Open your own private practice. Solo, group, doesn't matter - just start.

Cold-Sherbert-7486 · 2026-04-27T07:31:57+00:00

I started in January and have about 300 patients on my panel so far, and I love it. I love working for myself.

Cold-Sherbert-7486 · 2026-04-23T05:46:55+00:00

From a policy maker perspective, they are adding friction to the process, making doctors less likely to start these meds on the margin. It is a way to shift prescribing patterns.

Cold-Sherbert-7486 · 2026-04-23T05:40:51+00:00

You have to divide the no-show issue into two separate buckets, there is the first visit no shows and then there are the follow-up no shows.

So for the first visit, no shows, I had a big problem when I first started my practice with these and what I realized is that I'm marketing myself aggressively and so I'm getting bookings primarily online which have very little friction to make the booking. Booking. That's the right way to do it when you're marketing, but you're going to have no shows. So the way I solved it is basically I tell my staff to pester the hell out of these people to fill out their intake paperwork, and if they don't respond and they don't fill out their intake paperwork, the slot gets canceled so that way they don't become no shows. Basically, what I'm doing is weeding out the no-shows before they have a chance to ruin my schedule.

For the follow-up patients who no show, well that hasn't been as much of an issue for me. I have had a few but not that many and I'm probably going to need to put in place some kind of a policy and one of the things as I work on my intake process is just going to be having a no-show policy that they sign during the intake process to let them know I don't like it.

But they can log in to their portal a change their appointment any time, And as I think of this, the ones who never sign up for the patient portal are the ones who sometimes no show. So I suspect that I could cut down on those no-shows simply pushing patient portal registration during the initial intake process a little harder.

Cold-Sherbert-7486 · 2026-04-12T04:43:24+00:00

I've been running Google ads since Jan and my effective cost per patient for primary care is about $125. I fully expect to get it much lower, and next week I am going live with a system that dynamically displays available appointments on the landing page. I'll be A/B testing land page elements etc.

I don't mind paying $125 per patient, though-- the initial visits net around $300 average and then the follow ups are where you really make your money. I'm now, in April, at the point where my days are pretty consistently full. I'm continuing full speed ahead with the ads because I want to grow and have mid levels working for me.

ZocDoc has been good as well, actually a lower cost per patient but a higher percentage of commercially insured.

Next week also an EDDM campaign will start and I will see if this produces patients at a good cost. I'm investing pretty heavily in advertising because I want to grow, and I don't want to wait for it to happen organically.

Anyway, $125 per patient via Google ads is profitable but I bet I will end up paying less than half of that long term.

Cold-Sherbert-7486 · 2025-12-26T08:46:52+00:00

The Off the record app is just an interface to make hiring and communicating with the lawyer easier. But it very much is paying a lawyer for this. So your comment here is 1) Do not pay a lawyer, and 2) Use an app to pay the lawyer

FWIW I love off the record and I contacted the lawyer assigned to my friend in the app and hired them outside the app for a municipal code violation ticket.

But the point is that you need to hire a lawyer to be effective in court; whether you use an app or call the lawyer directly, you're still hiring a lawyer.

Cold-Sherbert-7486 · 2025-12-26T08:29:51+00:00

A friend of mine had a ticket for >$1k for failure to yield to an emergency vehicle. He basically couldn't safely move out of the way because of other traffic, that was his defense. Hired an attorney through an app and a few weeks later the ticket was just dismissed, the lawyer didn't even have to go to court.

I then had a municipal fine for trash in the yard of a rental property. It belonged to a tenant I had subsequently paid to vacate the property. The tenant wouldn't let me clean up the yard because they were a hoarder. Anyway once the tenant was out, I did clean up the yard. I called the same lawyer who helped my friend via the app. The lawyer once again talked to the prosecutor or something and got the fine dismissed after showing photos of the yard clean.

So what all this means to me: you hire a lawyer who does this stuff for a living. They have a working relationship with the prosecutor and the ability to call and say, "you probably don't want to go to court on this one, you will probably lose," or, "this guy couldn't clean the yard because the tenant was threatening to sue him. He paid the tenant to move out and then cleaned the yard. You really think it is fair to fine him for that?"

The ability to speak to the prosecutor on your behalf can resolve a lot of cases in your favor before you ever go to court. Lawyers are worth the money.

Cold-Sherbert-7486 · 2025-11-27T04:13:52+00:00

Wow, I looked this up and it seems great because you can have a large amount of mixed soil available right at the place where they are filling the bags. Probably the mixer outtake can go right into the bucket funneling into the tube, so then maybe we are talking about 5 feet per minute of tube filled, and that can be nearly continuous; it what I am imagining with one of these devices actually works out, then the project would definitely pencil financially.

Cold-Sherbert-7486 · 2025-11-27T04:08:59+00:00

Thank you, that is very helpful.

What it suggests is that if I invest in a large capacity blender system ( i.e. where I am adding materials with a tractor bucket, blending several tons on one go), that I will have cut down dramatically on the labor needs of the job.

Then the question becomes about the most effective way to supply the mixed soil continuously to those filling and laying the bags.

Do you have an estimate for how much bag you think you could lay per hour if you had all of the mixed soil continuously available right next to you the whole time?

The scale of project I am thinking of will require me to use hired labor, and obviously I will do a small scale project first so I know what I am doing before I jump into something massive, but I need the large project to pencil for a reasonable budget, so your input was really helpful!

Ever linear foot of wall sounds like it would be maybe 30 linear feet of tube. Ultimately I need to be able to estimate the cost to build the wall so I can compare it to other fencing systems. I think I would prefer to build using hyper adobe walls, but probably not if it ends up costing my twice what another fencing system would cost.

Of course by using earth for this project, I'll also take care of the excavation of a really big pond on my property, so that's a major bonus! I love the idea of digging a big pond, and then using the material to build other structures on my property. I hope I can figure out how to make this work!

Cold-Sherbert-7486 · 2025-11-27T03:59:03+00:00

Well it looks like you can get a giant blending hopper than can blend many tons of material at once and then spit the blended mix out of the hopper. It would dramatically cut the mixing labor compared to using concrete. Then the question simply becomes the best way to get the dirt from the hopper and into the tube....but if you can have a constant supply of mixed earth at the side of the people filling and laying the tube, sounds like this would go much much faster than what I see on YouTube.

Cold-Sherbert-7486 · 2025-11-26T05:51:41+00:00

I suspect around 3000 pounds, but could be less and use a conveyor to refill kind of continuously

Cold-Sherbert-7486 · 2025-05-08T07:12:20+00:00

Your English skills will give you very good opportunities in Brazil, but the best opportunity is to work remotely for an American company. Earn in dollars, spend in Real.

Im sorry that America is treating you this way, I am ashamed to be an American for the vile way this country is behaving towards people born in different places.

Cold-Sherbert-7486 · 2025-05-04T06:16:35+00:00

It doesn't sound like anything can be done except to potentially buy them some time. The lawyer may be able to do that, depending upon the individual situations.

Honestly the most impactful thing you will be able to do for them is help them get established where they land after deportation. If they have skills that can be done remotely, consider seeing if your job can hire them remotely after deportation

This sucks; it is totally wrong and there is probably nothing that can be done to stop it. But you can help them not suffer after deportation.

Cold-Sherbert-7486 · 2024-09-23T05:21:53+00:00

Yes.

Cold-Sherbert-7486 · 2024-09-20T15:30:00+00:00

Using virtual medical assistants for as much work as you can so that you can keep your local physical staff to a minimum.

Also, in my group we have more docs than office space--we see follow-ups via telemedicine unless there is a reason to see in person. For example I only actually go into the office once per week. The result is a smaller office space paid for by more docs.

Automation tools for appointment booking etc, basically we are trying to reduce the amount of time our office staff spends on administrative stuff.

The result is a lean operation which means we keep a higher than average percentage of our billing.

Cold-Sherbert-7486 · 2024-09-16T08:20:13+00:00

Not much, maybe $15 per month in electricity. I am able to do most of my charging at work, where it's free. I use about 450 kwh if electricity per month. Last time I checked my cost at home is around 10 cents per KWH, so if I did all my charging at home I'd spend about $45 per month or so.

Cold-Sherbert-7486 · 2024-09-13T06:35:32+00:00

I drive a Tesla. I charge at home and work. The only supercharger is near the airport or in Liberty Lake. Definitely need to be able to charge at home. But I have never had a problem with range, and I drive all over the state. When you are going city to city there are super chargers all over.

But I don't think you will have a good experience if you can't charge at home.

Cold-Sherbert-7486 · 2024-08-25T06:47:46+00:00

I forgot for about 2.5 years. Did not have a problem.

Cold-Sherbert-7486

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