Starting a Private Practice in Medicine-Pediatrics: A Comprehensive Guide

Understanding the Med-Peds Landscape Before You Launch

Launching a private practice in Medicine-Pediatrics (Med-Peds) can be one of the most rewarding—and complex—paths you choose after residency. You are not just hanging a shingle; you are building a dual-focused clinical home that serves both adults and children, often caring for families across generations and for patients with complex transitions-of-care needs.

Before you commit to starting a private practice, step back and analyze three big-picture questions:

1. Why Med-Peds specifically?
   Med-Peds offers unique advantages in private practice:

   • Seamless care for patients with childhood-onset conditions (e.g., cystic fibrosis, congenital heart disease, sickle cell disease, type 1 diabetes) as they become adults
   • “Whole-family” care—parents, children, and sometimes grandparents in the same practice
   • Strong appeal in communities with limited subspecialty access; you can serve as the de facto complex care coordinator

2. Where do Med-Peds physicians fit in the current market?
   The medicine pediatrics match has remained competitive, and many graduates join large systems or academic centers. Private practice is still viable, but:

   • Hospital employment and large multispecialty groups have grown
   • Payer contracts (especially for pediatrics) can be tight
   • Administrative and regulatory requirements are heavier than a decade ago

   This environment doesn’t eliminate the possibility of opening a practice—it just means you must be deliberate, data-driven, and prepared.

3. Is private practice right for you compared with employment?
   Consider private practice vs employment across several dimensions:

   • Autonomy
     • Private: High control over schedule, staffing, clinical policies, care model, and growth strategy
     • Employed: Less control, but fewer business pressures
   • Financial risk and reward
     • Private: Higher startup costs and personal financial risk; potential for higher long-term earnings and equity
     • Employed: Predictable salary and benefits, minimal risk, no ownership
   • Administrative burden
     • Private: You (or your partner/manager) handle HR, compliance, billing, marketing, and budgeting
     • Employed: Large system handles infrastructure, you focus more on clinical work

Ask yourself:

• Do I enjoy planning, leading, and making business decisions?
• Am I comfortable with financial uncertainty for 1–3 years?
• Do I have the resilience to handle both clinical and administrative roles?

If your answers lean toward autonomy, long-term vision, and entrepreneurship, Med-Peds private practice can be an excellent fit.

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Strategic Planning: From Vision to Practical Blueprint

Before signing a lease or ordering an EHR, invest time in structured planning. Treat this as your “pre-op” phase—good preparation prevents complications later.

Define Your Clinical Niche and Service Mix

Med-Peds allows significant flexibility in designing your practice. Clarifying your niche will drive everything else: location, space, staffing, marketing, and payer strategy.

Common Med-Peds practice models:

• Traditional primary care (50/50 adult/peds)

  • Routine well-child and adult preventive care
  • Acute visits for common conditions
  • Chronic disease management (e.g., diabetes, HTN, asthma, ADHD)

• Family-focused continuity practice

  • Emphasis on family units: parents and children seen in the same visit blocks
  • Convenient scheduling and care coordination (e.g., “family well visit” time slots)

• Complex care and transitions clinic

  • Focus on children with special healthcare needs and their transition into adulthood
  • Coordination with subspecialists, social workers, and community resources
  • Often higher complexity coding but also more administrative intensity

• Hybrid with procedures or special skills

  • Office procedures: joint injections, skin biopsy, basic gynecologic procedures
  • Addiction medicine, obesity medicine, or HIV care
  • Hospital medicine or newborn rounding integrated with outpatient work

Ask:

• What type of patient panel do I want in year 3–5?
• How will my Med-Peds training uniquely add value in my market?

Conduct a Focused Market Analysis

You do not need a 100-page consulting report, but you do need data that informs your decisions.

1. Define your catchment area.
   • Typically within 5–10 miles in urban/suburban settings; broader in rural areas.
2. Assess competition and gaps.
   • How many pediatricians, internists, family physicians, and Med-Peds physicians practice nearby?
   • Are they heavily booked or accepting new patients?
   • Are there major hospital systems dominating primary care?
3. Study demographics.
   • Age distribution: are there many young families? an aging population?
   • Insurance mix: commercial, Medicaid, Medicare, uninsured
   • Income levels: can the community sustain a more concierge-like model or primarily insurance-based?

Use sources like:

• State and local health department reports
• Census data
• Hospital and health system “find a doctor” tools
• Conversations with local specialists, ED physicians, and school nurses

From this, identify your advantage. For example:

• “Only Med-Peds practice within 20 miles”
• “Only practice explicitly focused on transitions of care for complex young adults”
• “First independent primary care practice in a region dominated by large systems”

Choose a Practice Structure: Solo, Partnership, or Group

1. Solo med-peds practice

• Pros: Maximum autonomy; consistent culture; clear branding
• Cons: Higher personal call burden; vulnerability to cash flow issues; you do everything (until you hire help)

2. Partnership with another Med-Peds or a complementary specialty

• Med-Peds + Med-Peds:
  • Shared call, cross-coverage, more flexible scheduling
  • Potential to grow into a small group quickly
• Med-Peds + Family Med or Internal Med + Peds practice:
  • Shared infrastructure and broader marketing reach
  • Can complicate decision-making and revenue sharing

3. Joining or forming a small group

• Pros: Economies of scale; better negotiating power with payers; shared admin support
• Cons: Less flexibility; group politics; requires well-constructed partnership/operating agreements

Consider your long-term goals. If you desire a modest, lifestyle-aligned practice, solo or 2–3 physician group is common in Med-Peds. If you anticipate rapid growth, plan for multi-physician space and systems from the start.

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Legal, Financial, and Operational Foundations

Opening medical practice doors without a solid legal and financial framework is risky. You are not just starting a clinic—you are launching a regulated healthcare entity.

Choose the Right Legal Entity and Protect Yourself

Common practice structures for small private practices include:

• Professional Limited Liability Company (PLLC)
• Professional Corporation (PC)
• Limited Liability Partnership (LLP) (varies by state)

Key steps:

1. Hire a healthcare-savvy attorney for:

   • Entity formation and registration
   • Drafting or reviewing your operating/partnership agreements
   • Ensuring compliance with state-specific corporate practice of medicine rules
   • Reviewing your lease and major vendor contracts

2. Obtain an EIN and NPI

   • Employer Identification Number from the IRS
   • Type 1 NPI (individual) and Type 2 NPI (organization) for billing and insurance credentialing

3. Licensure and registrations

   • State medical license(s)
   • DEA registration and any state-specific controlled substance registrations
   • CLIA waiver if you plan to run in-house labs (e.g., rapid strep, urinalysis, A1c)

Build a Realistic Startup Budget

Underestimating startup costs is a common error when starting a private practice. Costs vary by region and scope, but you should plan for at least 6–12 months of operating capital.

Major cost categories:

1. One-time startup costs

   • Legal and accounting fees
   • EHR setup and training
   • Practice management/billing software
   • Furniture, exam tables, medical equipment, and supplies
   • IT infrastructure: computers, networking, printers, telehealth setup
   • Signage, website design, initial marketing

2. Ongoing monthly expenses

   • Rent and utilities
   • Staff salaries and benefits
   • Malpractice insurance
   • Billing services or billing staff
   • EHR and software subscriptions
   • Medical and office supplies
   • Loan payments (if you finance startup costs)

Work with an accountant who understands small medical practices. Develop:

• A 12–24 month cash flow projection
• Conservative patient volume assumptions (it often takes 18–36 months to reach a stable full panel)
• Scenario plans: What if volume is 30% lower than expected? Can your practice still survive?

Funding Your Practice

You have several options for funding:

• Personal savings or loans from family (risk: personal relationships)
• Bank loans, often backed by an SBA (Small Business Administration) guarantee
• Lines of credit specifically for physicians (many banks cater to medical professionals)
• Gradual ramp-up while partially employed elsewhere (e.g., working part-time hospitalist or urgent care shifts as you build your panel)

Banks will look for:

• A detailed business plan
• Your personal financial history and credit
• Projected financial statements

Do not over-borrow, but also avoid the trap of being so under-capitalized that you are constantly in crisis mode the first year.

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Practical Setup: Space, Systems, and Staffing

Once your strategy and financial plan are in place, it is time to translate ideas into a working clinic.

Selecting and Designing Your Clinic Space

Key considerations when choosing a location:

• Accessibility: Easy parking or public transportation, handicap access
• Proximity to hospitals, labs, and imaging centers
• Visibility: Street-front signage vs office building; proximity to schools or community centers
• Lease flexibility: Ability to expand if your practice grows

Design with both adults and children in mind:

• Exam rooms that can comfortably fit a parent and child together
• Height-adjustable exam tables suitable for all ages
• Pediatric-friendly touches without making adults feel out of place (neutral colors, subtle children’s décor in a portion of the waiting room)

Make sure your layout supports:

• Efficient patient flow (check-in, vitals, exam, checkout)
• HIPAA privacy at registration and in exam rooms
• Team collaboration (workstations where clinicians and staff can coordinate care)

EHR, Billing, and Practice Management Systems

Your choice of systems will hugely influence daily operations and burnout risk.

Electronic Health Record (EHR)

• Look for:
  • Strong pediatric and internal medicine templates (well-child visits, adult chronic disease management)
  • Immunization registry interfaces and growth charts
  • Integrated e-prescribing, lab interfaces, and patient portal
  • Quality reporting and value-based care dashboards

Practice Management and Billing

• Decide whether you will:
  • Hire an in-house biller OR
  • Outsource to a billing company (typically 4–8% of collections)

Essential capabilities:

• Appointment scheduling and reminder systems (text/email/phone)
• Insurance eligibility verification
• Claims management, denials tracking, and reporting

Given Med-Peds’ mix of payer types (Medicaid for pediatrics, Medicare for older adults, commercial plans, and sometimes dual-eligible patients), robust billing support is vital to maintaining revenue.

Staffing Your Med-Peds Practice

At minimum, a new solo Med-Peds practice might start with:

• 1 physician (you)
• 1 medical assistant or nurse
• 1 front-desk/administrative staffer (may also handle basic billing or referrals)

As you grow, consider:

• Additional MAs or LPNs to support high-complexity or high-volume sessions
• A practice manager or office administrator once you have 2–3 clinicians
• A care coordinator or RN if you emphasize complex chronic care and transitions

Hire for:

• Strong communication skills
• Comfort with both pediatric and adult patients
• Alignment with your practice culture (family-centered, evidence-based, efficient)

Provide onboarding and cross-training so staff understand:

• Vaccination schedules and VFC (Vaccines for Children) program requirements (if applicable)
• Chronic disease registries and preventive care reminders
• Patient portal workflows and telehealth protocols

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Clinical, Business, and Growth Strategies Specific to Med-Peds

Your Med-Peds training gives you unique opportunities when starting a private practice. Use them strategically to differentiate your clinic and build a sustainable model.

Building a Panel: Marketing and Relationship-Building

A major fear for new physicians is: “Will anyone come?” There are concrete steps to grow volume steadily.

Branding and messaging

• Emphasize:
  • “Care for all ages—from newborns to older adults”
  • Expertise with childhood-onset conditions in adulthood
  • Family-centered care and continuity over the lifespan

Practical tactics:

• Create a professional website highlighting:
  • Your Med-Peds background, residency, and board certifications
  • Services offered and your philosophy of care
  • Online scheduling and patient portal access
• Engage local referral sources:
  • Pediatric subspecialists managing complex teens who need adult care
  • Adult primary care practices overwhelmed with young adults with congenital conditions
  • School nurses, college health centers, and community organizations
• Use low-cost digital marketing:
  • Google Business Profile, local SEO, and online reviews management
  • Educational blog posts on transitions of care, vaccines, and preventive care for families

Word-of-mouth is powerful in Med-Peds. Deliver excellent service, maintain timely access, and your patient community will build itself over time.

Payer Mix, Contracts, and Coding Nuances

Because Med-Peds spans age groups, your payer mix may be more complex than a pure peds or IM practice.

Insurance participation

• Decide early if you will:
  • Be in-network with major commercial plans
  • Accept Medicaid (which can be critical for pediatrics, depending on your location)
  • Opt out of Medicare, take assignment, or consider a hybrid/concierge model for adults

A purely self-pay or concierge model is possible but less common in Med-Peds, especially if you serve diverse communities and children with special healthcare needs. Many successful Med-Peds practices use a traditional insurance-based model with careful management of overhead.

Coding and documentation

• Make sure you and your staff are proficient in:
  • Well-child and preventive visit coding (with appropriate vaccine administration codes)
  • Adult preventive and chronic care visits (and when to add problem-oriented codes)
  • Transitional care management, chronic care management, and prolonged services codes where applicable

Correct coding helps ensure that your comprehensive Med-Peds care—especially for complex patients—is properly reimbursed.

Balancing Pediatrics and Adult Medicine in Daily Operations

Your schedule and clinic flow should reflect your dual training.

Scheduling strategies

• Block mornings for pediatric well visits and vaccines (to reduce infectious exposure for infants)
• Reserve late afternoons for school-aged well visits and sick visits
• Cluster complex adult chronic disease and transition visits in blocks where you have more time and resources

Vaccine management

• Decide if you will:
  • Join the Vaccines for Children (VFC) program, if eligible
  • Carry adult vaccines (flu, pneumonia, shingles, HPV for young adults)
  • Partner with local pharmacies for certain vaccines if storage or cost is challenging

Care coordination for transition-age youth

• Create standardized transition processes for patients with chronic conditions (e.g., at ages 16–21)
• Use checklists for readiness (self-medication management, understanding of disease, appointment scheduling skills)
• Coordinate closely with pediatric subspecialists as you gradually take over adult management

This is one of your most powerful differentiators as a Med-Peds physician and can attract a loyal patient base.

Planning for Long-Term Growth and Work-Life Balance

When opening medical practice doors, it is easy to focus only on survival. But you should also visualize your 5–10 year trajectory.

Consider:

• Do you eventually want to add another Med-Peds partner or an NP/PA?
• Are you open to incorporating telemedicine for follow-ups, ADHD management, or transitions visits?
• Would you like to add ancillary services (nutrition counseling, behavioral health, lactation support)?

Make decisions now that keep doors open later:

• Lease a space that allows adding an extra exam room within the same suite
• Choose an EHR that can easily scale to more providers
• Document standard operating procedures so that onboarding new staff and clinicians is smooth

Work-life balance is a major reason many physicians compare private practice vs employment. It is true that you may work harder in the first few years of private practice. However, once established, you can often:

• Set your own clinic hours
• Design call schedules that align with your life circumstances
• Delegate administrative tasks to trusted managers

The key is to avoid building a model that entirely depends on you working at unsustainable levels. From the beginning, structure your practice so others can share responsibilities as you grow.

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Common Pitfalls and How to Avoid Them

Many challenges in starting a private practice are predictable. Anticipating them will save you time, money, and frustration.

Pitfall 1: Underestimating the Business Learning Curve

Solution:

• Take a basic course or workshop on medical practice management or physician entrepreneurship during residency or early career
• Find a mentor who has successfully built a Med-Peds or primary care practice
• Meet monthly with an accountant and/or practice consultant in the first year

Pitfall 2: Overly Optimistic Volume and Revenue Projections

Solution:

• Model conservative scenarios (50–70% of your ideal panel build speed)
• Keep your personal expenses lean in the first 1–2 years
• Maintain PRN or part-time work (e.g., hospitalist, urgent care) while the practice ramps up, if needed

Pitfall 3: Poor Contracting and Credentialing Timeline Management

Solution:

• Start payer enrollment and credentialing early—often 3–6 months before you plan to open
• Track each application’s status and follow up regularly
• Prioritize major local commercial plans, Medicaid (if relevant), and Medicare

Pitfall 4: Neglecting Patient Experience and Communication

Solution:

• Train staff on customer service, empathy, and consistent messaging
• Offer online scheduling, timely portal responses, and clear after-hours instructions
• Design workflows for same- or next-day acute access whenever possible; this is a major differentiator from crowded systems

Pitfall 5: Trying to Do Everything Yourself

Solution:

• Delegate and outsource: billing, HR, IT, and even cleaning services
• Use technology thoughtfully—templates, standing orders, and protocols
• Remember that your highest-value activity is direct patient care and leadership, not troubleshooting printers or negotiating copier leases

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FAQs: Medicine-Pediatrics and Private Practice

1. How soon after residency can I start a Med-Peds private practice?
You can theoretically open immediately after residency, but practically, many physicians:

• Spend 1–3 years employed to gain clinical confidence and financial stability
• Use that time to learn about operations, billing, and local market dynamics
  If you plan to launch right out of residency, begin building your business plan and starting credentialing processes during your PGY-3 or PGY-4 year (if in a combined program with extra years).

2. Is a Med-Peds residency a good choice if I know I want private practice?
Yes. A med peds residency gives you:

• Breadth to care for patients across the lifespan
• Flexibility to adjust your patient mix as local demographics or payer landscapes change
• A strong position to serve families and complex young adults, which can differentiate your practice
  Just be mindful that it can be slightly more complex administratively than running a single-age-range practice.

3. How does starting private practice differ for Med-Peds versus Family Medicine?
Both can run full-spectrum primary care practices. Differences include:

• Med-Peds training is deeper in inpatient medicine and pediatrics but does not include OB
• Some patients or referring physicians may seek you out specifically for expertise in transitions of care
• Payer mix might differ depending on how you market (e.g., more complex pediatric and young adult cases)
  Operationally, most steps—legal entity, EHR, billing, staffing—are similar.

4. Can I build a Med-Peds practice that supports future starting private practice ventures, like satellites or subspecialty clinics?
Yes. Once your first clinic is stable, you can:

• Open a satellite office in a neighboring community
• Add niche services (e.g., adolescent/young adult clinic, complex care transitions program, obesity medicine or addiction medicine services)
• Partner with other physicians to expand under a shared brand
  The key is building scalable systems—strong finances, reliable staff, and efficient workflows—from day one.

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Starting a private practice in Medicine-Pediatrics is demanding but offers unmatched autonomy, clinical variety, and the opportunity to build deep, lifelong relationships with patients and families. With careful planning, realistic financial modeling, and a clear vision for how your Med-Peds skills will serve your community, you can create a thriving practice that aligns with both your professional values and your long-term life goals.