For many physicians, the allure of
independent practice is a compelling one — offering the autonomy to prioritize patient care, make key financial and operational decisions, and forge a more personal connection with their patients. However, the prospect of overcoming start-up
costs,
navigating complex
regulatory landscapes and managing a thriving
practice can be daunting.
Just ask Daniel Opris, MD, who was working in the hospital and clinic settings within a large consortium in Dayton, Ohio, when he realized he wasn’t happy.
“Between large empanelment sizes, time available to allocate to patient care and overall lack of autonomy, the environment unfortunately hampers personal growth and makes it extremely difficult for providers to deliver care to our patients the way we feel it should be,” he says. “When most days felt like a battle between administration and doing what I felt was best for my patients, I knew it was time to move on.”
So, a couple of years ago, Opris joined Executive Medical Centers of Ohio, a team of three family doctors and internists who all left their roles at large hospital systems in the area to focus on a more boutique, personalized approach to health care that has no affiliation with one specific hospital system.
“The autonomy gained within independent practice allows me and my partners to get back to a grassroots style of medicine where we can combine providing excellent evidence-based care [with] providing patients with the one thing that we felt they are severely lacking within the medical industry today, time,” he says. “As for myself, having a family with young children, work-life balance is extremely important and something I found has significantly improved once I made the transition.”
Annie DePasquale, MD, founder of Collaborating Docs, which has helped over 5,000 nurse practitioners and physician assistants start their own practices, has worked closely with many physicians who have left hospital systems to go on their own.
“A lot of clinicians I’ve worked with have felt that large organizations stifle their ability to provide individualized care or limit their ability to grow their practice in the way they envision,” she says. “The motivation, then, is often driven by a mix of professional burnout, the desire for greater control and the urge to establish a practice that fosters personal fulfillment.”
First steps
For those who transition to independent practice, the biggest challenges are typically financial and administrative.
“One of the hardest hurdles is securing initial funding or navigating the financial side of the transition, particularly if the clinician has been used to a steady paycheck,” DePasquale says.
Other common challenges include setting up a practice management system, establishing a patient base and ensuring compliance with health care regulations.
“There’s a lot to juggle when you first open a practice — such as finding a good location, hiring staff, and implementing efficient billing and insurance systems,” says John Lowe, MD, an internist in Ogden, Utah, who made a switch from a hospital setting to independent practice during his career. “Managing the business side of things is something that clinicians often underestimate when they leave the corporate world for independence.”
When setting up a practice, DePasquale recommends breaking the process down into manageable steps.
“First, it’s important to determine your niche or focus, which will guide everything from your branding to your patient acquisition strategies,” she says. “Clinicians should seek out resources like business coaches or consultants who specialize in health care start-ups, as they can offer invaluable guidance.”
Networking with others who’ve successfully made the transition is another great resource — learning from their mistakes and successes can save a lot of time and money.
“Additionally, it’s important to invest in good practice management software, as it streamlines everything from scheduling to billing,” DePasquale says. “Building a solid team and developing relationships with vendors for office supplies and equipment is another key part of setting up a practice.”
She also recommends outsourcing bookkeeping and accounting tasks, as this can free up time to focus on patient care rather than worrying about financial details.
“Another helpful resource is hiring a virtual assistant to handle nonclinical tasks like patient communications, follow-ups and administrative support,” she says.
Opris notes independent practice won’t eliminate the headaches of dealing with insurance or other regulated facets within the health care system, and may likely add new ones, which often comes from starting or growing a practice.
“However, in my opinion, if more providers are able to take the leap and transition back to independent practice, this has the potential to improve the way health care is delivered and refocus priorities where they should be, on the patients, while also allowing providers to take better care of themselves,” he says.
Lowe notes it’s vital to have the proper knowledge of all compliance requirements and contract obligations before switching to private practice.
“In terms of hiring a legal and financial adviser, those should be among some of the first things anyone making the transition should do,” he said.
Money matters
The shift to self-employed practice also starts with the decision of whether it will be a traditional fee-for-service or primary direct care example.
Michael Poku, MD, chief clinical officer of Equality Health, a value-based care enabler that works with 3,200 primary care physicians across five states in a value-based care (VBC) environment, notes making a transition from a large hospital system to an independent practice offers physicians a unique opportunity to establish a patient-centric model.
“Independent physicians should not navigate this transition alone,” he says. “They should partner with VBC enablement organizations that offer the necessary infrastructure, data analytics, and administrative and financial support. These partnerships can provide the resources and ongoing investment needed to thrive in a VBC environment.”
While a job in a hospital is usually secure, a private practice can be much more financially lucrative in the long run, Lowe shares, provided there are sufficient finances and business strategies in place.
“It’s important to develop a comprehensive plan for the practice setting with a focus on specific goals, potential earnings, costs, and how long you believe it’ll take for you to be in profit,” he says. “This can be a perplexing endeavor, but working alongside a financial expert who understands health care can make the course of action smoother.”
Lowe also suggests starting small with the intent of assisting a few patients and subsequently broadening this number to aid in growth.
“Independent physicians and organizations such as the American Academy of Private Physicians often help people transition to a financial plan privately,” he says. “Their experienced mentorship is beneficial for those making a switch.”
Legal considerations
Before transitioning to independent practice, it’s also crucial for physicians to familiarize themselves with the legal requirements specific to their state, including licensing, credentialing and insurance requirements.
“Hiring a qualified attorney with expertise in health care law can help navigate the complexities of contract negotiations and compliance with regulations, ensuring a smoother transition into independent practice,” Poku says.
Marketing and growth
When it comes to attracting patients and growing a new practice, word of mouth is invaluable, especially when starting out. It’s essential to establish strong relationships with the patients — taking the time to understand their needs and delivering exceptional care.
“Clinicians can also consider leveraging social media and digital marketing strategies to increase visibility,” DePasquale says. “Referral programs or offering free consultations can also help build an initial patient base. Retention comes down to providing excellent, personalized care and fostering an environment where patients feel heard and valued. I always encourage providers to prioritize patient relationships and maintain open communication channels to ensure they feel connected to your practice.”
What’s more, utilizing a multifaceted marketing strategy can be key to getting the word out. Physicians should harness the power of social media and local community events to boost visibility while implementing loyalty programs and patient engagement initiatives to foster long-lasting relationships and encourage referrals.
After all, creating a strong online presence through patient testimonials and educational content can significantly enhance patient trust and establish the practice as a reputable resource in the community.
“Utilize your connections,” Opris says. “Referrals and previous patients are a great starting point for building your new practice. When you need help with more extensive marketing needs, look for an agency that can help accelerate your marketing efforts.”
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