Personal and Business Goals for 2008

Setting Goals

As seems to be tradition for many, it’s that time of year where people write down their goals. Others write down resolutions (which are in my mind smaller steps one takes to getting toward the bigger goals). Either way, we all tend to do this now, with the plan to jump into action on Janaury 1.

Sometimes those goals can seem overwhelming. Here are 10 steps that might help you bring those goals closer to fruition.

Pick a goal. Specifically what is it that you want? Make it specific, and give it a deadline. If it seems really big like “Achieve world peace”, you may need to break it down.

What steps will help you attain this goal? For example, if you want to return to your previous perfect level of fitness, perhaps joining a gym or signing up for a class can help move you toward your goal.

What’s your why? Why do you want this goal? What motivates you about it? Dig deep on this, if it’s something you really want, and know why you want it, it’s more likely to happen.

What’s going to stop you? What obstacles are present? Come up with the solutions to what can throw you off tract. For example, if you want to loose weight, you obstacle may be that you like to munch, and your solution will be to keep the chocolate chip cookies out of the house.

You need a map to get where you want to go, so what’s the plan? How are you going to get there? What steps will you take? How will you organize it? An example would be taking a trip. You know where you want to go. In order to get there you will need to purchase tickets or perhaps put gas in the car; make reservations, etc.

Support! Since we are not here alone, we all need moral support, it makes the going so much easier, more pleasant, and helps ensure our success. Think about it…many of us have walking or jogging buddies. It helps keep us moving. Mentors are another source of support.

Visualize your goal. You know how when you drive, if you look at someone on the side of the road, the car starts to veer toward them? Keep you goal in sight and steer directly for it. See yourself achieving your goal.

Along these same lines, using positive affirmations can help move you toward a goal. You brain always wants to you be right, so make sure you feed it the good thoughts.

Rewards. How will your reward yourself or celebrate achieving your goal? Many of us do this by getting new clothes when we lose the weight we want or that new bike when we’ve hit our goal of getting through our first 50 mile day.

Working on and achieving our goals does not have to be difficult. Keep them small enough so that they are doable, and keep your plan in front of you so you don’t lose track of where you are going. Every new goal should build on the previous one. Keep going, soon you’ll have the business and personal life that you desire.

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  1. I intend to cram as much learning experience in the next few years and then proceed onto the DNP program. I think Doctor of Nursing Practice may sound pretty good!

  2. What a great time to have this topic posted. I have done much thinking this past week (actually several months) and have made the decision to close my practice in June. I am going to talk with one of the MD’s here in WS and discuss with him the possibility of being a I.C. at his practice. I can then work approx. three days per week, do my own billing and not have the HA of being the owner. I am doing this for a number of reasons, preserving a friendship is number one, but I also need to have a regular income coming in to help me with my finances also. I may choose to try again in the future, since I do love a challange. Does any body have any experience w/ Independant Contracting? If so let me know how it is working for you.

  3. Hi Grace,

    Wow, I just wrote in response to another post of yours about how your practice was growing, and how you also worked on a mobile van! Now you are closing your practice. My practice has been open 6 months and I am loving it, although I originally wanted my own practice inside of someone elses office, such as a chiropractor, to sub lease space, but it did not work out.

    The term Independent Contractor is truly defined by the IRS, so make sure it is what you want. You will be paid without any taxes taken out, and then you will have to come up with everything at the end of the year. You as an NP will bring your own equipment in, and will have your own little business. You will not be an employee for this doctor, just leasing space. Are you going to see a segment of the doctors patients, and use his/her reception/phones/? How are you going to do the billing? Are you going to share the biller at the office, or will you bring your biller from your other practice with you?

    As an independent contractor, you also will make your own schedule, and come and go..at your choice. Read the IRS website about Independent Contractors. Often Employers call employees that, so they dont pay taxes, but if your schedule is regulated by the doctor, and you see his/her patients, and you use his equipment, you are an employee, with or without benefits..It is all about the degree of direction, and control.
    I found that it was hard to be an independent contractor, as it is truly defined for an NP, because the places where I worked saw me as a “temporary” person, and the pay was way too low, and there was lack of stability for my position.

    Think about a massage therapist. Now they often are independent contractors, where they go into a provider office or a chiropractor, set up their table and see patients say 2 days a week. In no other way are they connected to the owner of the office. They see their own patients, they do their own billing, and they just sub lease a room during the time they are there. Or someone who rents space inside a hair salon. These are examples of independent contractors.

    I would be very interested to hear more about your position and how you will be an independent contractor in this office. I agree, stable income is so important, and I am single and have no other income, so I can sympathize with the worry of not getting a regular paycheck.. Carla

  4. Thank you Carla for your response. I have done my research in regards to the IRS, and I truly want to be an IC. I like to be my own boss. I do have my own supplies but will use some of his as well. I have not worked out all the details yet, but will possibly use his biller as he sends his out also. I may find my own as I know many that do it. I may pay him for space or a portion of what I collect from billing. I have great a accountant so the taxes arent an issue at this time. I know what it is like to to rent a station as a hairdresser because I was one of those also, but it seems a whole lot different with medical offices. We will most likely share front staff, but I may bring in my own MA. I still have some time and am trying to gather info from those that have done this so that I can get some “pearls of wisdom” from them.

    My practice is growing and will get even larger as I move my patients with me and accept new pts as well. I will gain new pts from his practice also and I will bill for them as I do my own. It will be a win-win I hope because we can share duties while I am there and cover for each other for vacations and sick times. I feel so guilty if I get sick or need to be away from the clinic. I know his practice as I have filled in for him as a locums when he has to be gone from the office and we have similar patient populations. There is also a OB/GYN and Dentist on site.

    I still do the BCHP mobile van and really enjoy that, it makes me happy to give back to the community. I have even been asked recently to be the provider at a clinic in Seattle for LBT females, which made me feel really good that they thought of me making that population comfortable while giving them care they really need.

    If you have any more suggestions or info to pass along to me I would truly appreciate it.

    Good luck in your practice and I like your website.

    Grace

  5. Hi Grace,

    That sounds like you have a wonderful set up, and you have done your homework regarding independent contracting. I agree, being independent is the way to go, I just didnt want the doc to “call you independent” so you had to pay your own taxes, but then still treat you as an employee, where you are not having your own patients, etc..

    Many of us, seem to learn by mistakes, or by the latest way that NPs get exploited (of which we are responsible for allowing this), and I think as long as someone has done the research, it can be a win win situation. I also initially looked to lease space in an office, and initially wanted a chiropractor’s office as there were not any physicians that were leasing space. I would have probably gone that way too, if it had worked out, as you can keep your overhead low, and as you said, you can share patients. I also think that having more than one provider in an office lends a nice warm clinic feel. My goal is to have a more integrated practice, but perhaps I will be able to add a massage therapist, and have an accupuncturist come in on a routine basis. My second choice was getting into a larger space with a partner, but the timing never worked out as far as a second person. So when my little space opened up, I took the plunge alone.

    What has been hard is the fact that I had zero patients to start with (did not work at a clinic nearby for over 2 yrs so no patient following) and that I did not have any connections.. And of course the urgent care across the street decided to go in direct competition with me, which is too bad..

    But one good thing is that an NP that has had her own practice for 30 years, is semi retired. And Her practice is 6 miles away, and she is a friend of mine. I am hoping that as she phases out, she will send some of her patients my way. I am still waiting to get Care Oregon (medicaid patients) and I know she does not wish to take anymore of them..

    I have a very good physician friend in California that opened his own practice a few years ago. If I had lived in his area, I would have loved to do what you are doing.

    I also have a yearning for the underserved as I used to drive and see patients on a mobile van too. I am trying to connect the poor patients, and those that qualify for BCCSP and other programs, and try to get them into my clinic. But in time..

    Good luck with your venture, and I will be looking forward to hearing how it works out. Thanks for the comments on my website. I am still going to get some better pics of me! Carla

  6. It will work out for you. I think you are doing all that you can and that helps alot. I would call daily to Medicaid and let them know you are very serious about seeing their patients. I think you are in a great place right now with your friend retiring and all. It should help you build your practice. I also started with one pt and have grown to approx. 300 now. Stop by the hospitals and let the ER’s and discharge nurses know you are open to any and all patients. Send letters out to business’s, volunteer time at health fairs, exhibit your clinic in community events and festivals. Pick something special that you offer and no one else does and let everyone know that is your specialty. Offer $20 sports physical, discounts to time-of-service-cash-paying patients. I did all of the mentioned and I am getting larger daily. I have on average 3 or 4 new calls per day. I know by large clinic standards that is no big deal, but for us it is huge. I wish you the best and will keep you posted on my progress.

    Grace

  7. Thanks Grace.

    Actually 3-4 new patient calls is fantastic. I average one to two, and I agree that is huge, as these are all brand new patients. I worked 3 weeks at a practice to fill in for someone who went on vacation, and there was no solicitation whatsoever, but 8 patients transferred care after looking me up and finding out where I was. They were looking for something different. I just had a new patient who really read my website, and came in specifically because of my philosophy. She loved it, and as she works for a large tech firm in the area, she said she will mention me, as many of the employees are looking for a provider. So this one patient may recoup many. She was a delight. I just got my regular ad in the paper, and as the urgent care was advertising 50.00 for sports physicals, I offered 35.00. I also plan to go to the schools, and donate a portion of all sports physicals back to the schools, which is needed. In my ad, I offer a free gift bag for first visits, which includes a 2008 small purse calendar, hand sanitizer, pens, magnets, a health magazine, and a sports bottle, all personalized with the practice name and logo of a “wave”, for Healing Presence.

    I do offer a discount for time of service cash paying patients already, and the pharmacy knows that and has sent many patients over. I do offer housecalls, and work on a blend of natural medicine and traditional. I am specializing more and more in adrenal health, lifestyle, and the natural hormone cascade to promote good health.

    I am working on developing a story board, so I can be ready for any presentations. As you know, what we do as Nurse Practitioners in Family Practice is incredibly diverse, and complex to explain, so I thought a story board would provide an easy to read description.

    I just hired one ma for 20hrs a week. She has been a bit distracted with her personal life and her other job, but I am going to start taking her out to lunch to really explain and get her on board with my philosophy of “personalized health care”, and getting to know our patients like family. There is too much non personal care, and she has experienced that, and so it will take some re education. I will also ask for her feedback, as it is valuable.

    I would love to hear about your progress. Lets keep in touch. Carla

  8. You are doing very big things and I am impressed with your ideas for marketing. In time you will see big benefits. I also believe that the way we treat our patients keeps them coming and referring others to us. I try to treat patients with the respect they deserve and always remember they are the reason why I am doing what I love. I keep true to myself and keep my sense of humor. They appreciate that I include them in the plans for their health care and what keeps my practice special. I will keep in touch and up date you frequently on my progress, please do the same.

    Talk with you soon, Grace

  9. Hi Grace,
    Your philosophy sounds very similar to mine. I treat patients the way I want to be treated and that is my motto. People are starting to pick up on our style. They are reading the website, printing, talking about it.. and getting more relaxed. We have coffee, water, decaf, tea and hot chocolate, we offer to the patients if they can have it, and for their children, as we are now getting some over lap occly in the waiting room. I worked for 4 hours in the morning at the office of the NP that has been in practice 30 yrs, is 70 yrs old, lives an hour away, and really wants to let go, but she has fear and trust issues. She said “make sure you dont tell anyone about your practice when you are there..” However, she is only open in the mornings 9-12, and one day in the afternoon. She is not open on Saturdays, and I could hear the receptionist turn people away.. I told the receptionist to clear it with the NP first, but if there are patients she clearly “does not want” (she is semi retiring, but she is conflicted) and she clearly does not take any Care Oregon anymore at all, I told the receptionist, if you are turning them away, please let them know I am happy to see them, …I was not soliciting, it just makes no sense to turn someone away, when I am standing there offering Saturdays, and accepting brand new patients with a new practice, when this NP does not want them. And the receptionist is a wonderful mature woman, who has known this NP a long time, and she said “oh great, I turn people away all the time, can I get your card?” I had called the office twice before and told them I am HAPPY to see any patients that they do not wish to see, or any Medicaid, as she no longer accepts that, but for some reason got no response. So I am hoping she now will not be so fearful. We all need to work together as NPs. My other friend NP and I share call, and we clearly do not worry. If I am out of town, and my patient calls there and happens to want to be seen in her office, she can go there, and vice versa..We do not worry about it.. But things are getting busier, and I am trusting that we are right on schedule. I will continue to keep you posted.
    Carla

  10. Carla, that is great that the receptionist is open to you seeing the over flow. No shame in promoting your clinic, as she (NP) clearly cant accommodate the needs of the patients in the area. I am happy to hear that things are getting busier. I also am growing at my current site, but I continue to tell patients I am relocating to a few blocks away. They don’t really care as long as I stay close. I am slowly transitioning into the new office. I have been covering for the MD while he goes OOT. I recently had two of his patients request my card while I was there. That was really a boost to the ego. I don’t solicit, but if they ask I tell them where I am. I am now telling them I am in the process of joining him in that clinic. I asked you a question on the collaboration fee blog, but did not get a reply so I sent you a message on your site. I want to get info on the EMR you use, Amazing Charts. It looks like a great system for the price. When I change practices I want to change to an EMR and start to pay closer attention to my billing and collections. I think that was one of my problems at my current site, I am not sure my billing is being done as well as it could be and that there may be money being taken out of the banking account that is not going towards expenses. Hard lesson to learn, but glad I learned it now rather than later. I will let you know how things are progressing.

    Grace

  11. I’m in my own LLC practice now working as an Acupuncturist/ Chinese Medicine practitioner, but I’m also an Adult Nurse Practitioner ( sub specialty in dermatology ( having retired from Kaiser Permanente 1.5 years ago after 25 years).I’m combining the Chinese Medicine with my expertise in Dermatology and adult medicine to see difficult clients to try innovative treatments. I combining both NP and LAc techniques. My current practice is slow and I would like to have more patients. I’ve been looking into leasing space at a Family Nurse Practitioner Clinic , where the owner would be open to having another NP. She is busy and making money but has a hefty overhead which she would like to divide. She is particularly interested in my Chinese Medicine/ Alternative Healing modality focus. She would like me to be an independent contractor. Is this possible? I’d be using some of her equipment, her MA and her staff for my booking and billing. I’d determine my own hours. I’d pay perhaps 40-50 percentage of the “paid” bookings towards the over head. Would it be better to pay a fixed price for the space? It had been suggested that I consider a tiered payment schedule 50% up to $2000 then 40% above $2000 -4000, 30 % above $4000 for example . Since I don’t know how the space arrangement will work out- some type of trial plan might be considered.
    If I’m considering this to be a permanent (part time) arrangement could I still be contract? Thank you for your consideration of this situation Mona

  12. Hi Mona,

    It was wonderful meeting you @ the Nurse Practitioners of Oregon conference!

    This is entirely do-able and you could be considered a contractor. You will need to look carefully at how this is set up. I recently heard from an NP where she had a similar set up and when the practice was evaluated, it was determined she was not an IC and the practice owner was fined.

    Carefully read what the IRS has to say about this (http://www.irs.gov/businesses/small/article/0,,id=99921,00.html). An IC will have their own business (and licenses) and are available to do this work anywhere. You will want to determine your own schedule and practice under your rules not the owners. You’ll see what I mean when you read this.

    As an aside, the November NPBO™ Success Webinar (for members only) is with an attorney and I’ve asked her to help us clarify the answer to this question.

    Barbara/NPBO™

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