The True Costs of Setting Up as a Private CDE

To help you decide, and navigate the path toward potentially starting up your own private practice as a CDE, this article aims to share with you some of the costs that you may incur in the process, and should take into account before leaping in. While most CDEs have gained extensive education in their primary field as well as diabetes education, most have not undertaken or received training in business or management disciplines.

The ADEA has a number of resources on this topic, including a helpful breakdown of financials in the Prices, Costs and Volume presentation available on the ADEA Learning Management System (LMS). Please have a look at this and the other resources available as part of this module, as a business that is not profitable may cause issues for the owner.

One of the first things you will need to decide is whether you will operate independently, or  become part of an existing business/practice. This decision will have a huge impact on set-up costs and revenues. There are advantages and disadvantages to both models, and even a huge range in revenue share amounts, so please take time to consider all options before jumping into any agreement

This is a list of some of the common costs that you may need to allow for when setting up a private practice:

• Business Name registration (development of a business structure that is right for you and your practice) and purchase of a website domain name.
• Insurance including professional indemnity, public liability and possibly business contents, workers compensation and cyber-insurance.
• Ongoing costs of your professional memberships.
• Rent/mortgage and any costs of fitting out and/or furnishing your new location (if rented independently). A lot of commercial landlords will prefer longer leases, but don’t be afraid to negotiate on this, and remember that you and/or the business (dependent on structure) may be liable to pay rent for the entire length of the lease even if you don’t stay in practice for the full duration.
• Ongoing maintenance/repairs.
• Utilities (such as electricity and water), and other costs (in commercial tenancies you may be expected to pay for the building owners expenses such as rates, land tax building insurance etc, commonly referred to as outgoings, so you should ask for a detailed list of before signing any commercial lease).
• Graphic design including the development of a logo, business card, stationary and signage. You may wish to engage the expertise of a graphic design or marketing company to help you navigate this or look online for logo creators, online print, and signage companies etc.
• Website including initial design and ongoing support and website hosting costs.
• Technology – computers/laptops/phones/printers (fax software is available online so this reduces the cost of a physical fax machine). Also consider whether you will need help with technical support.
• Practice software which offers electronic medical records, appointment book, billing and other features to help you run and organise your practice.
• General office supplies (paper, pens, tea, coffee, toilet paper etc.).
• Equipment to run your consultations – blood pressure monitor, scales, height measure.
• Blood glucose meters, insulin pens, and other devices to support you providing education. These are generally obtained free of charge from companies, but something else to consider when preparing.  Start early and make time to contact company representatives for support and resources.
• Educational resources/materials (such as information sheets and flyers for clients) and access to other online resource portals.
• Time costs of developing your practice business plan and policies – or the cost of outsourcing these (if you look online you can find lots of free resources but they will take time to adapt to your needs).
• Legal and/or accounting advice costs, initial and potentially ongoing.
• Accounting software such as Xero, Quickbooks or MYOB (which will hopefully integrate with your practice software).
• Advertising and marketing – producing, emailing, and/or printing monthly newsletters to keep your local referrers up to date with your services, advertising in the local paper, or online marketing campaigns. Some advertising may be free – contact local organisations such as your primary health network, pharmacies, and place cards or flyers in other local businesses if they are happy for you to do this. Remember to update your practice details on the ADEA ‘my clinics’ tab, so that you can be found as part of the Find a CDE function. This is an important consideration -if people don’t know that you exist how can they find you?

You should also think about how you will deal with factors such as leave/sickness and lulls in work. Ongoing costs of professional development and developing your own intellectual property are other considerations. It is important to budget for a period of time with little or no income, while you are setting up and growing your practice.

From this initial look at how to set up, it is easy to see that private practice set-up costs can add up very quickly. It really is important to understand and plan for these costs so you are not confronted with large unexpected costs. Planning will help you have an accurate idea of what to expect.

Other resources on the ADEA LMS include links to access small business support, business plan templates and checklists for starting a small business. These free resources are invaluable and could certainly save you time and money during your practice set-up

Please take the time to get advice from experts such as accountants, solicitors and even your peers (the forum on the LMS and  ADEA Private Practice Special Interest Group (PPSIG) Facebook groups are great resources about the best way to proceed).

Other non-financial costs to consider are those of a physical and emotional nature that you may experience when embarking on private practice. You will be working hard. You will be doing a lot of hard work yourself in the beginning and this can be tiring and stressful, with little or no initial financial reward. Emotional energy will be needed to build and maintain local relationships and referral pathways with allied health professionals, specialists, local primary health networks and GPs.  Incorporating self-care routines and strong support networks is one ‘cost’ you don’t want to leave off your planning list. Setting up a private practice may be hard work but having these things in place will help you greatly on your journey to reach your business goals and create your own successful private practice.  Importantly, it will also leave you energy to support your future clients.