The Right Stuff
Geeta Lalwani, MD, discusses the ins and outs of starting a private practice.
After talking to a fellow ophthalmologist based out of Boulder, Colo., her hometown, Geeta Lalwani, MD, decided on a change of scenery. She left her faculty position at Bascom Palmer Eye Institute in Miami, Fla., and formed her own private retina practice back home. After that, all parts of the business then became her responsibility, not just the clinical aspects. In an interview with NRMD, she discusses her journey as both a retina specialist and a practice administrator.
NRMD: Tell us about your education and your immediate post-education decisions following fellowship?
Geeta Lalwani, MD: I was lucky enough to land what I call my lottery ticket, a medical/surgical fellowship in retina health at Bascom Palmer Eye Institute in Miami, Fla. While I was going into my second year, I interviewed at several private practices, and, ultimately, I decided to stay at Bascom Palmer and join the faculty. I spent 5 years there.
Miami is not my hometown, however; I am from Boulder, Colo. My husband and I often spoke of returning to the area with our kids. I was back spending some time with my family when I had a coincidental meeting with an ophthalmologist who had recently started his practice in that area. We started talking, and, to my complete surprise, he said that there was no established retina surgeon in the area. This was a shock to me because Boulder has a decent-sized population, very affluent and very well-educated. I spent some time during that visit shaking hands and meeting ophthalmologists and optometrists in the community and found that what I had been told was true: there really was no established retina surgeon. This left room for me to open the door to a surgical retina practice.
NRMD: Before you opened your own practice, what kind of research did you do to prepare?
Dr. Lalwani: I did do a lot of research—it is amazing what Google can give you, quite frankly. It gave me a lot of tools to understand the demographics of the local population—not only in terms of age, race, and sex, but also in terms of the insurance market. You can understand it in terms of the current referring doctors, optometrist loads, ophthalmologist loads, and, in this instance, the lack of retina specialists. I did a lot of research to understand the community.
Additionally, I come from a very entrepreneurial family, and I think that had a lot to do with my even considering this move. Having seen my dad start his own company in the information technology industry, it was never something that I did not think I could do. My one brother has a series of bars and restaurants in New York. My other brother started his own law firm in technology and medicine. I think that family history had a lot to do with feeling comfortable going in this direction.
The second part to this is that I had already been in practice for 5 years. I was comfortable and had a strong foundation in the medical and surgical aspects of practicing retina. So learning the business aspects was something that I felt like I had the time and mindset to do.
NRMD: Coming from this entrepreneurial family, did you talk to your family about this venture for advice?
Dr. Lalwani: Oh, absolutely. My dad helped me set up the bookkeeping initially. My brother, who is a lawyer, helped me to establish the legal and background details of how the corporation works. I also had a couple of chance encounters that helped me tremendously for which I am incredibly grateful and that I have tried to pass forward.
First, I was introduced to a retina specialist who lived in Utah. To this day, I have never met him face-to-face, but we talked on the phone and through text messages quite a bit. He helped me create a list of everything that I needed to do to establish a retina practice. In fact, I saved all his text messages and have since passed them on to other friends starting practices.
Second, in Boulder, I met the ophthalmologist I mentioned previously. That was probably one of the most serendipitous meetings in my life, other than meeting my husband. He helped me in getting established, showed me the ropes of the community, and introduced me to all the demographic and relevant ophthalmic political aspects of the area.
NRMD: What characteristics are necessary to open your own practice?
Dr. Lalwani: First and foremost, you need to have a strong stomach. Opening your own practice is not for the weak of heart. You really need to have fortitude and resilience, you need to be able to multitask, and you need to have the right personality because you are the reputation of your practice. My No. 1 focus is always to do a good job for each patient. Your entire reputation depends on that.
Second, being personable and proactive is mandatory. Marketing yourself is a huge factor in developing your own practice. In terms of business, I think you need to be savvy. As with any business, you need to manage your overhead; that is just as important as building your patient base. In the beginning, I was very tight with hiring employees. For the first 6 months or so, I had only a receptionist; I did everything else myself. One time, my front desk person had to take off unexpectedly for a long weekend, which meant she could not be there on a Friday afternoon when I was supposed to be in clinic. I said, “Don’t worry about it, I’ll manage.”
So, there I was on a Friday afternoon, probably 6 or 7 months into the practice. There were only supposed to be five or six patients—nothing that I couldn’t manage. All of a sudden, the phone started ringing off the hook. Before I knew it, I had 20 patients lined up, including two retinal detachments. I was literally the only person in the office, running around frantically—not only taking care of patients and doing all the paperwork, but also answering the phones. At one point, I looked around and my patients were telling the new patients coming in the door to fill out their paperwork. My own patients were helping me! I can look back and laugh about it now, but it was definitely a turning point for me. I was like, “All right, I need to hire more help.” But I also realized I had enough patient volume to justify it.
NRMD: Tell us how your first and second years in private practice for yourself differed.
Dr. Lalwani: Honestly, the first year in private practice is scary. You start to realize what a big commitment you have made and everything that goes along with it. I don’t think you can ever overestimate how much work goes into starting a solo practice. Not only are you there to manage patients, but you are also there to manage and hire employees—as well as make sure your revenue is continuous and your billing is good. You are responsible for everything.
That being said, the first year is incredible because you are building something that is entirely your own. You have a say in every single decision. Then, as you go into your second year, you start to see that this thing you have built is growing on its own. It’s kind of like watering a seed. In the second year, you start to see that this plant is blossoming. It is incredibly inspiring, and it makes you feel very proud.
The second part that has been really fun for me is that Boulder is my hometown. I grew up here. I have two brothers and a sister, parents, uncles, and cousins. I have strong roots in this town. Every third person who walks in my door, especially if they are older and from the area, is somehow connected to my family. I had my fifth grade teacher as one of my patients. I have a sense that I am this hometown girl who came back to take care of her community, and I feel very good about that. It is unusual in this day and age to feel like a community doctor in the best sense of the word.
NRMD: What words of encouragement or cautionary tales do you have for young retina specialists who are thinking about starting their own practices?
Dr. Lalwani: You need to be able to withstand highs and lows in terms of both the business and medical aspects. I think one of the things I miss—and I am looking forward to extending my practice with other physicians—is having somebody with whom to discuss patients. Most retina specialists can talk about retina to no end, and having somebody to talk to about cases or presentations is wonderful and supportive. You also need to be comfortable with your medical and surgical knowledge, because you will need to manage anything that comes through the door—not only to help the patients, but also to put referring doctors at ease in sending patients to you. Government regulatory issues are a challenge, but they are probably less of a challenge for a younger person starting out than for an established practitioner later in life.
The important thing is: it’s doable. I encourage people starting out to connect with others in solo retina practice and discuss the issues involved. Most people are very willing to help. If you really want to do it, know your community and what you’re getting into beforehand. But it’s definitely a wonderful challenge to take on.
Geeta Lalwani, MD
• vitreoretinal surgeon at Rocky Mountain Retina Associates in Boulder, Colo.
• financial interest: consultant, Allergan, B+L; speaker, Ocugen, Genentech