Clarifying Your Business
to the Next Chapter
of Your Professional Life
Starting a business is exciting! So often, we receive calls from physicians
who are frustrated with what has become of healthcare, their career, their
practice revenues and overheads, and their work– life balance. If you have
already decided to launch a concierge or direct practice, all that is about to
change for you.
In the previous chapters, we worked on the ideal practice vision, what
you want it to be, and we worked on some introspective insights and your
reason for taking this step, and what you hope to achieve through expert
power, inﬂuence, and charisma.
Working with Consultants and Contractors
to Get You Started
This next section is not meant to be self- serving, by any means. I included
it because it is highly likely that you will ask several consultants (lawyers,
accountants, and other specialized consultants) for help and guidance. You
have to know how to best work with a consultant, or you might be taken
78 ◾ Handbook of Concierge Medical Practice Design
advantage of by those who sell good words, but have only greed as a goal,
preying on the rich doctors who have more money than sense.
You may not be all that familiar with how consultants and contractors
can play a role to help you clarify and execute your business concept. If
the people you plan to hire to help you clarify your business concept are
incapable of writing or discussing what I covered in Chapter5, at the level
of knowledge of how concierge medicine works and what it takes to dif-
ferentiate your concierge brand, think hard about whether you want them
guiding anything else about your business.
There are a small number of good consultants who specialize in develop-
ing this kind of a practice. They are available to assist you and be supportive
like a business startup Sherpa. Your consultants’ roles are to act as a guide
to facilitate your journey across the mountain peaks you are about to negoti-
ate in the development of your business.
If you outsource certain tasks, that is the role of a contractor, not a con-
sultant. The two are very different. If you jumped to this section of the book
without reading the previous chapters, you missed my view on the differ-
ence between consultants and contractors. One advises about things, and
helps you make decisions by calling on professional training and experience.
The other does things by the hour. Consultants sometimes direct the work
of contractors or help you design the scope of work that the contractor will
do for you. Knowing the difference between the two can save you time and
money and avoid costly mistakes and poor guidance.
In our ﬁrm, we employ both consultants and contractors. In addition to
guiding you and providing instruction and insight, if you get tired, over-
whelmed, can’t manage something, or simply don’t want to do a task, you
can hand it over to us for assistance. Not all ﬁrms do this, and some who
do it charge the same for contract assistance as they do for consulting. This
is not in your best interest. Consultants charge for their knowledge and
expertise. Contractors should be paid mid- market to top- market rate for the
job they are doing, plus about 40–45% to cover margins, overheads, and
expenses usually paid by an employer.
Contractors work on a deliverable or a list of deliverables, produced in
a certain time frame. They work by a speciﬁcation called a scope of work
(SOW). They are often not paid on retainer, but instead hired by the hour or
the project. They may ask for a deposit and tranche funding (paid in time
increments or at project milestones). In most cases, you will be charged for
any expenses incurred or paid out on your behalf.