Starting a group medical practice: decisions to make before opening
Agree on how the practice will work while the decisions are still easy to discuss. The small operational questions deserve a place beside the ownership agreement.
You and your future partners may share a clinical philosophy and still picture very different working days. One expects evening appointments. Another wants longer consultations. Someone assumes the office manager will handle the inbox, although that role has not been hired. Talk through those differences before the first schedule makes the decisions for you.
Write one description of the practice you are opening
Each founder should describe the intended patients, services, working hours, payment approach and reason for opening together. Compare the answers. Where they differ, make an explicit decision or record the question for further work.
Set the initial scope. Which services are ready at opening? Which clinician and location will provide them? What will you refer elsewhere? Keep future ambitions in a separate part of the plan so they do not silently become opening-day commitments.
A hypothetical two-physician group might agree to start with consultations and add a procedure service later. That choice changes the first equipment order, booking instructions and staff training. The useful output is a scope everyone can repeat accurately, including the person answering the phone.
Take the ownership questions to the right advisers
Use an attorney familiar with medical practices in your state and an accountant who understands the proposed arrangement. Ask them to explain the permitted ownership and entity options, contributions, decision rights, compensation approach, liabilities and what happens when an owner leaves. Record questions before choosing a structure.
The SBA's business-structure guidance explains that structure affects matters such as tax, liability and paperwork. Medical practice ownership also needs state-specific review; a general business checklist cannot decide which arrangement is appropriate for your group.
Bring concrete scenarios to the discussion. What if a partner reduces clinical hours, becomes unable to work, wants to sell, or disagrees with a new location? Who may approve a contract or borrow on behalf of the group? What happens to records access and continuity of care if the arrangement changes?
The worksheet accompanying this article helps organise those conversations. It is not an operating agreement. Have the relevant advisers turn the agreed decisions into the documents your practice needs.
Agree how money and management time will be handled
Build one opening budget with the partners' actual commitments. Identify who contributes what, when it is available, which expenses are shared and who can approve a purchase. Keep an explicit list of items still awaiting a quote or agreement.
Discuss clinical work and management work separately. Someone will meet vendors, review hiring, handle access questions and follow up on the bank or payer paperwork. Estimate the time those duties require and decide how responsibility will rotate or be assigned. Leaving that work invisible makes it easier to overlook.
Ask the accountant and attorney to review compensation and expense-allocation proposals before adopting them. Test the operational assumptions with an example: one clinician starts later, a payer arrangement is delayed, or a location has fewer sessions than planned. Decide who revisits the budget and when.
Use the medical practice business-plan template to put service scope, staffing and financial assumptions in the same document. Each partner should be looking at the same current version.
Make the shared decisions visible
Separate decisions reserved for the owners from work a practice manager or clinician can handle within an agreed policy. Give each recurring decision a responsible person, any required approver and a place to record the outcome.
| Decision | Question to resolve | Record to keep |
|---|---|---|
| Schedules | Who sets appointment types, session lengths, time off and urgent-slot rules? | An agreed scheduling policy with named approvers. |
| Spending | What can a manager approve, and what needs an owner decision? | A reviewed approval policy and current budget. |
| Staffing | Who hires, supervises and arranges backup when someone is absent? | A responsibility and coverage map. |
| Patient work | Who owns messages, results and follow-up when the usual clinician is away? | A clinical coverage process approved by the responsible leaders. |
| Technology | Who approves changes, controls access and contacts support? | A system owner and a documented change process. |
| Disagreements | How does the group resolve an unresolved operational or ownership issue? | The agreed escalation route and adviser-reviewed governance documents. |
The aim is to make an ordinary day easier to run. Staff should not have to ask three owners for three answers to the same scheduling question.
Standardise the handoffs patients depend on
Partners do not need identical consultation styles. They do need a shared understanding of the work that crosses between people: registration, intake review, appointment changes, outside reports, patient messages and the next step after a visit.
Choose a common minimum for those handoffs. Decide what information must be available, who checks it, where incomplete work appears and how a colleague knows the task is finished. Allow documented exceptions when a specialty or visit type genuinely needs something different.
Test the patient journey with each clinician's usual appointment types. A workflow that looks complete for one provider may need an extra step for another. Our EHR selection article offers a set of demonstrations to use before committing to the system.
Set access according to the person's role and assigned responsibilities. Have the practice's responsible privacy and security leads review access, external services and staff training. Use your approved record and task systems for patient information; a shared planning document is for operational decisions.
Walk through the difficult ordinary days
Choose a few plausible situations and ask each partner how the group would respond. A clinician is absent. A referral arrives for the wrong location. A patient calls about something that needs clinical review. The person who normally handles billing is away.
For each situation, identify the first owner, backup, escalation route and evidence of completion. Include after-hours arrangements. Clinical leaders should set the urgency rules and clinical responsibilities; the exercise checks that the team understands and can follow them.
Also rehearse how you will update one another. A short regular operational review can cover capacity, unresolved work and decisions needed from the owners. Keep clinical or sensitive matters in the appropriate setting and record only what belongs in the business review.
Finish with a short partner decision record
Download the editable group-practice partner worksheet. It covers launch scope, adviser questions, contributions, decision rights, shared workflows and absence coverage. Each section has room for the decision, owner, next action and review date.
Mark a question unresolved when it is unresolved. Give it a person and a next step. Revisit the record before opening, after the first month and whenever the group changes its services or working arrangements.
Should every decision require every partner? Agree that distinction in your governance documents and operating policies. Reserve the right decisions for the owners while giving staff enough authority to perform their assigned work.
Can each clinician keep their preferred workflow? Some preferences can coexist. Test where they affect shared staff, patient communication or continuity. Those interfaces need a common approach or a clearly documented exception.
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