Reader M. asks:

“Any advice for a new practitioner debating between joining a practice or starting a practice of my own? I am faced with an opportunity to join a thriving practice. I’m weighing the convenience/earning potential (esp. in the beginning) against loss of practice identity and opportunities down the line.”

If you’re only considering growth, there are really just two benefits to joining a practice. The first is the referrals you might gain from other practitioners in the practice. The second is exposure – growth you might experience simply from being in a busy office – walk-in exposure, signage, traffic, goodwill, and other benefits of the location and the business.

The challenge is that it’s pretty difficult to quantify either of them. Here are a few questions to help you out:

How busy is the practice?
You’re going to get the best mileage in exposure and referrals from a busy office. Practitioners who aren’t wildly successful just don’t tend to refer as much. There are exceptions, but they’re just that: exceptions. (And for practitioners in search of associates, the same applies: if you want to attract and keep associates and other partners, you need to be running a busy practice.)

While joining a multi-disciplinary setting may offset competition a bit, don’t count on it. Cash-starved practitioners want to solve patient’s problems with their own modality. A prosperous clinic is the best home for your practice.

Will the other practitioners refer?
Traffic volumes aside, some practitioners just don’t refer. How do you find out? Interview, interview, interview. Meet everyone in the practice. Do lunch. Chat. Get to know them, and understand the dynamic between practitioners in the office. Find out how much referral is currently going on – within the office, and to CAM pros outside. The keyword here is collaboration. A practice that refers out will be more likely to refer within.

What’s the track record for other associates?
This is an important one: how many have come before you? How long have others in the practice been there? How many people have come through? If you see signs of a revolving door, with many practitioners coming and going, you can bet there’s usually a good reason.

What are the location benefits?
Busy street? Great signage? Long clinic history? Established brand? Strong, regular marketing? These are all positive signs. Make sure you know up front how many of these benefits you can tap into. Is there signage space for you? Can you market your services to existing patients in the practice? Can you feature you name and information on joint advertising? The location benefits of the practice are only as good as the extent to which you can leverage them.

What’s the business relationship?
It’s hard to discuss all the variables here, but some important things to consider:

• Do you own the patient files?
• Are you an employee, associate, independent contractor, tenant, etc.?
• What’s included? Staff? Space? Equipment?
• What’s the duration of the arrangement? How can it be terminated on either side?
• Is there a non-compete? If things don’t work out, can you set up shop down the street?

How effective is the front desk/reception?
Here’s one of the best-kept secrets of great practices: the person who controls the appointment book controls your practice. If they don’t promote you, or if they (perish the thought) actively solicit your patients to see other practitioners instead of you, all your efforts will deliver small returns.

If they aren’t serious about the job of booking appointments, you’ll feel it.

Why are you being asked to join?
Are you being invited for the right reasons? Reasons that indicate a bright future for you include:

• A practice that’s so busy it requires more help
• A practice that wants to expand it’s range of treatments to improve patient health outcomes (as opposed to attract more patients to existing services). If you’re a lure for new patients and nothing more, those new faces might never make it as far as you.
• Practitioners that want to help new graduates gain experience – intern programs and the like.
• Practitioners who want to collaborate for the good of patients.

Reasons that aren’t so great for you:

• Someone covering their monthly overhead by filling the space with associates

How Much Do You Value the Non-Financial Benefits?
There are other benefits to playing well with others. Camaraderie, convenience and learning opportunities are all pretty darn fine reasons to hop on someone else’s ship instead of building your own. Do those outweigh the downside of joining a practice instead of building your own?

Can you hedge your bet?
What if things don’t work out? Can you make a clean break with your files and your brand intact? Here are some ideas to exit-proof your escape:

• Get your own phone number and have it forwarded/answered at the clinic. Otherwise, if you leave, people may still call the existing clinic with your old number.
• Have your own yellow pages listing with your own number.
• Have your own website and email address.

The trick is to ensure that you could open up for business down the road tomorrow, and still count on all your patients contacting you, not the previous clinic.

What do you really, really want?
This is what it’s really about in the end, isn’t it? Choosing the path that’s right for you as a practitioner – one that keeps you healthy, happy and jumping out of bed in the morning, and lets you make a decent living doing what you love. If running your own show is a requirement for that, you’re likely going to be disappointed in someone else’s business. It may seem difficult, but make the smart, joy-driven decision, not a fear-based one.

How do you get the answers to all these questions? Some are introspective, some are simple observation. The best information, though, is going to come from interviewing practitioners who are, or have been, part of the practice in the same capacity in which you’re going to join. Whenever possible, you need to talk to people other than the person who you’ll be making the agreement with – that includes patients, too.

Spend time in the clinic. Hang out. Make an appointment as a patient. Take the time to drink up the whole experience before you make your decision. You won’t regret it.