We recently connected with Kristin Schwartz and have shared our conversation below.
Hi Kristin, thanks for joining us today. Setting up an independent practice is a daunting endeavor. Can you talk to us about what it was like for you – what were some of the main steps, challenges, etc.
Prior to opening my practice, I spent almost an entire year taking courses, researching how to open a medical practice, talking to successful colleagues across the country, and researching different models of care (i.e. direct care vs insurance) to decide how I would build my practice. At the time I was pregnant and as I entered into the last stage of pregnancy, I knew how much growth for midwifery care in the US is needed and it drove me to focus a lot of my postpartum energy on developing a business plan, networking and getting the ball rolling. I had multiple colleagues, friends and family members encourage me along the way as well as, my wonderful husband helping me with his business knowledge and marketing. This created a good merriment of talent for us to create a business plan.
Main steps included: Networking, Business Class and developing a good business plan. Meeting with multiple business consultants, including SBA mentors. Planning out each detail needed to start a business successfully in the medical field.
Key challenges:
– Malpractice Insurance: We had to wait several months for there to be an option for malpractice independently within the state of Kansas. In other states it is not as difficult to obtain malpractice so this put us on a waiting timeline for several weeks to get started.
– Hospital Privileges: For nurse midwives in the state of Kansas, we have full practice authority. However, although we do have that, Advanced Practice Providers (APPs) are still required by hospital administration to have a collaborating physician prior to extending privileges. I think this was one of our main hold ups in the state of Kansas. We were fortunate enough to be able to establish with a previous group I worked with and have a very healthy collaboration with currently on the Missouri side.
– Vendor selection: As we selected our vendors I think we fell into relying on what others told us versus our own use and research. This led us to change several vendors within the first year including changing our EHR or Electronic Health Record. Now that the process is complete and we are well within our new system it was the best decision made for us and our effectiveness and usability. This is one of those areas you just live and learn!
– Start-Up Funding: As a new business, most lenders and financial institutions are not willing to approve loan applications without much business history as most of their decision would be based on hypothetical performance and projections. We had built our business model with the assumption that we would be able to secure a significant amount of funding and when that didn’t happen, we had to pivot and turn to personal sources of financial tools to fund the business, which was challenging. On top of this, we underestimated the amount of funding that we would need to get the business off the ground.
– Cash Flow: Starting an insurance-based healthcare business is one of the hardest businesses to achieve good cash flow from the start. It’s a double-edged sword, where you all services are self-pay at the beginning when you don’t accept insurance so your volume is low, and then when you do accept insurance, there is a long lag time (30-90 days) before you’ll receive payment so it’s very hard to maintain operations in the beginning while you are waiting on revenue to come in.
I think we would have done so many things differently if we had to do it all over again in relation to our key challenges mentioned above. Again, until you have done some of these things successfully, you live and learn and have some significant growing pains doing it. As for someone who is wanting to start up their own medical practice, here are a few key learnings I would pass along to others:
1. Start small with the minimum necessary staff. There are SO many things you can do yourself and it does help you to know every single in and out of your company to teach others as they come on board.
2. Get adequate funding. The most common mistake of every small business is underestimating funding needed for a startup. Meet with more banks, get options. At a minimum, I would suggest getting 12 months’ worth of operating expenses in funding before opening the doors.
3. Meet with multiple consultants or advisors (including SBA mentors) for increasing business knowledge
Great, appreciate you sharing that with us. Before we ask you to share more of your insights, can you take a moment to introduce yourself and how you got to where you are today to our readers.
My name is Kristin Schwartz, I am an Advanced Practice Registered Nurse (APRN) with a specialty in Nurse- Midwifery (Certified Nurse-Midwife) and a Women’s Health Nurse Practitioner (WHNP). I have been a midwife for almost 8 years. I am the Owner of KC Full Circle Midwifery & Family Wellness located in Leawood, KS. We offer full scope midwifery care, which includes routine gynecology needs (well woman care, contraception, STD/STI screening, breast health and screenings) and OB or pregnancy care (prenatal care, labor/delivery and postpartum). In addition, we have a family practice provider who offers annuals (routine screenings/blood tests), sick visits, pediatric care, and men’s health to take care of the whole family. As a group we also specialize in hormone replacement therapy, and offer weight loss management for both men and women. Additionally, we offer telehealth for hormone replacement, weight loss, sick visits or routine visits/needs.
The main thing I love most about our clinic is having direct access to your provider. It makes it feel like a concierge type clinic, but truly it should be the “normal”. You should have the ability to get ahold of your provider easily. Having a small practice, we are able to do that. We also have several different methods of contact to help determine urgency. Our pregnant clients are able to text or call at any time with concerns directly to the midwife on call instead of going through several hoops. This is something our providers enjoy too- being able to care for their patients well. We have developed a very close community of patients and have enjoyed watching their progress with either adding to the family, weight loss goals being achieved or significant resolution in symptoms with our tailored hormone replacement therapy through Biote.
We strive to offer a “full circle” of care, which is why we started this clinic in the first place.
Can you tell us about what’s worked well for you in terms of growing your clientele?
I think the best way we have seen our patient base grow is truly through referrals and community referrals from other providers. I think a huge part of why that has been successful is due to networking prior to opening and meeting several different providers. The midwifery community in Kansas is fairly close-knit and as a supportive community we want to see growth for all midwives in the area. In addition, one way I stay updated on new information is through having wonderful family practice and women’s health/midwifery students. I have been a preceptor for well over 100 students in the KC area for women’s health. I believe in mentorship and when I graduated from my Master’s degree that is something I always promised myself I would do was to teach and precept students in the future. Due to this and becoming close with so many of those students I think we have received a lot of referrals through different family practices as well for women’s healthcare. Lastly, I have seen several of my wonderful patient base I had already in my previous job from Lee’s Summit that I had been at for 5 yrs.
Can you tell us about a time you’ve had to pivot?
When I graduated from KU School of Nursing in 2013 I had in my head an idea of what my first nursing career would be like. I had worked at the hospital I wanted not only as a nurse intern (which was given based on application process), but also as a tech. I felt like I was a shoe-in for the roles I had applied, and I had applied to multiple. It was sometime after our graduation in May I got the notification that I would not be chosen for the role I thought I was destined to be in. My whole life felt like it shattered in one instant. Over the next few weeks I had to pick up myself and apply elsewhere and mentally allow myself to apply outside of my own hometown of Kansas City. Once I did that I began to see offers in other states, including a very special one in Houston, TX.
That fall I moved to Houston, TX and started my nursing career in a concierge style Oncology clinic that has clientele from all over the world, with many being international. It was in that role as a staff nurse there that I learned the importance of going above and beyond, caring for others as if they were your own family, and how to support patients through some of the most difficult times including watching loved ones pass. I learned so much at that clinic that I think directly plays into my care as a midwife. There are certain parallels between oncology and midwifery and learning how to support in good times and in difficult times. Had I not allowed myself to venture elsewhere I would have missed out on a huge part of what made me who I am, and brought me friends and family that I will forever be close with.
Contact Info:
- Website: https://www.kcfullcircle.com
- Instagram: @kcfullcirclemidwifery
- Facebook: @kcfullcirclemidwiferyandfamilywellness
- Linkedin: https://www.linkedin.com/company/kcfullcircle
- Youtube: @kcfullcircle
