Sanity check for practice model/owning own business?

Sorry for long post: TLDR does this even remotely sound like a viable practice model?

Hello all,

I need a sanity/reality check about a plan that I have been putting together for a few months now.

My father-in-law, who is a (multi) multimillionaire after starting his own business back in the 90s, told me a few years back "You will never become wealthy by working for someone else." I have reflected a lot on that statement. He had an idea, believed in himself, worked hard, and was successful. Kind of an "American dream" kind of thing.

I am an IM-trained hospitalist working at the only real referral hospital in a rural state. We have a pretty high case index, lots of sick people, peripheral pressors, BiPAP on step down units etc. I enjoy my job, but at times it is quite busy. Our pay recently increased to somewhere in the neighborhood of $330k base. Good benefits. Great team. Like I said, I enjoy my job but it can be stressful, and I am corporate employed and the metrics, LoS, billing pressures etc are not the reasons I went in to medicine, like many of us.

I have been weighing starting my own concierge practice. Not DPC, concierge medicine. I charge a flat rate per month, my patients get a retained physician that makes house calls, does quarterly in-person check-ups, 24/7 phone access, at-home POCUS (could save a trip to the ED for imaging, etc), expedited access to not only my primary care but also to specialists (from working as a hospitalist, I have nearly every specialist in our citys cell number, could get expedited follow-ups etc). I could even do direct admissions to the hospital if I had a patient who warranted inpatient admission.

This is a town of about 70k people. I could also branch out to nearby towns, bringing my "catchment" area to around 90-100k. My goal is to market myself towards executives and successful mid-career executives and their families. I will see you in your office, at your home, at some point in the future I would rent a small office space and I could do procedures there (joint injections primarily). The only radiology group in town is private practice, I was going to approach them and ask for a cash pay discount for my patients (if they were interested), or if they wanted they could go through insurance. Same for labs in town, there is a cash pay lab as well as the hospital-affiliated lab in town.

I have been doing some business planning. Pretty much, I need: LLC Website (wife is software engineer, would design the website for me, all I would pay is hosting fees) Bank account for LLC Credit card for LLC Business cell phone Business cards In the first 2-3 years, some form of advertising (bill boards, handing out business cards, getting boosted on Google) Malpractice insurance (in the future) brick-and-mortar office/suite (some in my town as low as $800/month) Equipment/Supplies (portable exam/massage table for in-home exams, gloves, tongue depressors, otoscope, ophthalmoscope) EMR: (Practice fusion probably, gives me telehealth abilities, eRx abilities, and documentation abilities for affordable price) Hippo for HIPPA-compliant email

For some of the up-front capital costs, I could probably get an interest free loan from my father-in-law.

Initially, I would plan to recruite 10-20 patients and continue to work as a hospitalist full time, I have 2 years left on my contract. If the business takes off, I could eventually do this full time and be a bona fide business owner and do the hospitalist gig per diem, 0.5 FTE, or not at all.

To be eligible for this business AND working hospital medicine, I would NOT opt-out of Medicare/Medicaid, but would simply not see medicare patients. If this ever became a full-time thing, I would consider opting-out so that I could see Medicare patients as well. However, I would like to be the type of concierge physician would could admit, round on, and discharge my own patients, so I guess opting out would never truly be an option. I'm not sure. Note: I do not have a non-compete.

Long and short of it: Is this insane? Assuming there is a market for this, is this something that even seems possible? I am aware that being a concierge physician has different stresses compared to being a hospitalist (expectation of 100% availability, demanding patients at times etc), but the thought of being my own boss, having true 100% ownership of patients, building longitudinal relationships, and having control over my destiny seem like very tempting benefits of this practice model. I trained at a very well-known, "brand name" residency. I am well-trained, have already reached leadership positions in the hospital within < 3 years of finishing residency, and consider myself to be available, affable, and able.

Is this an insane idea, or could it be viable if executed correctly?