10 Things Every Doctor Must Know When Starting Their Medical Practice
Starting a medical practice was the most liberating—and expensive—decision of my career. It doesn’t have to be the scariest one you make. Below are the ten truths I wish someone had shared with me before I signed a lease, hired my first receptionist, or plunged a clogged office toilet. Whether you’re still dreaming or already scaling, these lessons can help you build (and keep) a thriving, multi‑million‑dollar brand.
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1. Profit Won’t Come Overnight—Budget for the Gap
If you’re living paycheck‑to‑paycheck, hit pause. Even in the best scenarios you’ll float payroll, rent, and supplies for several months. I was profitable around the three‑month mark—but only after weathering a surprise $30 k claw‑back from Aetna. Set aside at least six months of operating expenses so growth pains don’t become personal‑finance nightmares.
2. Credentialing vs. Contracting—Know the Difference
Medicare is surprisingly quick (often <30 days), but commercial insurers can take 90–120 days after you’ve secured a brick‑and‑mortar address. And beware of “market‑rate” contracts: some pay well below Medicare once you’ve already signed. Build these delays into your launch timeline.
3. Choose Your EMR for the Practice You Plan to Be
Switching platforms mid‑growth is painful and pricey—I paid $600/month for a system that still cost $50 k to migrate. Map your five‑year vision first:
- DPC/Concierge? Pick an EMR with built‑in subscription billing.
- Multi‑site insurance model? Prioritize robust reporting, reputation‑management tools, and scalable integrations.
Cheap today can become crippling tomorrow.
4. Hire Slow, Fire Fast
Talent makes or breaks margins. One misaligned physician filled our review pages with 1‑stars and bled revenue. Set clear performance metrics, document miss‑steps, offer a short improvement window, then part ways if necessary. Unemployment premiums are pennies compared with six‑figure opportunity costs.
5. You’ll Be CEO First, Clinician Second
In year one I juggled plungers, website bugs, and 40‑hour clinical weeks. Decide early what deserves your time and what should be outsourced. Every extra hat you wear delays profits, but overspending on help too soon can do the same.
6. Patients Don’t “Just Show Up”
On day one I had no signage and wondered why the waiting room was empty. Today targeted Google Ads, local SEO, and community outreach keep schedules packed. Direct‑to‑patient marketing isn’t optional—learn it yourself or hire expertise fast.
7. Insurance Negotiations Are a Toxic Dance
Be ready to walk. Payers rarely budge until you submit termination notices. Specialists often have leverage; primary care can too if you prove your panel keeps their costs down. Document value, set a floor rate, and stay firm.
8. Cash Flow Beats Vanity Revenue
Six‑figure net months fund new locations, not six‑figure gross months. Track collections daily, guard your AR, and reinvest profits where ROI is clearest. Healthy cash flow is the engine of sustainable expansion.
9. Know the Line Between Frugal and Cheap
DIY‑ing my first website saved $3 k but cost months of brand credibility (and plenty of typos). Spend where expertise matters—design, compliance, and high‑stakes legal work—while bootstrapping low‑risk tasks.
10. Private Practice Is the Ultimate Freedom—Eventually
Hundred‑hour weeks and six‑figure mistakes were routine early on. Today I see patients two days a week, took two weeks at Disney without income dip, and am opening two new clinics. The grind is real, but so is the payoff.
Final Thoughts
Starting a practice is risky, rewarding, and entirely doable—if you enter with eyes wide open and cash reserves in place. These ten lessons cost me money, sleep, and plenty of plunging sweat so they don’t have to cost you the same.
Want personalized guidance? I coach physicians on launching and scaling profitable practices—schedule a consult or catch the latest episode of the InvestingDoc Podcast for deeper dives.
See you in the waiting room—yours, not mine.