By Hope Belli Tinney, Washington SBDC
MONTESANO, Wash. – One day Laura Raykowski, a nurse practitioner and owner of Hometown Family Health, walked out of an exam room to see her office manager talking to an indigent patient about billing.
“How much do you have in your pocket right now?” the office manager asked. She then talked with the patient about how much he would need for his prescription and bus fare, charged him some amount of what was left and called the account paid in full.
The best part, Raykowski said, is the man came back the next time he needed help.
“That is so important in our community because so many people fall through the cracks,” she said.
Providing community healthcare
A nurse since 1987, Raykowski became a nurse practitioner in 2002 so she could provide medical care in her underserved community. As a school nurse, she said, she would see children who failed eye or hearing screenings, or had other chronic conditions, and there were no healthcare providers available to treat them.
Washington is one of 22 states where nurse practitioners can diagnose, prescribe and treat medical conditions without physician oversight.
Raykowski worked with several agencies providing care to lower income patients and then began working at The Clinic in Elma, Wash., which was run by a local hospital. When that clinic closed abruptly in 2013, she was out of a job and several thousand people lost their healthcare provider.
Her husband, Jim Raykowski, said she should open her own clinic. But “all I want to do is see patients,” she told him, though the only jobs she could find would have meant moving out of the area.
Then former patients started looking her up in the phone book.
“I don’t know anything about running a clinic,” she told her husband. He told her to call Linda Wecker, the woman who had been the office manager at the hospital clinic for 18 years.
Motivation and decision making
They took another step forward and signed up for the Washington State Self-Employment Assistance Program. Through SEAP, Raykowski learned about the Washington Small Business Development Center and started meeting with Erik Stewart, an SBDC certified business advisor who meets with clients in Aberdeen, Wash.
The Washington SBDC (https://wsbdc.org/) is a network of more than two dozen certified business advisors working in communities across the state to help business owners and entrepreneurs start, grow or transition their businesses. The Washington SBDC is supported by Washington State University, the U.S. Small Business Administration and other institutions of economic development and higher education. SBDC advising is confidential and provided at no cost to the client.
“One of the biggest things Erik helped me do was look at why I was even doing this,” Raykowski said. Understanding her motivations and her goals was key because she had several big decisions to make right away.
One was whether to open her own stand-alone clinic or buy a franchise. Another was how to structure the business – whether to find a partner, be a corporation (or LLC) or be a sole proprietor.
In the end, she decided to be the sole owner of a stand-alone clinic, even if that put more of the administrative work on her shoulders.
“I’m kind of a bleeding heart,” she said, and she wanted to be able to make decisions without worrying about financial consequences for anyone else.
Setting up business and tracking systems
Not that financial consequences aren’t hugely important. If the clinic goes under, Raykowski can’t help anyone.
She and Stewart spent weeks and months going over financial spreadsheets, looking at cost and revenue projections, creating a budget, discussing marketing and setting up business systems, including an all-in-one online medical-business tracking system.
In the meantime, her husband found her a location – in a building that had been vacant for 20 years – and set about renovating it into an office with three exam rooms.
Three weeks before they opened Hometown Family Health (http://www.hometownfamilyhealth.com), another clinic in the area closed. In the two years they’ve been open, three more medical practices in the area have closed.
Hometown Family Health has about 3,000 active patient files, Raykowski said, and her staff includes one other nurse practitioner and three medical assistants. Wecker is the office manager.
A gratifying adventure
“I’m not making nearly as much money as I was when I was working for a salary,” Raykowski said, and she’s working far more hours. But, she said, the job satisfaction is high.
“It’s gratifying when people are excited to find me again and establish care,” she said. “It’s also gratifying when they say, ‘Will you see my mother? She needs someone to listen to her.’”
The thought of opening a clinic terrified her, but Stewart helped her see that “this is a big adventure, offering all sorts of new learning experiences.” With SBDC advising, she said, “it’s a lot easier to enjoy the ride.”