The paperwork nobody warns you about

Hey, it's Dr. Bernal.

Last email I left you hanging on one thing: what I did before I saw my first cash-pay patient. Time to close that loop.

I set up my LLC before I had a single patient booked. Not because some guru told me to. Because I got scared straight by a colleague who saw her first three cash-pay patients as a sole proprietor and only found out later what that actually meant for her personal liability.

Here's the thing nobody tells you in residency: the LLC isn't the exciting part of starting a cash-pay practice. It's not the part you'll post about on Instagram. But it's the part that decides whether one bad outcome becomes a lawsuit against your business or a lawsuit against your house.

I made a mistake here too, so you don't have to. I formed my LLC in Florida first, because that's where I lived. Then I realized I needed to check the rules in every state where I planned to see patients, not just where I was sitting when I hit the paperwork. Telemedicine crosses state lines. Your business structure needs to account for that before you're mid-visit with a patient in a state you didn't plan for.

I am not your attorney and this newsletter isn't legal advice. What I can tell you is what I wish someone had told me: talk to a business attorney who has actually worked with telemedicine practices, not just a general small business attorney. The multistate piece is where generic advice falls apart.

This week, do one thing: check name availability for your LLC in your home state. Every Secretary of State has a free business name search on their website. Takes five minutes. It will not build your practice, but it will make the whole thing feel real, and that momentum matters more than people admit.

If you're already past this step, use the five minutes differently. Pull up your state's telemedicine practice requirements and confirm you're covered for every state where you currently hold a license, not just the one you live in.

Someone in the Facebook group asked this week: "Do I need a separate LLC for every state I'm licensed in, or does one cover me everywhere?"

Short answer: it depends on your state and your specific setup, which is exactly why this is a "call an attorney" question and not a "trust a stranger on the internet" question. What I will say is that this exact question is why I mentioned above, checking your multistate exposure matters as much as forming the LLC in the first place. Don't stop at step one and assume you're covered everywhere.

Got a question like this? Drop it in the group. Odds are good three other physicians are quietly wondering the same thing.

Once your business is actually a business, the next question hits fast: what are you actually going to chart in? Next issue, I'm walking through how I chose my EMR, and the one feature I didn't think to ask about until it almost cost me a multistate patient.

Talk soon, Dr. Bernal