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In the second episode of Practice Matters, Payal Kohli, MD, founder of Cherry Creek Heart in Denver, and the 9News/Daily Blast Live medical expert, discusses how to legally register your private practice and start hiring your team.

The following is a transcript of her remarks:

Hi, everyone. I'm Dr. Payal Kohli, medical director and founder of Cherry Creek Heart in Denver, Colorado. In today's episode of Practice Matters: how to hire a team, who to get on your team, and how to get started with your new practice.

You know, starting a legal business can be quite a challenge and, if you haven't done it before, it is a bit of a learning process. I kind of fumbled my way into it. But I would say there's three levels to think about. Just like when you file your taxes, you think about three levels, right? You think about the government level, the IRS, the federal government, you think about the state level, and then you think about the city. Those are the three levels at which you really need to think about your business.

Of course when you start a new business, the first step is to come up with the name of a business. So you have a legal name for your corporation -- my corporation is called Heartistic Colorado -- and then you have a DBA name, "doing business as." You have to decide what the "screen name," so to speak, for your practice is going to be, what you want patients and healthcare providers to refer to your practice as.

Mine is called Cherry Creek Heart. So I'm Heartistic Colorado, LLC, doing business as Cherry Creek Heart.

The reason that the DBA piece is important is because you'll have to file two pieces of paperwork. The first is registration with the secretary of state of your specific state. That'll give you basically what's called an employer ID number, which is like a Social Security number for your practice. Then you use that to file a DBA form to figure out the screen name, so to speak, for your practice, and you're off to the races on the state level, so you're pretty much all set.

Now in your city, you'll have to tell them that you're working in this city so that you can pay them the appropriate taxes. You'll have to go to the city portal and register your business there as well.

Then for the IRS, you'll have to talk to your accountant about deciding whether you want to be an LLC, a limited liability corporation, an S corporation, or whatever classification you want your business to go under for tax purposes.

Once you get those three steps done, you're pretty much off to the races and ready to start finding your team.

I often say, when you're taking your first bite, don't bite off more than you can chew. It can certainly be very tempting to have a large team and it feels very rewarding to have a lot of people working with you and helping to set everything up, but start small. That's what I would like to say.

As an example, when I started my practice, it was during the pandemic and I had one other employee besides me. That was my assistant who answers the phones, he was a front desk, he helped register the patients and schedule their appointments. Now we've grown to several employees and I have about 10 to 12 employees working under me in different ways, some as contract, some as W2s. The idea is to make sure that you think about your typical day, think about what your first 6 months of your practice are going to look like in terms of how many patients, in terms of workflow, what are the tasks that need to be done, and then you decide the size of your team.

At the very minimum, you're probably going to need a front desk and a back desk person. A person who can do both jobs is "cross-trained" as we like to say. So they could put the patient in the room, do the vitals, do the EKG, they could also check them in, check them out, collect the copays, answer the phones, and help you with the prior authorization. That's called a cross-trained person who can do both tasks. I would start with that one at the very least.

Then you actually want to think about, of course, a billing person, because as many doctors we are not trained to handle our own billing. We don't know a lot about it, and sometimes trying to do it on your own can be a little bit challenging. Now, I certainly encourage you to be learned in the billing because the more you know, the more holes you can plug in your boat. Because the billing holes are the biggest holes in your boat, actually. But really having somebody who's there scrubbing your claims, running your copay sheets, telling you how much to collect from patients, working what's called the accounts receivable, which are the claims that have come back and they need additional information -- that is somebody that you're going to need on your team as well.

I would hold off on an office manager in the beginning, because they're expensive. They can certainly help with the hiring, firing, and all the other nuances of it, but in the first few months of the practice, that person may not actually earn back their paycheck. So perhaps it's going to be a Q3 or Q4 goal for your practice to hire the office manager.

Then if you have multiple providers, you want to make sure that you at least have one medical assistant according to their FTE (full-time equivalent). Depending on how much they're in clinic and working, they may need the full-time medical assistant for them as well.

In this current climate where it's so difficult to find people and everybody's hiring, it is really challenging. It is challenging to find the right labor and find the right people on your team. I would say to highlight the fact that you're small, right? It's like that movie "Enemy of the State," where Will Smith says, "Our advantage is that we're small," or maybe Gene Hackman said that, I can't remember.

But the point is, you're small so you can have personalized attention, you can do more teaching, and your staff can have more autonomy and more flexibility than they would in a big corporate hospital system where they may not be able to change much of what's going on, they'd just sort of have to accept it. So I would make sure you highlight those advantages of being a small private practice where you as the owner are personally invested, not just in your employee, but also in the success of the practice. So you're there for them.

Then I would be sure to reach out on Facebook groups. There's a Craigslist hiring forum that one of my friend's office managers told me about that has been really, really successful in finding people sometimes that may not necessarily be going out there looking for jobs, but they're not all that happy in their current position and so if they came across something, they might be more likely to take it.

I would say the most important thing when hiring an applicant is: reliability, reliability, reliability. Those are my top three for sure, because you can imagine when you're running on a very small staff and you're running a tight ship, that person being present can make or break your day, especially if it's a busy clinic day with lots of patients back-to-back.

So you really want to try to get somebody on your team that, even if they're not perfectly trained, even if they're not coming in with tons and tons of experience, but they're going to come in for their assigned shifts, they're going to stay the whole time. They're not leaving early, they're not calling in sick, because a lot depends when you have a smaller team on each individual member of that team, and as I said before, they're wearing multiple hats. Sometimes they're doing front office and back office and answering phones, and so it might be difficult if they don't show up because then it all comes upon you.

But in addition to reliability, of course, I think you want somebody who's engaged and who's enthusiastic. The really great thing about running your own office is that, especially as an outpatient provider, it's pretty low-key. In other words, you can teach them most of what they need to know. It's not like you necessarily need somebody to come in with a PhD in medical assisting in order to work in a small private practice office. You can kind of teach them the basic skills as long as they're enthusiastic, they're engaged, they're organized, and they're willing to learn.

So remember the phrase, "teamwork makes the dream work." Now hopefully with the right team around you, you can make your dream work.

Join us on the next episode of Practice Matters as we share more tips and tricks for you to start your private practice.

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