, it’s been a very hard few months – a lot of work. But having had a chat with my business partner, Fiona, I don’t think we would do it any differently. It’s actually been a blessing that we have been in charge of our own clinic, and that we can make sure that our staff are safe. And in that respect, we wouldn’t change it for anything.’

– Dr Maria Boulton

  • If you would like to learn more about Dr Maria Boulton’s experience and insights, visit her LinkedIn profile
  • If you would like to learn more about Dr Billy Stoupas’ achievements and insights, or would like to connect, visit his website
  • If you would like to learn more about Dr Gill Singleton’s achievements and insights, or would like to connect, visit her LinkedIn profile

Generally Speaking is an RACGP podcast, sponsored by CommBank and hosted by GPs.

Resources referred to in the podcast and on the webpage are not necessarily endorsed by RACGP and views of the presenters are their own.

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