Presentation by Dr. Mike Woo-Ming – 464
In today's lecture, Dr. Mike Woo-Ming his advice on how to take back control of your professional life with a cash based business.
The Seven Stages of Physician Entrepreneurship
Most physicians who think about building a business outside of clinical practice stay stuck at stage one, the wantrepreneur. They listen to podcasts, buy courses, do research, and then do nothing. Dr. Woo-Ming is direct about this: the only way out of stage one is to take an action, any action, that moves you forward. Stage two is the physician with a side business, not a gig, but a part-time operation generating at least $5,000 to $10,000 a month, which signals it is a real business worth developing. Stage three is the self-employed physician running a solo practice with full income dependence on personal patient volume. Stage four is the business owner with staff, where revenue is no longer entirely tied to the physician seeing patients personally.
Stage five is the physician as CEO, where the business runs and generates income without the physician seeing patients day to day. Dr. Woo-Ming currently sees one patient a month while running three clinic locations staffed by nurse practitioners. Stage six is the investor, using business cash flow and capital to take equity positions in other ventures. Stage seven is a generational wealth entrepreneur and mentor, building assets for the next generation and paying the knowledge forward. The goal of any business, in his view, is to eventually be sellable — and a practice where the physician is the sole revenue generator is almost never sellable.
The PERFECT Framework for Choosing a Cash-Based Service
Choosing the right cash-based medical service is not just about what is trending or what others are making money from. Dr. Woo-Ming uses the PERFECT acronym as a decision filter:
P for personal interest, E for ethical, R for replacement, meaning can someone else perform the service or does it require you personally. F for financially feasible, E for exemplary or what makes your service different from the competition. C for continuous through memberships and recurring treatment plans, and T for time conscious, or the service will NOT put you on call around the clock but protect your time.
Summary
Cash-based medicine is not a shortcut, but it is a path to practicing medicine on your own terms, building something sellable, and generating income that is not dependent on how many patients you personally see. Dr. Woo-Ming's seven-stage framework offers a clear picture of where most physicians are and what the next step actually looks like. The PERFECT framework gives a practical filter for evaluating any cash-based service before committing. The common thread across every successful physician entrepreneur he has worked with: they stopped researching and started building.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- How to Open Your Own Cash-Based Medical Clinic
- Cash-Based Infusion Lounge is a Fantastic Business – The Doctor’s Perspective
- How to Start and Grow a Profitable Cash Based Medical Practice – 293
- Now Is The Time To Start A Medspa
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Take Back Control with a Cash Based Business
Interview with Dr. Mike Woo-Ming
Episode 464
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You're listening to Physician Non-Clinical Careers with John Jurica, episode number 464, "Take Back Control With a Cash-Based Business." Welcome back, non-clinical nation. Today I'm presenting Dr. Mike Woo-Ming's presentation from the 2024 Non-Clinical Summit. Mike has been building and running cash-based medical businesses and teaching others how to do the same thing for decades.
In today's presentation, he provides examples of the business he has created, I should say the businesses he has created, because he's done many, why they are successful, and how you can emulate what he has done. So here we go. Here is Dr. Mike Woo-Ming thanks for being here, and take it away John, thank you. I'm honored to be here, honored to call you my friend, and, just, thank you guys for, listening and, coming onto this. I mean, I've been doing this for, being an entrepreneur going on 20-plus years, and in the early days, I felt like I was the only one out there.
And now through, through the, through the, work that, John and Tom are, doing, Peter Kim and Nneka, who you had earlier on, Sonny Smith, is, is just tremendous. And, and I think physicians are kind of finally seeing the light that, maybe it was because of what happened during COVID, that we need to start thinking about other streams of income.
I know that most of you, have... are an employed physician and, that's the majority of physicians these days, but we need to start thinking about different, ways. And through me, for, myself, I, learned that early on. I learned that about multiple streams of income.
Currently, I have about 11 different streams of income. I don't, actively see patients anymore, although I'll tell you about, a little bit about my story, is I own cash-based medical practices. We have three locations and, recently have now become a chief medical officer to turn those medical practices into a women's health franchise, so that's, that's pretty exciting.
but what I wanted to share with you, just kind of at the beginning, is to understand what it is about being a physician and what, what I like to call a physician, entrepreneur. I'll tell you a little bit about my story. I go more in-depth in, in my book. Cheap plug, you can find it on Amazon.
But, I am a graduate of Mayo Clinic, in family medicine, but I started my first, business as a resident. I started a medical education company. I started an online startup, but back in 1999, I started developing what are known as, e-books or information products. that actually was my first million, was selling, different books in different genres.
and that's where I learned about if I create something once and as a, in a book, I can generate, money while I'm sleeping. So, my first $100 was I sold five copies of a book that was $20. I may have spent five to six months writing that book, but I was making money while I was sleeping, and that kind of like clicked the, the light bulb in, in my head.
then I started a software company, that I later was able to sell. I was out of medicine. I was actually able to retire for, quite some time, was able to turn that into consulting. I got, honored to travel around the world in, in terms of consulting and selling software. started a online reputation management company for physicians.
But then in 2012, I went, back into medicine. I wanted to go back into medicine for my own terms, and that's where I fell in love with cash-based medical practices. I started a, first it was in occupational medicine, and then later it turned into a weight loss hormone therapy, then it turned into a- an aesthetic, services.
Added all these different services, and I'm actually gonna go and help you if you're thinking about going into cash-based medical services. I've, got what I call the perfect cash medical, service, Just, a way of when I consult with, doctors about determining what is the best, medical service for you.
I call it the perfect cash medical service, and we're gonna be sharing with that, tonight. but, I work with a number of different doctors and, I help a number of different doctors kind of find their own path and, and what's exciting is, is to see that, doctors are finally feel like they're finally doing something that, that they love.
I had a, mentor, way back, when. He says, "If, you wanna be in a business, you need to consider it ... called an ELF business," and that means easy, lucrative, and fun. And John, I don't know when the last time anybody described medicine as an ELF business, easy, lucrative, and fun, but it can exist, and it's just a way that, we kind of run, things.
Now, I'm not saying every day is, is wine and roses. I've got 20-plus employees, three different locations. I have new business partners that I, interact with on a regular basis. Certainly, it's not ELF, but just being, to aspire to that, to aspire to creating a business that, can be easy, lucrative, and fun is what we, all hope.
Uh, when I was looking at kind of what I wanted to share with you guys, John mentioned that we should talk about, the financial levels. I, came up with something in the book called, the physician, financial levels for physicians. And, it's like four to five levels there.
Since then, I've, kind of expanded that from, the book, and I want to wanted to share with you, and I call it the seven stages of what I call financial entrepreneurship. And, what's, what I think is helpful is it can determine where you are, what stage you are, and then what can be the crucial step to get you to the next stage.
Now, as doctors, we know that the road to becoming a doctor is a very linear path. We know the exact step-by-step things that we need to do to become a doctor, right? We need to get, go to a nice college. We need to get good grades. Hopefully, it's in the science-based... It could be a science-based major for, a majority of us.
Have good enough grades, and then take the MCAT, have great, great scores, get some great personal statements, do some volunteer work. That lets you get into medical school. Then we go through medical school. We do, based upon how we do, do we pass, do we get honors? Whatever, whatever the way that they grade us, that may determine, in third year we determine, what type of specialty, what we want to do, and so on.
We go into residency, may be fellowship, et cetera, then, eventually we, become a physician. Very linear path. Entrepreneurship, not so much, not so easy. So that's why I wanted to give you this, this insight, what I call the seven stages of physician, entrepreneurship. So let's talk about the first stage.
I don't wanna offend anybody on here, but have you ever heard the term wantrepreneur? This is what I'm calling the first stage. Uh, that is somebody who wants to be an entrepreneur, they become a wantrepreneur, and this is the largest group. Uh, oftentimes these are the employed physicians, right?
They, might be listening to, my, podcast. I have a podcast called Bootstrap MD. John's, amazing podcast. listen to Tom. they might maybe listen to lots of different things and, maybe they, listen to it, they watch the YouTube videos, they live vicariously, but then at the end of the day, they, kind of do nothing.
Maybe they buy a course. Maybe they, purchase this course. They listen to it. and I bought lots of different courses, and I'm not... I'm gonna be honest with you. There's some courses that I purchased, they be, can be thousands of dollars, I never even opened it, you know? These courses, and I, get so upset at myself, and it's what we call, it, it's when we turn self-help into what I call shelf-help.
We, put it on the shelf, and we feel, "Hey, we just bought it," you know, that, enough. And, talk with, them and then when you ask them, like, they're either working with me or such, they said, "Well, I, researching it right now." I know doctors who've been researching starting a non-clinical job for years, and then they never be able to, get that way.
And so, so that's the one stage you wanna get out of, I know want to be a wantrepreneur. We all hear about we need to take action, we need to take massive action. Do something. Do something that takes you into the next stage. So what is that next stage? That's the next stage, what we call physician with side gig, or I like the term side business.
So this is a physician with a part-time, business. You know, I don't like the term gig because it sounds like, you know, hey, I'm gonna be driving, like, a, an Uber for, like, a few months, you know? That's what I'm talking about. I'm talking about something where you want your side business to become an actual business because that's what it is.
You want your part-time business becoming a, full-time business. someone told me that, and this is kind of an arbitrary number, that they don't start a side gig unless it's making, at least 5 or $10,000 a month. That, means it's, it's a realistic business that, worth your time.
about your, side gig. Maybe you have something right now. Maybe you're doing some consulting. Maybe you're, you're write, writing part-time. I know that we've already gone through different things that maybe you're considering as, a side gig. for me, I've got, a number of different, quote, side gigs, that I do.
I guess if you consider me managing these employees, these three locations, that's kind of my full daytime gig, but I also do consulting on the side. I work with, entrepreneurs. I, a business coach. I work with Peter Kim. You may be familiar with him. I, do a lot of, consulting a- and coaching, for, them.
but there's some other things that, I've done in the past. I've done, one of the things that I do is, I do hormone pellet therapy, and I've been a trainer for a company where I go out and I work with other physicians to get them certified, in different training. sometimes people don't want me to talk about this, but I, work for the California Medical Board, where I've actually screened other doctors who are on probation for some unfortunate reasons, where I, work with them and, I visit them and, help them to get their license to get them out of, probation.
lots, of different things that, I'm, involved with. So, kind of focusing on that, that easy, lucrative, and fun, sometimes, it is, and sometimes it's not. And sometimes you, need that extra income, and it may be something that you're just doing temporarily just because you're just doing it to help you pay the bills.
But, that's kind of that second level where they're, doing the side gig, but they kind of remain in that. They don't want it to go, full-time, but it's, just enough that, maybe it, helping them. So what's the third? What is the third level? The third level is- Being the self-employed physician.
So this is the doctor who is that solo, who's got a, solo practice. Uh, his entire income is based upon, his business. So this could be a doctor, like I've got friends who, and it's kind of dwindling now, but they're, got that solo practitioner. They're, maybe, far away.
They, working for themselves. this is, could be the doctor who is a telemedicine. I know a number of different doctors who are running full-time telemedicine practices they're doing on their own. Uh, a- and, from what I see, they, love it. They, don't, they have low overhead because they're the only employee.
Uh, they've got control of when they want to work, when they want to work. there's, there's pluses and minus to, it, right? Uh, when you're doing everything yourself, what happens if you want to take a vacation? Then you're not bringing in your income, so your income is, is limited by how many...
doctor is seeing patients, he's limited by how many patients they see. Their income is limited by seeing how much patients see. But at least at this level, they're becoming their own boss, right? but like I said, there's always pluses and minuses because, you want to start...
This is where it focuses on the next level, is what can we bring, to bring in more, income besides us seeing patients? What, needs to be involved here? And that's the number four, and the fourth level is a physician as a business owner. So this is where, I got started, where I have a staff.
Uh, my first staff was, I remember, I was nervous. I hired an RN. We had started a weight loss practice, and I would see the patients initially, and then I would have the registered nurse do the follow-ups on there. And that's where, that's when we were doing injections, and we had others who were, injecting.
And, then we were bringing in revenue that way. So I wouldn't have entirely seeing all of the different patients. So I know that there's some, maybe some practice owners here. This is when you should start to think about these things, right? that you can't see... If you want to scale and grow, you're limited by how much that you can see.
I mean, you've heard of DPC, a direct primary care. That's great, but if you're the one who is, has the, you're at the beck and call for a patient, I don't know how long that, can last. Maybe that, works for you, and maybe you enjoy it. But I, me, I wanna have some flexibility in my life.
And then I realized that I need to have other people, uh, be able to see patients and bring in revenue besides me seeing it. I think it's very difficult these days in 2024 where to run a solo practice where you're doing everything on there, because you still got to work on... You know, maybe you're seeing 40 hours of, uh, of patients, but then how are you gonna running the practice?
Uh, important book you may have heard of, uh, I read it early on. They're called The E-Myth by Michael Gerber, G-E-R-B-E-R, E-Myth or E-Myth Revisited. The important, um, point in that book is to work on your business, not in your business. You wanna be working on your business. Uh, that involves, like, understanding the marketing aspect of it, and to understand, uh, that you gotta do other, other roles as a business owner, such as payroll and making sure all the insurance is being, uh, paid, and, and, and the rent, and dealing with all the different vendors and, and all that different stuff.
There's a lot of different tasks other than you seeing patients, and that's why it's important to getting to that next step, is where, um- You know, you want to be able to practice to run, and then if you go on vacation, your business doesn't suffer. So most never, doctors never really get past this stage four, and I want you to get past that, uh, because this is the one where, uh, John said early on that, that, uh, you know, when you have a business, I think the ultimate goal of the business is to eventually sell that business.
But how many times have you heard a doctor saying, "I have a business. Nobody wants to buy it"? The reason why nobody wants to buy it is because he's the one that is seeing all the patients. They're stuck in that stage three, right? They're seeing all the patients, uh, in there. So if he leaves- Well, how much is that business worth?
Maybe get some money from the equipment, but that... And maybe s- you know, maybe the, the patient database, but there, there's a lot to it because they understand that the primary, uh, revenue generator is the physician themselves. That gets us to what I want you to start thinking of is becoming number, stage five, which is the physician as the CEO.
So this is when you are income. Your revenue is not dependent on you being day to day. I saw, a total of one patient this month. seen a total of one patient this month, and I think the second patient is, will be my, wife later in there. That is because I have, three nurse practitioners who work under me, and I have a, a, a, a nurse, in another clinic who are seeing the majority of these patients.
So my clinics are open. I am, we're generating revenue, and that's a different level of it. It's obviously... Yeah, it takes time to get to that level, but if you understand business as you understand medicine, you can get to that. Going to attending these things that Tom and John, put together, you guys, I know you're at the next level here because you're, understanding that these things are important.
Um, so, I know some are, A, mid-level providers may feel one way or the other. For me, it works for my practice. It could be hiring other, doctors. My dad, recently passed away a few years ago, but he had told me, one wisdom he said that, his practice it really started generating revenue when he realized that, he could hire other doctors to see the patient.
He wasn't, it wasn't on him, and it actually allowed his practice to grow even further. Uh, so that's, what the importance of being a CEO is. That's stage number five. Then this is the, next stage, and this is the stage that I'm excited about being in, and that's, the physician as an investor.
So this is when you would use your capital. You're, making money in your business. You're using your cash flow, your capital, to now invest in other businesses, investing in, multiple, different businesses that, as I mentioned at the top- with our medical practices, I may or may not have said it, but I recently have taken on new business partners.
We're forming a new company where I have equity. We're building a women's health franchise. Uh, it takes a lot of, my time, but the, idea is that, I'll generate, equity, so hopefully at that time we, build this up. Hopefully, does very well, and then I'll be able to, have that equity in my business.
So right now, it's, a lot of work, to do it, but that's my eventual goal. Uh, the reason being is if... And I'm not saying money is the end all, but if you've ever looked at, like, what they call the ultra wealthy, the ultra wealthy people, these are people who make over $30 million a year- Uh, you know, what is the, what is the reason that, how did, they make their wealth?
Uh, they made their wealth, majority of them, is through a liquidity event, meaning there was some type of, event where they came in with a lot of money. Generally, it's a sale of a business. So it could be a sale of, real estate, whatever it is. That is what, what, the majority of ultra-wealthy is.
And, there's others, certainly number two was, like, inheritance. Number three, they had some type of special talent, so, like, your, uber athlete, right? The Michael Jordans, LeBron James. last time I checked, John, I wasn't six foot nine and I could dunk a basketball and, score 40 points, so I'm very limited at my five foot six 50-plus-year-old.
So for, me, I don't have a special talent, but what I can do is I can build a business, scale and grow it, do it ethically, efficiently, that someone would wanna purchase it, and then, have that. So, but that, next stage is becoming an an investor, and that's where you, start investing in other different businesses, maybe different franchises, different real estates is...
And, every one of you should start be calling yourselves an investor right now, you wanna look at ways that you can use your money, your capital, your cash flow to either invest in businesses, invest in, in real estate, whole bunch of different things. Uh, John, I told you I'm a, pickleball nut.
I'm actually getting in, trying to invest in pickleball now, in pickleball business, because I believe that's, that's the next thing. Maybe I'm crazy and, who knows? But it gets me excited to, look about different businesses that are outside of wealth. So what is the, last stage, the, seventh one?
This is when is physician as a, what I call an, generational wealth entrepreneur and mentor. This is when you pay it forward. This is when you've, come to the position in life where, really, it's not really about building wealth for your, yourself. Like, for, me, I don't need more things, but I'm trying to build more wealth for my kids.
And so I'm, thinking about building wealth for, them. So that, does that involve real estate? That involve different businesses? Uh, and that involves also, like, consulting and, teaching what I know and paying it, forward. So, those are the seven stages of, what I consider is a, the, seven stages of a physician entrepreneur.
One, entrepreneur. Number two, side gig. Number three, the self-employed physician. Four, business owner. Five, CEO. Uh, six, investor. And seven, becoming generational wealth entrepreneur and, mentor. Uh, so I wanna shift gears. I know you've got, had spotlighted lots of different cash-based, Practices. Uh, we've had, Lisa talked about med spas, and we've, talked about different types of ways that, you can generate, a cash-based services.
There's only a select number of cash-based medical services out there. I think last checked, maybe there's about 40 or 50 types of things that are from everything from concierge medicine, direct primary care to, aesthetics, to med spa, weight loss. There's functional medicine, there's telemedicine, lots of different things.
But what is the perfect cash-based medical service is for you? And I wanted to share with you a little acronym that I, came up with. It's called the PERFECT cash-based medical service. Why'd I call it PERFECT? Because PERFECT is the acronym. So the acronym is, like, okay, you're, thinking about a clinic, what is, the one that you wanna do?
And so P stands for, the first P of this acronym in PERFECT is personal interest. So obviously, what you're interested in. You know, what do you, what interests you? Um, you know, what have you... Maybe it's something you experience or maybe something in your specialty that, you enjoy. That's obviously where you're gonna gravitate.
For myself, one of the first things I wanted to do was, weight loss. I suffered from weight issues, for most of my adult life. Uh, I'm happy to say I'm about 40 or five to 50 pounds less than I was, last year, but it's something that I experienced and, because of this, I wanted other people to know, more about it.
So that was my, obviously, this is easy. P is personal, interest. Uh, E, is it ethical? Is it congruent with your own values? Uh, you know, so for, what type of cash-based, services that you in. And, it, it's different for others. You know, obviously in, in medicine, we, are held by certain standards, but there are some areas that, perhaps there are some, gray areas.
You know, I'll just give you, a, example. Um, you know, there are some who have a practice that involves CBD, cannabinoid oils and things like that. You may, believe in it, others may not. Uh, but is it, ethical for what you consider? And, and again, I'm not making any judgment on here.
What does it feel like for you? Maybe there's some areas in functional medicine that you feel great about, maybe there's some that isn't. That's the great thing about having a practice. You can determine where you want to go. I would just say, obviously there are, as being in, having working behind the scenes in the medical board, there are some things that, that may be more risky than others, that you maybe, maybe you wanna get into or not.
You don't wanna do it, just because you heard a lot of people are making money into it, right? Obviously, that's not the way you wanna do it. Uh- Is it ethical? Is it, helpful? Is, helpful in people's lives? You know, I do, bio, identical hormone therapy. Um, there's some doctors who, love it, other doctors who don't like it on here.
Uh, I personally benefited from it, but that's where that's congruent with my own values. Yours may be, different. Uh So P-E, P-E-R in the acronym PERFECT for the PERFECT cash-based medical service is R is replacement. Uh, this is important, guys, meaning replacement. Are you the only one who can do this procedure or service?
When I started out my practice, I wanted to create everything where I didn't have to do, I wasn't responsible for only the doctor can only do this service. Um, you know, so for example, in weight loss, my mid-level providers, my nurse practitioners can do these services. They can do nutrition consults. They can do the injections.
Certainly, let's say you're a a, board-certified, plastic surgeon, obviously, you're gonna be most highly skilled in doing, you know, some, intricate procedures that you spend years in, in training. You know, if that is, and if it's worth for you doing it, if it, feels that this is one you can do and you feel justified, that you say, "Hey, I can charge this.
I should be the only one doing it," that's great. Then just leave, like, those higher-end, those higher, income services just that you can do it. Um, but there should be other services where you're not the only one who can do it. And I see too many doctors who are doing services that, that they really don't necessarily needing to do it all.
Like, do you need to do every single injection, or can you hire a medical assistant or, a nurse to, do that in, depending on, what, is your state? Um, so, those are the things that you need to, understand. So R, can you be replaced? Um, F is kind of going along with this.
Is it financially feasible? You know, what are the upfront and ongoing costs? I know, Lisa had talked about doing, med spas. A big area in med spas where I see a lot of doctors get in trouble is they're ready to buy that $100,000, $200,000 laser. Uh, and then they realizes that, they don't know how to market it, they don't know, they think, the med spa, the med spa salesperson said it's the, the greatest thing since sliced bread, and then, two years later they come out with the newest, the greatest, thing since, sliced bread, right?
And, they're not seeing a return on investment, so be very careful. I didn't buy my, like, the high-end laser stuff until, like, my eighth or ninth year in practice, because I saw too many doctors, getting in, spending all this money, then having to pay it back, and then the, the laser becomes a coat rack 'cause they don't know how to market it and they don't know how to to do anything like that.
Um, and it was too expensive and, pra- their practice, their, patient population wasn't used to, spending that. So it's gotta make sense. It's gotta make, is it financially feasible in your area? So that's, P-E-R-F. Uh, E is exemplary. Exemplary meaning what makes your unique service?
And this is an important one. Like, what, how can you do to differentiate from the competition? We ask our staff this, regular. What do we do that is different from us? You know, we do a lot of aesthetic services. I'm in Southern California. There's a lot of different med spas, down the corner on there, but what do we do that's exemplary?
Um, you know, maybe for our weight loss, instead of just giving them, semaglutide or Ozempic, we're giving them nutrition consultations. We're giving them, a, cookbook. We're giving them, things that they, can take, home. Um, you know, in our aesthetics, I have my nurses, who have, you know, seven-plus years of experience.
They've done thousands of these. Uh, and, you know, one thing that we've recently coined is we're the, ones you see after you go to the ... at, that fix the other med spa's errors. We're the ones that, come see us. That makes us exemplary. Um, that's allowed us to win some awards and community award.
We were recently won, best weight loss clinic two years in a row. We're gonna hopefully get a third year, here. So that one makes us, exemplary. So what is it in your practice that you can, decide? Maybe you're certified in a, certain areas. Um, then so that's P-E-R-F-E. C is continuous, is you want to start thinking
C is continuous meaning memberships. You gotta people, get people onto memberships, recurring on, ongoing, treatments. Um- I recently, is how many of you belong to members, memberships? Uh, not, your, not just your medical memberships. I'm talking about your Netflix, your Hulu.
I know you're all out there, right? We all have, all these memberships until... We have a membership in, our location where they, pay, 99, 199 a month. What that does for our practice, it gives sustainable recurring, income on there. Uh, we recently, are using an app called Repeat MD.
Repeat MD, it, which is basically, it allows our own app. Um, I don't know how many of you are Starbucks fans, but my Starbuck usage increased when I had the Starbucks app. And so what Repeat MD does, it reminds people like, "Hey, you've got a free facial coming up," or, "You've got these points that you can use for the next thing."
It's all about loyalty. In these days of increasing competition, you have to have a, a time where you have to, you know, uh, start building up that loyalty. And one of the ways that you can do it is to have memberships, to have, use current technology that's out there, using apps that have reminders of like, "Hey, you've got these points."
You know, I, I have that all the time. You know, I have Amazon Prime. It, it tells me I'm getting, you know, faster shipping, uh, cheaper prices, et cetera. So you have to start thinking about memberships. So C is continuous. And I know I'm getting close to my time, but I wanna give my last one, which is, speaking of time, is time conscious, is being time conscious.
Is your practice, is, will this intrude on your own time? Meaning, do they need to see you on a regular basis? Or are, is this someone, is your practice dependent where you're at their beck and call? Um- There are some, uh, you know, when I, when I help consult with, with, with doctors who have got their concierge practice, I really try to dissuade them, like, giving out their cell phone.
They say, "Oh, I'll just give it to a few patients on there." You know, there are some relatives I don't give my cell phone out to. I- is, is that you don't want to, you won't always wanna be on demand. You know, why, in medicine, as someone who has, has been in medicine, quite a while, I really value my, time with my friends, my family, and, that's my time.
And it's okay to be selfish with your own time. But are you gonna be one where you're always on call or always on demand? I work with these doctors where they're always on call. They, sure they may be making quite a bit of money, but at what expense? And what the expenses come is, less time with their families, less time with their friends, and then they results in lots of different issues, burnout, et cetera.
Um, there's lots of different ways that you can make a living these, in life. How do you wanna live your life? For me, I wanna be very selfish with my own time. I wanna spend it with people that I cherish and love, do the things that I, want to do. So that was the acronym. So just to, sum up, when you're thinking of your, cash service, think of P, personal interest; E, ethical; R, can you be replaced; uh, F, financially feasible; E, exemplary; C, continuous; T is time conscious.
Uh, so wanted to give you that. Uh, John said a few things that I could share with you. I know a number of you have gone through, looked at different cash-based services. When you're looking at those different things, think of those, some of those things to determine which is the right perfect cash practice or cash treatment for you Thank you very much for that.
Uh, very, very helpful and very, very encouraging. Can you speak to what the role of a coach is in moving forward? Uh, and, how do you select the best coach for your given situation? You know, it is, it's funny. Um, is, you know, how do you find a coach? You know, my thing is, are there people out there who are doing what you want to do?
And do they look happy? You know, do they look happy doing what they what they want to do? Um, you know, they say the best coaches find one that, uh, happy and, well, he said he's wealthy or just, you know, well off. That, like what they wanna do. You know, the thing is, you know, 'cause a number of doctors, and I'm not saying just yours, but a number of doctors when they think of cash pay services, a lot of them are in the, med spas.
They, wanna, they're interested in the aesthetics. We know there are some companies out there that are actually looking for, like, nurse practitioners. They're, targeting them, “Hey, you know, get out of the hospital and, you know, join a, start up your own med spa on there.” In almost every major city, almost every weekend, there's a Botox course that, being taught on there.
What they don't teach you is how to have a successful business. Sure, they can teach you how to do the, technical stuff on, how to inject, Botox into the face and, what you need to know, sure. But they don't tell you about the business. And I say anybody who does, if you got a cash-based medical practice, and, I always say that to them is, there someone out there doing what you want to do?
I want you to reach out to that, them. "Uh, I don't wanna bother them." Well, then how do you know if, are they happy? So I've actually had people who they find their coach by actually, like, reaching out to that doctor. I know some who actually even applied for a job just to see, like, what is the inside.
I guess that's one way, of having a coach. But the thing is, you have to find someone. When I first got started in, my weight loss practice, I had a friend who had a series of weight loss, practices in, Texas. She had about five to seven. She was a non-physician. Good friend of mine. But I actually flew down to Dallas, and I got to see what are the inner workings is, on in there.
And there's things I liked, things that I didn't like, and I, took that back to them. Um, but you can't just say, "Hey, one day I'm gonna do it," without actually doing it. Before we do medical school, we all, we all shadowed the different, types of, specialties, and that was gonna determine where we're gonna be for the rest of our life in here.
You need to do the same thing, whatever you want to do. So coach, find out someone actually doing what you wanna do, and shadow them. Do whatever you can to, see is this the right thing for you. Have you found that there are specific specialties that have more or less problem in making a transition from the jobs that they don't like to the jobs that they like?
Um Could you rephrase that question? I, not sure I quite understood the- And so, I mean, do, say, surgeons, especially sub-specialty surgeons, proceduralists, have more of a trouble or less trouble making a transition, from being an employed physician to doing cash pay or to doing one of the other paths that you discussed?
Um, yeah, really haven't seen any, one thing that, you know, it doesn't... I mean, there, there's certainly some that are more... makes a lot of sense. So a number... I know a lot of plastic surgeons who open a cash-based medical, accessory practice in what they're currently doing.
So they'll have, like, their, they'll, do their, their plastic surgery, they'll do their, breast augmentation, they'll do, doing, and then they, have, they'll open a med spa on the side because that allows, that allows them to build some more recurring, revenue.
So it kind of makes sense. Now, if, you're a, if you're a pathologist and you're trying to go into, something that doesn't fit to what you're currently doing, it's, you're gonna, obviously you're gonna have a much more, difficult, mountain to, climb there. Um, so it, really, it comes down to that first thing is, do you have personal interest in it?
You know? Is, you know, even if you're, your specialty, you don't have a history of doing it, perhaps there is something that, that you've experienced that makes you want to go into that, you know? So I know some, doctors who, unfortunately they've had a cancer scare, but then they get interested in, into, like, functional medicine or, different aspects like that, just because they, had something that was a, very, traumatic or engaging experience that allowed them to say, "You know what?
This is the way that I wanna be involved in medicine, and I want to pursue this direction." And the people that you've worked with who have tried to make transitions, either into the cash pay space or into other directions, and they fail, why is that? What's the biggest barriers and, what are the biggest challenges that these folks face?
I think the biggest barrier is something that, unfortunately we get zero business training in, medical school. We have zero, zero in it. And I'm not necessarily you need to get an MBA. I don't have an MBA. But I think you, there's a, there's a process where you either decide that you got, you need to love business or you, need to have the ability to take risks.
And I think that's, that is a big part of why doctors, or they, say, which I don't believe, that doctors make terrible, terrible in business, is because we're risk-averse, because we're trained to be risk-averse. Well, the definition of being an entrepreneur is you have to be able to take risks.
And, there are some that it, it's, it's definitely something where you have to be able to say, "Hey, I may not be able to, generate my own salary for the next one or two years." You know? And that can be very difficult, to do. So, I don't say that everybody needs to be an entrepreneur, but they need, to understand the risk going, in there, and at least have the, cashflow to allow that to happen if they're gonna be involved in ventures such as this.
all the different types of the cash-only businesses that you know of, which ones are the least likely to be able to be scaled, into a situation where others are gonna be doing the work? Um, in my opinion, it's, the concierge-type of practice where it's the, the direct primary care or the concierge practice where, um...
You know, I know some doctors where they are, like, the, physician to the affluent. And certainly, they, charge a higher price, but they, doing so where they're giving them their cell phone. They're, on, they're on demand, 24 hours of the day. Uh, so they're the one...
They're seeing all of the patients, they know all the patients. Um, and some make it work. For me, that would be very difficult to, scale because you're never gonna be able to sell that business. And which I, as I mentioned, I feel is the, goal of a business. I had a, I had an offer when I, was in my transition from a person that had a, concierge practice to the well-to-do, and they had a small number of patients that charged $10,000 a year subscription fee to a, small number of patients.
He offered to set me up, recruit patients for me in exchange for 20% of my take for the next five years, and it, is a, that is a big question you have to ask yourself. Because when you have a small number of patients that are each paying a lot of money for you, then you're not really working for their wellbeing, you're working for them.
Yes. And that can be a challenge. Yes. And then there's conflicts of interest, and then, they may or may ask you to do things where you just feel uncomfortable. You know? Yeah. You don't wanna I've seen it happen a ton. You don't wanna end up being Michael Jackson's doctor, that's for sure.
You pointed it out, but that's, what I was thinking about in my head. Uh, would you advise partnering with another MD when you're starting out a cash pay business, or do you would you think that being solo would be the best way? I think partnership is, great. The, problem is, that you need to find a partner that they have strengths where you are weak and, vice versa.
And, you know, maybe that one has a stronger business acumen than they do. Um, where I see partners have all the, where, I see issues is, or where perhaps, like, one person is funneling the, revenue and the other isn't. And partners can be great. I've had partners that have been amazing.
I've had partners that have been crappy, and, not to the point of legal, but it, I've had partners where it's like there is miscommunication, and yet it's on me, it's on them, whoever. It's, like what are they bringing to the table, or is this something that you can do on your own? You know, anybody could...
You, I, wouldn't have a partner where, like, they're they're, you know, funneling the, income, 'cause you, you can get money different ways as, a doctor. You can get loans, different things like that. Um, is it a, physician or who is going to, share the costs, share the patients?
That might be, a good, way. You just have to kinda define it. And I think what happens is it's not clearly defined, and then, that's just in my experience. Um, but I, you know, so I've seen things where partnerships work, others and partner don't. Uh, I have, I can think of a situation right now, where, there's a partner who is young.
She's in young. She's, like, probably in her 30s, and she's partnering up with a doctor is in his late 50s, early 60s. They have different goals of what they want. He doesn't think he'll be in practice for five, the next five years. She will be in practice probably the next 30-plus years. There's gonna be important questions, important decisions to be making, and now they're kinda realizing it, moving forward.
And now she's feeling kind of the runt. She feels like, "Hey, I'm doing kind of all this work. My, my..." I'm not to say, like, the, older doctor is, m- may feel less responsible, but he clearly and what she's telling me is feels that, he isn't, helping in terms of practice as, he should, mostly because he's got different objectives of what he wants in his career, and now she's feeling it, and now there's, gonna be some, probably some important decisions and, that needs to be made, and, probably it's gonna go lay down legally.
Have you ever personally, felt the absence of, any formal business training, not having an MBA, for example? I can tell you what my and, my friend who, used to run, I don't know if he currently does, but he ran the MBA program, MD/MBA program at Johns Hopkins did. And I said, "Of those doctors who are in their MBA program, how many of them are actually, do you feel are actually gonna use their MBA?"
And he admitted that he didn't think most of them are gonna use their MBA. Sure, there are some who go on to become medical administrators, a number of people who get MBAs unfortunately are just doing it just to, do it. Um, I felt that, in my business, I learned the hard way, is when you're responsible for payroll for seven, 10 employees every two weeks, you get really good at learning business and learning marketing.
Uh, not to say that, just because I have an MBA I, didn't learn. I'm sure the MBA could have helped me understood things, but I never felt like I needed to have it, because I, like I said, I learn really fast when my, the revenue that's coming in, the money is in the bank, and I'm responsible for all of these different expenses.
I learn really quick about at least running, how to run my small business. Uh, and that way I felt I didn't need an MBA. responsibility can certainly focus the mind- Yes ... wonderfully. Mike, this has just been absolutely wonderful. To, wrap up, what is the one thing that you haven't told us that, uh, you think the folks still need to know before you, before you have to go?
What's the one thing that, that they should know? Uh, is, you know, I think you've, you've got lots of information. You got lots of different, lots of great speakers you've had on there. Um, and now it's determined, like, what now, what are you gonna do with that information? What are you gonna do with it? What, what is there?
You know, uh, John, Tom have, have brought you all of these great speakers, all of this great knowledge. Now what's the next thing? I don't want you to do what, like what I did and, and put it on the shelf. A- and, and that's not gonna help you out. This is when you need to start making decisions. And y- you, you came on here, you know, you're, you're hopefully, you know, watching this live or, or a recording.
You felt that this was important to do. Now you need to decide, you know, I think medicine is at a crossroads, and we realize that we can't depend on insurance companies. We can't always depend o- o- on these things. For phys- for medicine to survive, it's up to us physicians now to do it. You can shape what is, you know, not only for your own career, but in medicine.
There is breakthroughs out there already. We know th- we know there's things like AI that's out there th- that are gonna be very pivotal that, that are, that are coming on here. Um, but what's it gonna be for you, and w- what, what are you g- gonna do about it? And I feel that one of the best ways is, is to become your own boss and, and not to take insurance, letting you have cash.
And for me, it made me, you know, the, the, the subtitle of my book, The Physician Physician, is how, I was able to love medicine again. Yeah, that was so true because it wasn't for me, I didn't love medicine back then. I didn't in insurance-based medicine, that love was probably the last emotion I was, thinking about.
But going in and seeing patients, although I don't personally see all the patients, I enjoy going to the clinic, greeting them, seeing how I've affected their lives, how I've helped them lose weight, how they, helped them with their relationships, helped them with their appearance. And for me, in the type of medicine I do, that's what helped me to love medicine again, and I think you can find love medicine, too, if, perhaps you were in my, my thinking.
Uh, there is, there is still room for us as physicians who wanna do what we were trained to do.
Well, that's it for today's lecture. There is a common thread to many of the most successful physician entrepreneurs. They avoid headaches and hassles, eliminate much of the overhead, and keep things simple by not billing insurance companies
You can find the show notes for the audio podcast, links to related content, and a transcript of today's presentation by going to nonclinicalphysicians.com/cash-based-business, cash-based business. If you have any questions or comments about Mike's lecture, feel free to email me at john@nonclinicalphysicians.com, and if you're not already receiving my newsletters, be sure to sign up so you don't miss updates and special offers at nonclinicalphysician/newsletter.
And join me next week for another episode of Physician Non-Clinical Careers. Finally, don't forget that the opinions expressed here are mine and my guests'. While the information provided on the podcast is true and accurate to the best of my knowledge, there's no guarantee that using the methods discussed will lead to success in your career, life, or business.
So always consult an attorney, accountant, or career strategist before making any major decision about your career. Well, that's it. Bye for now
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Take Back Control with a Cash Based Business
Interview with Dr. Mike Woo-Ming
Episode 464
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You're listening to Physician Non-Clinical Careers with John Jurica, episode number 464, "Take Back Control With a Cash-Based Business." Welcome back, non-clinical nation. Today I'm presenting Dr. Mike Woo-Ming's presentation from the 2024 Non-Clinical Summit. Mike has been building and running cash-based medical businesses and teaching others how to do the same thing for decades.
In today's presentation, he provides examples of the business he has created, I should say the businesses he has created, because he's done many, why they are successful, and how you can emulate what he has done. So here we go. Here is Dr. Mike Woo-Ming thanks for being here, and take it away John, thank you. I'm honored to be here, honored to call you my friend, and, just, thank you guys for, listening and, coming onto this. I mean, I've been doing this for, being an entrepreneur going on 20-plus years, and in the early days, I felt like I was the only one out there.
And now through, through the, through the, work that, John and Tom are, doing, Peter Kim and Nneka, who you had earlier on, Sonny Smith, is, is just tremendous. And, and I think physicians are kind of finally seeing the light that, maybe it was because of what happened during COVID, that we need to start thinking about other streams of income.
I know that most of you, have... are an employed physician and, that's the majority of physicians these days, but we need to start thinking about different, ways. And through me, for, myself, I, learned that early on. I learned that about multiple streams of income.
Currently, I have about 11 different streams of income. I don't, actively see patients anymore, although I'll tell you about, a little bit about my story, is I own cash-based medical practices. We have three locations and, recently have now become a chief medical officer to turn those medical practices into a women's health franchise, so that's, that's pretty exciting.
but what I wanted to share with you, just kind of at the beginning, is to understand what it is about being a physician and what, what I like to call a physician, entrepreneur. I'll tell you a little bit about my story. I go more in-depth in, in my book. Cheap plug, you can find it on Amazon.
But, I am a graduate of Mayo Clinic, in family medicine, but I started my first, business as a resident. I started a medical education company. I started an online startup, but back in 1999, I started developing what are known as, e-books or information products. that actually was my first million, was selling, different books in different genres.
and that's where I learned about if I create something once and as a, in a book, I can generate, money while I'm sleeping. So, my first $100 was I sold five copies of a book that was $20. I may have spent five to six months writing that book, but I was making money while I was sleeping, and that kind of like clicked the, the light bulb in, in my head.
then I started a software company, that I later was able to sell. I was out of medicine. I was actually able to retire for, quite some time, was able to turn that into consulting. I got, honored to travel around the world in, in terms of consulting and selling software. started a online reputation management company for physicians.
But then in 2012, I went, back into medicine. I wanted to go back into medicine for my own terms, and that's where I fell in love with cash-based medical practices. I started a, first it was in occupational medicine, and then later it turned into a weight loss hormone therapy, then it turned into a- an aesthetic, services.
Added all these different services, and I'm actually gonna go and help you if you're thinking about going into cash-based medical services. I've, got what I call the perfect cash medical, service, Just, a way of when I consult with, doctors about determining what is the best, medical service for you.
I call it the perfect cash medical service, and we're gonna be sharing with that, tonight. but, I work with a number of different doctors and, I help a number of different doctors kind of find their own path and, and what's exciting is, is to see that, doctors are finally feel like they're finally doing something that, that they love.
I had a, mentor, way back, when. He says, "If, you wanna be in a business, you need to consider it ... called an ELF business," and that means easy, lucrative, and fun. And John, I don't know when the last time anybody described medicine as an ELF business, easy, lucrative, and fun, but it can exist, and it's just a way that, we kind of run, things.
Now, I'm not saying every day is, is wine and roses. I've got 20-plus employees, three different locations. I have new business partners that I, interact with on a regular basis. Certainly, it's not ELF, but just being, to aspire to that, to aspire to creating a business that, can be easy, lucrative, and fun is what we, all hope.
Uh, when I was looking at kind of what I wanted to share with you guys, John mentioned that we should talk about, the financial levels. I, came up with something in the book called, the physician, financial levels for physicians. And, it's like four to five levels there.
Since then, I've, kind of expanded that from, the book, and I want to wanted to share with you, and I call it the seven stages of what I call financial entrepreneurship. And, what's, what I think is helpful is it can determine where you are, what stage you are, and then what can be the crucial step to get you to the next stage.
Now, as doctors, we know that the road to becoming a doctor is a very linear path. We know the exact step-by-step things that we need to do to become a doctor, right? We need to get, go to a nice college. We need to get good grades. Hopefully, it's in the science-based... It could be a science-based major for, a majority of us.
Have good enough grades, and then take the MCAT, have great, great scores, get some great personal statements, do some volunteer work. That lets you get into medical school. Then we go through medical school. We do, based upon how we do, do we pass, do we get honors? Whatever, whatever the way that they grade us, that may determine, in third year we determine, what type of specialty, what we want to do, and so on.
We go into residency, may be fellowship, et cetera, then, eventually we, become a physician. Very linear path. Entrepreneurship, not so much, not so easy. So that's why I wanted to give you this, this insight, what I call the seven stages of physician, entrepreneurship. So let's talk about the first stage.
I don't wanna offend anybody on here, but have you ever heard the term wantrepreneur? This is what I'm calling the first stage. Uh, that is somebody who wants to be an entrepreneur, they become a wantrepreneur, and this is the largest group. Uh, oftentimes these are the employed physicians, right?
They, might be listening to, my, podcast. I have a podcast called Bootstrap MD. John's, amazing podcast. listen to Tom. they might maybe listen to lots of different things and, maybe they, listen to it, they watch the YouTube videos, they live vicariously, but then at the end of the day, they, kind of do nothing.
Maybe they buy a course. Maybe they, purchase this course. They listen to it. and I bought lots of different courses, and I'm not... I'm gonna be honest with you. There's some courses that I purchased, they be, can be thousands of dollars, I never even opened it, you know? These courses, and I, get so upset at myself, and it's what we call, it, it's when we turn self-help into what I call shelf-help.
We, put it on the shelf, and we feel, "Hey, we just bought it," you know, that, enough. And, talk with, them and then when you ask them, like, they're either working with me or such, they said, "Well, I, researching it right now." I know doctors who've been researching starting a non-clinical job for years, and then they never be able to, get that way.
And so, so that's the one stage you wanna get out of, I know want to be a wantrepreneur. We all hear about we need to take action, we need to take massive action. Do something. Do something that takes you into the next stage. So what is that next stage? That's the next stage, what we call physician with side gig, or I like the term side business.
So this is a physician with a part-time, business. You know, I don't like the term gig because it sounds like, you know, hey, I'm gonna be driving, like, a, an Uber for, like, a few months, you know? That's what I'm talking about. I'm talking about something where you want your side business to become an actual business because that's what it is.
You want your part-time business becoming a, full-time business. someone told me that, and this is kind of an arbitrary number, that they don't start a side gig unless it's making, at least 5 or $10,000 a month. That, means it's, it's a realistic business that, worth your time.
about your, side gig. Maybe you have something right now. Maybe you're doing some consulting. Maybe you're, you're write, writing part-time. I know that we've already gone through different things that maybe you're considering as, a side gig. for me, I've got, a number of different, quote, side gigs, that I do.
I guess if you consider me managing these employees, these three locations, that's kind of my full daytime gig, but I also do consulting on the side. I work with, entrepreneurs. I, a business coach. I work with Peter Kim. You may be familiar with him. I, do a lot of, consulting a- and coaching, for, them.
but there's some other things that, I've done in the past. I've done, one of the things that I do is, I do hormone pellet therapy, and I've been a trainer for a company where I go out and I work with other physicians to get them certified, in different training. sometimes people don't want me to talk about this, but I, work for the California Medical Board, where I've actually screened other doctors who are on probation for some unfortunate reasons, where I, work with them and, I visit them and, help them to get their license to get them out of, probation.
lots, of different things that, I'm, involved with. So, kind of focusing on that, that easy, lucrative, and fun, sometimes, it is, and sometimes it's not. And sometimes you, need that extra income, and it may be something that you're just doing temporarily just because you're just doing it to help you pay the bills.
But, that's kind of that second level where they're, doing the side gig, but they kind of remain in that. They don't want it to go, full-time, but it's, just enough that, maybe it, helping them. So what's the third? What is the third level? The third level is- Being the self-employed physician.
So this is the doctor who is that solo, who's got a, solo practice. Uh, his entire income is based upon, his business. So this could be a doctor, like I've got friends who, and it's kind of dwindling now, but they're, got that solo practitioner. They're, maybe, far away.
They, working for themselves. this is, could be the doctor who is a telemedicine. I know a number of different doctors who are running full-time telemedicine practices they're doing on their own. Uh, a- and, from what I see, they, love it. They, don't, they have low overhead because they're the only employee.
Uh, they've got control of when they want to work, when they want to work. there's, there's pluses and minus to, it, right? Uh, when you're doing everything yourself, what happens if you want to take a vacation? Then you're not bringing in your income, so your income is, is limited by how many...
doctor is seeing patients, he's limited by how many patients they see. Their income is limited by seeing how much patients see. But at least at this level, they're becoming their own boss, right? but like I said, there's always pluses and minuses because, you want to start...
This is where it focuses on the next level, is what can we bring, to bring in more, income besides us seeing patients? What, needs to be involved here? And that's the number four, and the fourth level is a physician as a business owner. So this is where, I got started, where I have a staff.
Uh, my first staff was, I remember, I was nervous. I hired an RN. We had started a weight loss practice, and I would see the patients initially, and then I would have the registered nurse do the follow-ups on there. And that's where, that's when we were doing injections, and we had others who were, injecting.
And, then we were bringing in revenue that way. So I wouldn't have entirely seeing all of the different patients. So I know that there's some, maybe some practice owners here. This is when you should start to think about these things, right? that you can't see... If you want to scale and grow, you're limited by how much that you can see.
I mean, you've heard of DPC, a direct primary care. That's great, but if you're the one who is, has the, you're at the beck and call for a patient, I don't know how long that, can last. Maybe that, works for you, and maybe you enjoy it. But I, me, I wanna have some flexibility in my life.
And then I realized that I need to have other people, uh, be able to see patients and bring in revenue besides me seeing it. I think it's very difficult these days in 2024 where to run a solo practice where you're doing everything on there, because you still got to work on... You know, maybe you're seeing 40 hours of, uh, of patients, but then how are you gonna running the practice?
Uh, important book you may have heard of, uh, I read it early on. They're called The E-Myth by Michael Gerber, G-E-R-B-E-R, E-Myth or E-Myth Revisited. The important, um, point in that book is to work on your business, not in your business. You wanna be working on your business. Uh, that involves, like, understanding the marketing aspect of it, and to understand, uh, that you gotta do other, other roles as a business owner, such as payroll and making sure all the insurance is being, uh, paid, and, and, and the rent, and dealing with all the different vendors and, and all that different stuff.
There's a lot of different tasks other than you seeing patients, and that's why it's important to getting to that next step, is where, um- You know, you want to be able to practice to run, and then if you go on vacation, your business doesn't suffer. So most never, doctors never really get past this stage four, and I want you to get past that, uh, because this is the one where, uh, John said early on that, that, uh, you know, when you have a business, I think the ultimate goal of the business is to eventually sell that business.
But how many times have you heard a doctor saying, "I have a business. Nobody wants to buy it"? The reason why nobody wants to buy it is because he's the one that is seeing all the patients. They're stuck in that stage three, right? They're seeing all the patients, uh, in there. So if he leaves- Well, how much is that business worth?
Maybe get some money from the equipment, but that... And maybe s- you know, maybe the, the patient database, but there, there's a lot to it because they understand that the primary, uh, revenue generator is the physician themselves. That gets us to what I want you to start thinking of is becoming number, stage five, which is the physician as the CEO.
So this is when you are income. Your revenue is not dependent on you being day to day. I saw, a total of one patient this month. seen a total of one patient this month, and I think the second patient is, will be my, wife later in there. That is because I have, three nurse practitioners who work under me, and I have a, a, a, a nurse, in another clinic who are seeing the majority of these patients.
So my clinics are open. I am, we're generating revenue, and that's a different level of it. It's obviously... Yeah, it takes time to get to that level, but if you understand business as you understand medicine, you can get to that. Going to attending these things that Tom and John, put together, you guys, I know you're at the next level here because you're, understanding that these things are important.
Um, so, I know some are, A, mid-level providers may feel one way or the other. For me, it works for my practice. It could be hiring other, doctors. My dad, recently passed away a few years ago, but he had told me, one wisdom he said that, his practice it really started generating revenue when he realized that, he could hire other doctors to see the patient.
He wasn't, it wasn't on him, and it actually allowed his practice to grow even further. Uh, so that's, what the importance of being a CEO is. That's stage number five. Then this is the, next stage, and this is the stage that I'm excited about being in, and that's, the physician as an investor.
So this is when you would use your capital. You're, making money in your business. You're using your cash flow, your capital, to now invest in other businesses, investing in, multiple, different businesses that, as I mentioned at the top- with our medical practices, I may or may not have said it, but I recently have taken on new business partners.
We're forming a new company where I have equity. We're building a women's health franchise. Uh, it takes a lot of, my time, but the, idea is that, I'll generate, equity, so hopefully at that time we, build this up. Hopefully, does very well, and then I'll be able to, have that equity in my business.
So right now, it's, a lot of work, to do it, but that's my eventual goal. Uh, the reason being is if... And I'm not saying money is the end all, but if you've ever looked at, like, what they call the ultra wealthy, the ultra wealthy people, these are people who make over $30 million a year- Uh, you know, what is the, what is the reason that, how did, they make their wealth?
Uh, they made their wealth, majority of them, is through a liquidity event, meaning there was some type of, event where they came in with a lot of money. Generally, it's a sale of a business. So it could be a sale of, real estate, whatever it is. That is what, what, the majority of ultra-wealthy is.
And, there's others, certainly number two was, like, inheritance. Number three, they had some type of special talent, so, like, your, uber athlete, right? The Michael Jordans, LeBron James. last time I checked, John, I wasn't six foot nine and I could dunk a basketball and, score 40 points, so I'm very limited at my five foot six 50-plus-year-old.
So for, me, I don't have a special talent, but what I can do is I can build a business, scale and grow it, do it ethically, efficiently, that someone would wanna purchase it, and then, have that. So, but that, next stage is becoming an an investor, and that's where you, start investing in other different businesses, maybe different franchises, different real estates is...
And, every one of you should start be calling yourselves an investor right now, you wanna look at ways that you can use your money, your capital, your cash flow to either invest in businesses, invest in, in real estate, whole bunch of different things. Uh, John, I told you I'm a, pickleball nut.
I'm actually getting in, trying to invest in pickleball now, in pickleball business, because I believe that's, that's the next thing. Maybe I'm crazy and, who knows? But it gets me excited to, look about different businesses that are outside of wealth. So what is the, last stage, the, seventh one?
This is when is physician as a, what I call an, generational wealth entrepreneur and mentor. This is when you pay it forward. This is when you've, come to the position in life where, really, it's not really about building wealth for your, yourself. Like, for, me, I don't need more things, but I'm trying to build more wealth for my kids.
And so I'm, thinking about building wealth for, them. So that, does that involve real estate? That involve different businesses? Uh, and that involves also, like, consulting and, teaching what I know and paying it, forward. So, those are the seven stages of, what I consider is a, the, seven stages of a physician entrepreneur.
One, entrepreneur. Number two, side gig. Number three, the self-employed physician. Four, business owner. Five, CEO. Uh, six, investor. And seven, becoming generational wealth entrepreneur and, mentor. Uh, so I wanna shift gears. I know you've got, had spotlighted lots of different cash-based, Practices. Uh, we've had, Lisa talked about med spas, and we've, talked about different types of ways that, you can generate, a cash-based services.
There's only a select number of cash-based medical services out there. I think last checked, maybe there's about 40 or 50 types of things that are from everything from concierge medicine, direct primary care to, aesthetics, to med spa, weight loss. There's functional medicine, there's telemedicine, lots of different things.
But what is the perfect cash-based medical service is for you? And I wanted to share with you a little acronym that I, came up with. It's called the PERFECT cash-based medical service. Why'd I call it PERFECT? Because PERFECT is the acronym. So the acronym is, like, okay, you're, thinking about a clinic, what is, the one that you wanna do?
And so P stands for, the first P of this acronym in PERFECT is personal interest. So obviously, what you're interested in. You know, what do you, what interests you? Um, you know, what have you... Maybe it's something you experience or maybe something in your specialty that, you enjoy. That's obviously where you're gonna gravitate.
For myself, one of the first things I wanted to do was, weight loss. I suffered from weight issues, for most of my adult life. Uh, I'm happy to say I'm about 40 or five to 50 pounds less than I was, last year, but it's something that I experienced and, because of this, I wanted other people to know, more about it.
So that was my, obviously, this is easy. P is personal, interest. Uh, E, is it ethical? Is it congruent with your own values? Uh, you know, so for, what type of cash-based, services that you in. And, it, it's different for others. You know, obviously in, in medicine, we, are held by certain standards, but there are some areas that, perhaps there are some, gray areas.
You know, I'll just give you, a, example. Um, you know, there are some who have a practice that involves CBD, cannabinoid oils and things like that. You may, believe in it, others may not. Uh, but is it, ethical for what you consider? And, and again, I'm not making any judgment on here.
What does it feel like for you? Maybe there's some areas in functional medicine that you feel great about, maybe there's some that isn't. That's the great thing about having a practice. You can determine where you want to go. I would just say, obviously there are, as being in, having working behind the scenes in the medical board, there are some things that, that may be more risky than others, that you maybe, maybe you wanna get into or not.
You don't wanna do it, just because you heard a lot of people are making money into it, right? Obviously, that's not the way you wanna do it. Uh- Is it ethical? Is it, helpful? Is, helpful in people's lives? You know, I do, bio, identical hormone therapy. Um, there's some doctors who, love it, other doctors who don't like it on here.
Uh, I personally benefited from it, but that's where that's congruent with my own values. Yours may be, different. Uh So P-E, P-E-R in the acronym PERFECT for the PERFECT cash-based medical service is R is replacement. Uh, this is important, guys, meaning replacement. Are you the only one who can do this procedure or service?
When I started out my practice, I wanted to create everything where I didn't have to do, I wasn't responsible for only the doctor can only do this service. Um, you know, so for example, in weight loss, my mid-level providers, my nurse practitioners can do these services. They can do nutrition consults. They can do the injections.
Certainly, let's say you're a a, board-certified, plastic surgeon, obviously, you're gonna be most highly skilled in doing, you know, some, intricate procedures that you spend years in, in training. You know, if that is, and if it's worth for you doing it, if it, feels that this is one you can do and you feel justified, that you say, "Hey, I can charge this.
I should be the only one doing it," that's great. Then just leave, like, those higher-end, those higher, income services just that you can do it. Um, but there should be other services where you're not the only one who can do it. And I see too many doctors who are doing services that, that they really don't necessarily needing to do it all.
Like, do you need to do every single injection, or can you hire a medical assistant or, a nurse to, do that in, depending on, what, is your state? Um, so, those are the things that you need to, understand. So R, can you be replaced? Um, F is kind of going along with this.
Is it financially feasible? You know, what are the upfront and ongoing costs? I know, Lisa had talked about doing, med spas. A big area in med spas where I see a lot of doctors get in trouble is they're ready to buy that $100,000, $200,000 laser. Uh, and then they realizes that, they don't know how to market it, they don't know, they think, the med spa, the med spa salesperson said it's the, the greatest thing since sliced bread, and then, two years later they come out with the newest, the greatest, thing since, sliced bread, right?
And, they're not seeing a return on investment, so be very careful. I didn't buy my, like, the high-end laser stuff until, like, my eighth or ninth year in practice, because I saw too many doctors, getting in, spending all this money, then having to pay it back, and then the, the laser becomes a coat rack 'cause they don't know how to market it and they don't know how to to do anything like that.
Um, and it was too expensive and, pra- their practice, their, patient population wasn't used to, spending that. So it's gotta make sense. It's gotta make, is it financially feasible in your area? So that's, P-E-R-F. Uh, E is exemplary. Exemplary meaning what makes your unique service?
And this is an important one. Like, what, how can you do to differentiate from the competition? We ask our staff this, regular. What do we do that is different from us? You know, we do a lot of aesthetic services. I'm in Southern California. There's a lot of different med spas, down the corner on there, but what do we do that's exemplary?
Um, you know, maybe for our weight loss, instead of just giving them, semaglutide or Ozempic, we're giving them nutrition consultations. We're giving them, a, cookbook. We're giving them, things that they, can take, home. Um, you know, in our aesthetics, I have my nurses, who have, you know, seven-plus years of experience.
They've done thousands of these. Uh, and, you know, one thing that we've recently coined is we're the, ones you see after you go to the ... at, that fix the other med spa's errors. We're the ones that, come see us. That makes us exemplary. Um, that's allowed us to win some awards and community award.
We were recently won, best weight loss clinic two years in a row. We're gonna hopefully get a third year, here. So that one makes us, exemplary. So what is it in your practice that you can, decide? Maybe you're certified in a, certain areas. Um, then so that's P-E-R-F-E. C is continuous, is you want to start thinking
C is continuous meaning memberships. You gotta people, get people onto memberships, recurring on, ongoing, treatments. Um- I recently, is how many of you belong to members, memberships? Uh, not, your, not just your medical memberships. I'm talking about your Netflix, your Hulu.
I know you're all out there, right? We all have, all these memberships until... We have a membership in, our location where they, pay, 99, 199 a month. What that does for our practice, it gives sustainable recurring, income on there. Uh, we recently, are using an app called Repeat MD.
Repeat MD, it, which is basically, it allows our own app. Um, I don't know how many of you are Starbucks fans, but my Starbuck usage increased when I had the Starbucks app. And so what Repeat MD does, it reminds people like, "Hey, you've got a free facial coming up," or, "You've got these points that you can use for the next thing."
It's all about loyalty. In these days of increasing competition, you have to have a, a time where you have to, you know, uh, start building up that loyalty. And one of the ways that you can do it is to have memberships, to have, use current technology that's out there, using apps that have reminders of like, "Hey, you've got these points."
You know, I, I have that all the time. You know, I have Amazon Prime. It, it tells me I'm getting, you know, faster shipping, uh, cheaper prices, et cetera. So you have to start thinking about memberships. So C is continuous. And I know I'm getting close to my time, but I wanna give my last one, which is, speaking of time, is time conscious, is being time conscious.
Is your practice, is, will this intrude on your own time? Meaning, do they need to see you on a regular basis? Or are, is this someone, is your practice dependent where you're at their beck and call? Um- There are some, uh, you know, when I, when I help consult with, with, with doctors who have got their concierge practice, I really try to dissuade them, like, giving out their cell phone.
They say, "Oh, I'll just give it to a few patients on there." You know, there are some relatives I don't give my cell phone out to. I- is, is that you don't want to, you won't always wanna be on demand. You know, why, in medicine, as someone who has, has been in medicine, quite a while, I really value my, time with my friends, my family, and, that's my time.
And it's okay to be selfish with your own time. But are you gonna be one where you're always on call or always on demand? I work with these doctors where they're always on call. They, sure they may be making quite a bit of money, but at what expense? And what the expenses come is, less time with their families, less time with their friends, and then they results in lots of different issues, burnout, et cetera.
Um, there's lots of different ways that you can make a living these, in life. How do you wanna live your life? For me, I wanna be very selfish with my own time. I wanna spend it with people that I cherish and love, do the things that I, want to do. So that was the acronym. So just to, sum up, when you're thinking of your, cash service, think of P, personal interest; E, ethical; R, can you be replaced; uh, F, financially feasible; E, exemplary; C, continuous; T is time conscious.
Uh, so wanted to give you that. Uh, John said a few things that I could share with you. I know a number of you have gone through, looked at different cash-based services. When you're looking at those different things, think of those, some of those things to determine which is the right perfect cash practice or cash treatment for you Thank you very much for that.
Uh, very, very helpful and very, very encouraging. Can you speak to what the role of a coach is in moving forward? Uh, and, how do you select the best coach for your given situation? You know, it is, it's funny. Um, is, you know, how do you find a coach? You know, my thing is, are there people out there who are doing what you want to do?
And do they look happy? You know, do they look happy doing what they what they want to do? Um, you know, they say the best coaches find one that, uh, happy and, well, he said he's wealthy or just, you know, well off. That, like what they wanna do. You know, the thing is, you know, 'cause a number of doctors, and I'm not saying just yours, but a number of doctors when they think of cash pay services, a lot of them are in the, med spas.
They, wanna, they're interested in the aesthetics. We know there are some companies out there that are actually looking for, like, nurse practitioners. They're, targeting them, “Hey, you know, get out of the hospital and, you know, join a, start up your own med spa on there.” In almost every major city, almost every weekend, there's a Botox course that, being taught on there.
What they don't teach you is how to have a successful business. Sure, they can teach you how to do the, technical stuff on, how to inject, Botox into the face and, what you need to know, sure. But they don't tell you about the business. And I say anybody who does, if you got a cash-based medical practice, and, I always say that to them is, there someone out there doing what you want to do?
I want you to reach out to that, them. "Uh, I don't wanna bother them." Well, then how do you know if, are they happy? So I've actually had people who they find their coach by actually, like, reaching out to that doctor. I know some who actually even applied for a job just to see, like, what is the inside.
I guess that's one way, of having a coach. But the thing is, you have to find someone. When I first got started in, my weight loss practice, I had a friend who had a series of weight loss, practices in, Texas. She had about five to seven. She was a non-physician. Good friend of mine. But I actually flew down to Dallas, and I got to see what are the inner workings is, on in there.
And there's things I liked, things that I didn't like, and I, took that back to them. Um, but you can't just say, "Hey, one day I'm gonna do it," without actually doing it. Before we do medical school, we all, we all shadowed the different, types of, specialties, and that was gonna determine where we're gonna be for the rest of our life in here.
You need to do the same thing, whatever you want to do. So coach, find out someone actually doing what you wanna do, and shadow them. Do whatever you can to, see is this the right thing for you. Have you found that there are specific specialties that have more or less problem in making a transition from the jobs that they don't like to the jobs that they like?
Um Could you rephrase that question? I, not sure I quite understood the- And so, I mean, do, say, surgeons, especially sub-specialty surgeons, proceduralists, have more of a trouble or less trouble making a transition, from being an employed physician to doing cash pay or to doing one of the other paths that you discussed?
Um, yeah, really haven't seen any, one thing that, you know, it doesn't... I mean, there, there's certainly some that are more... makes a lot of sense. So a number... I know a lot of plastic surgeons who open a cash-based medical, accessory practice in what they're currently doing.
So they'll have, like, their, they'll, do their, their plastic surgery, they'll do their, breast augmentation, they'll do, doing, and then they, have, they'll open a med spa on the side because that allows, that allows them to build some more recurring, revenue.
So it kind of makes sense. Now, if, you're a, if you're a pathologist and you're trying to go into, something that doesn't fit to what you're currently doing, it's, you're gonna, obviously you're gonna have a much more, difficult, mountain to, climb there. Um, so it, really, it comes down to that first thing is, do you have personal interest in it?
You know? Is, you know, even if you're, your specialty, you don't have a history of doing it, perhaps there is something that, that you've experienced that makes you want to go into that, you know? So I know some, doctors who, unfortunately they've had a cancer scare, but then they get interested in, into, like, functional medicine or, different aspects like that, just because they, had something that was a, very, traumatic or engaging experience that allowed them to say, "You know what?
This is the way that I wanna be involved in medicine, and I want to pursue this direction." And the people that you've worked with who have tried to make transitions, either into the cash pay space or into other directions, and they fail, why is that? What's the biggest barriers and, what are the biggest challenges that these folks face?
I think the biggest barrier is something that, unfortunately we get zero business training in, medical school. We have zero, zero in it. And I'm not necessarily you need to get an MBA. I don't have an MBA. But I think you, there's a, there's a process where you either decide that you got, you need to love business or you, need to have the ability to take risks.
And I think that's, that is a big part of why doctors, or they, say, which I don't believe, that doctors make terrible, terrible in business, is because we're risk-averse, because we're trained to be risk-averse. Well, the definition of being an entrepreneur is you have to be able to take risks.
And, there are some that it, it's, it's definitely something where you have to be able to say, "Hey, I may not be able to, generate my own salary for the next one or two years." You know? And that can be very difficult, to do. So, I don't say that everybody needs to be an entrepreneur, but they need, to understand the risk going, in there, and at least have the, cashflow to allow that to happen if they're gonna be involved in ventures such as this.
all the different types of the cash-only businesses that you know of, which ones are the least likely to be able to be scaled, into a situation where others are gonna be doing the work? Um, in my opinion, it's, the concierge-type of practice where it's the, the direct primary care or the concierge practice where, um...
You know, I know some doctors where they are, like, the, physician to the affluent. And certainly, they, charge a higher price, but they, doing so where they're giving them their cell phone. They're, on, they're on demand, 24 hours of the day. Uh, so they're the one...
They're seeing all of the patients, they know all the patients. Um, and some make it work. For me, that would be very difficult to, scale because you're never gonna be able to sell that business. And which I, as I mentioned, I feel is the, goal of a business. I had a, I had an offer when I, was in my transition from a person that had a, concierge practice to the well-to-do, and they had a small number of patients that charged $10,000 a year subscription fee to a, small number of patients.
He offered to set me up, recruit patients for me in exchange for 20% of my take for the next five years, and it, is a, that is a big question you have to ask yourself. Because when you have a small number of patients that are each paying a lot of money for you, then you're not really working for their wellbeing, you're working for them.
Yes. And that can be a challenge. Yes. And then there's conflicts of interest, and then, they may or may ask you to do things where you just feel uncomfortable. You know? Yeah. You don't wanna I've seen it happen a ton. You don't wanna end up being Michael Jackson's doctor, that's for sure.
You pointed it out, but that's, what I was thinking about in my head. Uh, would you advise partnering with another MD when you're starting out a cash pay business, or do you would you think that being solo would be the best way? I think partnership is, great. The, problem is, that you need to find a partner that they have strengths where you are weak and, vice versa.
And, you know, maybe that one has a stronger business acumen than they do. Um, where I see partners have all the, where, I see issues is, or where perhaps, like, one person is funneling the, revenue and the other isn't. And partners can be great. I've had partners that have been amazing.
I've had partners that have been crappy, and, not to the point of legal, but it, I've had partners where it's like there is miscommunication, and yet it's on me, it's on them, whoever. It's, like what are they bringing to the table, or is this something that you can do on your own? You know, anybody could...
You, I, wouldn't have a partner where, like, they're they're, you know, funneling the, income, 'cause you, you can get money different ways as, a doctor. You can get loans, different things like that. Um, is it a, physician or who is going to, share the costs, share the patients?
That might be, a good, way. You just have to kinda define it. And I think what happens is it's not clearly defined, and then, that's just in my experience. Um, but I, you know, so I've seen things where partnerships work, others and partner don't. Uh, I have, I can think of a situation right now, where, there's a partner who is young.
She's in young. She's, like, probably in her 30s, and she's partnering up with a doctor is in his late 50s, early 60s. They have different goals of what they want. He doesn't think he'll be in practice for five, the next five years. She will be in practice probably the next 30-plus years. There's gonna be important questions, important decisions to be making, and now they're kinda realizing it, moving forward.
And now she's feeling kind of the runt. She feels like, "Hey, I'm doing kind of all this work. My, my..." I'm not to say, like, the, older doctor is, m- may feel less responsible, but he clearly and what she's telling me is feels that, he isn't, helping in terms of practice as, he should, mostly because he's got different objectives of what he wants in his career, and now she's feeling it, and now there's, gonna be some, probably some important decisions and, that needs to be made, and, probably it's gonna go lay down legally.
Have you ever personally, felt the absence of, any formal business training, not having an MBA, for example? I can tell you what my and, my friend who, used to run, I don't know if he currently does, but he ran the MBA program, MD/MBA program at Johns Hopkins did. And I said, "Of those doctors who are in their MBA program, how many of them are actually, do you feel are actually gonna use their MBA?"
And he admitted that he didn't think most of them are gonna use their MBA. Sure, there are some who go on to become medical administrators, a number of people who get MBAs unfortunately are just doing it just to, do it. Um, I felt that, in my business, I learned the hard way, is when you're responsible for payroll for seven, 10 employees every two weeks, you get really good at learning business and learning marketing.
Uh, not to say that, just because I have an MBA I, didn't learn. I'm sure the MBA could have helped me understood things, but I never felt like I needed to have it, because I, like I said, I learn really fast when my, the revenue that's coming in, the money is in the bank, and I'm responsible for all of these different expenses.
I learn really quick about at least running, how to run my small business. Uh, and that way I felt I didn't need an MBA. responsibility can certainly focus the mind- Yes ... wonderfully. Mike, this has just been absolutely wonderful. To, wrap up, what is the one thing that you haven't told us that, uh, you think the folks still need to know before you, before you have to go?
What's the one thing that, that they should know? Uh, is, you know, I think you've, you've got lots of information. You got lots of different, lots of great speakers you've had on there. Um, and now it's determined, like, what now, what are you gonna do with that information? What are you gonna do with it? What, what is there?
You know, uh, John, Tom have, have brought you all of these great speakers, all of this great knowledge. Now what's the next thing? I don't want you to do what, like what I did and, and put it on the shelf. A- and, and that's not gonna help you out. This is when you need to start making decisions. And y- you, you came on here, you know, you're, you're hopefully, you know, watching this live or, or a recording.
You felt that this was important to do. Now you need to decide, you know, I think medicine is at a crossroads, and we realize that we can't depend on insurance companies. We can't always depend o- o- on these things. For phys- for medicine to survive, it's up to us physicians now to do it. You can shape what is, you know, not only for your own career, but in medicine.
There is breakthroughs out there already. We know th- we know there's things like AI that's out there th- that are gonna be very pivotal that, that are, that are coming on here. Um, but what's it gonna be for you, and w- what, what are you g- gonna do about it? And I feel that one of the best ways is, is to become your own boss and, and not to take insurance, letting you have cash.
And for me, it made me, you know, the, the, the subtitle of my book, The Physician Physician, is how, I was able to love medicine again. Yeah, that was so true because it wasn't for me, I didn't love medicine back then. I didn't in insurance-based medicine, that love was probably the last emotion I was, thinking about.
But going in and seeing patients, although I don't personally see all the patients, I enjoy going to the clinic, greeting them, seeing how I've affected their lives, how I've helped them lose weight, how they, helped them with their relationships, helped them with their appearance. And for me, in the type of medicine I do, that's what helped me to love medicine again, and I think you can find love medicine, too, if, perhaps you were in my, my thinking.
Uh, there is, there is still room for us as physicians who wanna do what we were trained to do.
Well, that's it for today's lecture. There is a common thread to many of the most successful physician entrepreneurs. They avoid headaches and hassles, eliminate much of the overhead, and keep things simple by not billing insurance companies
You can find the show notes for the audio podcast, links to related content, and a transcript of today's presentation by going to nonclinicalphysicians.com/cash-based-business, cash-based business. If you have any questions or comments about Mike's lecture, feel free to email me at john@nonclinicalphysicians.com, and if you're not already receiving my newsletters, be sure to sign up so you don't miss updates and special offers at nonclinicalphysician/newsletter.
And join me next week for another episode of Physician Non-Clinical Careers. Finally, don't forget that the opinions expressed here are mine and my guests'. While the information provided on the podcast is true and accurate to the best of my knowledge, there's no guarantee that using the methods discussed will lead to success in your career, life, or business.
So always consult an attorney, accountant, or career strategist before making any major decision about your career. Well, that's it. Bye for now
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The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career.
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