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Q Is there an industry standard for the frequency of mailing patient statements? We send each patient a monthly statement, but are thinking it would improve workflow and cash flow to mail 25 percent of the statements each week rather than one mass mailing.

A Ideally, you'd send statements on a rolling weekly basis. That is, for every patient you see Monday through Friday this week, mail statements by next Monday.

Shorter batches improve collections – a patient who just saw you is much more likely to pay than if a month has passed.

Q I have been employed for the past eight years in a pediatric practice, earning $150,000 annually plus about $25,000 in perks. I never get home or eat dinner until, at best, 9 p.m. I would like to start my own private practice in a brand-new office. My accountant figures it will cost me $26,000 per month in operating expenses. I have to see 25 patients per day to pay for this monthly budget. I have some personal debt and a daughter in college interested in graduate work. Is starting a new practice a risk I should take?

A Before making the big decision to start your own practice, explore all your options. Start by assessing where your passion is. Then determine what's truly driving your need for change.

Let me spin this out a little in the hope it will help.

Do you thrive in an entrepreneurial setting, enjoy the business side of medicine and don't mind long hours? Then by all means, open your own practice. But be very sure you're up to this. Risk and stress go hand in hand with new ventures. Maybe you prefer not to have that pressure with a daughter in college, existing debt and ever-looming retirement.

Seeing 25 patients a day – every day – will be hard, and you probably won't reach this level for six months to a year. This means operating at a loss at first, and even when you hit the 25-patient mark, you will only be breaking even – not coming anywhere close to your current salary, never mind the perks. Oh, and you'll have administrative duties as well as clinical duties, so your days will still be long.

Sound terrible? Then consider ways to make your current situation better.

How about finding employment at another practice? Or, if you decide to stay, can you find ways to be more productive or streamline your work flow more effectively? Would negotiating some changes with your employer increase your satisfaction? Perhaps a productivity-based bonus or getting your own physician assistant (PA) would do the trick. You can't get what you don't ask for.

Truth be told, $150,000 plus benefits isn't bad in pediatrics, especially when you have none of the risks or obligations of partnership. That's a nice, relatively carefree job in many ways. If you want more money and more time, I'm not sure the practice you envision will provide that. But if you want more autonomy and thrills, have at it. Don't be afraid to take less pay if what you really want is to run a practice your own way.

If you're set on breaking away, hire a consultant to advise you. Work with a financial planner to reduce your debt and costs so you'll have more options down the road. Think twice about that advanced degree for your daughter – do you need to fund it? This is a chance for you to set your own priorities, rather than those of your family or others.

So really, your options aren't limited to starting your own practice or sticking it out where you are. Examine what motivates and energizes you, and do that: Change your current position, seek another employed position, or, get a real estate license if that's what you really want.