Starting a Private Practice in Global Health: Your Essential Guide

Understanding What “Private Practice in Global Health” Really Means

When physicians think “starting private practice,” they often picture a solo or group clinic in their home city, negotiating with insurers, and managing a local patient panel. In global health, starting a private practice can look very different—and more varied:

Common models include:

1. Local brick-and-mortar clinic abroad

   • Example: A family medicine physician opens a primary care clinic in Kenya serving both local and expatriate populations, operating as a fee-for-service practice with sliding scales and community outreach.

2. Hybrid local–international practice

   • Example: A US-based internist with a global health residency track spends 6 months a year in a US private clinic and 6 months staffing a partnered clinic in Guatemala, with formal telemedicine follow-up in between.

3. Telemedicine-based international medicine practice

   • Example: A physician licensed in multiple countries offers remote consultation for migrant communities, travelers, or NGOs, focusing on infectious diseases, TB/HIV, and refugee health.

4. Consulting-focused practice

   • Example: An ID-trained global health physician builds a consulting practice advising NGOs, ministries of health, and academic groups on clinical protocols, outbreak response, and program evaluation, while seeing a smaller panel of complex patients.

5. Mixed clinical + NGO/academic contracts

   • Example: A pediatrician anchors a fee-based pediatric clinic in a low-resource city but also has contracted time with UNICEF and a local medical school, structurally woven into the private business.

Instead of asking “How do I open a clinic?” the more useful early questions are:

• Who do I want to serve? (e.g., refugees, rural communities, urban poor, migrant workers, travelers, expatriates)
• Where will care be delivered? (single country vs multiple; in-person vs telemedicine vs hybrid)
• How will I be paid? (fee-for-service, NGO contracts, university partnerships, retainer models, grants + consulting)
• How does it align with my training and licensure?

Global health training, especially via a global health residency track, gives a strong foundation in health systems, cross-cultural care, and resource-conscious medicine. But starting a private practice in this space adds layers: multi-country regulations, ethical dynamics, and significant logistical planning.

The rest of this guide walks through how to move from “interested in international medicine” to a realistic, sustainable, and ethical private practice in global health.

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Training, Skills, and Preparation Before You Launch

1. Clinical and Academic Preparation

For most physicians, the timeline runs:

• Medical school →
• Residency (often with a global health residency track) →
• Optional fellowship (ID, tropical medicine, maternal–child health, etc.) →
• Early career employment →
• Transition to opening medical practice, sometimes part-time first

Key preparation steps and credentials:

• Global health-focused residency or elective

  • Participating in a global health residency track offers:
    • Structured field experiences (e.g., 2–6 weeks/year abroad)
    • Mentorship with faculty experienced in international medicine
    • Exposure to health systems, public health, and ethics
  • These experiences also help you identify regions and partnerships that may later become practice sites.

• Additional training
  Consider:

  • Diploma or MSc in Global Health, Tropical Medicine, or Public Health
  • Courses in humanitarian response, disaster medicine, or travel medicine
  • Language training aligned with your intended region

• Licensure and board certification

  • Maintain active licensure in your home country; this underpins telemedicine, consulting, and income stability.
  • If planning in-person care abroad, research local or regional licensing routes; some countries allow short-term “visiting specialist” status, while others require full licensure.

2. Non-Clinical Skills for Private Practice

Running a global health-focused practice requires skills beyond medicine:

• Business basics

  • Reading financial statements, cash-flow projections, basic budgeting
  • Understanding “private practice vs employment” tradeoffs:
    • Employment: salary, benefits, lower risk, less autonomy
    • Private practice: higher potential upside, more control, but you carry the administrative, financial, and regulatory burdens
  • Even if you plan to outsource billing and accounting, you must understand the fundamentals to make decisions.

• Cross-cultural communication and community engagement

  • Global health practice relies on trust and partnership, not “medical tourism.”
  • Training or mentorship in community-based participatory methods is hugely helpful.

• Regulatory literacy

  • HIPAA or equivalent privacy frameworks
  • International data transfer rules (GDPR, local privacy laws)
  • NGO contracting terms (indemnity, intellectual property, liability)

• Leadership and negotiation

  • You’ll negotiate with landlords, local authorities, vendors, partner NGOs, and sometimes ministries of health.
  • Consider leadership courses or mentorship from physicians who already run international programs or practices.

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Designing Your Global Health Private Practice Model

Before filing legal paperwork or renting space, clarify your practice model. This strategic step will prevent costly misalignment later.

1. Clarify Your Core Service Lines

Common global health–oriented offerings include:

• Direct clinical care in low-resource settings

  • Primary care or family medicine
  • Maternal–child health, OB/Gyn, or pediatrics
  • HIV/TB/ID management
  • NCD (non-communicable diseases) management: diabetes, HTN, COPD

• Telemedicine in international medicine

  • Follow-up care for patients seen during overseas work
  • Travel medicine consults for individuals or organizations
  • Second-opinion services on tropical infections or complex global health issues

• Consulting and advisory services

  • Protocol development for NGOs or clinics (HIV/TB algorithms, triage systems)
  • Training local clinicians or community health workers
  • Program design and evaluation (maternal mortality reduction, vaccination campaigns)

• Hybrid clinical–educational practice

  • Joint appointments with academic global health centers
  • Hosting trainees at your practice site (e.g., elective rotations)

List your intended services and categorize them:

• Revenue drivers (e.g., private pay clinic visits, teleconsults, NGO contracts)
• Mission-driven/low-revenue (e.g., pro bono care, training programs)
• Strategic (building relationships, enhancing reputation, but less paid initially)

A focused launch (e.g., telemedicine + targeted clinic sessions at one vetted site) is usually more sustainable than trying everything at once.

2. Choosing Where to Anchor Your Practice

Options along a spectrum:

1. Home-country anchored with international components

   • Example:
     • Main office in Boston
     • 2 partner sites (Rwanda and Honduras) with defined annual rotations
     • Telehealth follow-up with patients and partners between visits
   • Pros: stable income, clear licensure, easier malpractice solutions
   • Cons: limited continuous presence abroad; travel costs

2. Primarily abroad, with home-country support

   • Example:
     • Full-time clinic in Nairobi, part of a local business entity
     • Occasional consulting or academic work back in the US/Europe via teleconferencing
   • Pros: deeper local impact and understanding
   • Cons: visa/licensing complexity, different legal risks, possible income volatility

3. Fully virtual (telemedicine and consulting)

   • Example:
     • Remote telemedicine for migrant communities in multiple time zones
     • Contracts with NGOs to supervise clinical protocols remotely
   • Pros: flexible, lower overhead, scalable
   • Cons: complex multi-jurisdiction licensure issues, tech dependence, patient access challenges

Be realistic about:

• Family and personal life (school-age children? partner employment?)
• Visa stability and local political context
• Financial buffers to handle instability or policy changes

3. Ethical and Equity Considerations

A global health private practice must grapple openly with ethics:

• Avoiding extractive or “parachute” care

  • Prioritize partnerships with local clinicians and institutions.
  • Aim to build local capacity, not dependency on visiting experts.

• Pricing and equity
  Consider tiered or cross-subsidized models:

  • Expat and medical tourist patients pay market rates.
  • Local patients pay reduced or sliding-scale fees.
  • Some NGOs or corporate clients subsidize services for low-income groups.

• Governance and local leadership

  • Include local clinicians or community representatives in your governance— e.g., advisory boards or co-ownership structures where feasible.

• Transparency

  • Clearly communicate what you can and cannot provide (e.g., limited imaging, referral pathways) to avoid misaligned expectations.

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Step-by-Step: From Idea to Opening Medical Practice

Think of your journey in phases: exploration, design, setup, and launch.

Phase 1: Exploration and Feasibility

1. Conduct a needs and context assessment

   • What are the unmet health needs in your target region or population?
   • Are you duplicating existing services or filling a clear gap?
   • What is the health system structure (public, private, NGO mix)?

2. Map stakeholders and potential partners

   • Local clinics/hospitals
   • NGOs and community-based organizations
   • Ministries of health and professional associations
   • Academic partners with long-standing presence

3. Spend time on the ground (if planning in-person practice)
   Avoid designing everything remotely:

   • Observe local clinics; talk to local clinicians and patients
   • Understand patient flows, payment mechanisms, and cultural norms
   • Identify local co-founders or senior clinicians if possible

4. Write a basic concept note
   Short (3–5 pages) document outlining:

   • Target population and region
   • Services and delivery model
   • Partnership plan
   • Rough budget and revenue expectations
   • Ethical framework

This concept note becomes a tool to get feedback from mentors, potential partners, and funders.

Phase 2: Practice Design and Business Planning

This is where global health intersects directly with starting private practice fundamentals.

1. Choose your business structure

   • In your home country: LLC, PLLC, S-corp, or equivalent professional structure
   • In host country: local corporation, NGO, social enterprise, or partnership with an existing entity
   • Consult an attorney versed in both health and international business law.

2. Financial modeling
   Build a simple 3–5 year financial model:

   • Start-up costs:
     • Legal fees (multiple jurisdictions)
     • Licensure and credentialing
     • IT systems (EHR, telehealth platforms)
     • Equipment and clinic setup if brick-and-mortar
   • Operating costs:
     • Staff salaries (local and remote)
     • Rent and utilities
     • Travel and housing (for international rotations)
     • Malpractice insurance
   • Revenue streams:
     • Fee-for-service visits
     • Telehealth consults
     • NGO/academic contracts
     • Corporate retainers (e.g., companies with staff working overseas)

   Include a worst-case scenario to ensure you have adequate cash buffers.

3. Legal and regulatory compliance

   • Confirm:
     • Medical licensure in each country where you’ll provide care
     • Telemedicine rules (geographic restrictions, cross-border practice, e-prescribing laws)
     • Data privacy rules (where servers must be located, encryption standards)
   • Secure malpractice insurance that explicitly covers:
     • International practice
     • Telemedicine across borders, if relevant
   • Create clear informed consent documents, tailored to your setting and language.

4. Clinical protocols and referral pathways

   Especially in low-resource settings:

   • Establish protocols adapted to local guidelines and available resources.
   • Map referral pathways:
     • Where will you send patients for imaging, surgery, intensive care?
     • Are there financial support mechanisms (charity funds, NGO partners)?

5. Technology and infrastructure

   For clinic-based practices:

   • Choose an EHR that:
     • Works offline or in low-bandwidth settings
     • Supports multiple languages
     • Meets privacy standards
   • Set up reliable backup for power and internet where unstable.

   For telemedicine-focused practices:

   • Use a secure, compliant platform (HIPAA and applicable international standards).
   • Plan for patient tech literacy and device constraints—sometimes simple phone-based systems work best.

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Running, Growing, and Sustaining Your Global Health Practice

Once you launch, the challenges shift from design to execution, quality, and sustainability.

1. Staffing and Team Building

Consider a distributed team:

• Local staff:

  • Nurses, mid-level providers, community health workers
  • Administrative/support staff
  • Local medical leadership, when possible

• Remote staff:

  • Billing and financial admin
  • IT support
  • Additional consulting physicians or subspecialists

Invest in:

• Ongoing training and mentorship for local staff
• Clear clinical governance (who makes final decisions, how standards are maintained)
• Fair compensation structures aligned with local norms and living costs

2. Financial and Operational Sustainability

Key principles:

• Diversify income
  Relying solely on out-of-pocket payments from low-income patients is rarely sustainable. Blend:

  • Middle- and high-income patients (expats, travelers, insured locals)
  • Institutional contracts (NGOs, universities, corporate clients)
  • Consulting or academic work

• Watch cash flow, not just revenue
  Delays in NGO payments, travel costs, or sudden equipment needs can destabilize your operations. Keep reserves and lines of credit.

• Iterate your service mix
  After 6–12 months, review:

  • Which services are used most?
  • Which are financially viable, and which require external subsidy?
  • Are there opportunities to adjust hours, staffing, or pricing?

3. Marketing, Referrals, and Reputation

Global health practices grow primarily through trust and word-of-mouth.

• Local outreach

  • Meet with community leaders and local clinicians
  • Run health education sessions and screening events
  • Partner with existing programs rather than duplicating them

• Digital presence

  • Create a simple, multilingual website explaining:
    • Services
    • Locations and telehealth options
    • Pricing or how billing works
    • Your approach to ethics and equity
  • Use professional networks (LinkedIn, specialty societies) to reach NGOs, academic programs, and global health organizations.

• Niche positioning
  Rather than “we do everything,” position yourself clearly:

  • “International medicine and travel health practice for NGOs and expatriates working in East Africa.”
  • “Global health pediatric care with telemedicine continuity between US and Latin America.”
  • “ID and tropical medicine consultation practice specializing in complex TB/HIV and migrant health.”

4. Quality, Safety, and Measurement

Your responsibility is to deliver care that is:

• Clinically appropriate for the local context
• Safe and consistent with recognized international and local standards
• Measurable and improvable over time

Build in:

• Key performance indicators (KPIs):

  • Access: wait times, panel size
  • Quality: vaccination coverage, BP control, HIV viral suppression rates
  • Patient experience: satisfaction surveys, complaint tracking

• Morbidity and mortality reviews

  • Regular case discussions, ideally including local clinicians and remote specialists.
  • Focus on system improvement, not blame.

• Audit and feedback loops

  • Chart reviews
  • Protocol adherence checks
  • Feedback from partners and patients

5. Work–Life Balance and Burnout Prevention

Private practice in global health can be uniquely draining:

• Emotional exposure to poverty, conflict, or systemic injustice
• Complex logistics and constant travel
• Being “on call” in multiple time zones

Plan upfront:

• Clear boundaries on availability (e.g., telemedicine hours, emergency coverage rules)
• Adequate staffing so you can take time off
• Peer support—mentors, supervision groups, or professional counseling
• A long-term view: avoid building a model that relies on you being everywhere all the time

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Private Practice vs Employment in Global Health: Which Path Fits You?

Many physicians wonder whether to jump straight into private practice or start in a more traditional employment arrangement. Both can support a career in international medicine; they simply emphasize different tradeoffs.

Advantages of Employment (Pre- or Instead of Private Practice)

• Stable salary and benefits
• Existing infrastructure and teams
• Lower personal financial risk
• Time to build experience in your target region
• Possibility of protected time for research or teaching

Examples:

• Global health faculty position at an academic center with built-in overseas sites
• Full-time physician with an international NGO or humanitarian organization
• Hospitalist role at a US hospital with periodic funded global health projects

Advantages of Starting a Private Practice in Global Health

• Full control over:
  • Where and how you practice
  • Which patient populations you prioritize
  • How to blend clinical care, consulting, and academic work
• Potential financial upside if the model scales successfully
• Ability to design truly hybrid careers that don’t fit institutional boxes

For many physicians, the most realistic path is sequential:

1. Early career in employment (to gain experience, reputation, and savings)
2. Gradual build-up of a side global health consulting or telemedicine practice
3. Transition to a more fully independent international practice once financially and professionally feasible

The right answer will depend on your risk tolerance, family obligations, and long-term goals.

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Frequently Asked Questions (FAQ)

1. Do I need a global health residency track to open a global health private practice?

No, it’s not mandatory, but it helps significantly. A global health residency track provides:

• Structured field experiences and mentorship
• Exposure to health systems and public health, beyond individual patient care
• Connections to international partners and institutions

If your residency did not have this track, you can supplement with:

• Post-residency global health fellowships
• Short courses and diplomas in global health or tropical medicine
• Longitudinal work with reputable NGOs or academic programs

2. How do I handle licensure and malpractice when practicing in multiple countries?

This is one of the most complex aspects of international medicine. Basic steps:

• Maintain valid licensure in your home country.
• For in-person care abroad, research:
  • Whether you need full licensure vs temporary visiting status
  • Requirements from local medical councils or ministries of health
• For telemedicine:
  • Check rules where you are located and where the patient is located—some jurisdictions require dual licensing.
• Obtain malpractice coverage that explicitly:
  • Covers international practice
  • Covers telemedicine, if applicable
• Work with an attorney and insurer familiar with cross-border clinical work.

3. How do I make an ethically sound income while serving low-resource populations?

Ethical income generation in global health private practice typically involves:

• Cross-subsidization: charging market rates to higher-income clients (expats, corporate clients, medical tourists) to subsidize lower-cost or free services for low-income local patients.
• Institutional contracts: negotiating fair contracts with NGOs, governments, or universities that fund your time and services.
• Transparency: clearly communicating your model to communities and partners.
• Local benefit: ensuring local staff are fairly paid, and systems you build are sustainable beyond your personal presence.

A purely fee-for-service model targeting only low-income patients is usually both unsustainable and ethically problematic.

4. Is starting a global health private practice feasible right out of residency?

It’s technically possible but usually not advisable. Newly graduated physicians often lack:

• Sufficient clinical depth for highly complex, low-resource settings
• Business and regulatory literacy
• Established networks and trusted partnerships abroad
• Financial reserves to handle start-up risk

A more sustainable pathway is:

1. Complete residency (ideally with global health exposure).
2. Work in a salaried role (domestic or global health–related) for several years.
3. Build relationships and test small-scale models (e.g., periodic consulting, telemedicine).
4. Transition to opening medical practice only when you have:
   • A clear model,
   • Trust-based partners, and
   • Financial runway to weather uncertainty.

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Starting a private practice in global health is ambitious, demanding, and deeply meaningful. By grounding your vision in rigorous preparation, ethical partnerships, realistic financial planning, and a clear understanding of the private practice vs employment landscape, you can create a career that serves both your patients and your long-term professional goals—while contributing meaningfully to more equitable health systems worldwide.