Building the infrastructure: Staffing, systems, and vendors

You’ve decided to go independent and have a financial plan in place. Now, how do you turn that vision into a functioning practice? The answer lies in building the right infrastructure. The people, systems, and partners you choose will determine whether your practice runs efficiently or gets lost in daily chaos.

Too often, physicians underestimate how critical these early setup decisions are. Infrastructure is not just logistics; it’s the framework that supports patient care, financial stability, and long-term sustainability.

Start with the right team

A well-chosen team can make or break an independent practice. In the early stages, every hire should directly contribute to clinical efficiency or patient experience.

Core roles typically include:

• Front desk or patient coordinator: Manages scheduling, intake, and the first impression of your practice.
• Medical assistant or nurse: Supports clinical flow, triage, and documentation.
• Billing and revenue cycle management support: Whether in-house or outsourced, this is essential for maintaining healthy cash flow.

For many practices, a small, cross-trained staff is more effective than a large team with narrow roles. Consider personality and culture fit as much as experience — you need individuals who align with your mission and are adaptable as the practice evolves.

Leverage outsourced and fractional services

You don’t need a full-time team for every function. In fact, strategic outsourcing allows you to stay lean while maintaining professional-grade operations.

Commonly outsourced services include:

• Billing and collections — reduces errors and speeds up reimbursement.
• Credentialing and compliance — ensures contracts and renewals are maintained accurately.
• Human resources and payroll — helps manage employee onboarding, benefits, and tax compliance.
• IT and cybersecurity — protects patient data and maintains HIPAA compliance.
• Marketing and digital presence management — keeps your practice visible and patient pipeline steady.

Outsourcing doesn’t mean losing control; it means gaining access to specialized expertise without the overhead of hiring internally.

Choosing technology that works for you

Technology is the central nervous system of your independent practice. The right tools should simplify your workflow, not complicate it.

Key systems to evaluate include:

• Electronic Health Record: Prioritize usability, cloud access, and interoperability with labs and pharmacies.
• Practice Management System (PMS): Handles scheduling, billing, and reporting.
• Telehealth platform: Offers flexibility for patients and expands your reach.
• Patient communication tools: Automate reminders, secure messaging, and feedback collection.

When comparing vendors, involve your team in demos. The system that looks great on paper may not fit daily clinical needs. And remember — no software is perfect. Choose a system that aligns with your workflow, not one that forces you to adapt to its limitations.

Vendor relationships: Quality over quantity

Choosing vendors isn’t just a transactional process — it’s a long-term partnership. From lab services to EHR support, each vendor plays a role in patient care and operational stability.

Look for partners who:

• Understand health care operations and regulatory nuances.
• Offer responsive support and transparent pricing.
• Are willing to customize services to your practice size and goals.

When possible, negotiate flexible terms rather than locking into long multi-year contracts early on. Independence means maintaining agility; avoid overcommitting before you fully understand your practice’s needs.

Workflow design: The hidden key to efficiency

Even the best team and technology will falter with inefficient processes. Before opening, map out every major workflow, from patient intake to billing.

Ask questions like:

• Where do handoffs occur between staff?
• How does information flow from the clinical to the administrative side?
• How can we minimize steps and reduce delays for patients?

A clear, standardized workflow reduces delays, minimizes errors, and improves the patient experience. Revisit these workflows regularly — what works for three patients an hour may not scale when you’re seeing 20.

Compliance and risk management

Operational excellence isn’t just about speed; it’s also about safety. Every independent practice must have policies that address:

• HIPAA and data security
• OSHA and infection control
• Incident reporting
• Controlled substance management
• Staff training and documentation

These protocols protect both your patients and your license — and they reinforce a culture of accountability from day one.

The foundation for growth

Infrastructure decisions are among the most impactful ones you’ll make as an independent physician. They shape your daily operations, patient satisfaction, and financial health.

With the right systems and support, independence doesn’t have to mean isolation. It can mean efficiency, innovation, and the freedom to deliver care your way.

In the next article in this series, we’ll explore how to manage growth in the first year — including patient acquisition, marketing, and scaling sustainably.

Melissa Starowitz, MHSA, is the owner of Cornerstone Healthcare Consulting and Management, which helps physicians launch, manage, and optimize independent practices nationwide. Learn more at www.cornerstonehealthcareconsulting.com.