Your Comprehensive Guide to Starting a Private Practice in Anesthesiology

Launching your own anesthesiology private practice is both exciting and daunting. Compared with many other specialties, anesthesiology presents unique challenges: dependence on surgeons and facilities for cases, complex payer relationships, and rapidly evolving models of hospital employment and corporate management groups. Yet for motivated residents and early-career anesthesiologists, starting private practice can offer autonomy, income potential, and the ability to shape your work environment.

This guide walks step-by-step through what you should consider—from residency to your first signed contract with a facility—so you can move from the anesthesia match to ownership with clarity and strategy.

---

1. Laying the Groundwork During Training

Even before you graduate, you can prepare for a future in private practice. The decisions you make during anesthesiology residency can shape your options for years.

1.1 Choosing Your Training Path With Private Practice in Mind

If you’re still in the anesthesia match or early in residency, keep these in mind:

• Program reputation and alumni network
  Programs with strong ties to community hospitals and ambulatory surgery centers (ASCs) often have alumni in influential private groups. These relationships can open doors for partnerships or contracts later.

• Case mix and autonomy
  Private practice anesthesiologists must be highly efficient and comfortable running multiple rooms and managing complex cases. Seek:

  • Heavy exposure to bread‑and‑butter cases (general surgery, orthopedics, OB, GI, ENT)
  • Opportunities to supervise CRNAs or residents
  • Experience in ambulatory and office-based anesthesia

• Fellowship decisions
  Fellowship is not mandatory for private practice, but strategic subspecialization can:

  • Increase marketability in competitive regions (cardiac, pediatrics, or pain, especially)
  • Strengthen negotiating leverage when joining or forming a group
  • Open additional revenue streams (e.g., chronic pain procedures)

1.2 Building Non-Clinical Skills Early

Owners of an anesthesiology private practice are not just clinicians—they’re small business executives. During residency:

• Take advantage of business and leadership electives
  If your program offers:

  • Healthcare administration rotations
  • Practice management lectures
  • Quality improvement/OR efficiency projects

  …lean into these. They mirror the skills needed to run a practice.

• Seek mentors in private practice
  Ask attendings:

  • How their group is structured
  • Whether they are partners, employees, or independent contractors
  • What they wish they had learned before entering practice

• Learn the language of reimbursement
  At a minimum, understand:

  • How ASA units work
  • The difference between ASA, Medicare, Medicaid, and commercial reimbursement
  • The basics of billing modifiers, concurrency, and documentation requirements

• Practice efficiency and communication
  Your future surgeons and administrators will judge you on:

  • Turnover times
  • Punctuality
  • Ability to solve problems without escalating unnecessarily
  • Collegiality with staff and surgeons

These “soft skills” often determine whether a hospital or ASC invites your group—or replaces you.

---

2. Private Practice vs Employment: Choosing Your Path

Before starting a private practice in anesthesiology, you should honestly evaluate whether you want to be an owner at all—or whether an employed model (hospital, large group, or corporate) better fits your goals.

2.1 Models of Anesthesia Practice

You’ll likely encounter several structures:

• Hospital employment

  • Salary-based compensation, sometimes with productivity or quality bonuses
  • Less control over staffing, schedule, and policies
  • Administrative support for billing, compliance, and negotiation
  • Often easier as a first job; harder to build equity or long-term ownership

• Private practice group (traditional partnership track)

  • You join as an associate, then become a partner after 1–3 years
  • Shared ownership of contracts, goodwill, and sometimes equipment
  • Income correlates with group profitability; usually higher upside
  • Greater say in governance, but also more responsibility and risk

• Independent contractor / solo practitioner

  • You bill directly and contract with facilities
  • Complete autonomy but highest administrative burden
  • Requires strong business acumen and local relationships

• Corporate anesthesia management companies

  • Employment within a larger, often multi-state entity
  • Variable autonomy; corporate policies often dictate practice structure
  • May offer geographic mobility and administrative support, but limited ownership of local practice value

Understanding private practice vs employment helps you decide whether to build your own group, join and later lead an existing one, or remain employed long-term.

2.2 Self-Assessment: Are You Ready to Be an Owner?

Owning an anesthesiology private practice demands more than clinical expertise. Ask yourself:

• Do you enjoy negotiating and advocating for yourself and your group?
• Are you willing to tolerate income variability and business risk?
• Can you delegate and manage employees or partners?
• Are you drawn to systems thinking—OR throughput, staffing models, call coverage, and quality metrics?
• Are you prepared to invest time in regulatory compliance, credentialing, and contract details?

If your honest answer is “not yet,” you may choose:

• A first job in a well-run private group to learn from inside, or
• A hospital-employed role while you build experience and local connections.

---

3. Strategic Planning: From Vision to Business Plan

If you decide to move forward with starting private practice, treat it like a startup. You need a strategic plan, not just a good CV.

3.1 Clarify Your Practice Model and Scope

Key choices include:

• Inpatient vs outpatient focus

  • Hospital-based anesthesia: larger case volume, call responsibilities, ICU or OB coverage
  • ASC/outpatient focus: shorter cases, more predictable hours, often lower reimbursement per case but higher throughput
  • Office-based anesthesia (dentistry, plastics, GI clinics): niche markets with direct contracts

• Clinical scope

  • General anesthesia only
  • Inclusion of:
    • Regional anesthesia for ortho and trauma
    • Obstetric anesthesia
    • Cardiac or thoracic (if fellowship-trained)
    • Chronic pain management (possible separate practice line)

• Geographic and market considerations

  • Urban vs rural:
    • Urban: competitive, higher volume, more existing groups
    • Rural: less competition, possible hospital subsidies or stipends
  • Payer mix:
    • High commercial insurance areas are generally more lucrative
    • Regions with heavy Medicaid/uninsured populations need careful financial planning

3.2 Market Analysis and Relationship Mapping

Before opening medical practice, conduct a focused local market analysis:

• Identify potential clients

  • Hospitals
  • Ambulatory surgery centers (independent or health system-owned)
  • Office-based practices (GI, dental, oral surgery, plastics, ophthalmology)

• Map existing anesthesia coverage

  • Which groups or companies currently staff each facility?
  • Are there signs of dissatisfaction? (complaints about coverage, turnover, quality issues)
  • Do facilities rely on locums coverage?

• Understand decision makers

  • Hospital CMO, CNO, or CEO
  • OR director or anesthesia medical director
  • Owners/administrators of ASCs
  • High-volume surgeons who influence administration

Start relationship-building early, even before you formally launch.

3.3 Drafting a Business Plan

Your business plan is a roadmap and a tool for discussions with banks, partners, and facilities. It should include:

• Executive summary

  • Your practice name, mission, and value proposition
  • Example: “Providing high-quality, efficient anesthesia services focused on regional techniques and enhanced recovery for orthopedic and outpatient surgery centers in [City].”

• Market and competitive analysis

  • Summary of local facilities, case volumes, and competing groups
  • Identified opportunities (e.g., a new ASC seeking coverage, a hospital unhappy with current staffing)

• Services and clinical model

  • Types of anesthesia and procedures covered
  • Staffing model: MD-only, MD/CRNA care team, or combination
  • Proposed call and coverage model

• Operational plan

  • Daily workflow, case assignment, preoperative clinic (if applicable)
  • Scheduling, coverage of add-ons, emergency cases

• Financial projections

  • Expected case volume (conservative and optimistic scenarios)
  • Payer mix assumptions and average reimbursement per ASA unit
  • Fixed costs (rent, insurance, staff salaries, billing services, EMR, equipment, legal and accounting fees)
  • Variable costs (drugs/supplies if you’re responsible, locums coverage)
  • Cash flow projections for first 12–24 months

• Risk analysis and mitigation

  • Loss of a contract
  • Slow volume ramp-up
  • Delays in payer credentialing and contracting
  • Backup funding or line of credit

Even if you self-fund and don’t share the plan with a bank, writing it forces you to think like an owner.

---

4. Legal, Financial, and Operational Setup

Once your plan is clear, you move into execution: forming your entity, securing contracts, and setting up systems.

4.1 Choosing a Legal Structure

Most anesthesiology private practices in the U.S. use one of:

• Professional Corporation (PC / P.C.)
• Professional Limited Liability Company (PLLC)
• Limited Liability Partnership (LLP) or general LLC (if allowed in your state)

Consider:

• Liability protection – shields personal assets from business liabilities (not from malpractice).
• Tax implications – pass-through taxation vs potential S-corp election for payroll/distribution optimization.
• State restrictions – some states require professional corporations for physicians.

Engage a healthcare-focused attorney to:

• Form your entity
• Draft bylaws/operating agreements (especially if there will be partners)
• Review or draft hospital/ASC service agreements
• Ensure Stark Law and Anti-Kickback Statute compliance (especially for pain practices or co-owned ASCs)

4.2 Contracts: The Core of an Anesthesia Practice

An anesthesia private practice typically derives most revenue through one or more of:

• Exclusive provider agreements with hospitals or ASCs
• Professional service agreements with specific surgeons or office-based practices
• Pain clinic services including procedures and evaluations

Key elements to negotiate in these agreements:

• Scope of services (which locations, hours, subspecialties)
• Coverage requirements (call, OB, trauma, ICU, remote sites)
• Staffing expectations (MD-only vs care team ratios)
• Quality and performance metrics (on-time starts, turnover, patient satisfaction)
• Compensation/support:
  • Professional billing rights (you bill and collect)
  • Facility stipends or subsidies to support coverage
  • Term, termination provisions, and non-compete terms

This is not the place to cut corners; legal review is essential.

4.3 Malpractice Insurance and Risk Management

You’ll need:

• Medical malpractice insurance (professional liability)

  • Claims-made vs occurrence policies
  • Tail coverage for claims-made policies when leaving a contract or selling your practice
  • Adequate limits based on your state norms and practice risk profile

• Business insurance

  • General liability
  • Cyber liability (especially if hosting your own EMR/billing data)
  • Workers’ compensation and employment practices liability if you hire staff

Integrate a robust quality assurance (QA) program:

• Regular peer review
• Incident reporting
• Morbidity and mortality reviews
• Protocols for airway emergencies, local anesthetic systemic toxicity (LAST), and difficult cases

Beyond safety and ethics, a strong QA program can differentiate your group when competing for contracts.

4.4 Revenue Cycle: Billing, Coding, and Collections

Your revenue depends heavily on documentation and billing accuracy.

Decide if you will:

• Hire an in-house billing team

  • More control but higher fixed cost
  • Requires expertise in anesthesia-specific billing (ASA units, concurrency, modifiers)

• Outsource to an anesthesia billing company

  • Performance often tied to a percentage of collections
  • Vet references and ask for anesthesia-specific metrics

Core elements to establish:

• Accurate, detailed documentation templates

  • Start times, end times, ANES start/stop times
  • ASA physical status
  • Procedure codes and diagnoses
  • Modifiers (e.g., QK, QX, AA, QS)

• Clear financial policies

  • Handling of patient balances after insurance
  • Charity care / hardship policies (if relevant)

Because cash flow may lag 60–120 days after starting, secure a line of credit or startup capital that covers at least 3–6 months of operating expenses.

---

5. Clinical Operations, Staffing, and Growth

With your legal and financial foundation set, the next step is running and scaling the day-to-day practice.

5.1 Staffing Strategy

Decide on:

• MD-only vs care team model

  • MD-only:
    • Simpler management
    • Higher per-case cost, often appropriate for smaller or high-acuity facilities
  • MD/CRNA care team:
    • Common in community hospitals and ASCs
    • Allows coverage of more rooms but requires leadership and supervision systems

• Employment vs contracting with CRNAs

  • Employed CRNAs:
    • You control hiring, culture, schedules
    • Responsible for benefits and HR issues
  • CRNA groups or independent contractors:
    • Less HR burden
    • Less control over staffing changes

• Administrative support

  • Office manager
  • Scheduler/credentialing specialist
  • Part-time HR or outsourced HR/payroll service

Hiring the right practice manager early can free you to focus on clinical care and relationship-building.

5.2 Scheduling, Workflow, and OR Efficiency

Your value proposition as a private practice group often hinges on how smoothly the OR runs:

• Create predictable coverage schedules

  • Clear policies for first-start times, add-on rooms, and late-running rooms
  • Transparent call and weekend distribution among providers

• Collaborate with OR leadership

  • Participate in daily or weekly OR huddles
  • Help surgeons and administrators problem-solve bottlenecks
  • Offer data: on-time starts, turnover times, block utilization

• Standardize common protocols

  • Pre-op evaluation pathways
  • NPO and medication management guidelines
  • Regional anesthesia pathways (when appropriate)
  • Enhanced Recovery After Surgery (ERAS) protocols

Being seen as a solution-oriented partner significantly improves your leverage and contract stability.

5.3 Marketing and Relationship Development

Unlike many outpatient specialties, anesthesiology private practice growth is driven less by direct-to-patient marketing and more by facility and surgeon relationships.

Focus on:

• Building trust with surgeons

  • Be available and responsive
  • Support their scheduling needs within reason
  • Provide excellent pain control and post-op outcomes for their patients

• Collaborating with administrators

  • Share quality and efficiency data
  • Be proactive about staffing challenges and cost pressures
  • Demonstrate flexibility when new service lines start (e.g., robotics, new GI lab, cardiac program)

• Reputation in the local medical community

  • Professional behavior in all interactions
  • Participation in hospital committees
  • Supporting residency programs or nursing anesthesia education if present

This relationship capital is often the difference between thriving and struggling practices.

5.4 Growth and Long-Term Strategy

Once established, think beyond mere survival:

• Evaluate additional service lines

  • Add chronic pain services (if appropriately trained and credentialed)
  • Partner with dentists or oral surgeons for office-based anesthesia
  • Expand into additional ASCs or satellite hospitals

• Develop a partner track (if group-based)

  • Clearly defined expectations and timeline for associates
  • Transparent buy-in structure (goodwill, AR buy-in, shares)
  • Governance structures: elected medical director, executive committee

• Consider future exit strategies

  • Sell to another private group
  • Merge with or be acquired by a corporate anesthesia company
  • Transition leadership to junior partners while maintaining partial ownership

Thinking ahead to your eventual transition can help you build a more sustainable and valuable practice.

---

6. Common Pitfalls and Practical Tips for New Practices

Starting an anesthesiology residency is structured and supervised; starting a private practice is not. Learn from others’ missteps to avoid costly lessons.

6.1 Pitfalls to Avoid

• Underestimating startup time and cash flow delays

  • Credentialing and payer enrollment can take 3–9 months
  • Build a realistic runway with savings or financing

• Signing unfavorable exclusive contracts

  • Overly broad non-competes that bar you from practicing in your own city
  • Termination clauses allowing the hospital/ASC to end contracts with minimal notice
  • Unrealistic staffing guarantees without adequate financial support

• Ignoring compliance and documentation

  • Poor documentation risks denied claims, audits, and legal exposure
  • Inadequate informed consent processes, especially in office-based settings

• Inadequate malpractice or tail coverage

  • A major claim can be financially devastating if not properly insured

• Scaling too fast

  • Adding new sites before your team, systems, and finances are ready
  • Taking on contracts with poor payer mix or unreasonable expectations

6.2 Actionable Advice for Residents and New Graduates

If you’re still in training or just finishing anesthesiology residency:

• Use electives strategically

  • Request rotations at community hospitals or ASCs where private groups practice
  • Ask specific questions about partnership, governance, and financial structure

• Keep a “practice notebook”

  • Jot down ideas about how you’d run pre-op clinics, manage staffing, or improve OR flow
  • Note what you admire—and what you’d avoid—about your current attendings’ groups

• Build financial resiliency early

  • Live below your means your first year or two out of training
  • Pay down high-interest debt but retain enough liquidity to pivot into ownership when opportunities arise

• Network intentionally

  • Attend local and state society meetings (anesthesiology and medical society)
  • Stay in touch with alumni and attendings who have practice leadership roles

These steps make the transition from residency to anesthesia private practice smoother and more intentional.

---

FAQs About Starting a Private Practice in Anesthesiology

1. Should I go directly into private practice after residency, or work as an employee first?

Either path can work. Many anesthesiologists work 1–3 years as employees or associates to:

• Gain real-world experience
• Understand practice finances and contracts
• Build relationships with surgeons and administrators

Going directly into independent practice is possible, but higher risk. If you choose that route, surround yourself with experienced legal, financial, and billing advisors.

2. How does income in private practice compare to employment?

In general, private practice vs employment breaks down as:

• Employment:

  • More predictable salary and benefits
  • Often lower ceiling on total compensation
  • Less direct exposure to financial risk

• Private practice:

  • Income can be higher, especially after partnership or once the practice is established
  • Income varies with case volume, payer mix, and contract stability
  • You bear business and legal risk, but also build equity in the practice

Consider your risk tolerance and life circumstances when deciding.

3. What’s the biggest mistake new anesthesiology private practices make?

Two common ones:

1. Signing poorly vetted contracts—particularly around non-competes, termination, and unrealistic coverage requirements.
2. Neglecting billing and documentation systems—leading to poor collections and cash flow problems.

Investing early in qualified legal and billing support is more cost-effective than trying to fix foundational errors later.

4. Can I start a private practice focused only on pain management after anesthesia residency?

Yes—many anesthesiologists build practices centered around interventional pain. However:

• A pain fellowship is strongly recommended (and often required) to:
  • Broaden your skillset
  • Improve credibility with referring physicians and payers
  • Navigate complex regulatory and prescribing environments

Pain-focused practices also have different regulatory and financial considerations, including Stark, opioid prescribing laws, and potentially different payer relationships. Engage a healthcare attorney with pain practice experience if you choose this path.

---

Starting a private practice in anesthesiology is a significant undertaking, but with deliberate planning, strong mentorship, and a clear-eyed look at both clinical and business realities, it can be one of the most rewarding ways to practice. Whether you’re still in the anesthesia match, finishing residency, or several years into your career and reconsidering your path, thoughtful preparation now will give you more autonomy and options later.