What hurdles do health care practitioners face today as they’re launching their practices? Should they venture out into the potential rewards of a sole practice or seek out security with an established group? What about social media - should they tweet about their expertise? Are they living on peanut butter and jelly sandwiches while they pay off their college loans? How competitive is it to begin a practice as a dentist or doctor these days in Greater Des Moines? 

Here’s a look at some of the challenges that three of Central Iowa’s newest practitioners have, from the perspective of a doctor, dentist and chiropractor, each of whom is starting his or her own practice.

Physician Seth Quam

While he was completing his residency at Iowa Lutheran Hospital, Dr. Seth Quam knew he wanted to become a primary care practitioner – and that he wanted to stay in Iowa. 
And through the course of his residency, he decided he wanted to practice in a smaller community that would have a wide variety of patients and procedures to handle. 

That led him to UnityPoint Clinic in Grimes, where he started in August 2012. 

Quam spent some time working at the Grimes clinic while he was a resident, so he knew what to expect at the busy clinic. He has quickly picked up new patients by serving as the overflow doctor for patients who didn’t already have a primary care physician. 

“So your name gets out there that way,” said Quam, 31. He helps out on the sidelines at Dallas Center-Grimes school sports events to treat minor injuries. He also follows up with clinic patients at each hospital in Greater Des Moines, within both the UnityPoint Health and the Mercy Medical Center systems, particularly for newborn care. 

“A lot of primary care family medicine has (gotten) out of newborn care,” he said. “I know that our patients are very grateful to us for taking care of their newborns; we do see a lot of newborns in Grimes.” 

Quam is a parent himself. He and his wife, who teaches sixth grade in Waukee, have a 2 1/2-year-old toddler and an 8-month-old baby. 

Electronic medical records, which can frustrate older physicians who were trained in paper systems, are second nature to Quam, who has never used paper records. 

“They’re very user-friendly and easy to use,” he said. 

To deal with the student debt he’s started to pay off, the Des Moines University graduate said he’s trying to maintain the spartan lifestyle of a medical resident. “I think more concerning is the large interest rate on the debt,” he said. “They’ve been significantly elevated over the past decade.” 

Quam said his biggest pressure is maintaining continued acceptance within the Grimes community. 

“It takes good medicine, good communication and education within the things that go on in medicine,” he said. “Just knowing that patients want to be heard.” 

Dentist Megan Miller 

During her first week at Urbandale Family Dentistry, Dr. Megan Miller tackled a professional task that dental school didn’t prepare her for – hiring an assistant. “I had never interviewed anybody before; I didn’t know what questions to ask,” said the 27-year-old, who joined the practice shortly after graduating from the University of Iowa College of Dentistry in June 2013. 

It’s one example of how dental school, while excelling in clinical preparation, falls a little short on preparing new dentists to run the business side of the venture. 

“We may have had a couple of lectures about business-related things, but even phrases like accounts receivable, just very basic things, we really weren’t taught much about,” Miller said.

Although the university provided a service to connect new dentists with established practitioners, Miller knew many practices don’t advertise openings, so she conducted an extensive email search. And there was a lot of competition from classmates who also wanted to practice in Greater Des Moines. 

Working with Dr. Tom Tippins, she is phasing into the practice and will eventually take it over as he nears retirement in the next several years. After working a couple of years as an associate, Miller will become a partner with Tippins and then eventually buy out his share of the practice. 

“We were very intentional at the beginning of negotiations,” she said, “because he had heard a lot about this process going sour. So there was a lot of thought that went into making it clear what we wanted out of this arrangement.” 

In the past six months, Miller has built up her appointment calendar from the one patient she handled her first day – a cleaning for her mother – to weeks that are now fully booked with patients.

“They say for a full-time dentist to be busy, it takes about 1,500 to 2,000 patients,” she said. “Right now, I get all the new patients walking in the door, and we average one new patient a day. So it will be quite a while before I build up to that level.” 

Miller said she chose dentistry because of its potential for a good work-life balance. Her parents are both health care professionals – her father’s an anesthesiologist and her mother is a pharmacist – so she was aware of the downfalls of those fields, particularly the long, irregular hours of a physician.

“For a woman who wants to have a family and a good work-life balance, (dentistry is) a really good career,” she said.

Although the composition of her graduating class was slightly more than half male, Miller noted that the 2015 class at Iowa is expected to be the first to have a 50-50 mix of male and female dentists. 

Just coming out of dental school, Miller counts herself fortunate not having any student loans to repay. She has some friends who owe upwards of $300,000 who are practicing in rural areas of Iowa in order to participate in the state’s loan repayment program for dental shortage areas. “For them, to have that loan repayment was just priceless,” she said. “I have a few friends in small-town Iowa; one I know is the only dentist in an entire county.” 

Since coming to the Urbandale practice, Miller has worked to build up its social media presence, which has become one of dentists’ most important referral sources. 

“We’re really trying to increase our search engine optimization by getting our name out there in as many places as possible,” she said. She also established a Pinterest page for the practice. “The No. 1 way patients today are finding dentists is they’re Googling ‘dentists in Urbandale,’” Miller said. “So the more social media websites we’re on, the more areas of Google we can be searched, the higher up we’ll be in the search. It’s been fun teaching Tom how to use social media. He’s really gotten into it and he’s hooked now.” 

What’s a good day for a new dentist? 

“I think the first day that I didn’t have to do a cleaning and I did all fillings and crowns, that was the first day I felt like I was really a dentist,” she said. 

Chiropractor Chris LoRang

For 28-year-old Dr. Chris LoRang, establishing a new chiropractic practice in Des Moines means building a lot of connections, and that includes using social media. “People will book appointments with me on Facebook,” said LoRang, who opened Capital Chiropractic and Rehabilitation Center in the East Village in July 2013.

For his practice, “the social media realm is almost more important than a website right now,” he said. “People go to that for patient testimonials and to see what sort of interactions those offices have.” 

LoRang – whose practice was recently named 2013 Business of the Year by the Des Moines Downtown Chamber – has also gotten his name out into the community by providing free chiropractic services at events such as the IMT Des Moines Marathon and the Hy-Vee Road Race during the Drake Relays. 

“With those events, part of it is literally just providing a service to athletes in the community,” he said. 

Building a clientele is a challenge, but it’s not the most difficult part of starting a practice, LoRang said. 

“I love building a clientele; I love interacting with people both inside the clinic and in the community,” he said, though he noted, “it takes work every day to interact with people and let them know how this place is different, and how we might be able to help them.” 

The most difficult task? Getting credentialed with the major insurance companies and mastering their complex claims systems.  

“I find that I learn a new (insurance) question to ask every day,” he said. “For a period of time, I thought that was only going to last the first couple of months, but really, it continues on a daily if not hourly basis. It’s a complex system, and there are so many levels even within each institution that you have to navigate. Thankfully, the chiropractic profession has integrated into the health care realm, so many insurance policies cover it.” 

Historically, chiropractors have tended to operate independently as solo practices, but that trend has been shifting toward more group practices to share overhead costs, LoRang noted. “I looked at several opportunities (with chiropractic clinics) within Greater Des Moines, but nothing fit my treatment approach at the time I was looking,” he said. 

As part of the curriculum at the Palmer College of Chiropractic in Davenport, LoRang was required to write a business plan for his practice. “Even the people who plan to go into practice with someone else still have that project,” he said. 

As he researched for his business plan, LoRang compiled best practices from the business plans of chiropractors, and then got a reality check by working with an adviser at the Small Business Development Center. He also got a primer on financial spreadsheets from a program provided by NCMIC Group Inc., a Clive-based malpractice insurance provider. 

A mentor has been Dr. Braxton Pulley, a chiropractor who practices a few blocks away in the East Village. 

“That relationship has been great,” said LoRang, who first met Pulley five years ago when he lectured at Palmer and later shadowed Pulley at his clinic. “That has made it a very easy transition into this neighborhood.” 

Now that he’s several months into his practice, LoRang is looking ahead to the day when he’ll hire his first employee – a part-time receptionist. 

“That time, thankfully, is approaching faster than I expected,” he said. 

Overall, just being open is a relief after years of preparation and anticipation. 

“Oftentimes, I have more work in a day than I can get through in one day, so it’s a constant game of staying one step ahead and then also finishing work from the day before,” LoRang said. “I think it is a relief now that I’m open, now that I have the brick and mortar, I can tell people where they can seek out treatment.”