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!