Setting Up Shop

Office Space – Where Will You Make Your Home?

Is the idea of where to set up shop daunting? It sure was for me when I was first getting started in private practice.

The possibilities of where a private practice dietitian can set up her office are seemingly endless. Here are some locations to consider:

A doctor’s office
A gym
A dance studio
A wellness center
A spa
A chiropractor’s office
A massage therapist’s office
A mental health professional’s office like a psychologist, psychiatrist or social worker
Your home
In the homes of your patients

Here are some questions to help further narrow down your decision:

How much space do you need?
What is your budget?
How do you plan to secure your space? Rent? Long-term lease to potentially bring down the cost?
Are you receptive to sharing space with another provider?
What type of setting do you feel most comfortable in?
What type of setting do you think your niche population will feel most comfortable being counseled in?
Do you need to be in close proximity to someone who might be a high-yielding referring provider?
Do you need high visibility and signage or would you consider your office more of a destination location?
What is the bathroom situation? Is it suitable for handicapped patients?
Are cleaning, maintenance, and things like snow removal included in the fee?
Is there sufficient well-lit parking?
Does the space appear safe? Or more importantly, do YOU feel safe in the space?

And as if that was not enough information to process! Here are the different financial situations to consider as well.

Renting

Renting is the most traditional option for securing space. However, depending on the location and your budget this option may be expensive.

Generally, if you are renting space you will need to sign a lease. Most leases are based on a term of one year. However, often to secure a lower monthly rate (as well as lock in your quoted rate) you may be encouraged to sign a lease for a longer period of time; say 3-5 years.

Benefits of Renting

There are lots of benefits to renting a space of your own. First and most importantly, you will have your very own space to call your own. While you don’t own the space, you can often do what you want within reason (often at your own expense) to the space.

If you want to paint the walls to be consistent with your brand you can. Don’t like the floor? Install a new one. Hot as heck in the summer? Install ceiling fans. Want a water cooler for your patients? Rent one.

When you rent your own space you really have the ability to make the space exactly what you want. And this fact alone is pretty awesome if you ask me.

Drawbacks of Renting

However, there are also several drawbacks to consider when renting space for your nutrition private practice. You know the saying, “Location, location, location!” Well, not surprisingly depending on where you rent it can be costly. Often the cost per month depends on several things but the two main variables are the size and location of the space. Often the bigger the space and more ideal the location – the higher the cost.

But with that being said the good thing about us dietitians is that we don’t need a ton of space to do our thang! However, that is really going to depend on the services as well as the populations you plan to cater to.

Do you plan to counsel patients one-one? Couples? Families? Do you want to provide educational classes in a group setting? Cooking classes? Do you need a waiting room? These variables can obviously influence the necessary size and potential setting of your office. As you can imagine some services require more specialized space. This in combination with other factors can drive up the potential cost.

Keep in mind that you can always change the services or even the population you are counseling. However, as noted previously, most leases are based on a term of one year. Therefore, if you start off counseling patients one-one in a teeny-tiny office but then decide you want to incorporate some group classes. Totally cool! But you will likely need to finish out the terms of your lease before jumping ship for a bigger, more badass location.

This my friends is NO biggie – just something to keep in mind. Might I note – growing pains are the best type of pain to encounter. It just means your business is expanding. Therefore, you just need to keep your cool and be patient as you further develop your growth strategy. Time to embrace the suck!

Also, one more thing to think about is the physical location of your office. Keep in mind that the location of a nutrition private practice is more of a destination. Meaning when people come to see you they have an appointment with YOU at a set time, get in their car, and drive to YOU.

Almost 99.9 % of the time in private practice we operate based on appointments rather than foot traffic or drop-ins. We are a service-based operation not retail. Therefore, from my experience, being in a super awesome location smack dab in the middle of things is not always necessary. While an ideal location say in a popular shopping center will likely increase your visibility; your patient volume is more likely to come from word of mouth, provider referrals, and your direct marketing channels. For that reason, I might stay away from ideal high-traffic expensive locations to cut down on the cost of prime real estate.

Lastly, remember that most landlords will require the first and last month’s rent upfront as well as a security deposit. This means if you go the route of renting on your own you will need to come up with a whole lot of dough-re-me from the get-go.

Co-leasing

Co-leasing is similar to renting but without the added pressure of all the financial responsibilities falling just on you. In this situation, you would be teaming up with another individual(s) who is looking for space at the same time as you and also in the same area as you. You would jointly sign the lease. Depending on the exact situation, in addition to splitting the cost of the monthly rent, you likely split the cost of utilities, start-up costs, and ongoing costs such as office cleaning, maintenance, and general repairs.

Benefits of Co-Leasing

The benefits are self-evident. Choosing to co-lease can substantially bring down the cost of renting an office for your nutrition private practice. In co-leasing, you would be encouraged to create a legal contract between both leasers that outlines both the financial responsibility as well as how the time would be split in the office space among the leasers. Therefore, rather than have to pony up the money for the first and last month’s rent plus a security deposit equivalent to one month’s rent – you would only need to come up with half of that amount. While that still works out to a pretty penny – it is still much less than you would need to pay if you were renting on your own.

Another cool benefit could be collaborating with your new partner. If you both work in a similar field (say nutrition and chiropractic) you could potentially develop a nice referral relationship. Your patients may benefit from chiropractic services and vice versa. Win-Win!

Drawbacks of Co-Leasing

But keep in mind while this scenario sounds pretty ideal there are lots of things to consider when co-leasing. First, you need to find someone who is in a similar profession and looking for a similar office set up in the same general area. It’s not like potential partners like this just magically appear! You may need to dig around for a while to find someone who is interested in the same thing. You may be able to find someone through networking, by word of mouth, or looking on spots like Craig’s List. Some real estate agents might be good resources as well as they tend to come across all sorts of people looking for space.

While it would be good to find someone in a similar or related field it is not necessary. However, what is necessary is that you both agree on a set time schedule for when each of you will be using the space. Depending on your partner this could prove challenging. Say for example if you both want to work Saturday mornings as this is a day most of your clients have off. You may need to come to a compromise and elect to rotate Saturdays so you both have access to prime times in the office.

Also, while it is awesome to have someone split the expenses it is also critical that the person who you are on the co-lease with is financially responsible. If not, that person could not only jeopardize the livelihood of your practice; but they could also potentially compromise your credit. That is why if you decide to co-lease you would want to make sure you have a crystal-clear contract in place for all the responsibilities of both parties involved.

Subleasing

Subleasing is different from co-leasing. In co-leasing both parties sign the lease together and are therefore equally responsible for the monthly payments.

Whereas subleasing means renting office space from a tenant who holds a lease to the property. Instead of renting directly from the landlord. You will pay the primary tenant a monthly rent per your agreement and also cover a percentage of the overhead costs of the space. The agreement you sign with the primary tenant outlines your rights and responsibilities as a subtenant.

For the most part, as a subtenant, you’ll have the same rights as the original renter. Therefore, when the lease is up, you’ll have to find a new place to live or see if the property manager will give you your own lease. Usually, you’ll have to abide by the same rules that the original renter would. But this varies depending on the arrangement the property manager has made with the original renter.

Subleasing can be a helpful solution, especially for dietitians getting started.

Benefits of Subleasing

There are many potential benefits to subleasing your space from someone else. Financially, it could be cost effective because in the beginning you may only need office space a couple of days per week. Rather than paying for using the space 7 days per week. It is possible that the person you are subleasing only needs the space part-time as well or just has extra space they are not using and might be happy to let you use it. Therefore, it might be possible to negotiate your lease on terms that fit the needs of your virgin and growing business.

As with all leases there is a written agreement. Often in subleasing the agreement terms are much more open to discussion. For example, you may only need to provide the first month’s rent and a security deposit to secure the space. You also may be able to negotiate the terms of the lease to a shorter duration than a year. That way you can try the office on for size and see if you like how it “fits” before making a long – term commitment.

Lastly, depending on the actual space and tenants it is possible there might be some added amenities included in the rent. For example, if you sublease from a doctor’s office you may have access to their receptionist for scheduling or billing, potentially their conference room for running group classes or even their fax/printer. Also, you don’t need to incur the added costs associated with building out the space, furnishing and establishing your own utilities. Not to mention the fact that once they see how awesome you are and the value you bring to their office they will hopefully serve a great referral source for you as well.

Drawbacks of Subleasing

Now for the cons of subleasing office space. Keep in mind when you are entering into a sublease this means working off of the existing commercial lease. One that you didn’t negotiate—between the principal tenant (who you are leasing from!) and the landlord. Be sure you review the original lease and the sublease so you are fully aware of the expectations of both you and tenant. You will probably have to accept the contract and the space “as is,” meaning you will likely be unable to make improvements or changes to the office space.

Also keep in mind that healthcare providers are subject to strict laws and duties regarding the protection of patient privacy and protected health information (PHI), such as medical records. If you are subleasing from a doctor’s office these procedures may not be hard to put in place. However, if you are renting space from a gym you may need to take extra steps to make sure your patient’s records are secure and protected at all times.

Additional precautions like having your own private file cabinet that is locked at all times (and only you had the key for), having a password encrypted computer as well as having access to a shredder for any confidential patient sensitive material will likely be necessary.

If the tenant is working in the space as well, keep in mind you’ll have to deal with their visitors, noise, outdoor signage, advertisements, and more. The best way to avoid problems with this is to rent from a tenant in a similar industry or keep your search limited to tenants just in the medical community.

While shorter lease terms may be a positive point, the uncertainty of your lease may also be a concern. The tenant may choose not to renew your lease, and you would be forced to move out and find a new space to rent, possibly under short notice. While this is often not the case in a doctor’s office or with a medical professional you just never know. So just like anything be mindful of all the variables you could run into so you are ready with a ‘Plan B’ if need be.

When deciding whether or not to sublease office space from a sublessor, you have a lot to consider first. The above benefits and concerns should give you a good starting point. Overall, my advice can be summed up with three short reminders: ask the sublessor lots of questions, examine the office space to make sure it’s what you’re looking for, and ask an attorney to scrutinize both the lease and the sublease before you move forward signing anything.

Home Visits

In-home visits, you don’t have a formal office space. You instead perform all your counseling sessions in the homes of your patients. Dietitians therefore must carry their office in their car, toting patient records, scales, teaching materials, and food models with them as they make their rounds.

Benefits of Home Visits

The obvious benefit of performing home visits is that you don’t have to shell out money for office space. This also means you don’t need to commit to any leases or long-term contracts. If you decide after 3 months you no longer want to perform home visits, you have the flexibility to immediately stop what you are doing with no financial constraints. This can be particularly appealing for dietitians new to private practice who don’t want to shelter the burden of committing to a lease with the uncertainty of whether or not they will have the patient volume to support their rent and overhead.

Another critical piece is that I would recommend charging more money than you would for a nutrition visit in a traditional office. The fee should be inclusive of your travel time, wear/tear on your car, mileage, gas, time you actually spend counseling the patient as well as the luxury provided to the patient for coming to their home. Even if your decision to pursue home visits is purely self-motivated (you can’t afford office space) think of home visits as very unique and valuable service to your patients. Therefore, your fees should reflect this.

Another cool benefit of performing nutrition home visits is that you have immediate access to your patient’s food supply. This provides direct insight into what your patients eat as well in some situations how it is prepared. When teaching concepts such as “portion size” or “how to read a food label” you don’t need to use make-believe props. You can use your patient’s actual food or food labels. Also depending on how you design your home visits this could create an excellent environment for cooking demonstrations. However, keep in mind with the inherent safety risks of cooking you will likely need additional liability insurance to protect yourself and your patient against any unforeseen circumstances.

Drawbacks of Home Visits

And speaking of risks let’s chat about something really important – your personal safety and comfort level. Remember, home-based dietitians, go from one home to another. This style of counseling is a whole different beast! The potential situations that arise in-home visits can often be anything BUT traditional and highly unpredictable.

The reality is you may end up in a not-so-good neighborhood. Or, you may not be comfortable with the patient’s family or friends visiting or living in the home when you arrive to provide your counseling session.

Unfortunately, with this style of counseling, there is an increased likelihood that you may not feel “safe” or “comfortable” from time to time. Therefore, if simply reading about these types of situations makes you feel uncomfortable, then I would seriously reconsider whether this approach is the best one for you.

Also, keep in mind aside from personal safety the general environment of the actual home could cause some challenges as well. You might be subjected to various types of animals, smoking, strange odors, and even family conflict. Therefore, it is important to understand the dynamic nature of home visits before pursuing this avenue of private practice.

Lastly, unless you drive a Winnebago (which might I add would BE AWESOME!), then you likely won’t have access to a microwave, freezer, toaster, or a Keurig. Therefore, more often than not you will be eating some of your meals in your car. While that may not seem horrible it could become tiresome day after day. Also, this means that you will need to prep like a mother to ensure you have healthy, tasty creative non-perishable meals ready to go or succumb to paying high prices for take-out meals. While likely not a deal breaker this is just something to keep in mind.

Home Office

Home offices come in many different formats and arrangements. Some offices are located in detached units with separate driveways and entrances, distanced from the main residence. While others are offices that are located in the dietitians’ living rooms, offices or designated bedrooms within the homes.

Benefits of a Home Office

Of the options we have already discussed a home office to run your nutrition private practice is likely the least expensive option. If you have extra space in your home then a home office is pretty easy to set up as well. Plus, you have access to all the comforts of home while running your kick-ass private practice and making a fantastic living.

Aside from your traditional mortgage, there is no additional rent or commitment of a lease needed. In addition, you can claim certain expenses as tax deductions minimizing your taxable income. Generally, the amount deducted depends on the percentage of the home used exclusively for business. Expenses that can be deducted for business use of the home may include the business portion of real estate taxes, mortgage interest, rent, utilities, insurance, depreciation, painting and repairs. Check with your accountant for further details on the use of the home office as a deduction.

Due to the fact that you own the home, you can control the presentation, look and feel of your office. Also, there is no commute to and from an office saving you loads of time, money, and potential aggravation.

Also, dietitians who work out of their homes, have the ability to flow more easily between the personal-familial and professional realms. They are in closer proximity to family and community obligations, children’s schools, etc. This can greatly increase the amount of time they are able to spend with significant others.

Drawbacks of a Home Office

Looks pretty perfect, right? Sounds like a perfect scenario where you can have your cake and eat it too. Right? Well, kinda sorta. A home office unfortunately does not come without drawbacks. Let’s examine the important ones.

When you start working from home as opposed to being in an office, the strict lines between your work and your personal life can become blurred. After all, you’re in a comfortable and familiar environment. This might prompt you to lose focus and default to your day-to-day personal home stuff rather than concentrating on your job.

Also, issues of privacy and confidentiality might arise. Confidentiality in health care refers to the obligation of professionals who have access to patient records or communication to hold that information in confidence. It is important that no matter where your office is that you always protect the confidentiality of your patients and their records. This might entail soundproofing your office as well as making sure all confidential paperwork is locked away when you’re not in your office. You may also need a password-encrypted computer to further safeguard your patient’s records.

Running a home-based practice often involves additional attention to zoning, tax, and insurance considerations. Dietitians who work from their homes should be aware of local zoning rules and codes regulating conducting a business from a residence. They should also make sure that they have all the appropriate forms of insurance in place before they even consider seeing patients in their homes.

Also, keep in mind while this often less formal setting can benefit some types of clients, it is not appropriate for everyone. Matters like parking, entrances, waiting areas, bathrooms, etc. are usually clearly defined in a traditional office setting. However, when your home becomes your office the setting becomes much more complex.

Therefore, in addition to the nutritional counseling you provide your patient, you must educate them on how you expect them to behave in your home. Your patients need to be informed of your boundaries in your home office and respect them. They must honor instructions in regard to where to park and which entrance, waiting area, or bathroom to use. This adds a whole new level of mandated communication between yourself and your patients.

Also, keep in mind in the home office, a client may encounter family members or pets and may overhear personal or phone conversations by members of the dietitian’s family. Thus, for some dietitians, this may seem like an intrusion into their private sacred space. Therefore, I would highly encourage you to think long and hard about all variables these variables when entertaining the idea of running your practice out of your home.