Q:

Dear Dr. Margioles,
	I have come to a crossroad, and would appreciate your input on my 
situation. I graduated from in 98 and moved to Florida with heavy 
debt (like everyone). It took me few months to find a dr. to sublet from at 
an affordable rate, and started my practice. It has gone slowly from the 
beginning, as I have had some distractions (new baby) altough I am growing. 
The dr. I am in with has offered to sell me the practice for 55,000$. The 
practice has been here for 14 years, mainly HMO. The Dr. does no marketing 
other than the HMO books. The hmo's are completely 
closed out in my city and it would be several years before at least before 
i could become a provider. Where we are it is a heavy hmo territory, and not being a 
provider makes practicing much more difficult.The dr. is not subluxation 
based, I am. The office is located in a professional building with no 
signage.he has 3 years left on his lease. The staff will stay and have been 
with him for 10 years. his hours of operation are limited M-W 8:30-11:30 and 
3-5:30,F8:30-11:00, Th 3-5:30. The Dr. has agreed to let me bill under his 
tax id, until I am eligible to take over as a provider (2 years). His Reason 
for leaving is he is "tired of practing". And he is considering becoming a 
claims reveiwer, I found out. The equipment is 2 us,2ems,cervical 
traction machine,1/2 x-ray equip.(other 1/2 owned by a different dr.) 2 
adjusting tables, flexion distraction table, spinalator, and business 
equip.Th town is growing very fast, both residentially and industrial, It is 
inland about 15 miles, not my ideal location since i moved to Florida for 
the coast.
	Or I am considering moving to another town and doing a new
start. This town is beach a town of around 60-70,000. and has 41 
chiropractors. This is where I would ultimately like to live. I 
have been told by many not to go to the beach towns for obvious reasons.This 
town is expecting a large amount of growth over th next 20 years.
	I have been paying my overhead with very little left over, and having to 
borrow more money just to pay rent and living expenses, i have to start 
paying the bills! Your input would be greatly appreciated.

A:

Thanks for the e-mail. First .. the best answer rests within your gut .. in other words what 
do you feel and how (for the long term) it will fit. In one breath you want to be close to the 
coast .. in the other breath .. there is some stability in the practice you presently work in. If 
you are unable to get within an HMO for another two years (due to your lack of experince 
years) then the risk is too great. If you were able to call and get in writing from the HMO's 
that you will be accepted because you will purchase the practice .. then the risk is lessened 
and you can then create your own subluxation based practice with each new patient. 
Remember .. you can always tailor your office hours to take advantage of the coast .. just 
get in the car and go .. living and working in the same area is not a must .. you can always 
live in between. 

Using the other doctors tax ID for a number of years (especially if you are the sole 
provider) is a reg flag and can be used against you as fraud. Be careful of this.

A practice is what you make of it .. obviosuly this is a pat and easy reply .. but in reality 
those that tell you not to open in beach community may be right .. for them .. but wrong 
for you. This is where your gut and mind must merge together .. will you do what it takes 
to create a new practice in a saturated area .. will you begin the process of doing things 
differently to attract new patients .. will you go beyond your comfort zone to reach out 
even when the going gets tough???? If the answer is yes .. the location is not important.

But .. if you find a location to open on your own and live close to where you wish to be .. 
and follow the steps outlined in my Smart Start Book and other consultants advice .. you 
should slowly but regularly build a successful practice. The key is to make the decision 
based upon your desires and your fears. If the desire (gut feelings) feels strong .. the fears 
will be used as a driving force to succeed rather than a force to fail. 

I hope that was some help .. these questions are always hard to answer.

As for the financial concerns .. create a master plan to get out of debt by not creating more.  
If you are not making enough money where you are .. then how do you expect to make 
more .. especially if the HMO's won't let you in and you'll have to go further into debt to 
purchase the practice. I would strongly recommend you look for a change .. begin to pay 
rather than take and if you have to get further into debt to start from scratch .. then get all 
your ducks in a row .. plant your community seeds correctly .. nurture the seedlings and 
watch it grow

Have a Great Day

Dr. M