The Dollars and Cents of Running a Practice.

I am not business oriented at all, which is kind of ironic.  I pay rent for my office space, I have a staff and expenses to cover to run my family practice.  I have a small business, actually.  Except that I have no formal training in business, nor do I ever wish to be a “business woman”.  Yet, here I am, almost 10 years out of school and I’m running a small business.

To this I say,


Since I started my family practice, I have always felt weird about charging patients for services not covered by the government.  I’m not entirely sure why.  Most patients think health care is free and it isn’t.  We pay taxes, and while I get paid pretty well for what I do, there are certain things that the government will not pay for, so it’s reasonable that a patient is expected to cover the cost.  I’m talking about sick notes for work, prescriptions for massage therapy, prescription renewals via fax, etc.  Our medical association gives us guidelines on what to charge for these non-insured services, and it took me a few years to implement these fees into my practice.  Needless to say, I was losing quite a bit of money.

So I started by sending out a yearly letter to all of my patients reviewing the non-insured services and offered patients two options – to pay a “block fee” that covers everything for the year, or to pay on a “fee for service” basis.  Most patients opted on the latter, which was fine, but after a while I realized that only accepting cash or personal cheques was inconvenient for most people.  So, I looked into purchasing a terminal for credit/debit payments. Suddenly I needed a “business account”, a “business name”, and was going to be charged an extraordinary amount of processing fees.  Yeah, no thanks. So, another few years went by.

But now, after almost 7 years in family practice, I have built up over a thousand patients and often spend a ridiculous amount of time writing sick notes, massage notes and renewing prescriptions over the phone and I am not being compensated for it. I found myself getting really annoyed at the stack of prescription renewals on my desk every morning and started to refuse to do them unless the patient came in.  Well, you can imagine how that went over.  Normally I give patients prescriptions for 3-6 months and for certain conditions (ie. high blood pressure, diabetes, depression), I expect them to follow-up regularly but of course life sometimes gets in the way and patients can’t come in to see me.  Or they just get lazy and complacent and “run out” and need a re-fill immediately.  Well, sorry folks, but times are changing and that will now cost you $30.  But how to enforce this?  It’s not like they can just show up and pay me cash, otherwise they’d just come in for an appointment, and sending an invoice in the mail is just going to get ignored.

I looked into the terminal for credit/debit payments and the fees and hassle was just not worth it.  Then, a few months ago, my colleague told me about something called Square.  Her teenage son told her about it and said it’s an app on the phone and it takes credit card payments.  Hmm, I was skeptical. But the concept was brilliant!  Then it just so happened, I bought something at a comic book store downtown and the shop used Square for my debit purchase.

So, I did some research and after another month of hemming and hawing about it, I signed up with Square.  Within days, I received the card reader in the mail (for free) and was all set to go.


I can’t believe it took me this long to get with the program.  It’s the best thing since sliced bread.  Thank you, Square!

9 thoughts on “The Dollars and Cents of Running a Practice.

  1. What a great idea! I’ve spent hours filling out school forms, refilling meds, making phone calls, filling out Family Leave forms, etc. Some nights I wouldn’t leave the office until eight. None of that was reimbursed, and I think most pediatric practices still don’t charge for these things. But it does take a lot of time to do. Sounds like you found a great solution.

    • I know of a few pediatric practices that do charge for some thing but you are right, it’s not very common. I will never charge a patient with financial struggles but those are usually not the ones asking for sick notes. It can be a tricky line with some.

  2. You charge $30 (!!!!!!) for a refill? OMG. Wow. I do not know of anyone in the US who charges this. Charging for sick notes, too? That idea is also foreign to me. Do you think charging for med refills like that makes patient compliance suffer? I am soooo curious about this! 🙂

    • Does charging for the patients’ convenience of going to their pharmacy to renew their medications affect their compliance? No, I don’t believe it does. For long term meds like anti hypertensives or anti depressants or even birth control I will often give prescriptions for 3-6 months and provide a refill. Most patients come back for a BP check but a lot often suddenly realize they’ve run out and can’t come in for an appointment. In those circumstances they would happily pay a fee than have to miss work for an appointment. After having to pay for a few renewals most patients will get their act together and book regular appointments for their medications.

      Where I live, many employers require a sick note if an employee misses more than a day or two of work. This is not an expense the government will pay for so the patient is charged. More often than not the patient gives their receipt to their employer and they are reimbursed.

      Obviously if a patient cannot afford these fees because they are on welfare or disability or fixed income, I will not charge them. I am not completely heartless. 😗

      • I love this idea. Some in the US are charging for calls after hours (“credit card number please and then I will ring the doctor”). Some are charging for portal messaging or “telemedicine” situations like the “I have a UTI and can’t come in” bit. I now charge for completing FMLA paperwork but charging for sick notes and refills is such a foreign concept to me. I love that you are doing it!

      • In the UK we are charged for sick notes as well and there is nothing wrong with it 🙂 Yours is the way to go and I would rather pay a fee than miss a day of work/school as well 🙂 Private practice is indeed a business, too bad not enough doctor enroll in MBA or at least executive MBA while still training. The other way is to pay an accountant or a consultant. I find it also very bizarre that not more doctor use financial services to smartly handle their loans, invest their money and create a clear retirement plan as soon as they start earning a salary and more so from attending level. There is still a bit of taboo I think.. Taboo which does not exist in other lucrative specialties.

  3. Doctorgeekette – you are so right. If I recall, I believe we had a 3 hour lecture at the end of residency on financial planning. Three hours! Ridiculous! Most people think that doctors have great benefit packages and government retirement plans. Ha! As if!

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