The Hybrid Brick-and-Mortar Practice

Smartphone Phone Medicine  - geralt / Pixabay

I get asked this question almost daily “Should I open a brick-and-mortar practice, a mobile practice, or a telemedicine practice?” and my answer is usually the same: you should do a combination of brick-and-mortar and telemedicine at a minimum. This is what I like to call the “hybrid practice.” In my opinion, it is the modern-day practice and the most optimal practice model in today’s environment. It doesn’t matter if you are getting ready to start a practice or already have an established practice; you should consider the hybrid model for your business.

The hybrid model is the best of both worlds. It allows you to have a physical presence in your area but also allows you to deliver care via the telemedicine route. This hits 2 different kinds of markets. I have found that those over the age of 40-45 tend to like in person visits more and those under the age of 40 usually prefer telemedicine visits and then there is always a mix of both. I have a 33 year old male patient at my men’s health clinic who has come in person for every single visit over the past 2 years yet have a 60 year old patient who I have only seen once in a year and half. Therefore, every patient will have a preference. Let’s face it though, some people just like to shake a hand and look you in the eye!

I recommend the hybrid model for multiple types of practices. I think it works best for the niche wellness model of practice because many niche services require an in-person encounter such as Botox, pellet insertion, hormone injections, and IV infusions. Other services on the other hand don’t require an in person visit at all, such as weight loss, routine hormone replacement therapy, basic primary care, laboratory-based medicine, skin care, and so forth. Because of this, a hybrid model works best for the niche practice that offers multiple services.

Well, what about mobile practices some of you might be asking? In my opinion, it still falls into the brick-and-mortar category because you are seeing patients in person. Because of that, maybe the hybrid model should be redefined as seeing patients in person and virtually. But I digress. You get the point… But remember one thing about mobile practices: you will have volume limitations because you can only see one patient at a time. Thus, keep that in mind.

So, what are the benefits of a hybrid model where you see patients in person but also can see them virtually? There are numerous and I am going to list them out:

  • First and foremost, having a physical location allows you to have a Google Business Listing. A Google listing is seriously one of the most POWERFUL components of a practices marketing strategy. And the best part? IT IS FREE. Seriously, patients are actively looking for you, therefore you need to make it as easy as possible for them to find you and a Google listing is one of the first places patients will go. Additionally, it is where you showcase your reviews. Just FYI: some folks have managed to get a Google Business Listing using an iPostal virtual address for their telemedicine practice, but you shouldn’t count on that… It is rare that actually works.
  • Having a physical location also allows you to have roadside visibility. Having a sign for your practice on a busy street is practically free marketing and it works WELL. I have dozens of men’s health patients that walk in monthly to my practice simply because they drive by and see our sign. Think of it this way: having a sign and an office on a main street for $1,000 a month can be part of your marketing budget… Yes, having roadside sign visibility can be that powerful.
  • Having a physical location can be a “watering hole” so to speak for your patients. It can be a place that they can stop in, say hi, and feel welcome. This is very important for some people. We have a multitude of patients that just love to come in and say hello. It makes it personable vs. a cold business.
  • When you have a physical location, it allows you to be able to have a place that patients can come in and ask questions. Some patients want to know you are real, therefore they will go out of their way to drop in to see if it is real and to ask questions.
  • Having a physical location also allows you to have a place where you can administer medications/infusions, dispense medications, and perform procedures. This is critically important for a variety of niche services.
  • Lastly, having the ability to see patients via telemedicine is critically important. I would estimate that I see 90% of my men’s health patients via telemedicine anymore. This does not mean that only 10% of my patients ever come into the office. I would guess that easily 50% stop in regularly for injections, to pick of medication refills, make payments, or just stop in to shoot the breeze for 10 minutes. But in terms of the visit with me, the majority do it via telemedicine.
  • Like I mentioned above, many patients will want to be seen via telemedicine exclusively simple for the convenience of it. Additionally, seeing patients via telemedicine allows you to extend your practices reach. Not only do I see patients in my county, but I also see patients throughout my state! If you have multiple licenses in other states, then you can extend your reach further. If you are in a restricted state, then you can see patients in other independent states without your physician collaborator!

The above reasons are why I think the hybrid model works best. I truly believe it is the most effective option for the nurse practitioner entrepreneur who wants to maximize patient volume and revenue.

Listen though, I am not saying that a brick and mortar only practice or a telemedicine only practice will not work. On the contrary… Telemedicine only practices do EXTREMELY well. I know multiple nurse practitioners who have telemedicine only practices and are absolutely killing it. Therefore, they work, but I bet they would make more money if they also had a physical location.

I think one of the biggest fears amongst nurse practitioner entrepreneurs about having a brick-and-mortar practice are the expenses associated with it. Personally, I don’t think a lease, utilities, and the expenses around a physical location are that much of a risk. The increase in patient volume will more than offset it in my opinion. Therefore, do not let that scare you into not having an actual office. Trust me, you will make enough to cover those expenses.

If you are on the fence about having a brick-and-mortar practice or a telemedicine only practice, then seriously consider having a hybrid model. When I opened my 2nd men’s health clinic, I opened it up as a hybrid model and I am glad I did because I get the benefits of both practice delivery methods. Having a hybrid model works and it allows you to extend your reach further vs. one or the other. Keep that in mind as you go through the start up phase or the restructuring phase of your practice!

6 Responses

  1. Thank you Justin, ! What are your thoughts about virtual vs physical location for psychiatric practice??

    1. I think the same principles apply. A lot of people just want to sit down in front of you and talk while others are fine with a phone call or a video call. I think with psych, going more virtual makes more sense in general though.

  2. Justin, I am getting started on my Men’s Health practice. I am trying to work out how to go about the face to face visits from the get go. I know they have temporarily granted ability to see Testosterone patients without the required face to face and ultimately, I would love to have a few patients on board before moving into a physical location. But would you recommend I just go ahead with a physical location from the get go? For reference, my husband is a firefighter for a large city, so I already have quite a few guys waiting for me to start my practice and those are just the ones who already know it is in the works without any effort.

    1. Honestly yes… I think hybrid practices are the best model. Having a physical location has multiple benefits that you can’t get with telemed alone.

  3. Hey Justin, I’m trying to figure out how to logistically go about creating my LLC and what address to use. I want to do a hybrid model for general psych and eventually have an office space once I’m ready to see patients but if that isn’t realistically going to happen for 3-6 months what are my options? Rent an office space that I’m not using? Get a virtual address? I’ve heard that having a virtual address can complicate things when credentialing with insurance. Is it easy to change the address of your LLC later on to your physical office location? Thanks in advance!

    1. If you can get a physical location, that would be best….. You can use it for a GOogle business listing as well. For the LLC itself, the address doesnt matter…. a po box is fine.

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