Interview with Dr. Mike Woo-Ming

In today's show, Dr. Mike Woo-Ming returns to the podcast to explain how to start and grow a successful cash based medical practice.

You’re a clinician and you know how to care for patients. Finding a way to provide clinical care for patients who are willing and able to pay us directly sounds pretty attractive.

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Benefits of a Cash Based Medical Practice

Since it eliminates the hassle of billing insurance companies, a cash based medical practice brings more autonomy and satisfaction. 

There are several types of businesses that follow this model, including:

  • weight loss
  • skincare and aesthetics
  • medical spas
  • concierge medicine

Reviewing the Steps

During the conversation, Dr. Woo-Ming describes how he started, how his business has adjusted to meet market needs, how he added new services, and how he grew the number of clinics over time.

His advice is to keep things simple, start small, leverage your team, and take advantage of opportunities when they arise.

Best of Both Worlds

As a physician, you invested many years of your life, and a potentially sizeable amount of money to learn your profession. When overwhelmed or burned out, removing payers from the equation can make your practice more enjoyable and meaningful. Our guest, Mike Woo-Ming is a living example of that promise.

NOTE: Look below for a transcript of today's episode. 

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Transcription PNC Podcast Episode 293

How to Start and Grow a Profitable Cash Based Medical Practice

- Interview with Dr. Mike Woo-Ming

John: Welcome back to the podcast, Dr. Mike Woo-Ming.

Dr. Mike Woo-Ming: John, it's always a pleasure, my friend. It's been a long time since we talked, and thanks for reaching out and wanting to find out more information about this.

John: Well, I can keep in touch indirectly by listening to your podcast and even going to one of your webinars if I want to, so that's nice, but it's not as good as actually talking face to face. But I have noticed you're always busy and you're always doing something, and it was time to catch up with what's new in the world of Mike.

Dr. Mike Woo-Ming: Yeah, yeah. There's been so much. I have I guess my day job, which is overseeing a bunch of cash-based medical clinics. And in the last six months, we opened two new locations, one in Orange County, California, and one in a town called Murrieta, California by a half hour away. And yeah, we've been pretty busy.

John: Yeah. Well, we're going to want to hear about that today and I'll mention why to me this is such an important topic. When I think about cash-based practices, I think what is the biggest pain in whatever from practicing medicine? Sometimes its long hours, sometimes if you're working for a big corporation you can get burned out, but basically it's all the rigmarole you have to go through to get paid if you're using care through an insurer, Medicare, Medicaid, you name it. You have to add more staff. You get paid less and less each year, despite the fact that we're in the middle of an inflationary time. I am assuming that was one of the reasons that you started all this years ago. What were the main reasons that you started cash-based businesses?

Dr. Mike Woo-Ming: This is now our 11th year of starting my first practice. As you know I'm kind of wired differently. I don't want to go back into my history, but I was a primary care physician, worked for someone for five years, and just like you, I learned firsthand about some of the frustrations and complications of dealing with insurance-based medicine. From spending long hours with the electronic medical record to trying to get something what I believe was the best treatment for my patients, but then getting a denial letter and then just having to do that dance just to see what we could do to best help our patients.

And so, I said out from the beginning, actually starting it, and probably pretty naive, was, "What could I do where I didn't have to rely on insurance based medicine?" And I just basically looked and learned about what are different ways that I could get cash to make sure I could not only myself get paid, but my employees who are very hardworking and that they deserve their rewards, and that we can do this and make it viable. And we certainly have had our ups and downs just like any entrepreneur, but like I said, we just celebrated, this will be our 11th year and we're expanding. So, we must be doing something right.

John: Absolutely, you've made it work. If I recall correctly, you've tried different things in the cash-based arena. Maybe give us a look at some of that. You can either walk through what you've done over the last 11 years, or just pick and choose whatever you think are the highlights we should know about.

Dr. Mike Woo-Ming: Right. Just as yourself, family medicine, we wear many hats, we know lots of different things, experts at none. But the first thing that I wanted to do was I wanted to start a medical practice on things that I was interested in. And at the time, gosh, this is probably late thirties, early forties. And I was looking at my mortality as I was getting older, and I was like, "Hey, what can I do to live longer, be there for my kids?" So, I was looking at things and I know your audience may or may not agree on some of these things, but I was looking at things like testosterone replacement, being in primary care I had patients who benefited from that.

And that was my first foray into that. And then it moved into different things. Weight loss was obviously something that I've struggled with, and I learned that there were practices that had done these, who had did this. They didn't take insurance, and they were pretty successful. And there was one in particular franchise out of Texas that was dealing with men's care, men's healthcare, and they were introducing these things. And I actually happened to meet with the CMO from there. He was interested in hiring me to become a medical director and bridge things in Southern California. And we opened two or three locations back then, but I didn't learn, I didn't learn that it might be more difficult to do this. And they actually stopped. They actually stopped putting in the funding for these clinics.

If you know anything about me, and you do, I'm a bit stubborn. And I said, "Well, there are things that they did, and I could learn from their mistakes and I could do things my own way." I also happen to have a good friend who would help open some weight loss clinics also in Texas. And she showed me some information. And so, I got that as well before I actually started my own.

Those were kind of my first forays into cash based practices. Just dealing with things that I wanted to do personally, that I was particularly interested. And I think if you want to be successful in a business, you got to do something that you are interested in and hopefully that you love doing, and then you're going to be more energized and ready to make it work. And those are my first few ways that I got interested in cash-based practices.

John: Well, it's funny you say how you should be passionate about and interested in. You might remember that about, I don't know, seven years ago I started urging care centers with some partners. And I think we're getting ready to open our third, although I've not set foot in the clinic in over a year and I did come to realize about two or three years ago that I kind of hate this. So, I don't tell anybody. I'm trying to extricate myself. And it's not a good plan for being committed to something in an ongoing fashion. So, you started your first clinic. You were doing some of those things that you just talked about. Now, did it stay that way? Did it morph over time? Did you add a clinic right away, or did you have that one for an extended period?

Dr. Mike Woo-Ming: My clinic is a little bit different in that I had this thing that maybe it was that Kevin Costner, "If you build it, they will come." Field of Dreams. And we started off doing hormone replacement. We started doing weight loss. I also had done a lot of different, as yourself, probably a lot of different sports physicals. We did some occupational medicine.

I wanted to do services not only that people wanted to do, but stuff they had to do. So things like employment physicals, DOT physicals, those kinds of things. They don't pay a lot, but it started to give us some regular patients that had to come in every couple years, at least in terms of DOT physicals.

And then I started getting into veteran's disability evaluations. San Diego was a big military town, and there's a big base nearby. And those were areas where I got paid for doing disability evaluations. We just slowly introduced different things. And then we had some cross promotions sometimes, patients who were coming in. They were also looking at our different weight loss treatments that we had for them. Then they got interested in those different things. About three or four years in, we added aesthetics. And my thing was almost like a one stop shop. We started introducing different treatments, different things just to get people into the door. And now we're well established into the clinic.

And then last year I just said it, I want to do this all again in a new location where they don't know anything about me. And that's what ended up happening. But people are getting the word out. We've actually had some interest in investors and such. I think we got to make it work. And I think if there's one thing that I pride myself on ever since this journey is that I've always made payroll. I've always made payroll and making sure that my employees got compensated. Because let's face it, I wouldn't have a business if I didn't have outstanding employees who are dedicated and loyal.

I certainly don't know everything. I'm always continuing to learn. There's always new ways to get into, there's always increased competition. You got to stay on your toes. But yeah, so far, it's made it work. And now I've been recently doing more training and consulting and helping other doctors learn how to do the same thing that I'm doing.

John: When I get out of that, then say you started with some core services that you knew well, you liked doing, and they were cash-based, and then you just found other new services that you could add over time that were also cash-based. You're not pouring into the insurance world at all from what I hear. So, that's cool.

I just want to spend a couple of minutes taking a real high view. What you're doing obviously is starting a small business. There's a whole process to that. So if someone who's thinking of doing this, what are those things that one should think about? Whether it's planning, financial, legal at a high level, what are some of the things that as physicians we don't necessarily know about, but you're going to have to master in order to create something like this or get consultants?

Dr. Mike Woo-Ming: Anytime you're starting on any business, of course, there are some things that you need to think about. First off, should you do it? Is this something that it's for you? If you're looking to "Hey, here's something that I can do that's going to be making some passive income." Well, this isn't the place for you. There's always real estate. There's always different things, syndications. There's always other things that you can be doing and putting in your money. For me, it was more of I have a medical license and I feel that I still should use it.

As you know, I actually had left clinical medicine for some time, started my own company. And I hear my mom, her son is the doctor. I come from a family of doctors and I still wanted to be able to use it. And even when I was out of medicine, I would still do some volunteer work doing sports physicals for my kids' games and things like that. But this was a way that I could leverage what I had.

I know we talk about nonclinical careers. I still wanted to do some clinical aspects in my life. And this allowed me to do it. But I think an important distinction between what I did, and sometimes I get some flak from other doctors, is I didn't want to be the one solely performing all of the different services. And I think that's where I differentiate myself from being just a solo practitioner, the solo doctor who's seeing all the patients. I know for some it can be very rewarding, but it also doesn't allow you to grow. You're still dependent on your income on how many patients that you see, as I've said many times.

And so, I wanted to create where I've trained all of the employees and I wanted to make sure that they're highly trained, but then be able to see the patients. So, I have nurse practitioners. I've hired physicians' assistants, I have RNs, I've had LVNs, I've had medical assistants. I'm not always in the clinic. That's allowing me to grow and scale and focus on my intention of what I need to do is to make sure that we're viable, that we're continuing to grow, that we're paying all the bills on time, that we're paying all the employees on time. That's what I do. I've then slowly given a lot of those different tasks and then delegated to my office manager and things like that.

I know I went down a tangent on there, but I think the first thing is to see if you actually want to do this. If you're someone who wants to do this, if you want to become your own boss, and that was again, very important to me to have some control dictated on the revenue that's coming in. Those are the first things to actually think about. But you have to actually look in to see what you can do. And you can start out small. You can start out small.

On my podcast, I interviewed a doctor who became a very successful med spa owner. She was an emergency room doctor, and she just said "I wanted to do something on my own. I'm interested in aesthetics, so I'm just going to rent a room for half day a week." That was her first beginning of it. And that's what I would actually recommend is actually just trying it out. Or even if you have an opportunity, shadow somebody for a month. Remember we used to do that in third year medical school and then we decided our whole career based upon that. It's surprising that I still see docs who said, I'm opening up a med spa, but they don't even know if they actually even like it. And they haven't taken the time to shadow and to actually see it. It's more than just taking a Botox course over the weekend. It's like, "Okay, this is how you get trained to actually do this procedure. But what about being the owner? What about having to deal with all of the other aspects of being an employer as you know a lot about?

John: Yeah, there's definitely a lot to it but I think you're right. Shadowing is awesome. I never used to put that, even for a nonclinical career, advice. I thought good about get mentors, maybe get a coach, do this, do that. But it was only recently someone reminded me you could actually spend time with someone and see what they're doing, shadowing that way. And you're going to learn a whole lot more than just talking for 10 minutes to a mentor or an hour to a coach. So that's really good advice.

Okay. Now you did allude to a little bit ago that through all this now, because you've been doing it for so long, and you've been doing this for a while, you're teaching other people how to do things. You've always done consulting or coaching or the merger of those two. Tell us now what's going on with that. I know you help us with the podcast, but you do these consulting and courses and so forth. So just lay out for us what you've got going on now and what you plan on doing.

Dr. Mike Woo-Ming: Yeah, I've always done consulting in this aspect. I have a small number of clients who I've helped over the years, especially during COVID. I wasn't doing any training as most people were doing but I would always get inquiries. I'm helping a doctor in Northern California building up a weight loss clinic. Another doctor out of Florida and we've helped them build up an anti-aging direct pay practice.

I have clients like this where they work with me, they pay me quite a bit of money to help them do it. It's not a small thing. But then when you look at terms of some of the revenue that they're generating, the average is at least $500,000 a year to a million, million plus a year.

And I'm short-cutting their success to actually do it. I feel that they get a bargain. But that being said is, I enjoy consulting and I enjoy training, and I like working with people who are starting up. And one of the reasons that I wanted to do more of this is because there are some changes that are happening in California where you can be a mid-level provider. I know that's a term people don't like, but you can be a nurse practitioner. I know, I'm just upsetting your audience, half your audience already, but they can now open up their own clinics. They can open up immense spas. And there's been a lot more competition.

I still want more physicians to be more empowered and to think that they can actually do this because there are non-doctors who are opening these kinds of things. I just spoke to a young man recently who's starting as an IV therapy practice. Nice guy but he is not medically trained. In my opinion, I feel that physicians should take back the role as being the main healthcare educator and leader in this. And so, I wanted to create more training to help doctors do this and make it seem it's not as difficult as could be. Kind of follow my lead into this.

So, I am doing some free trainings and some, and some other trainings if they want to take it even further where they can learn more about and just to see if this is something that they want to do. I'm creating some live trainings that are coming up that we're doing to kind of help that. And now, through the power of Zoom and everybody's doing virtual trainings, these kind of things, this has been more accessible. And so, I'm always eager to do this. I always have my teaching hat and love working with other doctors. And if they're so inclined and want to learn more, we've got some resources where they can find out more.

John: Now, I know people in my audience, although we talk about nonclinical careers, reality is most physicians really enjoy medicine when it's done appropriately and in a way that is good for them and not some assembly line worker in a hospital. But they don't have the business knowledge or the marketing knowledge that you have. So, if they want to learn more about this kind of thing, where would they go to find that?

Dr. Mike Woo-Ming: Yeah, we'll have a link. I assume you'll leave a link in the show notes. It's called And that's all lowercase. And that'll take you to the resources. You can watch a free training, learn more about my story, and then decide if this is something you want to proceed, I can give you different ideas where you could start your own practice. And I've helped doctors in so many different locations. If you want to build a med spa, you don't necessarily have to be on Park Avenue or Beverly Hills. I've seen aesthetic practices grow out of Fargo, North Dakota that are making multi-millions of dollars.

My own location, my main location, it's basically in a small medical complex. My other office is on a six story of a 12 story building, medical office. I've got a weight loss clinic that's in front of a strip mall. But it doesn't have to be very flashy. It doesn't have to be very expensive. I think in that training that I do, if they decide to look at it, I have one slide of my first picture of my first practice. And this furniture it's like the cost plus rejects. The blood pressure monitor, the automated blood pressure monitor is on like a student desk. Because I couldn't afford to get something but we made it all work. Although my medical office manager still says they don't spend too much on furniture.

John: They don't get enough money, a budget for that.

Dr. Mike Woo-Ming: Yeah. One of my RNs who actually does this kind of thing, I gave her a budget and she was able to make it much nicer. That's one of my weaknesses in some of these things. I don't have a very good interior decorating.

John: I'm with you there. I talk to my colleagues here who are burned out and so forth and I bring up things like DPC, concierge medicine, start something like, "Well, no, this is the wrong area." It's like, man, there's people here that have money that want to get these services. They're driving up to Chicago an hour away to get these things. But it's a mindset thing. And so, I liked your idea earlier too, of starting small and if it's working, then you just expand it. If it doesn't work, you try something else.

Dr. Mike Woo-Ming: Yeah. Yeah. I always will try something just to see if it works. As Thomas Edison say we're one step closer to success after all the failures that he had in creating the light bulb.

John: Absolutely. Okay. I will put that link in the show notes. I pretty much always ask my guests what advice would you have just in general for physicians who are in a situation where they don't feel happy, they're unfulfilled, they're suffering? They might have burnout, maybe not, but they're just not getting out of medicine what they thought they were going to.

Dr. Mike Woo-Ming: Well, the one thing, if they're listening to this, then I hope they understand that they do have options. They're different opportunities. If it is truly burnout and depression, please talk to somebody for this. Talk to a professional to see what that is. But if it is that you're not feeling that you're being fulfilled, which I wasn't, and I know you weren't as well in your career at one time, is that there are different options and to seek what you want to do.

I got an inquiry from somebody who say "Where is the best place where I can find a mentor?" Well, the thing is, there are people who are doing what you want to do. Seek out those people if that's what you want to do. If you want to start up a cash based medical practice come follow me. If you want to start up, get really successful in real estate, well, there are people who are very successful at real estate.

I think it's been amazing since you were starting your podcast and how much everything has been grown, and you can actually find different people who actually happen to be doctors, which I love, who are actually doing these kinds of things. They're developing businesses, they're developing telemedicine practices and they're doing these kinds of things. So seek them out. And if they have products and they have courses, well, the best way you can become a student is to purchase those products and courses and then just to see.

One of the reasons why I created this is to make something that's a little bit more affordable. You don't have to come to me for one-on-one coaching, which I've actually kind of put that on the back burner these days. It's to purchase these kinds of things and then not just have it purchasing it. Because a lot of people think just because I purchased it, then I've done it. No, you actually watch it, actually implement these kinds of things.

One of my courses that I have, not in this field, but in coaching, it's 33 hours and it's a lot of information. But most of them, and this is probably on me as a coach, is they don't get through the first few parts of it. There are some people who do complete everything. But it's more than actually just going through the material. You didn't become a doctor just because you showed up to the class. You actually had to pass the classes to get you to become successful in what you're doing.

John: Absolutely. You got to make that commitment and actually devote the time and effort. The information is there for you. And usually someone like yourself is also willing to answer questions, emails, and what have you, because they want this to work. They want this person to get that new skill and implement it.

All right, Mike, this has been very fascinating. I really am glad we were able to catch up again. I'll be looking to see what you're up to in the next six to 12 months. All right, Mike, with that, I'll say goodbye then. We'll see you next time.

Dr. Mike Woo-Ming: Thank you, John. Have a good day.


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