Open your clinic for $3,000—or less! I did. Here’s how.

PamelaWible

“It may sound silly, but what are the bare-bones requirements to practice medicine? I plan to launch a small, low-overhead, cash-only practice, but I’m having difficulty finding a clinic or physician to model.”

No surprise that this doc who called me today is having trouble finding a role model. Most physicians work at high-overhead jobs they hate. Happy docs are in short supply. 

I’m an expert on bare-bones medical practices. In 2005, I wanted to know how low I could go and still operate a real clinic in America. My start up costs? Less than $3000. I’ve learned a lot of savings strategies since then. So I’m pretty sure you can do better. Here are the basics.

Bare-bones requirements: A state medical license. For cash-only, opt out of Medicare. That’s really it. Optional: If you want hospital privileges or to be a “preferred provider” who’s in-network with insurance plans, complete credentialing forms and sign contracts. Done. Want to be out-of-network like me? Skip it all and you can still take insurance. Do NOT make this complicated guys!

Bare-bones start-up costs: An office (mine: $280/mo in 2005, now $425/mo in 2015). Utilities and Internet (included in my rent). Cell phone (mine $68/mo). Malpractice is cheap (mine $1230 first year, $1978 now, divided/billed quarterly). Laptop (I owned one, you probably own one too). Furniture (chairs, table, decor from Goodwill for $200). Exam table (free to $1500, I splurged at $795, ignore if you’re a psychiatrist). Premises liability insurance (included in most malpractice policies). Supplies (KY, gloves, scalpels, gowns for $300). File for LLC if you want ($50 most states).

There’s tons of FREE stuff for clinic start-up including free medical equipment from retiring docs/ hospital overstock. Seriously, you can get pretty much anything from morgue tables to NICU incubators for free! I created a free EMR on my laptop. You can get free business cards online. I use a free e-billing clearinghouse (officeally.com) to submit claims—and I get paid in a few weeks. Easy! Labs provide free supplies (Pap collection kits, urinalysis containers). Want more free stuff? Just Google “Free ____” and fill in the blank. 

Let’s assume you have your medical license and DEA from your last job. You already have a cell phone and a laptop like most Americans. So if you’re opening a small, low-overhead, cash-only practice, with no staff or on-site lab tests as a sole proprietor, you can do it bare bones for less than $3,000. Even less than $2000. Want to really go bare? Skip malpractice insurance and take off $1000+ per year. Take another $1000 off if you’re a psychiatrist since the only equipment you need is two chairs and your brain.

Congrats! Now invite me to your open house!

Want more cutting-edge business strategies? 

Get a copy of my free No B.S. Guide to Launching Your Ideal Clinic

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Pamela Wible, M.D., is a physician entrepreneur and business strategist who founded the Ideal Medical Care Movement. She was awarded the 2015 Women Leader in Medicine for her pioneering work in medical care delivery and medical student/physician suicide prevention. Photo by GeVe.

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64 comments on “Open your clinic for $3,000—or less! I did. Here’s how.
  1. Robin says:

    I did the same thing. Used our family laptop, added a $10 line to our cell phone family plan, got equipment on Craigslist and comparing prices online, rented a small space in an office building (not a medical one) three blocks from my house. Anyone smart enough to get through medical school can definitely open a practice.

    Along the way everyone I talked to was very obliging about explaining everything. I’d never had to handle the business aspect of medicine. My malpractice company explained their billing and discounts. They didn’t provide premises liability insurance so I called the company that I have my homeowners/car insurance and they had a sister company that would do my business insurance. My first furniture was mostly stuff from my house and as I’ve wanted pieces back or they haven’t worked out as well as I’ve liked, I’ve replaced them with “new” from Craigslist or the thrift store.

    I just kept reminding myself that if you dropped me off of a plane in the middle of nowhere with nothing, I’d still be a doctor and still be able to help. Everything in addition to me should only be what I need to make my job easier to do well.

    • Pamela Wible MD says:

      Now you’re inspiring me!!! Please mentor medical students. Med schools don’t generally expose students to the low-overhead models.

      • Robin says:

        I contacted the local medical school. We’ll see if they bite or not. 🙂

        I got free small business counseling through the county before I opened and the person who worked with me said, “I can’t find anything wrong with your plan but if it really works this way, why isn’t everyone doing it?” I will never forget his response!

        • Pamela Wible MD says:

          “Why isn’t everyone doing it?”

          1) Everyone was doing this pre-1965.
          2) Divide and conquer works (doctors spend too much time in isolation and competition)
          3) Too much money to be made by our predators to stop assembly-line medicine.
          4) Near-total lack of mentorship by happy doctors. Excess of cynical depressed docs.
          5) No business training in med school…

          Those are the top 5.

          Others?

          • Robin says:

            I think #4 and #5 are the biggies because if doctors had those two, it wouldn’t matter how much money there was to be made off of them, they could make the leap.

            In my case my residency encouraged us to learn to run our own practices and spend time with the office manager at every rotation site. That was huge! And most importantly, I started medical school in August of 2002 and Dr. Gordan Moore’s article in the AAFP had come out in February of that year. Someone had left the journal lying on an end table in the hall at my medical school and I happened to pick it up and read it. I didn’t realize at the time how life changing that was. Through all the mess of training, I always knew that all that complexity wasn’t completely necessary. Someone out there had done it differently.

            But opening my own practice just didn’t seem like a real possibility, partly because all the physician-owners I had met were male, older middle aged, and worked too many hours.

            But I put my practice together while on maternity leave with my daughter so I learned that it wasn’t just the older male demographic who could do this. 🙂 I didn’t take myself and my ability to run a business seriously so it surprised me that everyone else took me seriously and were willing to do crazy things like lease me an office space.

            I did all my planning in a comp book and one of the first pages was a list of every woman I personally knew who ran her own business. I was so unsure!

            I did contact my medical school (I still live in the same city as I did then).

          • Pamela Wible MD says:

            The value of a the right mentorship can’t be underestimated. Many medical students have no mentors—doctors who they would want to emulate. I hope you are now out there teaching med students, Robin!

    • Mary says:

      I started this about a year ago. I bought furniture at Goodwill and Ikea. I have had no problem getting patients who will pay cash. I get to set my own hours which is great for a mom. I even have my teenager cleaning my office for her afterschool job. Win/win! Only downside is a bit of isolation and having to have my phone with me 24/7. Looking to find someone to cover me so I can take some vacation. Also, looking for good phone answering service. You should write a nuts and bolts guide! That would be very helpful. Thanks!

  2. Keely says:

    I’m not too proud to admit I got one of those two chairs needed for a psychiatrist’s office dumpster diving!

    • Pamela Wible MD says:

      I’ve been a dumpster digger much of my life—just a frugal archeologist at heart. Maybe it started when my dad used to take me into abandoned houses as a child. Anyway, I found myself in a dumpster behind a plasma collection center and found some AMAZING medical equipment!!! Always dumpster dive behind medical office space, but beware of used needles (should be discarded in the red biohazard containers). Recently took some teenagers into a burned out house in Washington state on a road trip and discovered this: https://www.youtube.com/watch?v=2xMAB_788Uw

  3. Kurt Brewster says:

    Hi Pamela! Love your inspiring message. The only question I had was call. The insurance contracts I signed required 24/7 coverage by the provider. Is that true if you’re an out of network doctor?

    • Pamela Wible MD says:

      OON (out-of-network) no contract required. Just follow the state laws for your medical license and you’re good to go! You do not have to do anything extra to satisfy the insurance companies.

  4. Kelvin says:

    Great article. All sounds great. But I am in New York City. Rent alone can kill a budget. Malpractice is the next thing that can take a chunk out of your budget in my locale.

    Where are you located?

    • Pamela Wible MD says:

      I’m in Eugene, Oregon. In expensive urban areas can be more challenging to run a low-overhead office, but cost-saving concepts still apply. Have you thought of a house call practice. Take over a few block and have a vertical commute. 🙂

  5. Anisha Buben says:

    I have noticed that of all different types of insurance, health insurance coverage is the most questionable because of the conflict between the insurance company’s necessity to remain making money and the client’s need to have insurance policy. Insurance companies’ revenue on health and fitness plans are incredibly low, so some corporations struggle to profit. Thanks for the tips you share through this site.

  6. jazmine tucker says:

    I wanted to open a clinic but I am not a doctor. also I wanted to be able to have employees. is there a way I can incorporate

  7. Husan sanra says:

    Hello,

    I am a Healthcare administerator and came across this page in hopes for advice on opening my own clinic. I have a few Physicians that are willing to work and Bill under there NPI. I have seen it happen before but was wondering if anyone has heard of such a practice and can give me a few pointers?

    thanks

  8. Rush says:

    This is interesting. How do you make the financials work? For example, how much do you charge on a per visit basis? How did you get patients in your first 12 months? Surely you had to spend money on advertising.

    I’ve long thought about doing something like this.

  9. Jonathan Saunders says:

    Hello Pam me and my fiance want to open a clinc she is a nurse in the army and once she is out her dream is to open a clinic. I dont have any medical experience she is the one who has the experience. So any advice of how to get started since she is just a nurse? Thanks

  10. Ravi says:

    Hi,

    Medical student here. I’m wondering, if someone can open up a practice for this cheap, what is it exactly these days that make starting your own practice so expensive? Time and time again preceptors have told me not to go into primary care because it’s so difficult to open up a practice these days with all the start up costs and paperwork. I would love to go into primary care if what is posted here is actually feasible. I’m just wondering where the money trail leads if people keep saying that it’s so expensive these days. It’s really unfortunate that we haven’t had a single lecture in medical school about the business of medicine and I’ve only gotten exposure to this topic through my clerkship attendings.

    • Pamela Wible MD says:

      The money trail leads to the intermediaries who have inserted themselves between doctor and patient. I suggest you review the business strategy blogs on my site here: http://www.idealmedicalcare.org/blog/category/business-strategy/ and you will start to see the pattern. Essentially primary care is being held hostage to an unsustainable tertiary care model. For a lung transplant you need a 5-story hospital, a helipad, a team, a billing department, valet parking, the list goes on. For an ingrown toenail all that stuff would be in the way. Disintermediation (removing the middlemen) is the cure.

  11. I am a Nurse Practitioner looking to open my own practice. I am in north Atlanta. My specialties are integrative and regenerative medicine. I perform stem cell, prp (platelet rich plasma) and hormone therapy (Bio Te). I am a student of Dr. Charles Runels so I can perform his procedures (priapus shot and o shot). My concerns, like most on here is that the average person pays so much in mandatory insurance premiums that they either do not meet their deductible or cannot afford out of pocket services. I would love to find an MD or DO who would like to work with me.

    Holly Ridgley NP-BC

  12. Scott says:

    Can you share photos of what your office looked like with used furniture and equipment? Was your computer HIPPA compliant. regulations change, and patient expectations have changed.
    I like you are cash only, that is the best if you can survive or start with a strong patent base.

  13. Deepak Surana says:

    Dr. Wible, Would you be available for a call to discuss what my wife and I are trying to build near Austin TX? I found your information extremely helpful and would love to pick your brain as she ponders how to live a happier life as a practicing physician. Thank in advance for any time you can spare.

  14. S. Faye Rich says:

    I am a nurse practitioner who is looking to start my own clinic and looking to partner with alternative and ancillary providers. I’m looking to be an out of network provider that still can take insurance but want to be cash pay and provide statements so pts can submit. I have an MD to partner with. My question is next steps to get patients in the door. And do you recommend renting space from a medical practice that is already established?

    • Pamela Wible MD says:

      You can do that it you like. Keep overhead low. There are MANY ways to start. Download my guide to launching your ideal clinic on my website to review the various concepts.

  15. Bryan Hobson says:

    We are in the same boat with the office we have open already. We are HEAVILY comp but the medical field is something that our family has been involved with since 1978. We would like to transition to family practice and still do comp as well.

  16. Vy Vong says:

    What type of licenses or permits is needed to start a medical clinic?

    • Pamela Wible MD says:

      Medical license if you want to be the doctor or NP. If you just want to own a clinic then you may not need any license other than what is required in your state to run a business (like hair salon, gym, or whatever).

  17. Wesam Mahmoud says:

    I am international medical graduate
    What license I need to open a clinic
    Is it just USMLE ?
    I am hair transplant surgeon at my country

  18. Kaila Smith says:

    I know this is unlikely, but what if somebody wanted to open up their own practice after graduating? Do they have to practice under somebody first, or can they open it up as soon as they have a license?

  19. Sam says:

    Hi, i m a doctor specilized in homeopathy. I am very interested in starting my own practice. I hv read your blog andam very impressed by your thoughts. I alwts wanted to setup my personal practice. I m planning to start the practice at home, where i hv small study room. I would really aporeciate your thoughts on this. Any advice and recommendation would be highly appreciated.

  20. Charisse says:

    I figure office space rental cost vary geographically. How many square feet is your office space? Looking to determine reasonable cost range for price per square feet of space. I have never owned a businees/practice and am very excited by the prospect but am just figuring out the very basics. How did you approach the search for office space?

    • Pamela Wible MD says:

      Yes, There is geographic variation (more expensive in NYC, San Fran) however you can always find really cheap space (especially when you start out). If you are dedicated to keeping your overhead low (way better than trying downsize if you bit off too much early on) then always get creative about where you look for space. Craigslist, counseling offices, other medical clinics (rent a spare exam room). I’ve met one doc who has spent as little as $118/mo to rent a room in a nursing facility. Then there are others who have gotten FREE space donated to them from grateful communities. Avoid using a broker or real estate agent. Avoid high-priced real estate in the medical district of by hospitals. When I started I got my 280SF space for $280/mo ($1 per SF) in a wellness center. Over the last 12+ years I’m up to $425/mo now so still a great deal 🙂

  21. T.J. Bruner says:

    Hello

    Im trying to find out what are the requirements to open a low-T clinic in Texas (Austin). No Im not a doctor. but am an expert in the field of any aging medicine as it is called today.
    For example , I know a doctor needs to be on board to read the blood work etc but what and where would one get forms and the requirements needed to open such a clinic.
    an help would be appreciated.Thank You

    T.J.

  22. Angela says:

    I am not a doctor but would like to open a free/reduced cost women and childrens clinic. I would like to offer womens breast care, diabetes testing and nutritional classes, mental health services. How do I do this using volunteers and retirees?

  23. Thomas Easter MD says:

    I am considering a home health business. Do you think this could be operated from a virtual office? I would need a physical address (other than my home) to be able to have prescriptions issued.

    What do you think?

  24. Joshua Morris says:

    Came across your website and appreciate your thoughts. left Family Medicine after 7 years because of the rat race and went to ER medicine but now am wanting to go back and do a low overhead clinic…
    If I want to start a cash only low-overhead clinic do I have to opt out of medicare and medicaid (and jeopardize my day job) or can I just not see medicare/medicaid patients in my clinic ? It seems like you can go the other way (the DPC folks have it wired how to moonlight in the ER if you’ve opted out) but I cant seem to find the answer…Please point me in the right direction

    • Pamela Wible MD says:

      Hey Joshua, You do opt out if you want to take cash payments but can’t do that while working your day job. Put Mcaid/care patients on a waiting list while you get ramped up, then quit your day job and take folks in your practice as you are able. Happy to talk to you. I’ll email you. My phone 541-345-2437.

  25. Debra Myers says:

    so are you saying a physician asst. can open up a clinic. if its something like just lipotropic b12 injections? Or do you need to work under a doctors license.
    I am a nurse and want to open my own small clinic for just injectables. can I use a P.A. or have to have Doctor licensed.

    • Pamela Wible MD says:

      I’m not the expert on who can do what in what state; however, it is my understanding that PAs can not launch independent practices. I know that NPs can in a various states. I also know that some RNs can do independent practices in wound care. Check with your state med board for specific details.

  26. Trinell Robertson says:

    Hi Pamela,
    I am very impressed by your blog. I am really interested in starting a low overhead practice (walk-in/convenient care clinic) in a town where there is only one place to seek medical treatment. I am a family nurse practitioner in the state of GA. However, I am clueless as to where to start regarding licensing, insurance, etc. Any helpful suggestions/resources?

    • Pamela Wible MD says:

      I have some free material I can send you to get you started so do email me here: http://www.idealmedicalcare.org/blog/contact/. Also I can place you on my mailing list as I send out business strategy tips weekly or so. I’ve got a startup PDF to share and some teleclasses to start with. Just need your email & ph# (submit on link above)

  27. Kelly says:

    Hi! You may not be able to help but I am a PA-C with 11 + years of Orthopedic experience and had considered trying to open up a cash only Ortho urgent care type clinic that could save folks from going to the ER. Do you have any experience with PAs doing something like this?

  28. Mayra says:

    I am not a doctor and have worked all my life in the medical field, I would like to open a pediatric for family practice you think I could?

  29. Qadiyr Anderson says:

    What if you want to open a practice but don’t have a medical license at all. I would like to open a practice and hire a MD or two or three! I’m familiar with opening business and most of the time you don’t have know or do everything just know or know how to acquire the people that can. So can you open a practice not being licensed and hire someone licensed?

    • Pamela Wible MD says:

      Happy to help you do that. I know others who have lost their medical licenses who now run clinics and hire docs (who they care for very well).

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