There is an accountant by the screen-nick of 'unitednations' in one of the I140 forums, he would be the expert to advise in these matters. There are also some posts in the 'opening a business in the US' category.
From what I understand there are a couple of business forms suitable for a physician practice.
Single proprietor --> no corp at all. You essentially have the insurance companies remit payments into a personal business account. Easiest to set up. NO asset protection (if an employee sues you for harassment, your personal home is on the line). Tax wise simple.
INC. --> regular stock based corporation. You need to hold stockholders meetings, keep minutes etc. Has double taxation issues unless you have a GC or citizenship (
P.C. --> professional corporation. Stock based corp with only physicians as stockholders. Usually costs more money to open and maintain (e.g. state franchise taxes). Most common corp form for small practices. I believe you have a double taxation problem (profit taxed at the corp level and once you receive it as 'profit distribution')
L.L.C. --> limited liability corporation. Some states allow you to use this for medical practice, some don't. The 'limited liability' only extends to your general business liability, e.g. your practice going broke or beeing sued by someone hit on the head by an icicle. It doesn't insulate you from malpractice claims (no corporate structure does, that only applies to lawyers).
I think the key questions you have to answer for yourself before embarking in the adventure of setting a practice are:
- do you really think you can make it in this location. It is MUA for a reason.
- what is your current billing/collection volume. After accounting for overhead, would you be able to put food on the table ?
- are you able to raise enough capital (own or bank) to cover 3-6 months of practice expenses before you receive the first cent into your collections account ?
- what is the payor mix. Will you see anything else but deadbeats and medicaid ? The practice you are with right now might have some subsidies to make do, will you have a way to tap into the same revenue stream?
- do you already have billing numbers with the major payors in your area through your current practice ?
- Independent practice association (IPA). Will you be able to become a member of the one your current practice is with (giving you access to certain HMO and PPO contracts).
- how will you set up your payment scale
- if you are working on a NIW, I believe you have to offer a sliding scale discount for low-income customers.
- real estate. rent or lease.
- equipment. what specialty are you in. In peds, all you need is two exam tables and an otoscope to set up shop. If not, there are used equipment vendors out there. If you have lots of time before opening your practice (and some storage space), you can shop around and pick up some deals on the stuff you need.
- access to a hospital. Are you in a specialty that requires hospital priviledges. Is your current employer in a position to block you from staying on staff (e.g. by sitting on the credentialing committee). Usually, people get booted out in this situation through the locals ganging up on you and denying you entry into their call pool. Without hospital priviledges, you can't be on certain third party payor plans, even if you don't admit any patients.
- administration/billing. Will you try to set up everything yourself or do you go with one of the management companies. There are commercial outfits like 'PerSe' that set you up with things like electronic medical records/billing systems on a 'application service provider basis'. All you need to provide is the front desk girl who can swipe the patients medicare card through the card reader and type in the current address (overly simplified of course).
- insurance: malpractice, general business liability, supervisors liability..... It is nauseating.
