Creating a Practice Without Walls

25 years ago, due to my 30-year-old wife's battle with breast cancer while she was pregnant with our 2nd child,
I had to make the move from private practice to traditional employment.
-the whole idea was to simply my professional life as much as I could in a rural family medicine practice with surgical obstetrics so that I could focus on her care while I worked
-Back in the day, employed doctors still had quite a bit of autonomy over their professional life.---it was a pretty good deal--work hard, get paid based on productivity, and live 2 minutes from the hospital and practice that were on the same campus.
--but as you know our during the 30 plus years that mark our lives as attendings is a very dynamic stage.
-my wife lost her battle with cancer, I re-married, and have 5 children
-My practice and the hospital grew quickly and our relationship was win-win
-Then corporate consolidation began, the loss of local board control, and local governance began.
-The consolidation and re-organization just kept going til the decision makers were now just generic names who lived multiple states away.
-Then the micro-management began, the EHR and data mining accelerated, and I found myself working harder then ever--including a few hours of EHR at home in the evenings.
-The last straw came when I was asked to take a paycut on top of having to prove my worth with quality metrics that rewarded me with money that I had already earned.
-Burnout was nearby, and I knew I had to make a change
-I loved my community and the professional life that I had built--so I really didn't want to move.
-our community was controlled the hospital with virtually every doctor in the community being employed by them.
-I contemplated starting a private practice--but lacked the confidence that my patient loyalty could overcome their deep pockets and 3rd party alignments.
-I felt trapped--but I was smart enough to call for a lifeline. I met with healthcare business consults to discuss my options and that's when I was exposed to the option of long-term independent contracting, aka employment lite--for the first time.
-they helped me reflect on my professional assets in the marketplace, my power that was associated with their labor deficits from multiple doctors leaving the community, and kicker that I didn't have a non-compete clause in my contract
-In the end, I made the bold move to start a PC and negotiate a non-employee contract with them as long-term contractor rather than an employee, and simultaneously purchased a medical office building that include a letter of intent for them to lease it from me for my practice.
-the end result was a restoration of my professional autonomy, relief from the micro-management of employment, and the addition of a 2nd income channel through my medical office building---all while I continued to wear their team jersey and for all practical purposes in the visibility of the community nothing changed--but the invisible business of operating a practice without walls changed everything. I went on to monetize every element of my professional work life--to create more income channels--all things I used to do for free as a great corporate citizen--from hospital-ER calls to NP collaboration to trainer oversight in sports medicine to nursing home care. All of my work was now finally being transformed into business income channels.
-at the end of this presentation I'll walk you through the financial elements of the personal case study of my transformation--frankly, I wanted proof that it would "work" before I jumped in.

Fast forward to the present--to a world that my son-who is a 2nd-year family resident is entering--and everything has worsened.
-the system is even more rigged against individual physicians as large corporations control the marketplace
-Doctors are herded into traditional employment with a fatalistic awareness that the options are limited-which is why 90% of new graduates go this route and nearing 60-70% of all doctors are employed by large corporations
-the end result is pain--moral injury and a burnout rate nearing 60%
-acceptance of the broken status quo by doctors is akin to Einstein's definition of insanity--"doing the same thing over again and expecting different results"--that's what young doctors confidently believe--that they can come under the control of corporate overlords and win the battle--the proof--the reality is that they can't and don't--they are proof that their mindset is akin to "insanity"
-something has to change-and the needed change is for doctors to be empowered to choose their fate in the marketplace
-it is my belief and my experience that the first step to empowering yourself is to create a virtual micro-corporation around yourself.
-Let's look at the status quo

-The financial incentives of traditional employment are hard to pass up

-especially when coupled with the promise of not managing a business or practice

-and especially with a guaranteed sign and drive salary

-especially with the promise of paying off your massive school loans

This "Deal" to sign up as a traditional employee in exchange for your small business powers/revenue producing power seems like a pretty good move for both parties.

Frankly, it's hard to say no to these advertised "safe harbors" that are lined with jobs, recruiters that are selling them, and the simplicity of just choosing where you want to live as you launch your long awaited professional life as an attending physician.

It's certainly much easier to choose employment in contrast to private practices this are struggling elimination from the marketplace by

-3rd party forces that make it more and more difficult to make good living at a FMV rate

-the constant pressures from hospitals and private equity groups who so private practices as economic pawns in the healthcare marketplace--in essence forcing lucrative purchase agreements that are hard to pass up --rather than fighting what seems invetable

-all of this scuttle certainly makes a young doctor wary of the economic risks of"buying into a private practice" all while they drown in $300,000 education debt, and the consumer debt burden associated with a house and lifestyle as an attending physician.

-in contrast to these risks, it's so much simpler to accept a predictable paycheck and safe harbor that promises the elimination of student loans.

-there seems to be a binary choice, but increasingly it's a super highway that herds you in one direction

That's the status quo. A healthcare marketplace controlled by 3rd parties, big corporations, and the biggest force of all--the government.

Story of pathologist in Michigan
-3 year buy-in process to small practice
-The founder is planning to retire soon after her purchase
-PSA for services in place with rural hospital
-Changes began to happen due to Hospital System consolidation and assimilation with a large hospital system in the state capitol--led to service line consolidation with the elimination of the PSA with the private practice and a forced consolidation of the pathologist into the service line contract with a single pathology group in the state capitol as a W-2 employee and with a pay cut.
-this forced elimination of the private practice (small remote single hospital hospital) is a great example of what can happen to private practices--they are at risk for unilateral elimination by larger system players
-This pathologist loved her community, was firmly rooted with her adolescent children, and didn't want to move.
-What would you advise her to do?

I am passionate about helping you discover a 3rd space or 3rd rail of career options that allow you the most flexibility in the marketplace through creating a micro-corporation and using it in a host of marketplace options.

This provides you with a better alternative to traditional employment and private practice due to:

-Preservation of their professional autonomy

-Diversification of their income streams through job stacking

-Improvement of their tax planning options

-enhanced retirement funding options

Let me tell you the story about and Midwestern OB/GYN.

Chance Meeting

- Dr. B.A. had spent almost a decade working as a W-2 employee after finishing his residency.

- However, just before committing to a new contract with a substantial $500,000 annual salary, he came across an alternative that would alter the course of his professional journey.

-You see, he ran into a physician I had helped convert to an employment lite contract from their traditional employment. The physician was so thrilled about the return of autonomy and the financial benefits that he advised the OB/GYN to contact me to discuss things before signing the contract.

-I am glad he did!

-After speaking with me, Dr. B.A. discovered the concept of a virtual professional business entity called a micro-corporation.

-Unlike traditional employment, where physicians are bound by W-2 contracts, forming a micro-corporation provided him with the option to operate as an independent contractor via a 1099 contract.

-Here’s how it worked:

-Micro-Corporation: Dr. B.A. established a professional micro-corporation specifically for his professional services.

-This legal entity offered him various advantages, such as limited liability protection and tax benefits.

-It could be seen as a practice without physical walls, with Dr. B. A. as its sole employee.

-He could utilize it for his main job and his side hustle involving contracted laborist shifts.

Employment Lite Contract:

-Instead of the typical W-2 arrangement, I advised Dr. B.A. to request that his prospective employer access their "hidden menu" of contracts and retrieve the professional services agreement file.

-Under a PSA, a physician (or medical group) remains independent (i.e., not employed by the hospital) and offers professional services within the hospital or at a hospital clinic.

-Locums Tenens has been one of the more common PSA arrangements that healthcare employers use to tap into the professional services of doctors.

Expected Benefits

-1. Tax Efficiency

Dr. B.A. discovered the power of forming a professional micro-corporation, a business structure that is tailored for physicians. By opting for an employment lite contract, he could unlock significant tax efficiency unavailable to W-2 workers.

-Deductions for business expenses, home office use, home business meeting rental, and retirement contributions promised a more efficient use of his hard-earned income

-2. Higher Retirement Savings

One of the most enticing aspects of the micro-corporation journey was the potential for significantly higher retirement savings. -Dr. B.A. realized that the employment lite contract paved the way for generous contributions to a Solo 401(k) and other retirement vehicles such as a cash balance plan, propelling him toward financial freedom in the long run.

Solo 401(k): Dr. B.A. set up a Solo 401(k) plan for his micro-corporation. In 2024, he could contribute up to $69,000 (including catch-up contributions) to this retirement account.

-Cash Balance Plan: The corporation can establish a cash balance plan, which is a defined benefit plan. Contributions are based on factors like age, income, and desired retirement benefit but can be as much as $345,000 annually.

-3. Independence as a Contractor

Embracing the micro-corporation model meant embracing a new level of professional independence.

-No longer confined by the constraints of traditional employment, Dr. B.A. could negotiate terms that better suited his unique expertise and time commitments.

-The micro-corporation allowed him to operate as a contractor, cultivating a sense of autonomy and entrepreneurship.

Professional Autonomy: Dr.B.A. enjoyed greater control over his work. He could choose what % of FTE he wanted with his primary job, negotiate terms, and even take on additional side gigs.

-Location Independence: With the micro-corporation, he wasn’t tied to a single hospital. He could work in various clinical settings, offering services where he preferred.

-The Discovery of True Freedom

Dr. B.A.'s fateful decision to explore the micro-corporation wasn't just about financial gains – it was a quest for true professional freedom.

His story and mine shed light on this relatively hidden path of virtual micro-corporations for most doctors in the US.

-It’s my goal to expose this secret world and let you know that the same opportunity exists for each of you!

The so-called practice without walls reflects an evolving economy and healthcare marketplace

Whereby your hard-earned professional intangible assets are monetized through a micro-corporation structure where you are the only employee

-the only person you have to manage is yourself

-the micro-business and your individual life are synonymous like a glove slipping over a hand

-in this model you enter the marketplace as a business rather than as an individual--or at least you have the power to determine which type of entity you prefer to contract through

-you are among a unique group of service oriented professionals with this power to individually incorporate your professional services--lawyers, dentists, engineers, architects, and doctors can all do this

-When you enter the market place as a micro-business you eliminate the noose of control that is associated with traditional employment.

-When you enter the market place as a micro-business you avoid the numerous risks of private practice that include location dependence.

-your nimble state as a virtual business provides you with the flexibility to create multiple streams of income from multiple locations--all with the power to fuel a preferred lifestyle in a location that can be literally hundreds of miles from where your life circle emanates.

-this all fuels a professional satisfaction that enhances your well-being and financial health.

Sam is a dermatologist in the midwest near a college town.

-he loves his work as a dermatologist and his dad who was a private practice orthodontist always told him that self-employment was the way to go.

-Sam knew this was true as his childhood and life with his dad was a great experience and truly represented the "good life"

-Sam came out of training looking to join a private practice. He started out as a W-2 employee with a plan to buy-in in the future.

-but along came private equity and they purchased the practice, making partners a lucrative deal, which Sam missed out on.

-Sam worked for the PI group for a few years and loathes their mismanagement and soul-less style of medical care. The corporitization of medicine is heartless

-on top of this he is getting slaughtered in taxes as a specialist W-2 employee making over $500,000 per year.

-The admonition of his dad echoes in his brain as he sees no end to the W-2 train.

-He read my book "Doctor Incorporated: Stop The Insanity of Traditional Employment and Preserve Your Professional Autonomy" and reached out for a business consultation with me.

-What do you think would be Sam's professional options for reducing his tax burden and restoring his professional autonomy?

-Would a professional micro-corporation be an option?

One powerful strategy to navigate this complex environment is the formation of a professional micro-corporation. This model offers significant benefits, particularly in terms of increased professional flexibility through the ability to "job stack" W-2 and 1099 jobs. By leveraging their professional services in the marketplace via their micro-corporation, doctors can achieve greater autonomy, financial stability, and work-life balance.

Understanding Job Stacking

Job stacking refers to the practice of simultaneously holding multiple employment arrangements, such as traditional W-2 employment and 1099 independent contractor roles. In the context of a professional micro-corporation, physicians can effectively manage and maximize these diverse income streams. Here’s how it works:

W-2 Jobs: These are traditional employment roles where physicians are hired by hospitals, clinics, or healthcare organizations. They receive a regular salary and benefits, with taxes withheld by the employer.
1099 Jobs: These are independent contractor roles where physicians provide services on a contractual basis. They are responsible for managing their taxes and benefits, offering greater control over their work terms and schedule.

Benefits of Job Stacking through a Professional Micro-Corporation

Enhanced Income Opportunities: By combining W-2 and 1099 roles, physicians can diversify their income sources. This not only boosts overall earnings but also provides a safety net during economic downturns or changes in the healthcare industry. A micro-corporation structure allows doctors to strategically manage these roles, optimizing their revenue streams.

Example: Dr. Smith works three days a week as a W-2 employee at a local hospital, earning a stable salary and benefits. On the other two days, she operates as an independent contractor providing telemedicine consultations. By doing this, she supplements her income significantly while maintaining a stable base salary from the hospital.

Skill Diversification: Engaging in a variety of roles enables physicians to expand their skill sets and professional experiences. This diversification not only enhances their marketability but also keeps their work dynamic and intellectually stimulating. It opens doors to new opportunities and career advancements that might not be available in a single, traditional employment role.

Example: Dr. Johnson splits his time between working as a family physician in a community clinic (W-2) and consulting for a health tech startup (1099) that develops medical software. This dual role allows him to apply his clinical knowledge in a technological context, keeping him engaged and opening up potential future career paths in health tech innovation.

Resilience and Adaptability: The healthcare industry is subject to rapid changes due to technological advancements, policy shifts, and market dynamics. By having multiple income streams and professional roles, physicians can remain resilient and adaptable. A professional micro-corporation provides a robust framework to navigate these changes, ensuring long-term career stability.

Example: Dr. Patel works as a part-time emergency room physician (W-2) and also offers expert medical witness services (1099) for legal cases. When there is a policy change that affects ER staffing and shifts, he is able to rely more on his legal consulting work to maintain his income, demonstrating the resilience provided by job stacking.

Maintaining a healthy work-home balance can be a significant challenge for many physicians. The concept of a "practice without walls" offers an innovative solution that can help doctors achieve a better equilibrium between their professional responsibilities and personal lives. By contracting their professional services out virtually to corporations or individuals, or by taking on roles as long-term independent contractors, short-term locum tenens, or medical directors, physicians can design a work model that aligns with their personal needs and family commitments.

The Concept of a Practice Without Walls

A "practice without walls" is an approach where physicians utilize digital tools, telemedicine, and flexible contracting to provide medical services outside the traditional clinical setting. This model allows doctors to offer their services from various locations, including their homes, and often on their own schedules. The benefits of this approach are numerous and directly contribute to improving work-home balance.

Benefits of a Practice Without Walls for Work-Home Balance

1. Flexible Scheduling: One of the most significant advantages of a practice without walls is the ability to create a flexible work schedule. Physicians can choose their working hours, allowing them to better manage their time and prioritize personal and family activities.

   Example: Dr. Lee, a pediatrician, contracts with a telemedicine company to provide virtual consultations in the mornings and early afternoons. This arrangement enables her to pick up her children from school and spend quality time with them in the evenings. By not being tied to a traditional 9-to-5 schedule, she can be more present in her children's lives while still maintaining a thriving medical practice.

2. Reduced Commute Time: Working from home or other non-traditional settings eliminates the need for daily commutes. This not only saves time but also reduces stress and provides more opportunities for personal activities.

   Example: Dr. Martinez, an internist, conducts virtual consultations from her home office and occasionally works as a locum tenens physician for short-term assignments at nearby clinics. By eliminating her daily commute, she gains extra time each day, which she uses for exercising, cooking healthy meals, and spending time with her family. The reduction in travel time significantly enhances her overall well-being and allows for a more balanced lifestyle.

3. Personalized Work Environment: A practice without walls allows physicians to create a work environment that suits their personal preferences and needs. This can lead to increased job satisfaction and reduced burnout.

   Example: Dr. Anderson, a psychiatrist, has set up a comfortable and serene home office where she conducts her telepsychiatry sessions and consults for several mental health startups. This personalized space is free from the distractions and pressures of a traditional clinical setting, allowing her to provide better care for her patients while enjoying a more relaxed work atmosphere. She finds that this arrangement significantly reduces her stress levels and improves her overall quality of life.

4. Increased Family Time: The flexibility of a practice without walls means physicians can be more available for family activities and responsibilities. This increased presence can strengthen family bonds and improve personal relationships.

   Example: Dr. Nguyen, an OB-GYN, works part-time from home, providing prenatal consultations via telemedicine, and serves as a medical director for a local women's health clinic. This arrangement allows her to be more involved in her children's daily routines and attend important family events. By balancing her professional and personal roles more effectively, she enjoys a more fulfilling family life and a rewarding career.

5. Enhanced Self-Care: The autonomy provided by a practice without walls enables physicians to prioritize their health and well-being. They can schedule regular breaks, engage in physical activities, and ensure they have adequate time for rest and relaxation.

   Example: Dr. Patel, a family physician, integrates short breaks into her telemedicine schedule to practice mindfulness and meditation. She also works as a long-term independent contractor for a healthcare corporation, allowing her to have a consistent yet flexible workload. This routine helps her manage stress and maintain a positive outlook, contributing to her overall mental health. By taking care of herself, she is better equipped to care for her patients and sustain a long and satisfying career.

Practical Implementation

To effectively implement a practice without walls and enhance work-home balance, physicians should consider the following steps:

• Invest in Technology: Equip yourself with reliable digital tools and platforms for telemedicine, electronic health records, and secure communication.

• Set Clear Boundaries: Establish clear boundaries between work and personal time to prevent burnout and ensure dedicated time for family and self-care.

• Create a Dedicated Workspace: Designate a specific area in your home for work to maintain professionalism and minimize distractions.

• Develop a Routine: Establish a consistent daily routine that includes regular work hours, breaks, and personal activities.

• Communicate with Patients and Colleagues: Clearly communicate your availability and working hours to patients and colleagues to manage expectations and ensure smooth operations.

By embracing the concept of a practice without walls, physicians can achieve a better work-home balance, leading to improved job satisfaction, personal fulfillment, and overall well-being. This innovative approach empowers doctors to create a harmonious and sustainable professional life that aligns with their personal values and commitments.

Achieving work-life balance is an ongoing process

The healthcare landscape is rapidly  evolving, and physicians are seeking innovative ways to optimize their  professional and financial lives. The concept of a "practice without  walls" offers a powerful solution for enhancing financial health. By  contracting professional services virtually to corporations or  individuals, taking on roles as independent contractors, or serving as  medical directors, physicians can unlock numerous financial benefits  that go beyond the traditional employment model.

Enhanced Financial Health

A  practice without walls not only offers flexibility and work-home  balance but also provides substantial financial advantages. Here are key  ways this model enhances a physician's financial health:

1. Income Diversification: Active, Passive, and Retained Income

   • Active Income:  This is earned through direct provision of medical services, such as  virtual consultations or locum tenens assignments. By engaging in  diverse roles, physicians can maintain a steady and varied income  stream.

     Example: Dr. Johnson provides  telemedicine consultations, works as an independent contractor for a  health tech startup, and occasionally takes on short-term locum tenens  assignments. This combination of active income sources ensures financial  stability and reduces dependence on a single income stream.

   • Passive Income:  Physicians can generate passive income through investments, royalties,  or rental properties. The flexibility of a practice without walls allows  more time for managing and growing these passive income streams.

     Example:  Dr. Lee invests in rental properties and medical-related startups. The  income generated from these investments supplements her earnings from  her telemedicine practice, providing a steady passive income stream.

   • Retained Income:  By operating through a professional micro-corporation, physicians can  retain income within their corporation, allowing for strategic  reinvestment and growth.

     Example: Dr.  Patel retains a portion of her earnings within her micro-corporation,  which she then reinvests in expanding her telemedicine services and  purchasing medical equipment. This retained income strategy helps her  grow her practice and increase her overall wealth.

2. Tax Optimization

   Operating  as a micro-corporation offers significant tax advantages. Physicians  can leverage various tax deductions and strategies to optimize their tax  liabilities.

   Example: Dr. Martinez  deducts business expenses such as home office costs, professional  development, and travel related to her locum tenens assignments.  Additionally, she utilizes tax-advantaged retirement accounts to reduce  her taxable income, significantly lowering her overall tax burden.

3. Individualized Fringe Benefit Plans Using Pre-Tax Dollars

   A practice without walls allows physicians to create customized fringe benefit plans that maximize their financial well-being.

   Example:  Dr. Nguyen establishes a comprehensive benefit plan through her  micro-corporation, including health insurance, retirement contributions,  and continuing education allowances. By using pre-tax dollars, she  effectively reduces her taxable income while enhancing her benefits  package.

4. Enhanced Retirement Funding and Accelerated Net Worth

   The  financial flexibility provided by a practice without walls allows  physicians to allocate more resources towards retirement savings and  accelerate their net worth growth.

   Example: Dr. Anderson strategically enhances her retirement savings through a combination of retirement plans:

   • Solo 401(k): She contributes the maximum allowable amount each year.

   • Cash Balance Plan:  Dr. Anderson supplements her Solo 401(k) with a cash balance plan. This  plan allows her to make substantial annual contributions, doubling her  retirement savings to nearly $200,000 annually.

   By  leveraging these retirement vehicles, Dr. Anderson not only secures her  financial future but also accelerates her net worth growth, positioning  herself for long-term financial success.

Practical Implementation

To effectively enhance financial health through a practice without walls, physicians should consider the following steps:

• Consult Financial Advisors: Work with financial advisors and accountants experienced in healthcare to optimize income, tax strategies, and benefit plans.

• Invest in Financial Education: Continuously educate yourself on financial planning, investment opportunities, and tax laws to make informed decisions.

• Leverage Technology: Utilize financial management software and tools to track income, expenses, and investments efficiently.

• Diversify Income Sources:  Actively seek diverse roles and opportunities that align with your  skills and interests to create a robust and varied income stream.

• Plan for the Future: Establish and regularly review long-term financial goals, including retirement planning and wealth accumulation strategies.

By  embracing a practice without walls, physicians can significantly  enhance their financial health. This approach not only provides  immediate financial benefits but also ensures long-term financial  stability and growth, empowering doctors to achieve greater financial  freedom and security.

In today's healthcare environment,  physicians are increasingly drawn to the concept of a "practice without  walls" as a means to reclaim their professional autonomy and embrace a  lifestyle that prioritizes flexibility and personal development. This  innovative approach allows doctors to contract their services virtually,  diversify their income streams, and shape their careers according to  their own terms. Let's explore how a practice without walls offers  significant benefits across these key areas:

Preservation of Your Professional Autonomy

One  of the most compelling aspects of a practice without walls is the  preservation of professional autonomy. Physicians can maintain control  over their practice decisions, patient care approaches, and professional  collaborations without the constraints often imposed by traditional  employment models.

• Example:  Dr. Thompson, an orthopedic surgeon, operates her telemedicine practice  from home, setting her own patient care protocols and treatment plans.  This autonomy allows her to provide personalized care while maintaining  professional integrity and patient trust.

Independence & Flexibility

A  practice without walls empowers physicians to design their work  schedules and locations according to their preferences and personal  commitments. This flexibility is crucial for achieving a balanced  lifestyle and adapting to evolving professional and personal needs.

• Example:  Dr. Garcia, a family medicine practitioner, balances her telehealth  consultations with intermittent locum tenens assignments across  different states. This flexibility not only broadens her professional  experience but also allows her to explore new communities and healthcare  settings.

Lifestyle—Better Work-Life Balance

By  eliminating daily commutes and offering flexible work arrangements, a  practice without walls promotes a better work-life balance. Physicians  can allocate more time to personal pursuits, family responsibilities,  and self-care, leading to improved overall well-being.

• Example:  Dr. Kim, a psychiatrist, structures her telepsychiatry practice to  accommodate her children's school schedules, enabling her to be actively  involved in their daily routines while maintaining a fulfilling  professional career.

Personal Development of Micro-Business Skills

Operating  within a professional micro-corporation framework, physicians develop  essential business skills such as financial management, marketing, and  strategic planning. These skills are invaluable for long-term career  growth and sustainability.

• Example:  Dr. Patel, an internal medicine specialist, oversees her telemedicine  practice's marketing strategy and financial planning. Through hands-on  experience, she hones her entrepreneurial acumen and strengthens her  practice's market position.

Creative Freedom

A  practice without walls fosters creative freedom, allowing physicians to  innovate in their service delivery and explore niche areas of  healthcare that align with their interests and expertise.

• Example:  Dr. Smith, a pediatrician, pioneers a virtual pediatric obesity  management program, leveraging telehealth technologies to reach  underserved communities. This initiative not only expands her  professional impact but also fulfills her passion for preventive  medicine.

Practical Implementation

To effectively harness the benefits of a practice without walls, physicians should consider the following steps:

• Define Your Goals: Clarify your professional and personal objectives to align your practice without walls strategy accordingly.

• Invest in Technology: Utilize reliable telemedicine platforms and digital tools to enhance patient care delivery and operational efficiency.

• Build a Support Network:  Surround yourself with mentors, peers, and advisors who can provide  guidance and support in navigating entrepreneurial challenges.

• Continuously Learn:  Stay abreast of healthcare trends, business practices, and regulatory  requirements to sustain and grow your practice without walls.

By  embracing a practice without walls, physicians can cultivate a  fulfilling and sustainable professional career characterized by  autonomy, flexibility, and continuous personal development. This  innovative approach not only enhances professional satisfaction but also  enables physicians to thrive in an evolving healthcare landscape.

Establishing Your Professional Micro-Corporation: A 6-Step Guide

Step 1: Understand the Basics of a Professional Corporation

Before diving into the establishment of your professional micro-corporation, it's crucial to understand the foundational aspects of this business structure. A professional corporation (PC) or professional limited liability company (PLLC), both taxed as S-corporations depending on your state's regulations, offer significant advantages for physicians looking to operate independently while maintaining legal protections and tax efficiencies.

• Example: Dr. Thompson, a dermatologist, opts for a PLLC taxed as an S-corporation to establish her dermatology practice. This structure not only shields her personal assets from business liabilities but also provides flexibility in managing her practice's financial affairs.

Step 2: Initial Planning and Decision-Making

Successful establishment begins with strategic planning and thoughtful decision-making to align your micro-corporation with your professional and personal goals.

• Assess Your Needs and Goals: Clarify your objectives for starting a practice without walls. Consider factors such as desired work-life balance, income targets, and long-term career aspirations to guide your business strategy.

• Choose a Business Structure: Select the most suitable business entity based on your state's regulations and personal preferences. SimpliMD recommends considering a PC/PA taxed as an S-corp or a PLLC taxed as an S-corp for optimal tax benefits and operational flexibility.

Step 3: Legal Formation Process

Navigating the legal formation process requires attention to detail and compliance with regulatory requirements specific to healthcare professionals.

• Consult with a Lawyer: Seek guidance from a healthcare and corporate law specialist to ensure compliance with state laws, draft necessary documents, and address liability concerns unique to medical practices.

• Utilize SimpliMD's Business Formation Guide Services: SimpliMD offers a comprehensive business formation guide to assist physicians in navigating the complexities of establishing a micro-corporation. We can connect you with trusted legal professionals and CPAs from our professional network to streamline the process.

• File the Necessary Documents: Complete and file articles of incorporation or organization, obtain required licenses and permits, and adhere to state-specific regulations to formalize your micro-corporation.

Practical Implementation Tips

To effectively execute these initial steps in establishing your professional micro-corporation:

• Develop a Comprehensive Business Plan: Outline your practice's mission, target market, financial projections, and growth strategies to facilitate informed decision-making and operational success.

• Build a Financial Foundation: Establish separate business accounts, secure appropriate insurance coverage, and implement accounting systems to manage finances effectively and ensure financial stability.

• Establish Governance and Operational Protocols: Define roles, responsibilities, and decision-making processes within your micro-corporation. Draft bylaws or operating agreements to govern corporate operations and promote transparency.

By methodically progressing through these foundational steps with SimpliMD's guidance and support, physicians can establish a robust professional micro-corporation. This structured approach not only mitigates legal risks and ensures regulatory compliance but also sets the stage for sustainable growth and entrepreneurial success in a practice without walls.

In today's dynamic healthcare  landscape, many physicians are exploring innovative ways to maintain  professional autonomy, enhance financial stability, and achieve a better  work-life balance. A "practice without walls" offers a compelling  solution, enabling doctors to contract their services virtually,  diversify income streams, and manage their careers on their own terms.  This guide provides a comprehensive overview of the essential steps to  establish your professional micro-corporation, ensuring you have the  tools and knowledge to thrive in this modern practice model.

Step 4: Financial Setup

Setting  up your financial framework is critical to ensuring the smooth  operation and fiscal health of your professional micro-corporation. This  step involves strategic planning and consultation with financial  experts to maximize tax benefits and streamline financial management.

• Consult with a CPA:  Engage with a certified public accountant (CPA) who specializes in  healthcare and micro-corporations. They will provide expert advice on  financial planning, tax strategies, and regulatory compliance.

• Choosing Tax Classification & Personalized Fringe Benefits:  Work with your CPA to select the most advantageous tax classification  for your corporation. Typically, this involves choosing between an  S-Corporation or C-Corporation status. Additionally, develop  personalized fringe benefit plans that maximize tax savings and cater to  your specific needs, such as health insurance, retirement plans, and  continuing education allowances.

• Set Up Financial Accounts:  Establish separate financial accounts for your corporation, including  checking and savings accounts, to ensure clear separation of personal  and business finances. This separation is crucial for accurate  accounting and tax reporting.

• Compensation Planning:  Design a compensation plan that aligns with your financial goals and  business structure. This includes setting your salary, determining  dividend distributions, and planning for bonuses or profit-sharing  arrangements.

Step 5: Operational Setup

With  your financial foundation in place, the next step is to set up the  operational aspects of your micro-corporation. This involves  establishing the necessary technology, marketing strategies, and  compliance protocols to ensure smooth and effective operations.

• Technology and Infrastructure:  Invest in reliable technology and infrastructure to support your  virtual practice. This includes secure telemedicine platforms,  electronic health records (EHR) systems, and communication tools that  enable seamless interaction with patients and collaborators.

• Marketing and Branding:  Develop a strong marketing and branding strategy to attract and retain  patients. This includes creating a professional website, leveraging  social media, and utilizing online marketing techniques to build your  brand and reach your target audience.

• Compliance and Legal Maintenance:  Ensure ongoing compliance with legal and regulatory requirements. This  includes maintaining proper documentation, renewing licenses, and  adhering to state and federal healthcare regulations. Regular  consultations with legal advisors can help you stay updated on  compliance issues and mitigate risks.

Step 6: Ongoing Management and Optimization

Establishing  your professional micro-corporation is just the beginning. Continuous  management and optimization are essential to ensure long-term success  and adaptability in an ever-changing healthcare landscape.

• Review and Adjust:  Regularly review your financial performance, operational processes, and  business strategies. Make necessary adjustments based on performance  metrics, patient feedback, and changes in the healthcare industry to  stay competitive and efficient.

• Leverage Professional Networks:  Utilize professional networks, such as SimpliMD, to connect with other  physicians, legal advisors, and financial experts. These networks  provide valuable resources, support, and opportunities for collaboration  that can enhance your practice's growth and sustainability.

Practical Implementation Tips

To effectively implement these steps in establishing and managing your professional micro-corporation:

• Develop a Comprehensive Financial Plan: Work with your CPA to create a detailed financial plan that includes budgeting, cash flow management, and tax strategies.

• Invest in Professional Development:  Continuously seek opportunities for professional development and  education to stay informed about industry trends, new technologies, and  best practices.

• Monitor Key Performance Indicators (KPIs):  Track KPIs related to financial performance, patient satisfaction, and  operational efficiency. Use these metrics to inform decision-making and  drive improvements.

• Engage with Professional Communities:  Actively participate in professional communities and forums to share  knowledge, gain insights, and foster collaborations that benefit your  practice.

By following these steps and  utilizing the resources available through SimpliMD, physicians can  establish a robust professional micro-corporation that offers financial  stability, operational efficiency, and professional fulfillment in a  practice without walls.

-I believe every resident in America should spend the $4000-$5000 needed to start a professional micro-corporation before they complete their training

-I have an e-book that walks through 20 reasons to do this--there are many

-in the end compared to the $300,000 to $400,000 investment you have made in your medical education--spending only $4000-$5000 to create the capstone that preserves your professional autonomy is a minimal investment that will actually dramatically enhance the next 30 years of your life

-let me share an example of resident who caught this vision. He is a family medicine resident, and immediately after completing his internship, he applied for an independent medical license for moonlighting purposes. He want on to form his own micro-corporation and is flowing his $20,000-$40,000 in professional earnings through his micro-corporation.

-his goal is to slowly and incrementally understand how to operate and manage his micro-corporation that he will use as the foundation for his entry into the markeplace

-in essence he will be informing the marketplace that he plans to enter it as a business and he expects use his his power and skills to evaluate all options--job options that we'll fully unpack later in the presentation

-ultimately he plans to Job Stack to create a preferred personal and professional lifestyle

Job stacking involves seeing your virtual micro-business structure as having the power to "stack " multiple sources of income.

-the old view of working as a W-2 employee in 1 job in 1 location with a completely dependent single source of income as being an old idea

-the new view involves having multiple jobs in multiple locations that create multiple sources of income

-the more advanced model involves a complex tapestry of active professional income coupled with multiple passive income sources.

-For instance, that is what I did when converted to an employment lite contract, monetized my other professional work like call and then added a passive income with real estate rental in my medical office building

-my enterprise has continued to grow as I now have 10 businesses and I am about to launch an e-visit based start-up venture.

-the most common move that I see currently going within the market place is a shift to part-time W-2 traditional employment at say 0.5-0.8FTE positions that then have various 1099 job/income sources layered into them.

-The major advantage of this sort of configuration is employment fringe benefits and the power of tax optimization and retirement planning through micro-corporation based 1099 income.

ntroduction: The Benefits of Job Stacking with a Practice Without Walls

In the evolving healthcare landscape, physicians can benefit immensely from job stacking within a "practice without walls" model. This approach allows for multiple revenue streams, professional flexibility, and a customized career path, ultimately enhancing financial stability and work-life balance. By contracting professional services virtually to corporations or individuals, or taking on roles as long-term or short-term independent contractors, physicians can enjoy greater autonomy and diverse professional opportunities.

Job Options for a Practice Without Walls

Traditional Private Practice

1. Solo Practice: Physicians can operate independently, offering personalized care to their patients. This model allows for full control over clinical decisions and practice management.

2. Group Practice: Joining forces with other physicians, either as partners or associates, can provide shared resources, reduced administrative burden, and enhanced collaborative opportunities.

3. Part-Time Practice: For those looking to balance clinical work with other professional or personal interests, a part-time practice offers the flexibility to work fewer hours while maintaining patient care standards.

Independent Contracting

1. Employment Lite: Physicians can take on roles with organizations that offer the benefits of employment, such as steady income and benefits, but with more flexibility and less commitment than traditional full-time employment.

2. Locum Tenens: Temporary positions that fill short-term needs in various healthcare settings. This option allows physicians to travel, experience different practice environments, and avoid the long-term commitment of permanent roles.

3. Per Diem Work: Working on an as-needed basis for hospitals, clinics, or other healthcare facilities. This approach provides maximum flexibility and allows physicians to manage their own schedules.

Direct Care Models

1. Concierge Medicine: Offering high-touch, personalized care to a limited number of patients who pay a retainer fee. This model focuses on quality of care and patient relationships rather than volume.

2. Direct Primary Care (DPC): Similar to concierge medicine, but typically with lower fees and more emphasis on providing affordable care without the complexities of insurance billing.

3. Cash-Based Practice: Providing services directly to patients who pay out-of-pocket. This model simplifies billing and reduces administrative overhead.

Telemedicine

Virtual care has become increasingly popular, allowing physicians to consult with patients remotely. This model can be integrated into various practice types and offers convenience for both doctors and patients, expanding access to care.

Medical Consulting

1. Medical-Legal Work: Providing expert opinions and testimony in legal cases involving medical issues. This can be a lucrative side business for physicians with expertise in specific medical fields.

2. Insurance Work: Acting as medical reviewers or consultants for insurance companies, helping to assess claims and develop policies.

3. Healthcare Technology Consulting: Advising technology companies on the development and implementation of medical devices, software, and other innovations.

Other Opportunities

1. Medical Writing: Creating content for medical publications, journals, or online platforms. Physicians can leverage their expertise to educate and inform both professionals and the public.

2. Medical Education: Teaching and training the next generation of healthcare providers. This can include academic positions, continuing education courses, or mentorship programs.

3. Medical Directorships: Leading clinical programs or departments within healthcare facilities, guiding clinical practices, and improving patient care standards.

4. Research: Participating in or leading clinical research projects, contributing to medical advancements and evidence-based practice.

5. Coaching: Offering guidance and support to other physicians or healthcare professionals in career development, wellness, or specific medical skills.

6. Pharma: Engaging with pharmaceutical companies in roles such as clinical trials, advisory boards, or educational outreach.

7. Start-Ups: Collaborating with or founding healthcare start-ups, bringing innovative ideas to market and improving patient care through new technologies or business models.

Chance Meeting

In the fast-paced world of medicine, characterized by long hours, administrative burdens, and burnout, I'd like to share a story about an OB/GYN physician who discovered a path to professional freedom that revolutionized his career. Dr. B. A. had spent almost a decade working as a W-2 employee after finishing his residency. However, just before committing to a new contract with a substantial $500, 000 annual salary, he came across an alternative that would alter the course of his professional journey.

You see, he ran into a physician whom I had helped convert to an employment lite contract from their traditional employment. The physician was so thrilled about the return of autonomy and the financial benefits that he advised the OB/GYN to contact me to discuss things before signing the contract.

I am glad he did!

The Micro-Corporation & Employment Lite Revelation

After speaking with me in a micro-businesss consultation, Dr. B.A. discovered the concept of a virtual professional business entity called a micro-corporation. Unlike traditional employment, where physicians are bound by W-2 contracts, forming a micro-corporation provided him with the option to operate as an independent contractor via a 1099 contract. Here’s how it worked:

1. Micro-Corporation: Dr. B. A. established a professional micro-corporation through SimpliMD specifically for his professional services. This legal entity offered him various advantages, such as limited liability protection and tax benefits. It could be seen as a practice without physical walls, with Dr. B. A. as its sole employee. He could utilize it for his main job as well as for his side hustle involving contracted laborist shifts.

2. Employment Lite Contract: Instead of the typical W-2 arrangement, I advised Dr. B. A. to request that his prospective employer access their "hidden menu" of contracts and retrieve the professional services agreement file. By "hidden menu," I mean that every physician employer has multiple contractual templates to choose from, but they typically only present the traditional employee contract, which heavily favors them. You won't see any other options unless you specifically request them from their "hidden menu" list. Following this advice, the employer revealed the previously hidden professional services agreement files, and Dr. B. A. negotiated a more favorable employment lite contract. This contract allowed him to work as an independent contractor while still providing services to the hospital. "Employment Lite" is a hybrid employment model that mirrors most components of full employment without complete integration. Full employment represents the highest level of alignment between hospitals and physicians, while Employment Lite indicates a significant level of alignment that falls just short of full employment. This is formalized through a professional services agreement tailored to this arrangement. Under a PSA, a physician (or medical group) remains independent (i. e., not employed by the hospital) and offers professional services within the hospital or at a hospital clinic. Locums Tenens has been one of the more common PSA arrangements that healthcare employers use to tap into the professional services of doctors. Here is what employment lite looks like:

Expected Benefits

1. Tax Efficiency

Dr. B.A. discovered the power of forming a professional micro-corporation, a business structure that is tailored for physicians. By opting for an employment lite contract, he could unlock significant tax efficiency not available to W-2 workers. Deductions for business expenses, home office use, home business meeting rental, and retirement contributions promised a more efficient use of his hard-earned income.

• Self-Employment Tax: Dr. B. A., while working as a W-2 employee, covered his employee portions of Social Security and Medicare taxes. However, if he establishes a micro-corporation, he has the opportunity to significantly lessen his self-employment tax liability.

• Business Expenses: Dr. B.A. could deduct business-related expenses, such as malpractice insurance, CME, health insurance, and vehicle use/transportation. These deductions lowered his taxable income.

• Retirement Contributions: The micro-corporation allowed him to contribute more tax advantage dollars to his retirement accounts. Let’s explore this further.

2. Greater Retirement Savings

One of the most enticing aspects of the micro-corporation journey was the potential for significantly higher retirement savings. Dr. B.A. realized that the employment lite contract paved the way for generous contributions to a Solo 401(k) and other retirement vehicles such as a cash balance plan, propelling him towards financial freedom in the long run.

• Solo 401(k): Dr. B.A. set up a Solo 401(k) plan for his micro-corporation. In 2024, he could contribute up to $69,000 (including catch-up contributions) to this retirement account.

• Cash Balance Plan: The corporation can establish a cash balance plan, which is a defined benefit plan. Contributions are based on factors like age, income, and desired retirement benefit but can be as much as $345,000 annually.

3. Independence as a Contractor

Embracing the micro-corporation model meant embracing a new level of professional independence. No longer confined by the constraints of traditional employment, Dr. B.A. could negotiate terms that better suited his unique expertise and time commitments. The micro-corporation allowed him to operate as a contractor, cultivating a sense of autonomy and entrepreneurship.

• Professional Autonomy: Dr.B.A. enjoyed greater control over his work. He could choose what % of FTE he wanted with his primary job, negotiate terms, and even take on additional side gigs.

• Location Independence: With the micro-corporation, he wasn’t tied to a single hospital. He could work in various clinical settings, offering services where he preferred.

The Discovery of True Freedom

Dr. B. A.'s fateful decision to explore the micro-corporation wasn't just about financial gains – it was a quest for true professional freedom. As he signed the employment lite contract, the burden of traditional employment lifted, unveiling a new chapter of autonomy, tax savings, and higher retirement aspirations. Dr. B. A. had uncovered the secret world of Employment 2.0, which enabled him to thrive both professionally and financially.

I have had the same experience as Dr B.A. through my professional micro-corporation and employment lite contract. It is fantastic!

His story and mine shed light on a relatively hidden path for most doctors in the US. It’s my goal to expose this secret world and let you know that same opportunity exists for each of you!

Just like in this story, it's simply a matter of one doctor sharing their experience with another doctor who can benefit from it.

If you have benefited from being a part of the SimpliMD community, I would like to ask for your help to grow our community by inviting your colleagues and peers.

You can invite them to become free subscribers by sharing this link. Just shoot them an email that goes something like this: “I have found the SimpliMD community to help me grow professionally, you should get on their free e-mail list here.”

If you want to get paid for sharing our our paid products with your peers, you can sign up to become an affiliate by following the link in the resources.

As I wrap things up, let me break down for you my own financial case study of what transitioning from W-2 employment to a "practice without walls" would look like.

-obviously, in this employment lite structure, was still working in a clinic environment--and in my case it was for the same employer, in the same community, providing the exact same services.

-That is what made it a non-speculative apples-to-apples comparison

-as you can see over a decade the net benefit to me in this contractual structure was over $700,000. That's a lot of money!

-but on top of that I had a million-dollar building that their lease paid off over that decade--leaving me with $100,000 in income annually as get ready to retire from the practice

-and on top of this my FMV compensation rose in the employment lite contract bringing the net benefit of my professional income over 10 years to nearly $2 million dollars.

-To say the least, it was a great move financially to transition away from W-2 employment to a professional micro-corporation.

-But psychologically the restoration of my professional autonomy had an even more profound effect--one that I didn't fully expect, nor planned--but it's probably my favorite part of the transition

-and it's why I see professional micro-corporations as a market place solution that will help solve the burnout crisis.

-Read my attached article on how household dollars flow differently for the self-employed doctor.

In the end, I want to empower you to enter the market place through your professional micro-corporation because it will provide you with the greatest alternative to traditional employment--a job model that WILL force you to lose control of your life

-your best move is to make this move into a practice without walls that will preserve your professional autonomy, enhance your well-being, and increase your financial health

Take your next step with SimpliMD micro-business guide services for only $500. And the great news is that by taking this course, I will provide you with $100 off for this service by using the link in the resources section.

Don't make the mistake of watching or listening to this and doing nothing with it!

Taking action by applying these principles is your next step!

Don't let fear be an obstacle!

In this course, you learned how to:

Embrace the Concept of a Practice Without Walls:

• You redefined your understanding of a "Practice Without Walls," challenging traditional practice models. You can now embrace the freedom of not owning the physical space, the patients, or even being physically present at the service location. This shift will empower you to deliver care more flexibly and effectively.

• You can transition from physical clinic spaces to virtual and adaptable practice structures, confidently operating across various healthcare delivery settings. You will technology to expand your intellectual services, making your practice more location independent, innovative and responsive to modern demands.

Leverage the Benefits of Flexibility and Autonomy:

• You will embrace flexible work arrangements, using this flexibility to enhance your professional life and achieve a healthier work-life balance. You will design a career that fits your personal and professional goals.

• You will experience the profound impact of increased autonomy in your practice, elevating your professional satisfaction and well-being. This autonomy will become your key to reducing burnout and ensuring a long, fulfilling career in medicine.

Establish a Virtual Professional Corporation:

• You will take decisive steps to establish a professional micro-corporation tailored to your medical practice, optimizing your professional assets effectively. You will take control of your career and financial future.

• You will capitalize on the tax optimization and financial benefits of a micro-corporation, strategically positioning yourself to maximize wealth accumulation and secure your financial independence.

Customize and Control Your Professional Assets:

• You will actively customize your micro-corporation to reflect your specialty, interests, and personal style, ensuring that your practice is a true expression of your unique professional identity. This customization will bring you greater satisfaction and success in your career.

• You will take full control of your professional assets through your micro-corporation, gaining financial and operational independence. You will adapt to changing circumstances, maintain location independence, and leverage new healthcare delivery models.

Preserve and Enhance Professional Autonomy:

• You will safeguard your professional autonomy by embracing the micro-corporation model, thriving in your medical career with greater freedom and control.

• You have been inspired by practical strategies from real-world examples of physicians who have successfully maintained autonomy through micro-corporations, empowering you to do the same.

Explore Diverse Job Structures with Micro-Corporations:

• You will explore and adopt the micro-corporation-based PSA structure as an alternative to traditional employment, creating a more flexible and autonomous career path tailored to your needs.

• You will embrace the benefits of 1099 Independent contractor work, whether full-time or part-time, and strategically combine job stacking with part-time W-2 positions and 1099 roles for maximum flexibility and income diversity.

• You will evaluate and implement innovative practice models, such as direct care models and employment lite structures, using your micro-corporation as a foundation for success in these areas.

Call to Action:

You will take control of your professional future and thrive in the evolving medical landscape. You will join SimpliMD as a member for only$99 to access over $2500 in tools, strategies, and community you need to succeed as a self-employed physician.

-Share your great experience with this course on your favorite social media outlets and use this link to share.

If you are need for business consultation for only $99, you can go here.

If you would like me to help guide you through getting your professional micro-corporation started you can go here.

If you are looking for some ongoing holistic physician based business coaching, you can go here.