Making the switch to solo practice is challenging

You might be thinking about making the jump from working in a hospital system to solo practice. See why the leap won't be without its challenges.

Q: My employment at a hospital system is being terminated. I am allowed to keep my privileges and can bring my cases to the hospital, but as of next month I no longer will be an employee. I’m thinking of going into private practice. What do I have to do to accomplish that?

A: I applaud your entrepreneurial spirit longing for solo practice. Accomplishing the transition from hospital employee to solo, however, is a difficult leap to make.

Start by working with your healthcare attorney and your accountant to determine whether you are in a financial position to embark on a solo practice. You also may want to reach out to a bank to discuss what forms of financing it may have available for healthcare practitioners. After determining finances, the next step will be deciding whether you would like to form a corporate entity to practice under.

Next (and early on), tackle the credentialing process, which may take several months and must be addressed before you are able to bill third-party payers for your services. After formation and credentialing have been handled, another issue is space-how much you’ll need, and where you should locate your practice.

Another important question is what support-billing, front office staff, a practice manager-your practice will require, and where you will find people to fill those positions. You also may need outside professional assistance with administrative work as well as potentially professional assistance from attorneys and accountants.

Going from hospital employee to solo practice is not an insurmountable task. But it requires a great deal of work, and that may be overwhelming for some. It may be easier to ask the health system you are leaving whether another form of relationship is available for you there. Perhaps it would be open to a license arrangement, whereby you could rent space, personnel, and equipment from the hospital, allowing you to remain in the same office with the same administrative and professional support.

This may be an option if your employment is not being terminated for professional reasons, but for failure to meet your employer’s financial goals. That’s because under a license arrangement, you would be paying the hospital system, usually at a flat rate, for use of its facilities and services.

The fact that you have kept your privileges or that they are not being challenged is a testament that your services rendered were most likely appropriate, and that the hospital is ready and willing to have you to continue practicing there. The hospital, however, is apparently no longer willing to guarantee a salary for you.

If a license arrangement with your former employer is not possible, you may want to explore employment elsewhere rather than taking the risk of solo practice. On the other hand, if you believe you are up to the challenge, being your own boss and building a business can be very rewarding,

The author is healthcare department managerfor Kirschenbaum & Kirschenbaum, PC, Garden City, New York. Send your pratice management questions to Also engage at and 


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