How to open a private medical office? What you need to open a private medical practice: equipment, documents and SES requirements. How to open a private medical office from scratch
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There is always a need for qualified medical services. In Russia, the number of private medical and beauty parlors is increasing, many doctors prefer their own business and individual practice to the bureaucracy of state hospitals.
The most promising are medical offices working in the field of dentistry, gynecology, urology, cosmetology, plastic surgery, radiation studies (ultrasound, x-ray,).
The process of opening a medical office includes several stages.
1. Search for premises - for example, renting an office in a medical institution or office building.
2. Registration of entrepreneurial activity in the Federal Tax Service with obtaining a certificate (issued within five days). Activity code 85.1 (medical practice). At the same time, you need to submit an application on the method of calculating taxes (clause 3).
3. Choice of taxation method. Accounting for the work of medical organizations is carried out according to a simplified scheme. Two options are possible: 15% from the difference between income and expenses, or 6% from income. In the second case, you do not need to conduct a rigorous calculation of costs, and such a scheme is usually more profitable. An application for choosing a simplified taxation system must be written and submitted immediately, when registering a business.
4. Registration with the Pension Fund and the Regional Statistics Committee.
5. Licensing of medical activities - the list of required documents is provided by the relevant department of the regional Ministry of Health, and most of them can be issued only if there is a lease agreement for the premises. According to reviews, from the main documentation it is most difficult to get permission from the sanitary and epidemiological supervision - it is faster and easier to contact not a state body, but an authorized commercial structure. After collecting all the documents, a fee is paid, the licensing organization appoints an expert.
An approximate set of additional documents that an expert may require (depends on the profile of the office, staff and services provided):
- contracts for the purchase and service of medical equipment;
- a contract for the performance of work by third-party medical organizations (for example, laboratories);
- log of checks by specialists of the dispensation;
- an agreement with a specialized medical institution or clinic for the provision of urgent care in case of complications;
- documents on the education of doctors, assistants and assistants who will work in the office.
If the check ended successfully, the permit is issued within a month. From the very beginning, the procedure can be simplified by contacting a specialized company, ordering document verification or turnkey licensing. Re-licensing is carried out after five years.
After obtaining permission, it is necessary to acquire a book of accounting for income and expenses (need to be registered with the Federal Tax Service), strict reporting forms and a journal of desk audits.
For employees, you will have to pay contributions and submit annual reports to social funds (pension, social and medical insurance), keep work books. On average, the payback period for a private medical office is 1.5–2 years.
The first stage is the registration of an individual entrepreneur or LLC. Code of economic activity (OKVED) - 85.1 - "Medical practice". The procedure itself will take about a month.
License and other documents
To open a medical office, you need a special license from the Ministry of Health.
The list of documents required to obtain it:
- Certificate of registration of a legal entity and registration with the tax office;
- Constituent documents (originals);
- Documents confirming the ownership of the premises, or a lease agreement;
- Conclusion of SES and State Fire Supervision;
- List of medical office services;
- Documents confirming the professional suitability of the personnel;
- Receipt of payment of the license fee (100-150 dollars).
Permission from the sanitary epidemiological station
Of all of the above, it is most difficult to obtain permits from the SES and the State Fire Supervision Authority. And these are the most important documents for obtaining a license for their activities.
Private practice means that in addition to certificates of professional suitability of the staff, it is necessary to confirm that you have a fully equipped premises at your disposal. In the orders of the Ministry of Health, you can find the standards for equipping a private office for each specialization.
It is also required to examination of water, flushes, air and implement a production control program. These checks take from a week to a month and cost from $70.
Permission from the State Fire Supervision
What is needed to obtain a positive opinion from this authority?
- Install a fire alarm (from $100);
- Purchase fire extinguishing equipment ($10-20);
- Develop an evacuation plan and instructions for action in case of fire;
- Complete fire safety courses and obtain the appropriate certificate.
Collecting documents, checking them, obtaining all kinds of permits can take several months, or even more. Start as early as possible. It is best to contact a lawyer or special companies that check documents, provide assistance in their preparation and execution. Their services can cost up to $600-700.
Doing the paperwork yourself will cost you up to $200. But at the same time, for an error in the application for a license, for example, you will have to pay a fine. At least in the first case, you will be sure that everything is done correctly.
Your application will be considered within 45 days after the submission of the documents. The license is valid for five years, after which it must be renewed.
How to choose a direction of work
It is most advantageous for a small business to open a single-profile office. The most profitable areas at the moment are dentistry, ophthalmology, gynecology, urology, medical cosmetology and plastic surgery. The service of ultrasound examination is widespread.
room
There are several options for arranging the premises:
- Built-in-attached premises in a residential building;
- Own house or apartment on the ground floor. In this case, it must be transferred to a non-residential fund;
- Rent an office in a medical institution. This method is convenient because the rented room, most likely, is at least minimally equipped, and the room does not require appropriate repairs. In addition, all issues with the sanitary and epidemiological station have already been resolved in the clinic.
The rental price is in the range of 10-30 $ per square meter. It is necessary to carry out repairs in the room and install a fire alarm, check the correct operation of all communications (water, electricity, etc.)
Equipment
The list of specialized medical equipment differs depending on the direction of work.
But any private medical office should be equipped with:
- Wash basins with water;
- Furniture: cabinets for storing tools, preparations, documents, a couch, medical chairs;
- A set of disinfectants;
- Clean towels and bathrobes are required.
All this will require costs in the region of 1500-2000 dollars. According to average estimates, medical equipment for a small office requires costs from 4 to 15 thousand dollars. Dentistry, gynecology, and an ultrasound room cost the most. But you can equip and for $ 1500.
Staff
The main figure in your enterprise is a doctor. He must be highly qualified and have at least three years of experience. For one medical office, you need to hire two doctors, nurses (one nurse can work with two doctors), an accountant and an administrator. The salary fund will be about $4,000 per month.
Costs and profits
Starting investments in documentation, premises and equipment start at 13 thousand dollars and can reach 20-25 thousand. Monthly expenses (rent, salary, disinfection and disinfestation) - about $ 5,000.
Such a business will not pay off immediately. It may take a year or two to develop a client base and reputation. But even with an average attendance of 10-15 people per day, you can count on 3-5 thousand dollars of net profit per month. And the net income of a successful medical office can reach 10 thousand dollars a month.
In order to start such a business from scratch, you will need considerable endurance and patience. But it is not for nothing that it is considered so profitable. After a few years, you can start expanding your business and earn decent amounts by helping people.
The market of medical private offices in our country has appeared recently. And for a long time it was not so easy to reach it. A doctor I know, who was an employee in a budgetary polyclinic, could not open a private practice precisely because of many bureaucratic obstacles: he collected almost a cabinet of all kinds of certificates and conclusions, but the Ministry of Health continued to find one or another violation. As a result, he had to give up the dream of his own business.
Yes, and many doctors still postpone the thought of opening their own business, remembering the existing problems. But in recent years, with all this, the growth in the number of newly opened medical institutions has been noticeable even to the naked eye. It turns out that there has been some progress in this direction?
Medicine is a delicate matter
Indeed, in the past, in order to obtain permits, it was necessary to deal with many problems, according to the head of the Doctor's dental office, Valery Mikhailovich Udaltsov. Now everything has become much easier. Another issue is that a large amount of money is needed to open a medical office, even a small one. People sometimes don't even realize how expensive it is. Many people think that if they leave a big hospital or clinic to work for themselves, they will immediately become much richer. In fact, everything turns out to be completely different. There are plenty of expenses even for small private offices. For example, to open a dentistry office, at least for a couple of jobs, you need at least 1.5 - 2 million rubles. And the payback occurs in the medical field in 2-3 years.
Many other owners of private medical offices will agree with this opinion.
So, ? Here is a list of documents that will be needed in order to obtain a long-awaited license to operate in the field of medicine:
Application for the provision of the established form of a license;
Copies of certified and bound constituent documents, with the seals of the license applicant (for a legal entity);
A copy of the certificate of making an entry on legal entities in the Unified Register of State Legal Entities;
A copy of the certificates of state registration of the license applicant as an individual entrepreneur;
A copy of the certificates confirming that the applicant for a license has been registered with the tax authorities;
A copy of the conclusion of orderlies and epidemiologists on the compliance of the work performed with sanitary rules and the services provided, which constitute medical activity;
Copies of all documents that confirm the qualification of individual entrepreneurs or employees of a legal entity that meets the licensing requirement and condition;
Documents confirming the payment of license fees for consideration by the licensing authorities of an application for a license;
A specific power of attorney for the rights to represent the interest of the license applicant.
You must know, how to open a medical office correctly and legally, therefore we also submit a list of documents required in order to verify the compliance of applicants with licenses, their conditions and requirements:
Documents that confirm that the license applicants own the relevant premises to him on the right of ownership or on another legal basis;
Documents that confirm the availability of appropriate organizational and technical conditions, as well as material and technical equipment, taking into account equipment, tools, transport, etc.;
Documents that confirm the availability and maintenance of fire protection equipment (fire extinguishing and fire alarm);
Documents that confirm the presence of employees in the state (doctors, medical nurses, engineering and technical workers, etc.) with at least 5 years of experience - for legal entities;
Documents that confirm the presence of a secondary or higher medical education and at least 2 years of work experience in the licensed activity - for individual entrepreneurs;
Documents that confirm an increase in the qualifications of employees of legal entities operating in the field of medicine, as well as individual entrepreneurs, at least once every 5 years.
Medicine is a rather costly area., according to the owner of the eye center "Honey, Eye" Mikhail Ivanovich Aleshaev. Imagine for yourself how many devices you need to purchase to equip at least one doctor's office! All of them are specialized. You can't even buy ordinary furniture. For example, a doctor's chair, to receive a patient only (and not for a special examination!) Will cost about 20 thousand rubles. Judge for yourself how much you spend. Therefore, before how to open a medical office, calculate everything well.
The fact that there will be no problems with obtaining a license now, we decided to see for ourselves. Having inquired whether we had a medical diploma, several offices immediately offered us to issue all the necessary documentation for a certain fee. The price of the issue is quite differentiated and depends directly on the range of services that will be provided by the private office.
My name is Nikolai Romanov, an endoscopist with 35 years of experience. He worked in large regional medical institutions of Rostov-on-Don. I have organizational experience: department, chief freelance specialist of the Ministry of Health of the Republic of Kazakhstan, chairman of the regional section on endoscopy, head of the committee in the Russian Society of Endoscopists (in the past). Now I combine work in the office of the district clinic with work in my commercial office in the same specialty - the 9th year (IP, license).
Dear colleagues! Probably, each of you, working in budgetary medical institutions and receiving a meager salary, more than once thought about starting your own business.
Today I will try to tell you how to open a medical office. And I will do this by my own example: for more than eight years I have been working in my commercial medical office.
The idea of opening your own medical office
He is an endoscopist by profession. I have been working since 1977. And all this time, like many, he combined somewhere, once he was on duty. During the emergence of medical cooperatives, he worked in several of them. We unsuccessfully proposed to the head physician that we be allowed to work as self-employed (1988).
By 2003, being the head of the department of the most prestigious medical institution in the region, I suddenly began to think about the degree of freedom of a specialist in our healthcare. It should be added that during this period I was also the chief freelance specialist of the regional Ministry of Health, the chairman of the regional section of endoscopists and the head of the committee in the Society of Endoscopists of Russia (ROEPS). But more and more I depended on some bureaucratic games and whims of leaders. Yes, and the salary remained budgetary ...
Previously, when talking with colleagues, I was always of the opinion that private medical practice, as applied to endoscopy, is hopeless, unprofitable (expensive equipment and consumables).
But, on the one hand, I knew very well that the need for endoscopic examinations in the city's polyclinics greatly exceeds the capabilities of budgetary institutions. On the other hand, I saw the readiness of patients to pay for qualified and fast medical care. This was evident in the example of paid forms of work in our diagnostic center.
I started counting. First, I calculated the possible amount of work and the likely monthly income of the commercial office, taking into account expenses. It turned out well. But without taking into account the cost of endoscopes. Of course, there was no money to purchase them ...
But when there is a dream, sooner or later, there will be a way to implement it. I told about my project to my friend - the head of a company selling medical equipment. And he immediately agreed to pay for the purchase of two endoscopes (in debt). And the Moscow company Olympus gave me the maximum possible discount.
Thus, I became the owner of two endoscopes. By the way, I gave money ($ 15,000) for five years ...
Opening a medical office
Here's what you need to do to open your own medical office.
1. Find a room for rent
I know two doctors who used their apartment (or part of it) for their office, transferring it to a non-residential fund. But now the rules for transferring an apartment to a non-residential fund have become more complicated: the consent of all (!) Residents of an apartment building is required.
It is much easier to rent an office in a medical institution. Moreover, the best option is an office according to the profile of your specialty; there will be less hassle with sanitary and epidemiological supervision.
That's exactly what I did.
In this case, it is necessary to deal with the conclusion of a lease agreement with the DIZO of the city administration; it will take about a month. When preparing documents, it is important to note in the schedule that you will work a certain time per week. Otherwise, the rental rate will be calculated for round-the-clock use (go broke).
2. Become an entrepreneur.
This is easy to do on your own, within five days you will be issued a Certificate at the regional Federal Tax Service. It is important to choose the code of economic activity (OKVED) - “ medical practice» (85.1).
3. Choosing a tax regime (important!)
But it is equally important to immediately determine the tax regime. Work in general (which is defined by default) it is impossible for an ordinary doctor: you will have to pay a lot of taxes and keep complex accounting.
A simplified system is allowed for medical practice taxation (USN). It is divided into two modes:
- "income minus expenses" - a rate of 15% (now, depending on the region, the rate ranges from 5% to 15%) and
- "income" - a rate of 6%.
The first option involves a complex accounting of all expenses. All checks and receipts must be kept and accounted for. This is almost impossible, since, in practice, not all expenses can be documented.
Usually doctors choose "income".
So here it is an application for the simplified tax system must be submitted simultaneously with the registration of entrepreneurship. Nobody explains this. You should know it. I didn't know. And so, later I had to use my connections to correct the mistake ...
4. Registration
Then you will need to register with the Pension Fund (as an entrepreneur). They sometimes send notice, but not always; better to come. You also need to register with the Regional Committee of Statistics.
5. Obtaining a license to carry out medical activities
In the licensing department of the regional Ministry of Health you can find out the list of documents required for licensing. The list is quite large - tune in for energetic action. And you can start them only if you have a lease agreement.
The most difficult thing is to get the conclusion of the sanitary and epidemiological supervision.
If you go to the state branch of this department, then, firstly, it will take a long time, and secondly, everything will be very strict and complicated. Therefore, it is more expedient to contact a commercial firm of this profile. Pay a little more, but they will do everything faster and much easier ...
During the last licensing (and this must be done every five years), the services of such a company cost me about 11-12 thousand rubles (but this is an acquaintance).
In general, licensing is now becoming a chore. The order is this:
- They collected the documents, paid the fee (300-400 rubles), passed it.
- They check and offer to wait for the visit of an expert to your office. We need to bring an expert by car (and then deliver it to the Ministry of Health).
- The expert will make his opinion, most likely, will say what additional documents need to be collected. In general, the set of documents depends, for example, on whether you have any equipment, and on many other features of your profession. I had to provide, in addition to general documents:
- equipment sale and purchase agreement
- agreement with a service organization for the maintenance of equipment
- contract with the pathomorphological bureau for the performance of histological analyzes
- distance check log
- an agreement with the clinic for the provision of emergency medical care in case of complications.
- After the visit of the expert, if he admits you, the case is submitted to the commission of the Ministry of Health.
- If you were allowed to work, within a month (more often earlier), by paying 1000 rubles. for the form, you will receive a license. I don’t know if anyone is denied… Everything must be decided at the stage of collecting documents and during communication with an expert.
There are many firms willing to help physicians through the licensing process. Our prices in the region are as follows: 5000 r. for checking the collected documents or 30,000 rubles. for turnkey licensing. To be honest, I would have been strangled by a toad if I had only thought of contacting such a company.
The deputy checked my documents for free. the head physician of our polyclinic; There was one small but valuable remark. That is why it is convenient when a doctor in this institution not only rents a room, but also works in its structure - "not a stranger."
Immediately after obtaining a license, you can start working. Just don't forget:
- buy and register with the Federal Tax Service "Book of income and expenses",
- strict reporting forms (this will save you from the need to purchase and register a cash register),
- "Book of Accounting Forms of Strict Reporting",
- as well as the "Book of cameral checks";
- keep a fire safety log
- and many other magazines, depending on the nature of your activity
In addition to endoscopes, I had to purchase additional and auxiliary equipment, consumables.
You will need to pay:
- mandatory contributions to the Pension Fund of the Russian Federation and to the Medical Insurance Fund, depending on the size of the minimum wage; now it is, respectively, about 14.4 thousand and 2.8 thousand rubles. per year (moreover, regardless of whether you really work or not); it is more convenient to pay quarterly installments
- The “single tax in connection with the application of the simplified tax system” must also be paid quarterly, and a declaration on the simplified tax system must be submitted once a year. You calculate the tax and fill in the Declaration yourself, or you hire an accountant; It's not hard to learn on your own.
- You will also pay rent at DIZO. True, now this moment is simplified: you can pay at the clinic and renew the contract (annually) too.
The nuances of the work of the medical office
Nuance number 1
If you have employees, then from an ordinary individual entrepreneur, you turn into an individual entrepreneur. And immediately increases both responsibility and the number of cases that you have to deal with. You will have to pay for employees:
- contributions to the Pension Fund of the Russian Federation (and submit reports annually)
- contributions to the health insurance fund
- contributions to the social security fund
- And also pay for the sick leave from your own pocket, if you do not pay in Social Insurance and make entries in the work book of the employee.
Nuance #2
Your earnings depend not only on the correctness of the business plan, but on many factors and circumstances. For example, for the first three years my earnings corresponded to the calculation and basically satisfied me. At that time I was working only in my commercial office.
But after the adoption of the National Project, polyclinics were given equipment and began to strictly check its use. The leaders had to urgently allocate states and fill them. The part-time workers that appeared in our clinic gradually took away from me part of the volume of work and money. And when 2 bets were filled completely, my volume dropped by almost 2 times.
I took immediate action. I decided that rather than someone taking money from me, it would be better for me to do it myself. Just leaving, the doctor who occupied the headquarters; I returned to public health. It turned out that this is not only profitable (relatively), but also convenient: I retain (to a certain extent) control over the flow of patients.
And there are many more nuances ...
I wish you success! But always be prepared for surprises!
Private medical offices in the domestic market of medical services appeared relatively recently. A few years ago, it was almost impossible to open your own office due to the huge paperwork that accompanied the main activity. To date, all work on the preparation of the necessary documentation can be entrusted to organizations specializing in providing legal assistance. The last barriers to opening your own medical office are large financial investments, as well as a relatively long payback period.
Which direction to choose
A medical office is more of a conventional concept, which, as a rule, refers to a separate room that is part of the structure of a medical institution. In such offices, a fairly wide range of services can be provided, from diagnostics to, for example, treatment or rehabilitation of injured people. Typically, medical offices by type of assistance are divided into:
- medical offices where direct assistance is provided
- auxiliary rooms where the patient undergoes various examinations.
Among all areas of paid medicine, the most profitable at present are:
- gynecology;
- dentistry;
- plastic surgery;
- medical cosmetology;
- urology;
- ophthalmology.
Medical office space
As a rule, rented space in a medical institution is used as a room for a medical office. In this case, there are no problems with sanitary and epidemiological supervision. Medical offices organized in residential buildings are much less common. In some cases, such a choice is really justified, for example, if the location of the apartment is convenient, and the main target audience of the medical office is the residents of the house.
Staff
To organize the work of a medical office, you need:
- 2 nurses;
- 2 doctors;
- accountant;
- administrator;
As a rule, one doctor should work with one nurse, but at present it is quite difficult to find nurses, so it is often practiced to work with one nurse with two doctors. Of course, in this case, failures in the work of the office are possible.
It is worth noting that the responsibility for accounting and timely reporting can be assigned to companies specializing in such.
A rather subtle point is the salary of a doctor. Recently, the practice has become most widespread, according to which the salary of a doctor consists of two parts:
- minimum wage in the region;
- 10-30 percent of the cost of services rendered.
Equipment
The most expensive part of organizing a medical office is the purchase of the necessary equipment. It should be noted that the spread of prices in Russia is extremely large and depends, in fact, only on financial capabilities. To purchase the necessary equipment, it is best to contact a specialist. As a rule, the cost of the services of such a manager is up to 15% of the equipment price, which is offset by a discount provided by the equipment seller. The average cost of equipment for one type of activity ranges from 15-25 thousand dollars.
Required investment and profitability
The required investment for opening a highly specialized medical office ranges from $25,000 to $60,000. It is worth noting that to open a multidisciplinary office, you will have to spend at least 100 thousand dollars.
The profitability of the office, ultimately, depends on its attendance. It is difficult to give exact numbers, since the number of clients depends heavily on the professionalism of the doctor and the chosen location. According to statistics, a small medical office with an average workload really pays for itself in 1-2 years.
