Starting a medical practice is one of the most exciting—and terrifying—decisions you’ll ever make as a physician. You’re stepping away from the safety net of an employer, building something from scratch, and placing your professional reputation and financial stability on the line.
I know, because I’ve done it. I started in a cramped 800-square-foot office with two exam rooms, no signage, and a check-in desk that patients had to find by accident. Fast forward six years, and I’ve scaled to multiple locations, over 20,000 patients, and a thriving team. I’ve also consulted with more than 600 physicians across the country who wanted to start or scale their own practices.
Through all of that, I’ve learned what truly matters when opening a medical business. It’s not the fancy office furniture, the perfect business plan, or even the MBA you might be tempted to pursue. Instead, it comes down to a few timeless principles that determine whether your practice will succeed or fail.
Here’s what you really need to focus on.
A lot of doctors I consult with show up with a thick, detailed business plan. It’s full of spreadsheets, pro forma projections, and ten-year forecasts. That’s fine, but let me be blunt: those plans rarely survive first contact with reality.
What matters more is clarity of vision. You need to know what kind of practice you’re building and where you’re taking it. Are you fee-for-service? Concierge? Insurance-based primary care? Do you want to be known as the go-to sexual health expert in town, the gastroenterologist who handles advanced endoscopy, or the internist who blends traditional medicine with aesthetics?
That vision is your north star. It guides every decision—from your branding, to how you design your schedule, to what services you add down the line. Without it, even the most beautiful business plan is useless.
Vision sets the direction, but culture fuels the engine. Early in my journey, I hired a physician assistant who decided she wouldn’t see more than 16 patients a day. With no-shows, that meant she was averaging closer to 12.
The problem wasn’t just her productivity—it was the ripple effect. Other providers started asking, “Why am I working harder than her? Why should I see more patients?” The culture shifted from teamwork to resentment. Bonuses evaporated, and morale tanked.
The lesson? Culture is fragile, and toxic attitudes spread quickly. As the owner, you need to protect your culture like your life depends on it—because your business does. That means setting expectations, rewarding effort, and cutting loose anyone who undermines the team, no matter how good their résumé looks.
When I opened my first practice, my office was embarrassingly bare. No logo, no sign, no art on the walls. The check-in desk was hidden behind a corner, so patients literally had to be yelled at by the front desk staff to turn around.
It was awful. But you know what? None of it mattered. Within nine months, I was drowning in patients. People didn’t care about the décor—they cared about getting a good doctor who actually listened to them.
I even drew blood in the hallway because we didn’t have a phlebotomy room. I put a couple of plants in front of the fire escape to make it feel less weird. Patients joked about it, but they stayed. Not one left a negative review because of the setup.
The truth is, healthcare demand is so high that if you’re a good physician, patients will come. Nice furniture and designer art can wait. Focus first on building trust and delivering excellent care.
Here’s one of the most painful lessons I’ve seen new practice owners learn: you cannot count on insurance companies to backdate your contracts.
Too many doctors open their doors, see dozens of patients, and then realize they’ll never get paid for $80,000 worth of claims. That kind of hit can bankrupt a practice before it ever gets off the ground.
If you’re taking insurance, start credentialing early. Have a financial buffer. And don’t assume contracts will magically sort themselves out—they won’t.
When you’re small, every dollar matters—and every connection counts. One of the best returns on investment I’ve ever made was handing my business card to a local cardiologist. That single card has resulted in hundreds of patient referrals over the years.
Think about the lifetime value of those patients. That’s not just tens of thousands of dollars—it’s years of relationships, follow-up care, and trust built in the community.
This is why, in the beginning, you need to do things that don’t scale. Shake hands. Visit urgent cares. Drop in on other specialists. Let people know you’re open and available.
I’ve seen doctors refuse to spend $5,000 on Google Ads while sitting on $300,000 in student debt. Think about that. You already bet your financial future on medical school. Why stop investing now?
Your practice will only grow if you fuel it. That means pouring money into advertising, marketing, branding, and patient experience. The pens at your front desk, the swag you give away, the layout of your website—it all shapes how patients see your brand.
You can still take a good salary, but if your dream is to scale, you’ll need to delay gratification and reinvest. Otherwise, you’ll stall out.
The first 100 patients you see will define your reputation. They’ll leave your first reviews, tell their friends, and create the early word-of-mouth buzz that makes or breaks your clinic.
But here’s the trap: don’t over-deliver to the point of unsustainable expectations. I once spent over an hour with a patient who had a toenail infection and some anxiety. Word spread that “Dr. Brad spends an hour with everyone.” When I eventually had to set boundaries, patients felt betrayed.
Give excellent care, but be careful not to set promises you can’t maintain. And for the love of your sanity, don’t hand out your personal cell phone unless you’re running a concierge practice.
My brother got an MBA and used it to launch a successful oil and gas business. That worked for him. But for doctors starting a private practice, an MBA is rarely the key.
What you need more than anything is mindset—the willingness to grind, to problem-solve, and to keep going when everything feels impossible. You’ll learn payroll by doing it. You’ll learn HR by firing your first employee. You’ll learn purchasing when a $30,000 vaccine shipment gets delivered to the wrong address.
No classroom can prepare you for those moments. Only mindset can.
Starting a practice isn’t a side hustle. It’s not something you can do in 10 hours a month unless you’re paying someone else to carry the load.
Think about internship year—the long hours, the sleepless nights, the sheer mental exhaustion. Starting a business is the same, only now the stakes are higher. It’s not just your patients’ health on the line—it’s your employees’ livelihoods, your family’s finances, and your own reputation.
If you’re not ready to grind, you’re not ready to open.
At the end of the day, none of this matters if you never take the leap. Too many doctors stay stuck in analysis paralysis—researching, planning, perfecting, but never opening the doors.
The truth is, you’ll never feel 100% ready. You’ll never have every answer. But if you wait until the conditions are perfect, you’ll be waiting forever.
Whether your path is doing locums to build capital, joining an MSO, or opening your own solo shop—just start. Take the first step, and adjust along the way.
Building a medical practice is not just about medicine. It’s about vision, culture, mindset, and relentless persistence. You’ll make mistakes. You’ll have sleepless nights. You’ll wonder if you’re crazy.
But if you stick with it, the rewards are immense. You’ll build not just a business, but a brand. You’ll create jobs, touch lives, and gain control over your professional destiny.
Six years ago, I was drawing blood in a hallway next to a fire escape. Today, my clinics see 150 patients a day and support dozens of employees. None of that would have happened if I had waited until I felt “ready.”
So my final advice is simple: believe in your vision, protect your culture, and just start.
