One of those things that you definitely shouldn't do a second time in this life is to develop a small business to medium business. Whoever went through this knows that this is a spent five to ten years of life. If you have the right skills and understand the processes of your business, then you can start right away right away. But, unfortunately, either at the beginning of the path there are no necessary skills, or there is no ability to build processes, or greed arises in the spirit: “I want everything myself, so that only mine, mine”.
Let me tell you what Catch-22 looks like using the example of small dental clinics. What does this have to do with IT? And such that now there are a lot of them knocking on us with questions about how the IT system helps the clinic to become larger. Because they don't really see other ways. Below will be why there is an IT system at all and what does this have to do with the difference in the quality of the founder's work as a doctor and a hired doctor.
In the field of dentistry, a “home business” is a two-chair clinic. Most often this is a clinic formed by one or two doctors who decide to go on an independent voyage. We worked in a government agency, a large private clinic and came to an understanding that they want their own and do as they like. We saved up money for equipment, jointly rent and jointly purchased.
Start
The businessmen in this model are the doctors themselves. This is both a plus and a minus. The plus is that they make themselves comfortable self-employment, that is, they do not plan to make a profit, but simply are content with their own salaries. But now they have a comfortable place of work, where it is very pleasant to do the same manipulations as in another clinic, but for themselves. A European clinic of this type often becomes a cozy place in a small town for 30-50 thousand people and does not develop further, and this suits everyone.
In our first three years it looks like one doctor and several people on a dancer, or a couple of doctors on a joint lease. Doctors are usually of different specialties, often a therapist and orthopedist. They cannot afford the receptionist and permanent assistants one at a time, but together they can already.
Most often they come to such their own clinic with an already formed set of clients. If they are both with their hands from the right place, then in principle it is impossible to ruin such a clinic (but also to earn a lot too). The fact is that already in the third seat, monthly costs begin to rise sharply, and you need to be able to recruit patients, that is, to understand marketing. But at a two-chair clinic, 20-25 patients per month are enough for payback, depending on the region, since the set of equipment is small and the rent is often very low.
As a loan for equipment, either savings from salaries or a loan from relatives are used, because we are talking about several million rubles.
By the way, rent is a problem at once. It is not the place where you would like to open the clinic (on the stream, in convenient transport accessibility) is chosen, but it just looks more or less suitable option from the available ones. Or in general, the opening takes place near the house of one of the doctors. In the case of a three-chair clinic, this usually puts an end to business (but they flounder for a while), but a two-chair clinic survives normally. Business planning is at zero: I remember dissuading a doctor I know from opening a five-chair, simply asking them to calculate costs and revenues four months in advance. In this horizon, he was already broke, but he had enough to discover.
Repairs are usually not done normally, which also limits the growth of the clinic in the future: the level of renovation does not allow it to grow from the middle segment to the premium one. And often, even in the middle + does not.
Doctors from premium clinics rarely open their own offices: they are accustomed to high-end equipment, and in a two-chair clinic even a tomograph usually does not pay off, because it is still an area and another five million for a minimum new one or two or three million for a used one.
2-3 years
In the second or third year, the composition of patients settles down, the doctors establish stable work, the equipment is partially defeated, and earnings begin. There are no more double shifts, no more taking money out of the founders' salaries to pay rent. The administrator begins to understand what needs to be done.
I want to grow and earn more. There are two ways:
- Delegate to less efficient employees.
- To develop the current clinic in terms of assortment and level of services.
Delegating is usually difficult. The founders work for themselves, so they do everything efficiently and very well. They know how to sell, know how to talk, are responsible for their actions in front of patients. Hired doctors not only do not do everything the same way, do not have the same level of medical service (most often), but also try to gain their own client base, experience and open their own clinic in the future. Or they can simply move with clients to another larger one, where the equipment is better. Personnel at a higher level cannot be recruited - it is limited by the absence of the same tomograph, a branded microscope, and much more.
If there is a commercial streak, then at this moment the doctors decide to buy out the premises together with the neighboring one (this is in the regions, in Moscow only for rent). Often this is a move of the clinic: an apartment is bought on the first floor of a building, transferred to a non-residential fund and begins to work as something stable and warming the soul. In cities with a population of one million, the model is different, there you have to rent on a stream, but in any case, doctors come to expand in areas. At this moment, a sea of alterations is revealed, because they did not think about development at the start and all technical errors from ignorance come with renewed vigor. A separate room for oxygen is not needed yet: this is only for anesthesia, and these are five chairs: usually this is the ultimate stage in the development of one doctor's business, until he himself becomes a businessman.
If the first composition of assistants and administrators consisted of a team that often worked with these doctors in old places of work, now they have changed several times. Our doctors attract part-time workers, and those work part-time with them. These are shaky agreements.
4-5 years
The cost of dentistry is formed from rent, infrastructure (electricity), consumables, salaries and advertising. At the beginning of the path from salaries - own, two nurses and two shift administrators. There is no founding income. In the fourth or fifth year, I already want to do nothing, go to the clinic from time to time, but get paid. Or develop two or three more clinics.
An understanding of marketing comes. If in the beginning it was chaotic with unstable costs and an unstable result such as a freelancer on Instagram, now, in addition to word of mouth, there is also a funnel for attracting people, often through GIS, search and contextual advertising + social networks. It has not yet reached the OMC / VHI.
For a very long time, the gap between "sharash-installation" and normal equipment and repairs, because it is expensive and right now, is never needed. Doctors cannot immediately afford expensive repairs and an expensive set of equipment. Even a workaholic goes to a pretentious clinic in ten years. Therefore, the first call is almost always the economy, and the economy is a bad model for the first business, it does not forgive mistakes (each means months of delay). Such clinics for the fourth or fifth year will always lose to big players, because a person looks at service and convenience, for them this is also an indicator of the quality of treatment. Therefore, you need to either be a bearer of unique knowledge by this time, or develop a personal brand, or take on especially difficult clinical cases. But the average physician in the market is mediocre, these are harsh statistics.
There is an understanding that there are 300-500 people per doctor in the area and this is the ceiling. Now there are 38 thousand dental clinics in the country according to an average estimate (from 23 to 54 thousand according to various sources), the most mundane statistics are 38 thousand. In Moscow, plus the region, there are 4.5 thousand dentists. St. Petersburg without the region - about 1700 units, the largest of the millionaires in terms of the number of sick teeth Krasnodar - 560 clinics (without Sochi and Anapa). Basically, from 350 to 420 clinics per million-plus city, the average size of a clinic is three to four chairs (eight doctors). It is clear that there are large clinics with 30 chairs and small one-chair offices. The doctors working in the clinic are not mono: there is usually a therapist, surgeon, they grind the same patient in business processes.In my practice, it is necessary to have in the database 18-20 thousand patients per clinic of 13 chairs for a reliable payback (in fact, I had 13).
This means that if the clinic is working steadily at least six days a week, two patients should pass through the chair a day. That is, either 75 unique patients or an average of 25 unique patients with a treatment plan of four visits.
In the fourth or fifth year, the understanding comes that the district's market is exhausted, and then the growth curve turns into a lid. And I want more money.
And this is where the search for a normal IT solution for the clinic begins. Because you need something that, in addition to the charisma of the doctor, will keep the patient ( here is a post about the work of the administrator and processes). You need something that will take into account all consumables and all procedures so that there is no abuse. It is necessary to explain to the doctors that one cannot just let the patient go after caries, but at least advise him of the orthodontist to fix long-term problems - if the founder does this with his charisma, then the hired doctor usually does not understand the meaning of unnecessary conversations, and this should be done as part of the process for him and the administrator, that is, to revise the diagnosis and the path of the patient. You need to take into account the warehouse, working hours of assistants, control cards and a thousand more things. Only through automation can you free up some of your personal time, which would otherwise be eternally spent on routine. And only then can you focus on opening another clinic (which will also need to be controlled) or developing your own breadth.
Clinic example
Yudenta - Bolshaya Marfinskaya near VDNKh.
“Initially, we had a 1C program. Well, we've been using it for a long time. It's just that it was already familiar, but it did not quite perform all the functions that we need in terms of the fact that there, well, a rather complex program itself and various reporting that we needed for statistics, let's say, well, changes in some policy in the very enterprise, it was not always convenient to arrange them there. We were told about the StomPRO program, about its advantages, and it seemed to us quite convenient in terms of, well, more simply, it is like on the shelves, everything is already laid out in advance in it and significantly simplifies all processes. Both the administration and the dental appointment, and therefore they decided to roll it over to her. In any case, before that we had problems with the systematization of patients, their management. And in any case, the best option was probably to start with a new program,from a new implementation, in order to do it all in advance and only after that lead it.
There are five doctors, one is an orthodontist, and the rest are mostly generalists. They are involved in almost all treatment, except for the orthodontist.
Well, we discussed the implementation itself at the end, it turns out, in August, but the implementation itself began somewhere in September, somewhere at the end of the first week, in my opinion. Somewhere like that. And they systematically implemented it there, transferred patients to the database, made a schedule, made, well, appointed doctors, administrators, patients. Somewhere by the end of the month, in principle, it was already ready. 1C - I just unloaded a database of patients, it turns out, in Excel format and has already given it to your specialists for processing. Training - not all have completed it. This is due to the fact that doctors are very busy and do not always have time to look at everything, but like this, in principle, well, everything seems to be fine. We are already drawing up a comprehensive treatment plan for primary patients ”.
Links
This is something like self-employment in dentistry, and, I think, there are many more in the service sector. In the next post I will tell you what happens when two doctors and a businessman open a clinic: this story is usually richer in adventure.
We make software for dentistry. Here are the previous posts:
- How a premium project was made from unprofitable dentistry in Ulyanovsk in 3 years.
- Why treatment planning is a necessity for the patient and clinic.
- Where the clinic loses money at every stage of the treatment plan (and where it gets stolen).
- How does a dental clinic administrator work - and how he should.
- How competitors with a weaker set of features began to spread rot.