r/PrivatePracticeDocs

I’m considering buying a small pediatric practice and have a ton of questions, particularly for those who have experience owning an independent practice vs. working for a large hospital system.
The practice I’m looking at currently gets by with one provider per day. My goal wouldn’t necessarily be to see 30+ patients a day—I’d ideally like to have a sustainable practice where I could see something like 20–25 patients/day and still make a good living.
One of the things that attracts me to private practice is the potential upside beyond just physician compensation: greater control over my schedule and how I practice, the ability to build something that I could eventually sell, potentially hire another physician and generate income from the practice as I approach retirement, and potentially having more flexibility with retirement contributions/tax planning.
On the other hand, a hospital-employed position has some pretty significant advantages: excellent health insurance, multiple retirement plan options, stability, and potentially better insurance contracts because of the size of the organization.
So I’m trying to understand how significant those differences really are.
For those who own or have owned a small pediatric practice:
Can a small independent pediatric practice still be profitable without seeing 30+ patients/day? With increasing overhead, what kind of patient volume do you realistically need?
How much worse are insurance contracts for a small independent practice compared with a large hospital system? Is the difference actually significant enough to materially affect profitability?
If a hospital system has better insurance contracts and generates more revenue per visit, does that actually translate into significantly higher compensation for the employed pediatrician, or does most of that additional revenue get absorbed by the system?
How significant is the difference in vaccine pricing? Do large systems get substantially better pricing because of volume, and does that meaningfully affect the profitability of an independent pediatric practice?
For those who have been practicing for many years, how sustainable is high-volume pediatrics long term? If you’re seeing 30–40+ patients a day, does that become significantly harder to sustain as you get older? Do you find that owning a practice gives you more flexibility to gradually reduce your patient volume, or does the financial pressure of ownership make it difficult to slow down?
More generally, how much do you think the benefits of ownership outweigh the stability and benefits of being employed by a large system?
I’m trying to figure out whether a small practice like this can be a good business while still allowing the owner to have a reasonable lifestyle, rather than simply creating another job where I have to see a very high volume of patients to make the numbers work.
Would really appreciate perspectives from pediatricians who have actually owned or operated an independent practice.

I’m finding that opening the practice is one thing, getting a consistent patient flow is another. We can have a great website, decent reviews and people finding us on Google, but that doesn’t always translate into a calendar that stays full.

The part I’m trying to improve is the gap between someone showing interest and actually becoming a patient. A phone call gets missed, someone fills out a form after hours, another person says they’ll call back and disappears. By the time we look at the numbers, it’s hard to tell where those patients went.

I’m curious how other practice owners handle this. Do you have someone dedicated to follow-up? Are you measuring where each patient comes from? And what do you guys consider a useful metric, booked appointments, conversion rate, revenue per source, or something else?

Edit:

I’ve been trying PatientGain on our side and it’s helping me spot patterns I wasn’t seeing before. I can actually trace the enquiries back to their source and see which ones turn into real appointments, instead of just looking at a pile of calls and assuming the marketing is working.

I’m considering a few EMR+billing options and looking to gain some thoughts from other private practice owners’ who have experience with Elation. I’d greatly appreciate any insight. Thank you

I am planning to switch from hospital medicine to outpatient primary care. Fairly new in my career. Assuming I will have resources to start my own practice in couple years, I want to get used to the outpatient world. With constant change in reimbursement structures is it better to start out with a fee for service model or value based care model? Do they matter if I consider a DPC practice? Appreciate your input.

I mean, I get it. People are sick of insurance companies. I am too. I understand why people are moving to DPC or why some independent doctors are adding some type of yearly fee.

I'm an IM hospitalist, and that world is increasingly burning me out because of corporate medicine. I'm in a private group and even then, ultimately, the hospital controls us. I'm not leaving hospitalist medicine tomorrow, but as someone still relatively early in my career, I've realized I need to start planning my exit now.

Lately I've become increasingly interested in becoming a PCP. I'm talking about what you FM docs actually do; real primary care. Not referring every problem to somebody else. I genuinely like the idea of being the community doctor who knows their patients, manages most things themselves, and does procedures when they're within my skillset.

So I've been planning a very small, lean, insurance-based IM/primary care practice.

I posted about this in a physician group and got absolutely roasted. The overwhelming response was basically: Why the hell would you take insurance? Do DPC.

Maybe I didn't explain my plan well enough, but I don't understand why traditional private practice has become such a crazy idea.

I'm in an affluent Midwestern area with a strong commercial payer base and surprisingly little immediate PCP competition. There are plenty of physicians in the broader metro area, but not many right around where I'm opening. I specifically chose the location for that reason.

I've found a \~1,200 sq ft office that's essentially move-in ready: three exam rooms, my own office, bathroom, and work area. A retiring physician friend gave me almost all the medical equipment I need. I'm doing most of the cosmetic work myself. I already have my EMR, billing software, malpractice, etc. figured out.

My total fixed overhead should be around $3,500 to $3800/month, with \~$2,200 of that being rent. The rent is higher than I'd ideally like, but I'm paying for the location and avoiding what could easily become a major medical-office buildout.

I also don't understand why people were horrified that I don't intend to hire an MA and receptionist on day one.

If I'm seeing 1–3 patients a day initially, why would I immediately put people on payroll to sit in an empty office?

That doesn't mean I intend to operate a mature practice with no staff forever. Of course I'll hire as volume justifies it. There are virtual assistants, AI reception/scheduling tools, automation, and plenty of tasks I'm perfectly capable of handling myself at low volume. I know when my time is better spent paying someone else to do something, and I'll hire when I actually reach that point. I feel like this is the number one biggest mistake that physicians who start an independent practice make, too much overhead too soon. I spoke to multiple colleagues, they all gave me the same advice. KEEP. OVERHEAD. LOW.

I already have a biller taking 6% of collections. She's handling my credentialing now, well before opening, because I know it can take months. She also handles claims, denials/rebuttals, and follow-up. She currently does this for a colleague of mine who is also a hospitalist with his own independent primary care practice, so this isn't someone I'm randomly hiring and hoping for the best.

I'm also realistic about payer contracts. I'm a new independent physician. I'm not expecting to walk into BCBS or another major payer and negotiate some amazing reimbursement rate. If there are opportunities to negotiate or join arrangements that improve rates, I'll certainly explore them, but favorable negotiated contracts aren't what my entire business model depends on.

I'm comfortable drawing blood, doing injections, arthrocentesis, simple biopsies/procedures, suturing, POCUS, etc. If eventually it makes sense to have an MA, phlebotomist, or someone else there, great. I'll hire them when there's actually enough work to justify it.

Another thing I kept hearing was that I'd need to see 20–25+ patients/day to make private practice financially viable.

But that's not necessarily what I'm trying to build.

I don't want to see 25 patients/day. I currently work several days a month in an outpatient clinic partly because I wanted more outpatient experience, and one thing I've learned is that I don't enjoy seeing 20–25 patients/day. My eventual target would probably be closer to 15–18.

I also don't need this practice to replicate my hospitalist salary.

I have a number in my head that would make me perfectly happy with the practice. Beyond that, I have hospitalist income and other businesses/income streams. I'm not trying to turn this clinic into a multimillion-dollar operation or squeeze 30 patients into every day.

Based on my projected fixed overhead, I need roughly 30–35 encounters per month, not per day, just to get the office around break-even before variable expenses. I can continue doing PRN hospitalist/locums work while the practice grows. The practice doesn't need to feed me from month one.

My philosophy is really pretty simple: keep overhead low, bill appropriately for the work I'm actually doing, capture the services I'm capable of providing rather than unnecessarily referring everything out, collect what I'm legitimately owed from insurers, and gradually outsource tasks as the economics justify it.

And yes, I know accepting insurance creates administrative work. Prior auths, denials, quality requirements, referrals, records, billing, credentialing, etc. are real. I'm not pretending otherwise. Maybe I'll discover that I've underestimated some of it. That's partly why I'm posting here.

But I also have experience building and operating businesses outside of medicine. I'm comfortable building systems, doing things myself initially, automating what can reasonably be automated, and recognizing when it's time to pay someone else to take something off my plate.

The other thing I don't understand is why DPC is automatically assumed to be the answer.

DPC absolutely has advantages, and I understand why physicians love escaping insurance. But it also requires convincing someone who already has health insurance to pay another recurring monthly fee for primary care.

In my market, I genuinely think getting 30–35 insured patient encounters per month is going to be easier than convincing 30–35 people to pay me \~$100/month out of pocket.

And frankly, I don't want to build a personal brand around myself. I don't want to become a physician influencer, constantly make social media content, or sell people on why they should subscribe to me. I know DPC doesn't necessarily require that, but that style of patient acquisition doesn't appeal to me.

I want to become the local community doctor.

I want someone to search for a PCP nearby, see that I'm in-network, get an appointment without waiting three months, and hopefully have a good enough experience that they tell their spouse, neighbor, or friend. And for those not in network, maybe I could do a per month fee or per visit fee. As long as I don't mix the two, who says I can't incorporate some DPC in the future? Why does it have to be all or nothing right now?

Maybe that's naive. That's why I'm asking people who actually practice family medicine and especially those who have owned independent practices.

My biggest logistical question is how aggressively I need to protect clinic availability while I'm starting.

My ideal, and current, hospitalist position is round-and-go, which allows me to round early and be at my clinic by mid-morning. There's some uncertainty around that position right now, however. I have other reliable physician work and can do PRN hospitalist/locums shifts while the clinic grows, but obviously every daytime shift I work somewhere else is a day I'm not physically at my own office.

When there are only a handful of patients, I'm reluctant to sacrifice substantial guaranteed physician income just to sit in an empty office five days a week. At the same time, I don't want to establish a practice where the lights are always off and nobody can get an appointment.

So I'm genuinely curious how those of you who started independent practices handled that ramp-up period.

Did you start with 2–3 predictable clinic days and add days as demand increased? How quickly did the administrative burden become enough that you needed your first employee? For those still accepting traditional insurance in independent practice, is this model really as crazy as people are making it sound?

I'm not looking to be talked into DPC simply because insurance sucks. I already know insurance sucks. I'm trying to understand whether a deliberately small, low-overhead, commercially insured practice where I eventually see \~15–18 patients/day is still a viable way to practice medicine.

I have a specific vision of what I want my career and practice to look like, and maximizing income isn't the only goal. I want ownership, independence, reasonable volume, and the ability to practice medicine the way I think it should be practiced. And why not accept insurance too?

Maybe there are things I'm underestimating. I'm completely open to hearing them. But I want to understand the actual obstacles and numbers from people who have done it, rather than simply being told that traditional private practice can't work anymore.

Why the hell not?

I know the world is moving towards greater access but as a solo provider practice it becomes quite overwhelming o get that many messages in addition to having to see patients, etc.

How do you reduce the amount of patient messages you get? Has anyone here just gotten rid of their patient portal altogether?

I run a small private practice and have been looking at ways to bring in more patients without adding to my front desk workload. DearDoc keeps coming up, a few colleagues mentioned it and it's been showing up in my research consistently.

From what I can tell they offer an AI chat that sits on your website and engages potential patients after hours, online scheduling, reputation management to help with Google reviews, and some SEO and website work. The pitch is basically that it converts website visitors who would otherwise bounce into actual booked appointment.

The problem is every platform in this space sounds incredible in demo. I've been burned before by software that looked great until we actually had to use it.

Things I'm genuinely trying to figure out before I book a call with them: does the AI chat actually convert real patients or does it mostly collect leads that go nowhere? How responsive is their support once you're locked in? What do the contracts look like, are there long term commitments? And for smaller practices specifically, is the ROI actually there or is this more of a large practice tool?

Would really appreciate honest takes from anyone who has used it, good or bad experiences both useful.

Hi all, I am looking for medical office/clinic space to sublease in the Raleigh–Cary-Durham area for a specialty medical practice.

Ideally looking for:

• 2 exam rooms
• Access to a waiting room/reception area
• Existing medical office/clinic preferred
• Weekend availability (Saturday or Sunday)
• Initially only 1 Saturday/Sunday per month, with potential to increase
• Raleigh, Cary, or nearby areas

We would be a very low-impact tenant and are happy to work around the primary practice’s schedule. This could be a good opportunity for a medical practice with unused space on weekends to generate some additional income.

If you have space available or know a physician/practice that might, please DM me. I have reached out to multiple clinics in the area without luck. Reached out to commercial real estate agents but they only do whole month-use leases rather than one day a month.

I've been running google ads for about 2 weeks now. I've tried in the past and I stopped because I felt like I wasn't getting a good ROI and felt like I was wasting my money. It's been 3 years since I've run ads on google and started again because I saw a few other practices in the area utilize them.

Anyone use them consistently and what's been your experience? How do you get the best ROI with them?

I'm getting fed up with the healthcare situation here. I pay top dollar for insurance, but every time I need to see a primary doc or a specialist, I’m still stuck waiting weeks for an appointment. When I finally get in, the doc rushes through in 10 minutes because they're juggling 30 other patients.

My time is extremely limited and I just want a doctor who knows my history, answers my texts when something pops up, and doesn't make me sit in a crowded waiting room.

For those in NYC, how are you handling primary care? Are you all using concierge doctors or is there a better way to bypass the standard system?

Update:

So a colleague recommended Dr. Tina Sindwani’s concierge practice in Manhattan, said her zero-wait policy and direct 24/7 access are unmatched. Anyone here worked with her or a similar Flatiron practice? Want to hear real experiences before reaching out for membership.

How many specialist referrals per month should a practice have before considering a specialist to visit 1-2x per month? Additionally what is the daily production minimum required by different specialists?

I spent the last year cutting our clinic's no-show rate from twenty-eight percent down toward fifteen. Thought I'd share what actually worked, since this is a common challenge in this field.

1. Timing beats frequency on reminders. We stopped blasting reminders days ahead and focused on a well-timed message the evening before, plus one a few hours out. Fewer messages, better placed, moved the needle more than volume ever did.
2. Two. Make rescheduling effortless. A huge chunk of no-shows aren't people who don't want to come; they just hit a conflict, and it's too much hassle to rebook. We gave them a one-tap reschedule option, and a lot of would-be no-shows turned into kept appointments.
3. Three. Predict your high-risk slots. Certain appointment types and time slots no-show way more than others. Once we flagged those in advance, we could double-confirm them or overbook slightly, as airlines do.

Happy to go deeper if useful. I've been working on writing up the full process to share.
Would that help anyone here, or is this already well covered?

Ok I will admit this is kind of a weird post. Our practice is located in a booming suburban area of a major metro.

We have two ways to approach our practice. The smaller eastbound approach is right next to a golf course with winding trails and some confusing streets on one side. But the other westbound approach is RIGHT NEXT TO MAJOR INTERSECTION and is very easily accessible.

Both approaches are perfectly locatable on Apple Maps, Google Maps, Bing Maps, Mapquest, paper maps etc. 99% of our patients find us with no problems.

But 1% of our patients (particularly older folks on Medicare) somehow end up on the eastbound side by the golf course winding trails and are totally lost. They call our staff who direct them how to find us while they are driving a car! Senior drivers on the phone frustrated/nervous/angry and upset at our staff while being guided how to make it is a recipe for a car crash and potential blame on us.

How do we avoid this while remaining polite? Is this a liability for us? What is our responsibility here and how do we still maintain a good patient relationship? We can't just say "this is how to find us here is our address and we will see you soon" and hang up the phone. The patients will feel abandoned while they are lost.

Its a bit of a delicate situation and I want to thread the needle here.

Note: Our appointment reminder emails contain all the direction instructions but no one really reads them.

We have been getting a lot of visit cancellations lately. How do you guys reduce this? We send out calls, emails, texts to remind people. We use Phreesia so they can complete their forms in advance. But this summer we have noticed a big uptick in those cancellations

I’m in a surgical/medical subspecialty private practice and part of an IPA that can give us EPIC Community Connect with all the fees waived.

Does anyone here use Epic strictly outpatient, including the billing side?

Would love to hear how you like it. How’s the workflow, billing, support, etc.? Any major downsides or things you wish you knew before switching?

Especially interested in hearing from other private practices or surgical/procedural specialties. Thanks!