The War Zone: Private Practice

Summary

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Podcast Summary: The War Zone: Private Practice

Podcast: The Practical Dermatology Podcast
Host: Dr. Neil Bhatia (A)
Guest: Dr. Colin Blattner (B)
Date: February 27, 2026

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Episode Overview

This episode, titled “The War Zone: Private Practice,” explores the challenges, realities, and critical strategies of running an independent dermatology practice. Dr. Neil Bhatia interviews Dr. Colin Blattner, a private practice dermatologist in Oregon, discussing building a sustainable, multi-site operation in less saturated markets. The candid, practical discussion covers everything from startup decisions and operational hierarchies to financial oversight and mentoring the next generation.

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Key Discussion Points & Insights

1. Starting Out in Private Practice during the Pandemic

[01:00–02:41]

• Dr. Blattner recounts launching his first solo practice in July 2020 during the heart of COVID-19.
• He intentionally chose an underserved rural location (The Dalles, Oregon) 80 miles east of Portland, capitalizing on local demand after other area practices closed.
• By targeting a large catchment area, he quickly built a substantial patient base—seeing 40–50 patients daily within two weeks.

Notable Quote:

“I decided to go out on my own... And I said, you know, I’m going to take you up on one of those two things. I’d love to rent her office, but I want to run my own shop.”
– Dr. Colin Blattner [01:19]

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2. Go Where the Demand Is

[02:02–03:09]

• Both Dr. Bhatia and Dr. Blattner emphasize the importance of choosing practice locations with high patient need.
• They highlight a generational shift: new dermatologists favor big cities and lifestyle perks, but these areas are often oversaturated, impacting success.
• The “simple economics” of supply and demand is key for a thriving practice.

Notable Quote:

“It’s simple supply and demand.”
– Dr. Colin Blattner [03:08]

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3. Organizational Structure & Operational Consistency

[03:38–04:54]

• Dr. Blattner outlines his carefully designed management hierarchy:
  • Practice administrator reporting directly to him
  • Heads of HR, revenue cycle management, and regional managers under the administrator
  • Each regional manager oversees office managers; each office manager oversees a lead medical assistant
• Systematization is critical: every office is organized identically for efficiency and easy cross-coverage.

Notable Quote:

“Everything is systematized. If I’m going to go and open an office, I have the same opening office order...Rinse, wash, repeat.”
– Dr. Colin Blattner [04:27]

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4. Managing Multi-site Practices & Staff Flexibility

[04:44–05:07]

• Standardizing workflows allows plug-and-play flexibility; staff can rotate across sites seamlessly.
• Traveling between sites is unavoidable in multi-site practices, requiring commitment from providers.

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5. The Threats & Benefits of Being “Indispensable”

[05:07–06:20]

• Dr. Bhatia notes that being a key community provider makes a practice attractive for buyouts but also risky—larger systems can displace independents by bringing care in-house.
• Sustainability depends on maintaining autonomy, managing billing, and keeping a close eye on overhead.

Notable Quote:

“There is a certain amount of benefit with the practice like mine, but there’s also a certain amount of risk.”
– Dr. Colin Blattner [06:06]

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6. Financial Oversight & Prevention of Fraud

[06:31–07:34]

• Meticulous monitoring of accounts receivable and robust training for financial front-line staff are essential.
• Dr. Blattner recommends and uses independent quarterly audits to deter embezzlement and maintain financial integrity.
• Emphasizes acting early—don’t wait until year-end to uncover issues.

Notable Quote:

“I have an independent auditor audit all of our books quarterly. And I think that’s the way you keep everyone honest.”
– Dr. Colin Blattner [07:11]

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7. Advice for Aspiring Private Practice Owners

[07:34–08:29]

• Choose underserved markets for faster growth and sustainability.
• Avoid oversaturated areas—even peers in major cities struggle to build patient volume.
• Learn by doing, and be willing to step outside comfort zones.

Notable Quote:

“Go to where the demand is...That is something that a lot of people don’t want to do. But if you want to get up and going in a relatively reasonable time frame...”
– Dr. Colin Blattner [07:57]

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8. Learning from Failure & Adapting

[08:42–09:46]

• Get hands-on experience, accept that failures will happen, and focus on avoiding catastrophic errors.
• Cutting losses on unsuccessful ventures is necessary for long-term viability.
• Flexibility and “grit” are essential attributes.

Notable Quote:

“It takes a lot of grit... You have to realize that you will fail.”
– Dr. Colin Blattner [09:12]

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Memorable Moments & Quotes

• On physician influencers:
  “We’re living in an era where people want to come out of residency and be an influencer and not do the job...”
  – Dr. Neil Bhatia [08:59]

• On balancing work and life:
  “What you’re doing is phenomenal, that you’re keeping that number of offices open, maintaining your sanity, keeping your kids and having a dad, but also just being yourself and not losing your mind.”
  – Dr. Neil Bhatia [09:48]

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Timeline of Important Segments

| Timestamp | Segment/Topic | |------------|-------------------------------------------------| | 01:00–02:41| Dr. Blattner’s pandemic-era practice launch | | 02:02–03:09| Location selection—underserved vs. saturated | | 03:38–04:54| Management structure and office systemization | | 05:07–06:20| Indispensability, M&A risks, consolidations | | 06:31–07:34| Billing, overhead, and fraud prevention | | 07:34–08:29| Pearls for new practice owners | | 08:59–09:46| Learning from failure and the importance of ‘grit’|

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Summary

This lively, insightful conversation underscores the realities of private dermatology practice: the critical need for entrepreneurial strategy, operational rigor, and personal resilience. Dr. Blattner’s success in rural Oregon is attributed to smart market selection, disciplined management, and uncompromising financial oversight—offering a pragmatic roadmap for current and aspiring independent dermatologists. The tone is candid, practical, and occasionally humorous, making these lessons both accessible and memorable.

Transcript

[A]

Hi there. I'm Dr. Neil Bhatia. I'm chief medical editor of Practical Dermatology. This is another installment of the Practical Dermatology podcast, and I'm with one of my favorite people on earth, Dr. Colin Blattner from Portlandia, Oregon. Colin, welcome.

[B]

Thanks, Neil.

[A]

This is a. What are we going to call this? The war zone? Give us the title that you just made up.

[B]

We're going to call it the War Zone. Private practice.

[A]

Private practice. The war zone. I mean, this is basically. Basically. And again, I give you the credit, you are one of the last of the frontier men who have set up private practice in such a way that you have made something that is totally sustainable, can still work, and yet maybe one day will be something somebody will want to offer you some money for.

[B]

God willing.

[A]

God willing.

[B]

God willing.

[A]

So tell us a little bit about how you got started in Oregon and the method of building as many offices and successful offices as you have.

[B]

I got started in 2020. After I got out of fellowship, Covid happened and most of the other dermatologists in the state were shut down. So I decided to go out on my own in this little rural town about 80 miles east of Portland called the Dalles, Oregon. And the hospital CEO actually called me and he said, you know, we just had a dermatologist leave and you could rent her office. And he said, we'd love you to be an employee at the hospital. And I said, you know, I'm going to take you up on one of those two things. I'd love to rent her office, but I want to run my own shop.

[A]

Yeah.

[B]

So that was how I started my own private practice in July, I think. 5th of 20. 20. 2020 was the first day I saw patients. So Covid happened February, March, and yeah, that was how I started. Just started going.

[A]

But you started in the right way because you went where the demand was.

[B]

I went where the demand was, yeah. I did not go to New York or LA or Chicago. The town I was in there was 20,000 people, but it had a large and catchment area because it would draw from basically 100 miles east of where it was. And I caught all of the other little surrounding outlying communities. And within two weeks, I was seeing, you know, 40 or 50 patients every day.

[A]

Oh, you can imagine. Exactly. Because they probably were waiting to find somewhere within an easy drive rather than

[B]

within an easy drive because they didn't want to drive another 80 miles to Portland.

[A]

Exactly. And be seen by a system here. They could be seen by a dermatologist.

[B]

Yeah, that's correct. Right.

[A]

That being said, you know, and I think the point comes back to go to where you want to work versus where you want to live, which is the opposite of where we're seeing residents coming out of training now. They want to all live in the cities.

[B]

It's very, very different now. They all want to work four days a week, they want to live in a big city. All of the amenities, unfortunately, those areas are really saturated, so.

[A]

But it's simple economics. Right. You go where the demand is.

[B]

It's simple supply and demand.

[A]

Yeah, exactly. And if you go to where the access is better for getting to patients quickly and you can be their guy, you can still figure out a way to not only have a good living, but also be comfortable in managing the practices, especially multiple sites. So that builds the next question. How do you as obviously the owner or the boss, how do you manage multiple sites with many employees? What's your hierarchy and algorithm for management?

[B]

So I've got a practice administrator who directly reports to me. Under her, I've got head of hr, head of revenue cycle management. We've got two regional managers that report to my practice administrator. Under the regional managers, each office has an office manager. And then under the office manager, we have a lead medical assistant. So I've kind of make it a hierarchy pyramid.

[A]

Exactly.

[B]

Everyone knows who they report to. And that's the only way you have to structure it in a way where everything is set up exactly the same in each of the offices. If you look in one of my exam drawers in the Dalles, it's going to have the same things that we have in Lake Oswego. It's going to be set up exactly the same.

[A]

Exactly.

[B]

Everything is systematized. Right. If I'm going to go and open an office, I have the same opening office order. If we're gonna apply for a cleat license, it's the same thing. We have the same paperwork. Everything is done. Rinse, wash, repeat, rinse, wash, repeat. Right.

[A]

And that way you could also have employees come in. Maybe they could value different sites or vice versa, that you could be plug and play where you need to be.

[B]

Yep.

[A]

And everything is the same.

[B]

Yep.

[A]

And that makes patient care.

[B]

That makes. That makes patient care easier. Especially if you need to travel. That's the hardest thing, I think, for a lot of younger dermatologists. If you want to be busy, you may have to travel more than you want to.

[A]

Yeah. So, I mean, obviously I'm older than you are by many years. My path was similar. I started my own place. But I was in the city. I was the opposite of what you're doing in Oregon. Obviously Oregon has more opportunities to be spread out than where I was in Wisconsin. But I had to eventually sell my practice because my referral basis of practice, primary care and everybody else were being squashed by hospital systems and consolidation. So when you're making yourself available and you could be actually somewhat indispensable, does that make you an attractive potential purchase for someone of, let's say, consolidation or private equity or hospital system or what have you?

[B]

I think it makes you more attractive, but I also think it makes them more cautious because they know the tale. Like you experienced. Right. What if the hospital went and brought in their own dermatologist? What if the hospital went in and brought in their own dermatology nurse practitioner or pa? We're seeing this happening. So I think there is a certain amount of benefit with the practice like mine, but there's also a certain amount of risk.

[A]

Very much so. And to sustain yourself and not have to worry about being bought out, obviously, the billing and the overhead, you're watching that.

[B]

Yeah. You have to watch every single month. You need to look at your accounts receivable and make sure that your RCM is correct. You have to make sure that the front desk is collecting the co pays, the deductibles, the coinsurance. And there's a lot of training that goes into those positions and a lot

[A]

of sleepless nights wondering, is everything being collected or have a hand in the cookie jar? And even more so like, are we going to make payroll? Are we going to make pay our bills? And everything else, of course, what fails things do you have in place that maybe would be a deterrent to embezzling in the office or even more so that you're not having that risk.

[B]

I have an independent auditor audit all of our books quarterly. And I think that's the way you keep everyone honest. You have to have not just your practice administrator or your own CPA doing it. You have to have an independent auditor. And I recommend doing that quarterly just because that's a way to minimize the damage. You don't want to wait until the end of the year.

[A]

Right. And what about just thinking in terms of if you had to mentor someone along or whether it be you're taking them on in your practice, or even let's say you had to teach a class today on how to start a practice from the ground up and run it. What would pearls would you give to anyone out there?

[B]

Go to somewhere where there is an underserved population.

[A]

Go to where the demand is.

[B]

Go to where the demand is. Right. That is something that a lot of people don't want to do. But if you want to get up and going in a relatively reasonable time frame. For example, my friend in Florida, very competitive. Right. In Miami, he's been in practice for three years.

[A]

There's dermatologists on every corner.

[B]

There's. There's more dermatologists than there are McDonald's.

[A]

Yeah, right, exactly.

[B]

And, you know, for him, it's taken him, you know, three years to get 20 patients a day.

[A]

Oh, I'm sure. Yeah.

[B]

So that's the biggest thing, is you have to go where the demand is.

[A]

Yeah. When you can just as easily go to Miami on vacation.

[B]

You go to Miami on vacation every single day. I mean, we're sitting here in Maui.

[A]

Yeah, exactly.

[B]

We're on vacation in a way.

[A]

That being said, too, I remember one of the biggest lessons I used to teach was learn from somebody else's mistakes. You know, your first job doesn't have to be your last job, and you can learn how to manage a practice by watching others on the job, but at the same time, you have to get your hands dirty and do the work.

[B]

Of course.

[A]

And, you know, again, we're living in an era where people want to come out of residency and be an influencer and not do the job because maybe they don't have the chutzpah to start a practice or.

[B]

It takes a lot of grit. Yeah, yeah. And it takes a lot of determination, and you have to realize that you will fail.

[A]

Yeah.

[B]

I've opened offices that I've closed because they were mistakes. Not every decision you make is going to be a good decision. You just want to try to avoid making catastrophic decisions.

[A]

Catastrophic decision is key. And it's hard because you're also dealing with employees and people and patients. Where are they all going to go? But at the same time, if it's not sustainable to keep that office open, that it's bad for the business. I mean, that one bad apple might cost the rest of the apples.

[B]

That's correct.

[A]

Right.

[B]

So you have to be willing to occasionally cut your losses.

[A]

Yeah. Well, I think what you're doing is phenomenal, that you're keeping that number of offices open, maintaining your sanity, keeping your kids and having a dad, but also just being yourself and not losing your mind.

[B]

Thanks, Neil.

[A]

Keep that up. That's good.

[B]

Thank you.

[A]

And this was another installment of the Practical Dermatology Podcast. We'll see you next time.