Starting Your Neurology Private Practice: A Comprehensive Guide

Starting a private practice in neurology is both a clinical milestone and a business launch. For many neurology residency graduates, the neuro match is followed by fellowship, then an employed role—but an increasing number of neurologists are interested in building something of their own. Whether you’re transitioning from hospital employment or planning ahead during residency, understanding how to go from idea to fully functioning clinic is critical.

This guide walks you step-by-step through planning, launching, and growing a neurology private practice—with a specific focus on the realities of today’s health-care environment.

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Understanding the Landscape: Is Private Practice Right for You?

Before you commit to opening medical practice in neurology, you need a clear sense of:

• What practicing neurology in private practice really looks like
• How it differs from an employed model
• The market in your region

Private practice vs employment: What really changes?

Clinical autonomy and schedule

• Private practice

  • More control over appointment length, patient mix (stroke follow-up vs headache vs epilepsy vs movement disorders), and procedures (EMG/NCS, EEG, Botox, nerve blocks, LPs).
  • You can design your template (e.g., 60-minute new visits, 30-minute follow-up, protected procedure blocks).
  • You control clinic hours, but remember: responsibility for the business often extends beyond clinic time.

• Employed position

  • Less administrative burden; hospital/practice management handles contracts, billing, HR.
  • Often higher initial financial stability (salary + benefits).
  • Less control over staffing, workflows, and sometimes clinical decisions (e.g., formulary restrictions, test ordering).

Income and financial risk

• Private practice

  • Potential for higher long-term income once volume and payor mix stabilize.
  • You bear startup costs (space, EHR, staff) and early income volatility.
  • Your income is directly tied to collections, not simply work RVUs.

• Employed

  • More predictable income, often with RVU targets and bonuses.
  • Limited upside; less direct participation in growth profits.

Lifestyle and stress

• Private practice
  • Greater flexibility over time, call, and vacation once established.
  • Short term: stress from managing staff, finances, compliance, marketing.
• Employed
  • Less “business” stress but potentially more control by administrators over schedule and throughput.

Key question: Are you comfortable being both a physician and a small-business owner? If not, consider starting with an employed role while learning the business side and transitioning later.

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Laying the Groundwork: Market Research and Strategic Planning

A neurology residency prepares you to read an MRI, not a market analysis. But basic planning now will prevent expensive missteps later.

Step 1: Clarify your clinical niche

Neurology is broad. Defining your scope helps you design your practice, choose equipment, and market effectively.

Examples of neurology practice models:

• General outpatient neurology

  • Headache, neuropathy, epilepsy, dementia, movement disorders, stroke follow-up.
  • Requires flexible scheduling, broad diagnostic testing network, good PCP relationships.

• Subspecialty-focused

  • Headache clinic with infusions and Botox
  • Epilepsy with ambulatory EEG and close relationship with EMU
  • Movement disorders with DBS programming and botulinum toxin therapy
  • Neuromuscular with EMG/NCS and infusion capabilities

• Hybrid

  • General neurology with select subspecialty focus (e.g., “general neurology with a focus on headache and neuromuscular disease”).

Your niche will shape:

• Space needs (e.g., EMG room, infusion chairs)
• Equipment (EMG machine, EEG, ultrasound)
• Referral targets (PCPs vs oncologists vs rheumatologists)
• Reimbursement mix (procedural vs cognitive)

Step 2: Assess local demand and competition

You don’t need a formal consultant; you need structured observation:

• Count neurologists in your area

  • Use state medical board, hospital websites, Google, and insurance directory searches.
  • Note: Are they hospital-employed, large group, or solo?

• Identify service gaps

  • Long waitlists: Call practices pretending to be a new patient and ask about next available appointment.
  • Subspecialty gaps: Are there headache specialists? MS fellowship-trained neurologists? EMG/NCS availability?
  • Geographic gaps: Are rural or suburban areas underserved?

• Study referral patterns

  • Talk with PCPs, cardiologists, rheumatologists during residency or early career.
  • Ask: What neurology services are hardest to access?

Example:
You discover that in a growing suburb, wait times for non-urgent neurology are 4–6 months, there’s only one general neurologist, and no dedicated headache clinic. That’s a strong signal there is room for a general neurology practice with a headache focus.

Step 3: Define your practice model and goals

Answer these core questions in writing:

• Will you be solo, two-physician partnership, or join a small group with plans to expand?
• Will you be office-only, or do you plan to take inpatient consults/call?
• Will you personally own expensive equipment (EMG/EEG/ultrasound), or use hospital/satellite centers?
• Do you want to grow into a multi-physician group, or remain small and boutique?

These answers feed into your business plan, which, while not formally required, is incredibly useful for:

• Bank loans and lines of credit
• Negotiating with landlords
• Keeping your own strategy and priorities clear

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Legal, Financial, and Regulatory Foundations

Many neurologists postpone this step and end up scrambling later. Setting a solid structural foundation from the beginning will save you time, money, and headaches.

Choosing a legal structure

Work with a health-care attorney and accountant familiar with your state. Common options:

• Professional Corporation (PC) or Professional Limited Liability Company (PLLC)
  • Often required or preferred for medical practices.
• LLC or S-Corp (depending on state law)
  • Pass-through taxation, some flexibility in how you pay yourself (salary + distributions).

Key considerations:

• Liability protection (for business debts and contractual issues—malpractice is separate)
• Tax implications (self-employment tax, retirement plans, deductibility of expenses)
• Future partners/ownership structure

Essential legal and compliance tasks

• Obtain an Employer Identification Number (EIN) from the IRS.
• Register with your state medical board as required for practice entities.
• Malpractice insurance
  • Choose between claims-made vs occurrence policies.
  • Understand tail coverage requirements if transitioning from an employed position.
• Licenses and registrations
  • State medical license (if new or moving)
  • DEA registration
  • State controlled substance registration (if applicable)
• HIPAA compliance
  • Business Associate Agreements (BAAs) with your EHR, billing company, IT support, and any vendors who access PHI.
  • Written privacy policy, Notice of Privacy Practices, and staff training.

Consider a short consultation with a health-care attorney to:

• Review your entity structure
• Draft basic contracts (employment agreements, office policies, independent contractor agreements)
• Review leases and major vendor contracts before signing

Building a financial foundation

Start-up budget

Common start-up categories:

• Space build-out and furnishings
  • Leasehold improvements (walls, lighting, wiring, signage)
  • Waiting room furniture, exam tables, desks, chairs
• Technology
  • EHR and practice management software
  • Computer hardware, tablets, scanners, printers
• Clinical equipment
  • BP cuffs, reflex hammers, tuning forks, ophthalmoscopes
  • EMG/NCS machine, EEG system, ultrasound (if chosen)
• Operational
  • Initial malpractice premium
  • Utility deposits, first month’s rent + security deposit
  • Office and medical supplies
  • Legal and accounting fees
  • Marketing and website
• Staffing
  • First 2–3 months of payroll (front desk, MA, biller if in-house)

Depending on size and location, start-up can range from $80,000–$400,000+. You don’t need the high end to start a lean, efficient neurology practice.

Working capital

This funds the gap between opening and when insurance payments begin flowing (often 60–120 days). Neurology is heavily insurance-based; plan for at least 3–6 months of expenses as working capital.

Funding sources:

• Personal savings
• Bank loan or line of credit (often secured with personal guarantee)
• Partner capital contribution
• In rare cases, hospital support (e.g., recruitment incentives, income guarantees) in underserved areas

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Operational Design: From Empty Suite to Functioning Neurology Clinic

Once the structural pieces are in motion, you design how your practice will actually operate.

Space and clinic layout

A typical solo neurology practice might include:

• 1–2 physician offices
• 3–4 exam rooms
• 1 procedure/EMG room
• Front desk/reception area
• Waiting room
• Storage and staff break area

Location considerations:

• Proximity to referring PCPs, hospitals, and imaging centers
• Patient parking and accessibility
• Ground-floor access (helpful for mobility-impaired patients)
• Neighborhood safety and visibility

Lease tips:

• Consider a 3–5 year lease with renewal options.
• Negotiate tenant improvement allowances for build-out.
• Ensure medical-use is clearly permitted in the lease.

Technology: EHR and practice management

For neurology residency graduates, EHRs are familiar—but now you must choose one.

Key questions:

• Does it include a practice management system (scheduling, insurance verification, billing)?
• Are neurology-specific templates, exam forms, and procedure documentation available?
• Is it cloud-based (less up-front cost, easier remote access) or server-based (more control, higher initial cost)?
• Are there integrated e-prescribing, e-fax, and patient portal options?

Popular options for small practices often charge per-provider per-month fees. Evaluate:

• Total cost of ownership (licensing + add-ons + implementation fees)
• Usability (do you like charting in it?)
• Training and support

Staffing your neurology practice

At minimum, most solo neurologists need:

• Front desk / receptionist
  • Check-in/out, phone calls, scheduling, insurance verification, collecting co-pays.
• Medical assistant (MA) or nurse
  • Rooming patients, vitals, basic neuro exam elements, preparing procedures, refills, prior auth assistance.
• Billing support
  • In-house biller or outsourced billing company.

As you grow, you might add:

• Additional MA or RN
• Practice manager/administrator
• Infusion nurse (if you add an infusion suite)
• EEG/EMG technologist

Hiring tips:

• Look for staff with prior outpatient neurology or internal medicine experience.
• Check references carefully; early staff set your culture.
• Provide explicit training in neurologic terminology and workflows (e.g., seizure safety instructions, MS infusion risks, triage for acute neurologic symptoms).

Clinical and scheduling workflows

Structured workflows keep your days predictable and reduce burnout.

Sample clinic day for a new solo neurologist:

• 8:00–9:00: 1 new patient (60 minutes)
• 9:00–12:00: 3–4 follow-ups + 1 EMG slot
• 1:00–2:00: Admin/notes/calls
• 2:00–5:00: 1 new + 3–4 follow-ups

As volume grows, you may compress follow-ups to 20 minutes if appropriate and add more procedure slots.

Operational priorities:

• Define triage rules for urgent calls (e.g., new focal deficit, sudden severe headache, first seizure).
• Create standardized intake forms (history of present illness, past neurologic history, medication list).
• Build templated notes in your EHR for headache, neuropathy, epilepsy, movement disorders, etc.
• Set clear policies for prescription refills, prior authorization timelines, and missed appointments.

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Revenue, Contracts, and Building Your Patient Base

Neurology is predominantly an insurance-based specialty, so understanding payors and cash flow is central to success.

Insurance credentialing and contracting

Start this process early—ideally 4–6 months before your planned opening.

Common steps:

1. Obtain NPI (National Provider Identifier) and group NPI for your practice.
2. Register with CAQH and keep your profile updated.
3. Apply to major insurers in your region:
   • Medicare
   • Medicaid (depending on your practice vision and patient demographics)
   • Major commercial plans (Blue Cross/Blue Shield, United, Aetna, Cigna, etc.)
4. Negotiate contracts (if possible):
   • As a solo neurologist, leverage is limited, but in underserved areas you may be able to negotiate rates or terms.
   • Ensure essential procedures like EMG, EEG, Botox injections, and lumbar punctures are adequately reimbursed.

Considering a hybrid model (accepting some insurances, offering cash-pay for others) is possible, but requires careful ethical and regulatory navigation. A fully concierge/cash neurology model can work in select markets but is less common.

Billing, coding, and collections

Whether you use an in-house biller or a third-party billing company, you must understand:

• Common neurology E/M codes and documentation requirements
• Procedure codes for EMG/NCS, EEG, Botox, nerve blocks, LP, DBS programming
• Modifiers and bundling issues

Insist on transparent reporting:

• Charges vs payments by CPT code
• Days in accounts receivable (AR)
• Denial rates and reasons
• Collection percentage by payor

Meet regularly (e.g., monthly) with your billing staff to review performance and troubleshoot denials.

Marketing and referral-building

Neurology is largely referral-driven, so targeted relationship-building matters more than billboards.

Key strategies:

1. Build strong referring-physician relationships

   • Visit local PCPs, hospitalists, cardiologists, endocrinologists, rheumatologists, and psychiatrists.
   • Bring a concise, one-page referral packet:
     • Your clinical focus (e.g., “general neurology with a focus on headache and neuropathy”)
     • Appointment wait times (aim for fast access for urgent referrals)
     • Direct contact info for referring offices
   • Send timely consultation letters back to referrers; this is one of the most powerful marketing tools you have.

2. Create a professional online presence

   • Website with:
     • Your biography (neuro residency, fellowship, interests)
     • Conditions treated and procedures offered
     • New patient instructions, forms, and insurance list
     • Contact info and map
   • Google Business Profile for local search visibility.
   • Patient education content (blog posts, FAQs) on common neurologic issues like migraine, neuropathy, TIA vs stroke.

3. Patient experience and word of mouth

   • Short wait times, respectful staff, clear communication.
   • Follow-up phone call or portal message for complex new diagnoses.
   • Clear written instructions after visits, especially for seizure safety or medication titrations.

4. Community and hospital involvement

   • Give educational talks to PCP groups, senior centers, or support groups (Parkinson’s, MS, epilepsy).
   • Maintain privileges at a local hospital if feasible; inpatient consults often translate to outpatient follow-up in your practice.

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Planning Your Career Trajectory: Private Practice Across Your Timeline

For many residents, the question isn’t “Can I open a practice?” but “When should I?” Thinking ahead—even during the neurology residency or neuro match phase—can position you for future success.

During neurology residency and fellowship

You don’t need to draft a business plan yet, but you can:

• Rotate with private practice neurologists; ask specifically about:
  • Their practice model (solo vs group vs hospital-based)
  • Pros and cons of private practice vs employment
  • How they handle EMG, EEG, and procedures
• Attend optional lectures on health-care finance, practice management, and coding.
• Save: Aim to minimize debt load and build an emergency fund; this offers flexibility later if you choose entrepreneurship.
• Read basic practice-management resources and podcasts; you’ll at least be familiar with language like “RVUs,” “overhead,” and “payor mix.”

Early career: Employed first, then private practice?

Many neurologists spend 3–5 years in an employed setting before opening medical practice. This can:

Advantages:

• Provide financial stability to pay down loans and save capital.
• Offer real-world experience in outpatient neurology volume and workflow.
• Let you observe what works (and what doesn’t) in existing clinic models.

Watch for:

• Non-compete clauses that could restrict your ability to open nearby.
• Malpractice tail coverage obligations when you leave.
• Contract language around intellectual property (e.g., patient education materials you create).

Long-term: Growth, associates, and exit strategy

Once established, you might:

• Hire a PA/NP to increase access while maintaining your lifestyle.
• Recruit a second neurologist (perhaps with a complementary subspecialty).
• Add revenue lines like:
  • EMG/EEG expansion
  • Infusion services
  • DBS programming center
  • Tele-neurology services to rural areas

Think early about your exit strategy:

• Do you want to eventually sell your practice to a hospital, larger group, or younger neurologist?
• Will you phase to part-time work before retirement?
• How will you value your practice (charts, equipment, contracts, goodwill)?

Answering these questions over time ensures your neurology private practice supports your personal and professional goals across your career.

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FAQs: Starting a Private Neurology Practice

1. How soon after residency can I start a neurology private practice?
You can technically start immediately after residency or fellowship, assuming you have:

• State license, DEA registration, and malpractice coverage
• Business structure, location, and staff
• Insurance credentialing underway

However, many neurologists prefer at least a brief employed period to gain confidence managing outpatient cases independently and to stabilize finances. If you’re determined to start right away, partner with experienced advisors (accountant, attorney, billing specialist) and consider mentorship from a nearby established neurologist.

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2. How does income in private practice compare to being employed?
In the early years, income in private practice is often lower and more variable than an employed neurology position due to:

• Start-up costs and loan repayments
• Time lag before insurance payments start
• Lower initial patient volume

Over time, if the practice grows and overhead is well-managed, net income can exceed that of many employed positions. Importantly, you also build equity in a business that can eventually be sold. The tradeoff is higher risk and responsibility.

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3. Is neurology suitable for a concierge or cash-based private practice model?
It can be, but it’s more challenging than in primary care or dermatology because:

• Neurologic testing (MRI, EMG/EEG) is expensive and usually routed through insurance.
• Many patients with chronic neurologic conditions (MS, epilepsy, dementia) rely on Medicare/Medicaid.

That said, some neurologists have created boutique practices focused on:

• Headache management with cash-based infusions and procedures
• Cognitive/behavioral neurology consults not covered fully by insurance
• Second-opinion or diagnostic clinics

A hybrid model—accepting major insurances while offering an optional concierge-style access fee—is more common. Always consult legal counsel regarding compliance with insurance contracts and federal regulations.

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4. What’s the most important step I should not overlook when opening medical practice in neurology?
Two areas are often underestimated:

1. Insurance credentialing and contracting – Start early; delays can severely impact your initial revenue.
2. Referral relationships and communication – Prompt, clear feedback to PCPs and other specialists fuels your patient pipeline more than any advertising campaign.

Equally critical is recognizing that private practice vs employment is not only a financial decision but also a lifestyle and personality fit. Be honest about whether you enjoy leadership, decision-making, and some degree of business risk. With careful planning, mentorship, and realistic expectations, starting a private practice in neurology can offer a rewarding, autonomous, and impactful career path.