Private Practice Resources and Education

(Starting a private practice, Resources for existing private practices, & more)

Obviously, we love physician entrepreneurship and autonomy here, and encourage private practices. Although many doctors love the idea of having their own practices, thinking about the numerous steps to set up a private practice can be overwhelming! This page is intended to serve as a repository of private practice related resources (including perks from our partners!), provide guidance on how to start and grow a private practice, answer FAQs we often see on the groups, and help you find ways to optimize your existing private practice.

Disclosure/Disclaimer: This page contains information about our sponsors and/or affiliate links, which support us monetarily at no cost to you, and often provide you with perks, so we hope it's win-win. These should be viewed as introductions rather than formal recommendations. Our content is for generalized educational purposes. We are not formal financial, legal, or tax professionals and do not provide individualized advice specific to your situation. You should consult these as appropriate and/or do your own due diligence before making decisions based on this page. To learn more, visit our disclaimers and disclosures.

Quick Links

Resources
- Educational Resources
- Directory of Resources and Perks from Our Partners
How To Start A Private Practice
Initial Logistics
Credentialing
Contracting
Hiring Staff
Physical Location
How to Choose an EMR
Getting Paid
Marketing and Social Media
Increasing Revenue for Your Practice
Ways to Reduce Private Practice Overhead

Resources

Free Private Practice Real Estate Educational Series

Events

Sign up here to be notified of upcoming events. You can also check out our events page for recordings of past events. (note, you must be a member of our Physician Side Gigs community to view events, which is free to join.)

Blog

See our for dedicated blog content regarding private practices. Some member favorites:

Real Estate Agents

Explore local commercial real estate agents for physicians.

Office Space Directory (new)

We offer a new office space directory. Click here to advertise an office space in your private practice and here to browse available office space from members!

Private Practice Resources and Perks from Our Partners

AI Scribes

We have a partnership with Abridge, founded by one of our physician members, where members can get 50% off AI scribing services, bringing the price down to only $99 dollars per month. You can try this free for one month without inputting payment information through our affiliate link with code PSG50.

Medical Information

OpenEvidence is the leading AI-powered medical information platform for physicians. It is currently used in over 7000 hospitals and care centers, and over 150 countries, serving millions of conversations per week. It is free and unlimited for physicians, and built from the ground up to give trustable, verifiable information. Every response is grounded in the high quality medical literature, spanning everything from clinical trials to meta-reviews to guidelines. Sign up today through our affiliate link.

UpToDate offers trusted, evidence-based clinical, drug, patient, and member content to support health professionals. Physician Side Gigs, through its collaboration with Wolters Kluwer, offers a discount on personal UpToDate subscriptions as a special member perk. PSG physician members can save 15% and trainees get 20% off on an annual or longer subscription to UpToDate! Join our physician online community to get the code to access this exclusive perk.

Billing and Coding

Our partner Cosentus has been highly reviewed by several physician clients and has helped several of our physician members' private practices with their credentialing, billing and coding, revenue cycle management, and accounts receivable services. As part of a perk for PSG members, they offer a free professional billing and coding review as well as 5% off services through our affiliate link with the code PSG5OFF.

Visit our primer page on understanding medical billing and coding.

Financing

When you need financing for your medical practice, you want to work with someone who understands your industry. For over twenty years, Bank of America Practice Solutions has helped doctors across the nation reach their goals through smart financial solutions1 and expert guidance. Whether you own a practice or are just getting started, we can provide customized financial help for your short-term needs and long-term aspirations.

Purchase and start-up:

Practice sales and purchases
New practice start-ups
Owner-occupied commercial real estate products2

Growth and restructuring

Improvement and expansion financing
Equipment financing
Practice debt consolidation3

Expert guidance. Personal attention. Real solutions.

To learn more, reach out to Paul Belau, 614.679.5321 or paul.belau@bofa.com.

1 All programs are subject to credit approval and loan amounts are subject to credit worthiness. Some restrictions may apply.

2 For Owner-Occupied Commercial Real Estate loans (OOCRE), terms up to 25 years and 51% occupancy are required. Real Estate financing options are subject to approval and product availability is subject to change. For SBA loans, SBA eligibility and restrictions apply.

3 Bank of America may prohibit use of account to pay off or pay down another Bank of America account.

4 To be eligible for this reduction, applicants must provide association name and membership number at time of approval.

Learn more at bankofamerica.com/practicesolutions

Disclosure: Bank of America is a sponsor of our Private Practice Education Series and partner of ours, which means that we may earn a referral fee if you decide to contact them.

Credit Card Payment Processing

Square offers PSG members a hardware discount and an opportunity to explore lower processing fees through our group affiliate link.

E-Prescribing

iPrescribe is e-prescribing tailored to your preferences to streamline the prescribing process, including fully compliant electronic prescribing for controlled substances (EPCS). Their desktop application offer flexibility with EHR integration. PSG members receive 10% off using our affiliate link with the code PSG24.

Furniture for the Office

Herman Miller makes highly rated furniture known for ergonomics. You get a 20% discount through our group affiliate link and discount code. In order to get the discount code, please go to this post on the group or post on the group as we can not list it publicly on the website.

Lab Testing

We have partnered with Ulta Lab Tests to help physicians provide affordable and high-quality lab testing for their self-pay patients while improving revenue streams for their practice. Ulta Lab Tests offers access to 2,000+ tests and panels at wholesale prices, with testing available at over 2,100 patient service centers, through mobile phlebotomy, or via in-house specimen collection. As a perk to PSG members, they are giving away 50,000 free CMPs to offer your patients. Registration is free and there are no subscription fees or minimum orders, helping keep overhead costs low while providing added services to patients and generating additional income. Learn more and sign up through our PSG affiliate link.

Malpractice and Tail Insurance

Jason Shah (Jason.Shah@aleragroup.com) is a physician who started a malpractice company that is now under the umbrella of Alera Group. He's great and has helped many members of the group get malpractice and tail insurance. We do have a referral relationship so please let him know you are coming from PSG if you reach out.

Questions on malpractice/tail insurance? We have you covered on our medical malpractice insurance page.

Medical Licensing

Email Jennifer Lincoln at Blue Shift Licensing at jen@blueshiftlicensing.com for 10% off of licensing and credentialing related services through our advertising relationship! They are experienced and have helped so many physicians and companies get their licensing completed efficiently.

Marketing, Website, SEO & Reputation Management

GMR Web Team offers a comprehensive suite of digital marketing solutions for physicians, including SEO, content creation, website design/management, and more. GMR can help you build a strong online presence, cultivate patient loyalty, and achieve sustainable growth for your practice. PSG members receive 20% off blog writing services, website design, and website hosting when they sign up through our affiliate link.

RepuGen is a powerful online reputation management platform designed to enhance patient acquisition and drive business growth, while integrating seamlessly with existing systems. Its automated patient feedback collection and review generation helps practices build positive online reviews and reduce negative reviews. PSG members receive 50% off the integration fee, as well as the Testimonial Widget and CommentWiz tools for free when they sign up through our affiliate link. Learn more and schedule a free demo today.

Artillery designs attractive websites that are pretty reasonable in price (usually 2-5k depending on complexity). Mention PSG for $200 off.

Constant Contact offers several different marketing tools to help you set up and manage your mailing list and dive deeper into social media marketing and analytics. Use our affiliate link to get started today.

Squarespace offers a really easy way to create websites with stylish templates yourself. Mention code PARTNER10 for 10% off through our affiliate link.

Moo allows you to make business cards and other advertising materials. I get asked about these every time I hand them out. They are visually appealing and memorable. Get 25% off your first purchase through our referral link.

Payroll/Benefits and Accounting

Gusto Payroll (affiliate link) has been highly reviewed by many of our members, and includes options for benefits.

Quickbooks offers PSG members 30% off discount on payroll and accounting products for the first 6 months through our affiliate link.

Visit our considerations and costs when choosing an accountant page to dive deeper into whether you should hire an accountant to help with your private practice.

Virtual Employees

Edge Health provides college educated remote employees that work full time for your practice. They perform tasks such as primary or secondary phone support, billing, claims, insurance verifications, scribing, social media, and other tasks. Practices tend to use the services in multiple different ways. They are trained prior to starting in your office, and the cost is substantially less than what you would pay an in-house employee. To learn more about Edge's services and schedule a demo, and receive $500 off each of your first 3 months, connect through our affiliate link.

GSD Associates provides full-time and part-time virtual assistants for a comprehensive range of administrative, sales, marketing, and management services, with a focus on enhancing efficiency and productivity. Their mission is to streamline and optimize business management for physicians and other professionals, offering efficient solutions that free up valuable time and resources. Use our PSG partnership inquiry form for 10% off your first year of services.

View all our resources and perks for physicians in private practice.

Checklist

How to Start A Private Practice Checklist

Considering opening up your own private practice? Prepare well in advance to set yourself up for success. While the process is time and resource intensive and will require a willingness to learn and get your hands dirty, you can make it easier by leveraging the expertise of your colleagues and vendors. Start by establishing the big picture and ensuring viability, and then take a step by step approach (some steps may take longer than you think, so plan accordingly).

Here’s a broad overview list of your priority steps. To dive in deeper, visit our checklist for starting a medical practice page. We also offer an introduction to the direct primary care (DPC) medical practice model and a guide to starting a medical micropractice.

If you aren't sure if private practice is right for you, check out our pros and cons of private practice.

Checklist for starting a private medical practice

Business Pro Forma
1. What is your business model? Insurance-based or other?
2. Who is your ideal patient population?
3. Analyze the competition to determine the need for your services: wait times, practice type, volume, reviews. SWOT analysis on your practice model.
4. Financial analysis/budget. At minimum, determine start up costs, year 1 expenses, and expected revenue
  - Major expenses: lease, equipment, payroll, software/technology, vendors
  - What do you need to generate to break even?
  - 1 year, 3 year, and 5 year conservative projections for revenue
Location
1. Determine location most accessible to the target patient population.
  - Heavily research patient demographics, payor mix, local competition, proximity to referring providers and hospitals. A consultant can help you.
  - A commercial real estate agent can help identify potential spaces; we also are creating a member to member office space listing.
2. Certificate of Occupancy to use the space (need fire, safety, and city inspections)
3. Furnishings, signage, equipment, utilities, and/or potential rehab for space
Secure your financing and documentation
1. Financing - line of credit and loan to cover at least 120 days of initial expenses.
2. Accounting - EIN/tax ID, business accountant, bank account, credit card
3. Entity structuring: Healthcare attorney, articles of organization/incorporation
Staffing
1. Practice manager: most important/first hire, ideally with past practice management experience. Oversees strategy/execution and hiring.
2. Medical assistant, nurse, technician, front desk, etc. Stay lean as possible.
3. Employee management - Policies and procedures manual, HIPAA, OSHA, Stark, CLIA, Universal Protocols, Disaster response, Harassment training
Vet potential vendors/services as applicable.
1. Payroll services
2. Billing/Coding/Compliance
3. Information Technology (data backup and storage, phone lines, internet)
4. Website/social media/SEO/marketing
5. Electronic Health Record
6. Practice management software
7. Cleaning/groundskeeping
8. Credit card processing
Credentialing/logistics
1. Get your state medical license - this typically takes longer than you think
2. Group NPI/DEA/Medicare provider numbers
3. Get credentialed at your local hospitals
4. Apply for insurance and Medicare/Medicaid coverage
  - It is likely if you are on your own you’ll have little ability to negotiate private insurer contracts
5. HIPAA and MACRA compliance
Insurance/Benefits
1. Malpractice, Health, Disability, Life, Business/Corporate/Workers Comp, and Umbrella Insurances
2. Other employee benefits such as retirement plans; ensure legal compliance

Initial Logistics

You need a legal name, so that you can do all the other things. Although you can name your business whatever you want, people often include their specialty, region, and/or name. Make sure there is not another company with the same or overly similar name in your state.
Once the name is ready, purchase a domain name so that it doesn't get taken. Even if you plan on having someone else build the website, owning your own domain is a good idea. You can also get an email address up and running related to the domain, or use a generic email account.
You'll need an address. If you've found your practice location, that's great. Otherwise use a UPS box or other address (note, USPS PO boxes will not work for credentialing or bank accounts).
Set up your LLC. For something as big as a practice, you may want to get legal consultation to make sure you do it right, especially if there is more than one owner. Don't forget when you set up your business entity to do your Beneficial Ownership Information (BOI) report filing.
Get a TaxID/EIN number (the IRS provides EIN guidance ).
Get a phone number. You can get a Google Voice number, which is free, but also has the ability to add a HIPAA compliant option for texts through Google workspace.
Get a fax number. You can use Doximity for free or use a paid e-fax provider if you anticipate more volume.
Set up a Group NPI number (different than your individual NPI). You can do this with the National Plan & Provider Enumeration System.
Set up a bank account.
Create a patient scheduling template for your practice.

Credentialing

Credentialing is the process of getting on insurance panels so that you can accept payments from patients who have that insurance. This process can take a while to be finalized (usually 90-120 days, but expect up to six months), so initiate the process well before you start seeing patients. Each application is time consuming, involving submitting the application, as well as often times ensuring they’ve received the application and following up on the status of the application. Many say they have to resubmit applications, submit further information or contest decisions, and spend a lot of time on the phone. Sometimes, insurance companies will state that they are full and not accepting physicians of your specialty in your location, and you will have to monitor carefully for openings to come up.

If you need help with credentialing, you can use a company such as our partner, Cosentus. Use our affiliate link for a free professional billing and coding review as well as 5% off services with the code PSG5OFF.

Decide which insurance companies you want to be credentialed with

This will be based on who the major insurance carriers are in the region. You don’t have to get credentialed with every single insurance company off the bat, but will want to at least get the major carriers on board so that you can see the largest number of patients from the start. An easy way to figure out who the biggest insurers are in the region is to see what insurances the other practices in the area accept.

As reimbursements have not only failed to keep up with inflation but decreased, many of our private practice physicians have had to consider whether they can afford to see Medicare patients. This can raise questions and dilemmas for doctors, which we cover separately in our article on what to know and consider before opting out of Medicare.

CAQH (Council for Affordable Quality Healthcare)

CAQH (Council for Affordable Quality Healthcare) is a database that serves as a repository of credentialing information used by insurance companies and others that need credentialing information. These companies pay for access, but you do not. Importantly, this will not preclude you from having to do an application, just from having to submit individual documents. Not all payers use it, but the majority of the big ones do.

Insurance companies require a lot of documentation, and much of it is repetitive from one company to the next and needs to be kept updated. Examples include:

CV
W-9
Board certification
Diplomas
Proof of malpractice
State licenses
DEA and CDS (Controlled Dangerous Substances) or equivalent certificates
Proof of hospital privileges.
References (typically three)

Your CV has to be in the correct format, with month/year, or it will be rejected, and there can not be gaps in employment history so make sure all dates are accounted for. If you keep the documents uploaded in CAQH and update them regularly, the insurance companies that do participate in CAQH can directly access those documents, saving you a lot of time and energy. Note that you will regularly have to attest that the information is accurate and up to date.

You will also need information about your practice entity, including:

Legal documentation/articles of organization
Address
Tax ID number
Group NPI
Your NPI
Office hours
Phone and fax numbers.

If applicable, you’ll also need billing company information and contacts for billing and credentialing.

Submitting Your CAQH Profile

You can set up your CAQH profile at https://proview.caqh.org/pr/registration/selfregistration. If you are currently employed, your employer likely already has a CAQH on you, and you’ll have to request your CAQH ID#, login, and password from your human resources department. While there is a paper version, it is long and cumbersome, and has to be manually inputted by someone, increasing the chances for delays or paperwork getting lost.

Grant access to the payers by signing and dating the provided attestation form, and uploading the document.

Regularly check your profile every 60-90 days to make sure everything is up to date.

Credential With Each Insurance Company

Expect at least 10 hours per company including getting the application (in a lot of cases, you will need to print the application and complete by hand), organizing the information/documentation, and submitting the application, as well as following up with the company by phone. It is generally recommended to call the insurance company after you submit documentation to ensure they got it and that there are no issues to avoid the application being in limbo and potentially expiring, thus starting the timeline again. Many people also say to call the insurance company every 2 weeks thereafter to check in on the status. You should ask to speak to provider relations and establish a contact person at the company who you can speak to directly and start forming a good relationship with. You should then follow up your conversations with an email to ensure a paper trail.

FAQs

How long will it take?

Usually 90-120 days, but it could be as long as 6 months.

Should I assume I'll get credentialed?

In most cases yes, although some insurance companies require being licensed or practicing for a certain amount of time before you can join their panels. Sometimes, the panels will say that they are full.

What happens if a panel says it’s full?

Call them and pitch them on why they want you on their panel - emphasize what you bring that others in the area don’t offer (offering pediatric or underserved options, extended office hours or weekends, speaking another language, performing niche procedures, etc.). If all else fails, keep calling back to check for openings.

Dive deeper into credentialing with tips and tricks for credentialing with insurance companies and payors.

Contracting

Contracting is different than credentialing. This is where you actually negotiate reimbursement and terms with the insurance companies. Once you've passed through the credentialing process, the insurance company will send you a contract that includes the "fee schedule" that they propose, in which it is stated how much you will be paid for each service. Before you waste your time on the fine print, start with the compensation information (usually located at the end), because if the numbers don’t make sense, the rest of the contract will change throughout negotiations, or you may just elect not to go forward.

Know that even with the same payer, they will have several different fee structures, and what they will offer you will likely depend on what they think your negotiating power is and what their need for you is. They may not pay you what they are paying your friend down the street. Similarly, you should research the competition and compare fee schedules from different companies, even if you’re not planning on using that insurance company for one reason or other. Understand which insurance companies have which payor mixes and different types of plans (Medicare, Medicaid, Medicare Advantage, HMO, PPO, etc) and what other physicians or hospitals are in the network for referrals. In most cases, you can’t pick and choose the lines that you are contracted with, so assume you will have to accept all of their plans. If you have concerns about particular lines, ask about them and what, if anything, can be modified. If there are certain medications or services you routinely provide, ask about their formularly restrictions or preauthorization requirements. The more data you have, the better.

It’s also very important for you to decide whether the proposal makes sense. Don’t just decide you are going to take it because you feel that you have to be in-network. You can also decide to be out of network, or decide to negotiate. Your goal is to work smarter, not harder, and you should run the numbers for different scenarios. Decide the point where more patients and volume isn’t worth it at a lower reimbursement rate, and it’s better to have fewer patients reimbursed at a higher rate or to leave time in your schedule for something that pays better.

When you’re first starting out or if you’re a solo practice, you may not have much room for negotiation, but you should of course try to get yourself the best deal possible. Understand that the rate you lock in at initially will be the rate you will be stuck with for a few years, and also understand it will be the starting point for negotiations at the next round, so whatever rates you agree to will follow you. Therefore even a small increase will justify the effort over the long run.

When you negotiate, you can ask for a conversation with the payer. It is very important to come into that conversation prepared, so that you can most effectively advocate for your worth.

You should know what things make you attractive to the insurance company. If there are things that you can offer that nobody else in the area can, mention those things (specialized expertise or training, procedures that others can’t do, languages that you can speak, better patient satisfaction, large patient base, dominant brand, etc). If you know there are things they will try and use against you (e.g. nearby competition), be prepared to counter those with numbers.

After the conversation, they’ll usually have you put your asks in writing. This is good because it will create a document that can be passed between various people at the company as well as a record of correspondence. This document should be written at a lay person’s level and include:

Information about you - basic demographic information, where you’re located, who your patient base is, which hospitals you’re credentialed at, specialty and board certifications
More specifics about your practice: procedures you do and codes you use, any subspecialty focus or interests.
Any other factors that make you unique.

Be very organized in these negotiations. Clearly document everything that’s agreed upon, the person who agreed to it, and the date they agreed to it on, so that you can ensure that it ends up in the final contract. Take lots of notes about the discussions, what was used against you, and what worked for you, as they will help you when you renegotiate contracts in a few years.

You’ll also want to assess the term, conditions for termination and renewal, and how the claims will be filed and paid. Most plans will not let you terminate your participation until a certain amount of time has passed, and will require a certain notice period. Know if either party can terminate without cause or if there is an automatic renewal clause. If you terminate, what will your obligations to the patients be? You will also want to understand details of payment timelines such as how long you have to submit a claim, what classifies as a late payment, and what happens with overpayments. Are there any nuances or caps for payments? What data is the RVU value being determined from?

As you read through the contract, read every word (don’t skim!), track changes and take notes about possible concerns or questions. Red line your changes and insert the exact wording you prefer. Make a copy before you send off the document, send the letter via certified mail, and then follow up to have a phone conversation with your contact at the payer. Good negotiation skills and demeanor will get you far. While nobody will care about the process as much as you do, if you don’t trust yourself to do the negotiations or don’t have the time to do it with every payor, you can outsource it to a billing company. This will likely cost a few thousand dollars, but again is a fixed cost that will pay itself off if the alternative is not negotiating.

When the time comes to renegotiate the contract, repeat the exercise of listing what has changed about your practice that makes you attractive to the insurance company. How much has your practice grown? Do you offer new services? Has the competition changed? Standard contract increases are only a few percent, if any, so if you want something higher, you’ll want to be persistent about declaring your worth.

Explore tips and tricks for contracting with insurance companies and payors.

Hiring

Hiring Staff

Your practice manager is your most important, and your first hire. They are going to be the one to handle or oversee everything, including human resources and staffing issues, payments, relationships with vendors, hiring and firing, and marketing. It is critical to find someone with the right skill set to do this and someone that you get along with well, as you’ll be working with them quite closely. Important qualities will include:

Experienced (ideally 3-5 years). Especially if this is your first time starting a practice, you want someone with substantial previous medical practice management experience. They need to anticipate the problems you don’t know to anticipate, and be able to draw upon prior experience to deal with them quickly.
- Vet them carefully and check references. Ask what tasks they took care of in previous roles.
Strong people skills, compassion, flexibility, and adaptability. The practice manager needs to get along well not only with you and the other physicians, but with your staff, your vendors, and your patients. They should have a personality that is approachable and be well-spoken and mature enough to control emotions in difficult situations. You do not want your practice manager to be the reason you lose staff or contracts.
Organized and detail oriented. The right person is going to need to multi-task and will be overseeing lots of small details. In order to make sure the ball doesn’t get dropped on marketing, payments, billing and coding, and other critical day to day functions.
Has authority but also has the ability to delegate. The ideal practice manager will be adept at empowering the rest of the staff to take ownership of projects or tasks. As the practice grows, it will be harder and harder to keep an eye on everything.
Negotiating skills. The practice manager will be dealing with vendors, staff, and patients and all the complaints and concerns they have. They should be able to politely but firmly enforce rules or procedures when necessary.

Once you’ve figured out your practice manager, you’ll move on to the other hires. You’ll have to decide exactly how much staff that you need. Start as lean as possible. Remember people can have multiple roles, and this is actually beneficial so that they can cover each other if someone is out sick or on vacation. As you scale, their roles will become more specialized.

At a minimum, you will likely need a front desk staff member/scheduler and a medical assistant. We've covered what to consider when hiring a medical assistant separately. At the beginning when things are slower, they can also help you with things like social media, scribing, or cleaning up between patients. Depending on your specialty you may need some specialized staff like an ultrasound or x-ray tech, a nurse, or a phlebotomist. You will need to make the decision about whether to keep billing in house or outsource to a billing company. Be intentional about your decision with billing, as this is what will keep the lights on, so if you decide to keep it in house, make sure your staff can keep up with timely submission of claims as well as follow up of denials.

Also know there are various ways to outsource some of this if you want to stay lean. You may be able to outsource some staff through a hospital, MSO, or billing company, or share resources with another small practice. You could use virtual employees through a company like Edge Health or GSD Associates. Our virtual assistants page gives several examples of tasks virtual employees can help with in a private practice.

Now to the hiring process. You’ll first have to look at how many hours each person will be working and decide whether it makes sense to have them as hourly employees or salaried employees. Typically, office staff and MAs are usually paid hourly, while other medical practitioners and the practice manager are salaried. Research what other practices are paying for these positions in your area but looking on job sites and postings, or asking around. Then decide salary rates and what kinds of benefits you’d like to offer. Is there a bonus structure? Are you going to have retirement plans? Is there paid time off, and if so, how much? Is there an ability to work from home some days? What will a typical day look like and what will the exact responsibilities for each position be? Prospective employees will ask these questions, and you want to instill confidence that you know what you’re doing and that you’ll be a good employer. At the same time, they should know they’re helping launch a new practice and they will be expected to be a team player and get their hands in the weeds.

You can advertise the jobs via local job boards, community resources, word of mouth through friends and family, or in advertising for your upcoming practice. Cast your net far and wide, but be specific about the job description to avoid spending time on leads that won’t work.

Have a contract ready to be signed so that when you meet the right people, you can take action quickly. Many hourly employees are looking for immediate availability and will not wait weeks for a contract like we are used to with physician job searches. Make sure the contracts or onboarding process include confidentiality agreements and non-disparagement clauses.

You will also have to have some basic human resources like an employee handbook that delineates staff roles and personal policies. Things that should be included in your employee handbook include medical office policies such as work hours, attendance at office meetings, break policies, PTO, benefits, how payroll is handled, how performance will be assessed, and how disciplinary issues will be handled. These should all be compiled and given to the new employees during the hiring and orientation procedure.

You will also need some additional compliance materials that will offer you protection as an employer. Have a method for storing personnel files. Make sure everything is in compliance with ADA, Federal Equal Employment Opportunity (EEO) Laws, Age Discrimination Act of 1967, Fair Labor Standards Act, Equal Pay Act, and FMLA. Training should include modules on all of these things as well as training for things like practice protocols, disaster response, cultural sensitivity, and harassment training.

Lastly, your employees will need a way to get paid. You can either do this through your accountant or use a payroll service like Gusto. or Quickbooks Payroll (PSG members receive 30% off Quickbooks Payroll products for 6 months using our affiliate link).

Location

Physical Location

The next legal and accounting steps will likely require a medical office address for necessary paperwork/applications, so you’ll have to secure a location.

Choosing the Location

Some things to consider when choosing the location for your private practice:

Where does your ideal client live?
Is there a need for extra physicians in your field in this area? If not, what will set you apart from the existing competition?
Do you want your own space from the beginning or do you want to rent space from another practice, retiring physician, etc temporarily to limit costs?

We recommend hiring a commercial real estate professional to take you on tours of vacant office spaces. Consider:

Where would your practice get visibility?
Is there ample parking?
Is there room to grow as you expand?

Negotiate your private practice lease agreement, and run the lease by a real estate lawyer before securing the location.

Considerations when choosing a private practice location

If you decide to invest in a medical office building versus leasing, consider as you set up your practice if there is an opportunity to rent out any unused office space in your private practice to add an additional revenue stream.

Preparing for Opening

You'll want to start by furnishing the building. Depending on the previous occupant's setup, you may need a contractor. You may also want to consider hiring an interior decorator. Make sure when planning out the space, you plan for:

Front desk
Exam rooms
Back office

Equipment and supplies

Try and limit overhead at first. See if you can get heavily discounted or even free from other medical practices, retiring physicians, or hospitals in the area. Things to remember and budget for:

Exam tables
Stethoscopes
Otoscopes
Blood pressure monitors
Consumables such as: ointments, gloves, scalpels, syringes, gauze, antibacterial wipes, and tongue depressors
Hardware such as: fax machines, computers, phones, and credit card machines
Clothing such as: lab coats, staff uniforms, name tags, and patient gowns

Visit our resources section above if you need assistance with equipment loans for the essentials.

Certificate of Occupancy

Make sure you cover the following:

Fire Inspection
Safety inspection
City inspections

Utilities

You'll want to create accounts with and get your utilities (phone, internet, electricity, water, trash, etc.) set-up.

Aesthetics

To make your practice inviting, professional, and easy to find, don't forget to account for the following as well:

Landscaping
Signage
Decor

A little bit can go a long way.

Learn more about choosing and preparing your private practice location.

Choosing EMR

Choosing an EMR

These days, there are lots of options for EMRs, each with their own features, pros and cons, and price points. Understandably, making the decision about which to choose is perplexing and time consuming. While it’s tempting to make a decision purely based on cost, it’s important to remember the most likely, the actual most important factor is that you pick the system that maximizes your team’s productivity (and by extension, your revenue).

Given these things, sit down and list what your needs are. Think about the daily workflow in your practice or if you’re starting a new practice, that of previous places you worked. Think about the things that detracted from your productivity, the features you wished you had, the complaints that you and your colleagues voiced, and the features you and others appreciated about the EMR.

Also, remember that your entire practice will be interacting with this EMR, so it’s important to get their perspectives on the software as well. You will want to consider things like ease of scheduling, automation features, the patient portal experience and relevant patient resources or notes, ease of charting, whether you need a cloud based system that can be accessed from outside of the office, integration with other systems such as labs, hospitals you admit at, and e-prescribing, the ability to customize templates and other functionality and integrate results into notes without having to copy and paste or type, and aiding in billing and coding. Some systems will have time-saving features like the ability for patients to schedule, patient notifications, ability to communicate with pharmacies, integration with patient handouts and necessary notes, and integration with billing and coding and Medicare platforms. You’ll also want to assess how intuitive the system is, as this will minimize training time and frustration.

Be organized as you assess these features, and take note of things like how many clicks and popups you encounter in commonly used processes, how easy it is to create templates and macros, how long it takes to complete a typical note, and how much time you spend going back and forth into new portals or signins. You will want to assess how easily you can access the patient’s history of prior visits, workups, labwork, imaging, etc. Are notes prepopulated for you? While a lot of vendors will tell you their average number of clicks as a selling point, it’s also important to assess loading times and ease of use and customizability for the various menus and screens that may be necessary to navigate through. Are there easily accessible shortcuts on the keyboard or via dictation? Time is money.

Remember that in some cases, you or your staff will be entering information in front of the patient, and you want that to be as seamless as possible so that you can spend more time looking at your patient and less time charting after hours. This will also translate to a better patient experience, which will help you to grow your practice’s reputation.

Additional things to consider are how much the system helps you to do your job better. Does it alert you of possible drug interactions or allergies in a helpful way? Does it actually facilitate increasing your reimbursement? Recent changes are confusing to many, and some EMRs will actually provide suggestions about what you need to qualify for higher levels of service or suggest codes based on your documentation. Having a patient friendly portal will allow your office to communicate more efficiently with your patients without the extra time on the phone, phone tag, as well as send important screening reminders or education which could improve patient care.

Once you’ve assessed all of these things, revisit the list of needs you created initially and decide what things are essential, what things are nice but not necessary, and what things you absolutely can’t stand. Take the ones that are dealbreakers off the list, and list the remaining options in terms of most ideal to least ideal.

Now, pick a few candidates that would work and start negotiating! Remember that while price is a huge factor, other negotiating levers to pull include added functionality/features, price locks for a certain time period or free months, added users or training, etc. If you can, try and time your purchase with the end of a quarter or fiscal year, as just like car salespeople, the sales representatives may have bonuses they want to hit based on closed sales.

Learn more on our choosing the right electronic medical record (EMR) system page.

Getting Paid

Billing and coding is an extensive topic and discussed in more detail on our understanding medical billing and code page.

For basic banking, you are going to want a relationship with a bank, not just for your business banking accounts, but also for things like lines of credit, practice loans, or other issues that come up in your life as a small business owner. Smaller banks may be more flexible and provide better service, so make sure to assess different options. We have a financing resource above to help you get started.

Patients need an easy, secure, and convenient way to submit payments, different payors may have different ways of paying you, and you will need a secure way to submit payments to your vendors. You should have your own business credit card - make sure you pick one with perks, given that you'll likely be spending a lot of money on it!

Most patients will pay their co-pays, co-insurance, deductibles, or cash for uncovered services via credit or debit card, although some may still pay via cash or check. You will have to decide what mechanism(s) you want to accept. Credit card fees can get expensive, so it’s important to shop around and negotiate! When you don’t have much volume, it may be hard to get competitive processing fee rates, but as you grow, you should regularly renegotiate with your payments processor for lower fees. Our partners at Square will allow you to do this.

An additional thing to keep in mind is that unfortunately, for in network payments, you may not be able to pass on credit card fees because you have to paid exactly at your contracted rates.

Marketing

Marketing and Social Media

One of the critical factors to success in private practice is actually having patients come in the door. This requires a multi-pronged approach to creating awareness about your practice’s existence and the breadth and quality of services offered amongst both referring physicians and patients. Before you do anything, you should identify your target demographics and market. List the specialties of the referring physicians who are most likely to refer to you, and then look within your referral radius for all of the applicable practices, noting the size and popularity of their practices. Determine what your ideal patient population looks like based on the services that you offer, and get insights into where they spend their time, what services they need the most, and what kind of marketing they would respond to. Keep an eye out for how your competitors advertise, and what seems to be successful.

Once you’ve done that, you’re ready to create a marketing strategy. We've covered setting up a side gig and growing your side gig. The same advice can be used for your private practice, so make sure to check those pages out, where we cover topics such as:

Creating a website with search engine optimization (SEO)
Developing marketing materials
Networking

Below, we'll cover a few more strategies specifically for private practices. Dive deeper with our marketing guide for private practices.

Network Within the Community

Make a real effort to be seen within the community. Most people like to support their own, and attending and holding social events is a great opportunity to introduce yourself and your services. Go to hospital events and introduce yourself to other physicians. They may need someone in your niche to refer to, or will remember you when another colleague is asking about services you offer. Sponsor booths at local school, sporting, or fundraising events and talk to members of the community and hand out giveaways like coffee mugs or t-shirts that are likely to be seen by others. Don’t be shy about telling people you’d love for them to refer you patients. Encourage them to feel free to post about you or their neighborhood or local Facebook groups (and try and join them as well and provide helpful advice to relevant questions).

Relevant resource: Moo has some customizable items like water bottles and notebooks. 25% off your 1st purchase through our referral link.

If you are hosting or sponsoring events such as free sports physicals or skin screenings, let the local news or newspaper know about your events.

Social Media Advertising

Whether you like social media or not, a social media presence can be a huge boon to a practice. It’s worth considering investing time and energy (and if necessary, money) in social media services to create eye-catching and engaging material. Post reminders, answers to commonly asked questions, promotions you’re running, or pictures of you and your staff at work. The more that your practice feels like home to them, the more loyalty they’ll have to your practice, and the more they’ll tell others about it.

You’ll also want those social media accounts so that they can tag you when they talk about (hopefully positive!) experiences at their doctor’s office. You can target advertisements to the friends of your followers, a large percentage of which are likely to be within your encashment as well. Several companies exist to help you create this material if you’re not able to dedicate that bandwidth amongst you and your staff. Price points can vary a lot, so put some thought into what you think you actually need and where to spend those precious marketing dollars.

Consider Billboards, Radio, and Newspaper Advertising

Brainstorm which outlets you think your target patient population are likely to see and focus advertising there as well. While social media is great, if your practice tailors to an elderly population, don’t forget to make sure you are using appropriate outlets to reach them.

Your Patients

Last, but definitely not least, is to leverage your patients to bring in more patients. Nothing brings in more patients than happy patients. If you know they're happy, give your patients some of your business cards, ask them to post on social media or to leave a review on review sites, or to otherwise spread the word. Some aesthetics practices will have referral perks as well. Stay on top of patient complaints and do your best to make sure your staff puts their best foot forward in regards to customer service. Also use automated systems to remind patients when it's time for their next appointment, as you want them to keep coming back as well!

Learn more with our guide to marketing a private practice for physicians.

Should you find yourself in a situation where you receive a bad patient review and you're worried how it will affect your marketing efforts, check out our guide to handling bad online patient reviews for physicians and practices. Putting a proactive online reputation management strategy in place can help you actively monitor for reviews and build up a favorable online reputation with positive reviews.

Additional Income

Increasing Revenue for Your Practice

Once your medical practice is up and running, there are opportunities to increase your revenue. This can include:

10 ways to increase profits for your private practice

Learn more about ways to increase your private practice revenue, or jump directly to topics including:

You can also explore the following ancillary income streams to see if they might be a good fit for your practice:

Decrease Overhead

Ways to Reduce Private Practice Overhead

As inflation, decreased reimbursement, and rising labor costs hit medical practices, owners look for additional ways to help reduce costs to keep their practice sustainable. We explore ways to decrease overhead and cut costs for private practices, including eliminating expenses that don't ROI, renegotiating services, and optimizing current resources.