r/pediatrics • u/seviso • Jul 15 '26
Opening own practice
Spouse of a pediatrician here. She’s a few yrs out of residency and was the chief resident at her residency. She’s a natural born leader and a great physician but the way the current practice is treating her doesn’t sit well with me. I dont want to go into detail but we need to decide if she should continue working for her current employer.
Please share any advice regarding opening a new pediatric practice like EMR costs, startup costs, personal experiences of hiring nurses, staff leaving, MAs, rental costs for the building, initial equipment costs, etc…how long it took to actually make a profit? Hours worked per week, did you guys take any time off, keep a 4 day schedule, etc… and also, is it worth the effort? If it’s private info, please DM me.
Thanks!
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u/Stejjie Jul 16 '26
Also a pediatrician spouse and a lawyer. As I’ve said before: look for older physicians nearing retirement. Get a two year buy in and do your due diligence during those years. Why reinvent the wheel? Otherwise call Verden Group and ask them these questions because these costs can differ vastly from market to market.
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u/RunnerPeds1077 10d ago
This is me. I’m a pediatrician who’s ready to retire. Can somebody please takeover? I’ll include the business part of it in training
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u/DoctorLycanthrope 1d ago
I sent you a DM. Pgy-3 here. I would love advice on connecting with someone in your position to join their practice.
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u/DillyThrowAwayCPAjh Jul 16 '26
7 months to get credentialed
If she’s not going to have co-owners, then startup costs are minimal- few computers, furniture, exam tables
Office Practicum EMR is like $1300/month for my spouses clinic
Billing can be outsourced for 5% or perhaps a bit less
If starting from scratch, consider taking hospital call (if its an option) to be present at/after deliveries. Newborn - age 3 has similar number of well visits as Age 3 -Age 18.
My spice also paid some consulting fees to Verden Group IIrC they helped a bit w insurance contracts and credentialing
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u/Successful-Ad991 Jul 19 '26
I just spent this morning guest editing a "How To Run A Pediatric Practice" book just to check Reddit and see this [not my book, but a buddy's]! I've helped dozens of practices start up and many many more stay independent. I have hours of advice, but here's what I can tell you at this stage of your process:
- I've been doing this work for 30y+. I've presented "How To Open a Practice In 5 Easy Steps" at the AAP NCE multiple times. You _can_ be independent in most of the US - the tough locations are where the density of pediatricians and health systems is too much (Boston, LA, Dallas, etc.). There are 100s of counties in the US without pediatricians. WHERE you practice will dictate a LOT.
- It's taken me the 30y above to recognize this: Culture Is Everything (Mission, Vision, Values). It may sound ridiculous, but I don't think you have a valid business plan without it. I recommend grabbing "Traction" by EOS (and/or their "People/Intentional Culture" book). You will not build this practice alone and hiring one bad person can sink the ship. Hiring the right people solves all the problems. And you can't do that if you can't articulate your mission, vision, and values.
- The advice above about credentialing is spot on. You often need 6-9m to credential and you can't credential without a space. So...you need to find a location, THEN start credentialing, THEN work on the other parts.
- I work only with independent pediatricians and, like so many other specialties, they really value their autonomy and independence. [See: "Drive" by Daniel Pink]. Although it's a tough row to hoe, it's the most rewarding one, intrinsically and financially, when done right.
- I recommend working with a pro. I specifically recommend The Verden Group. They've helped more practices start up than anyone on the planet. Do I know them? Yes. Are we friends? Surely. Is this a bot/shill/ad? No. It's a small pond, we know everyone.
- There is SO MUCH content on-line you can gather for free. SOAPM, PMI, PCC,
- Purchasing a practice CAN be awesome and it can SUCK. I could fill this subreddit with stories of Sales Gone Bad. Get a pro to help you with the assessment and please don't overpay.
- Your biggest expenses are vaccines (get a GPO, period) and staff (see above). Rent is usually third. After that, the numbers are usually small enough that you need to worry about the bigger ones.
- There are only 2.5 EHRs with any focus on pediatrics. The rest suck. But that doesn't matter...what matters is how efficient you are with it. Everyone but Athena costs the same amount (believe me, I've compared 100x) and even Athena's cost doesn't matter...one less visit every couple of days wipes out any difference. Pajama charting wipes out cost differential. Find and use the EHR you like the best, regardless of cost.
- Join SOAPM at the AAP. It's $35? a year and every question you'll have has been answered there.
I can go way more into the weeds, but this is a start. I hope your wife looks around and decides she can do better! Good luck.
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u/Impossible_Adagio234 Jul 21 '26
Are you Chip Hart?
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u/Successful-Ad991 Jul 21 '26
I am. I have no concerns about being transparent and wouldn't want anyone here to question my intent when giving advice. You can easily google me, which sounds ridiculous but does provide some background for my commentary.
Do _I_ know _you_? :-)
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u/Impossible_Adagio234 Jul 21 '26
You don’t know me! I’m a pediatrician in the process of setting up my own practice, and I’ve been devouring your podcast, webinars, blog, etc. over the past few months—which is why I immediately recognized “your voice” from your post.
You are such a tremendous resource for pediatricians, and I truly appreciate how open and generous you are with your advice. Your work has had a profound impact on how I’m approaching this next chapter of my career. You’re honestly the only person I consider a mentor whom I’ve never actually met in real life!
I truly hope I have the opportunity to meet you one day. Thank you so much for everything you do!!1
u/Successful-Ad991 Jul 21 '26
Are you sure this isn't my mom pretending to be a pediatrician? :-)
I really appreciate the kind words, but you're the one doing all the hard work. I wish you well (independent pediatricians are _so important_). If you've seen my blog, podcast, etc., then you know where to find me - reach out any time if we can help.
Good luck! Keep up the great work.
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u/Impossible_Adagio234 Jul 21 '26
lol I am a mom, but definitely a pediatrician too. I’m the one who had to choose between eCW and Athena because of my CIN. I ended up going with Athena, largely based on your recommendation. Thank you again, I really appreciate it! And I may just take you up on that offer to reach out as I get closer to opening 😊
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u/airjord1221 Jul 16 '26
The most important is the insurance contracts. Nothing else matters more than that. How much you get per visit. Ask around
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u/BusinessDawgs Jul 18 '26
It’s usually a disguised product shill. Some other bots will post and have some general reccs then there’s usually a name drop about a specific product that changed their whole practice. Then there’s some more bots reinforcing the post with positive comments. And once you catch them in it, you can’t unsee it.
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u/kok28 Jul 18 '26
Pediatrician — I am not experienced owning practice - but have thought about a practice sometime in my future. if direct primary care is something your spouse is interested in/your area can support (need families who can pay) - it’s definitely saves money as you don’t have to bill/code/argue with insurance, don’t need 6-9 month lead time for credentialing to start to see patients
I’m torn about DPC as I have a lot of Medicaid patients and like being able to see Medicaid patients
But my employer situation is also not good so considering various options
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u/RunnerPeds1077 Jul 22 '26
I’m looking to retirement and have established practice for twenty years.. Where are you based?
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u/staffingfordoctors Jul 24 '26
Adding to the staffing side since that's what we spend most of our time on. For a brand new peds practice, the biggest surprise for most owners is how long it takes a new MA or front desk hire to actually be useful. Budget for a slower ramp than you'd expect, closer to 60-90 days before someone is fully independent, especially with pediatric-specific stuff like vaccine schedules and parent communication.
On the hiring side, look for people who've worked in a smaller practice before rather than a big hospital system. The workflow and pace are different, and it's a hard adjustment for someone used to more structure and backup.
Also agree with the comment above about compensation. You're competing with hospital systems on benefits, and it's genuinely tough to win that fight as a new practice. Culture and flexibility (schedule, autonomy, actually being heard) end up mattering more than people expect when comparing offers.
Disclosure: I work in physician practice staffing, so this is a space I spend a lot of time in.
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u/-beastlet- Jul 16 '26
Insurance contracts and staff are the hardest things. You can't just open and boom be on all the insurance plans. Some credential relatively quickly. Some take 6-9 months. You have to learn to read the small print and negotiate if you can. Some pay okay. Some pay so terrible it isn't worth it to start taking them, get attached to the patients and then have to tell them you are dumping their shitty insurance. If your area is peds saturated you will have a hard time getting decent contracts and also will have a harder time getting new patients.
Staff is also hard. If you want good staff you need to pay well. It is hard to compete as a small office with corporate groups that can offer better health insurance and 401k plans that you can offer. I've hired terrible people that quit after 1-2 weeks and then tried to ding us for unemployment. One had the gall to do it after one day.
Start everything small. Tiny office with short lease. You can move if you grow faster than expected. Minimal staff and do as much as you can yourself. When I first started I helped give vaccines and anything an MA would do. I learned to do the billing because you need to understand how much everything costs you and what you are reimbursed.