Your Guide to Starting a Private Practice in Obstetrics & Gynecology

Understanding the Landscape: Is Private Practice in OB GYN Still Viable?

For many residents entering OB GYN residency, the path seems to split early: join an employed position in a health system or group, or aim for owning a practice. With consolidation, hospital acquisitions, and ballooning administrative complexity, many trainees wonder if starting a private practice in Obstetrics & Gynecology is still realistic—or wise.

The answer is yes, it is viable, but it is not simple.

Trends to understand:

• Consolidation: More OB GYNs are employed by hospital systems, large multispecialty groups, and corporate entities than ever before.
• Financial pressures: Reimbursement compression, rising malpractice premiums, and increasing overhead make margins thinner.
• Lifestyle and liability realities: 24/7 call, emergency deliveries, and high-risk litigation environment complicate solo or small-group models.
• Patient expectations: Patients expect convenience (online scheduling, portals), rapid responses, and comprehensive services (ultrasound, contraception procedures, minor surgeries).

Yet private practice offers distinct advantages:

• Autonomy and control: You decide your schedule, clinical protocols, staffing, and patient mix.
• Practice culture: You shape the patient experience and team environment.
• Entrepreneurial upside: Over time, you can build equity, add partners, and expand services.
• Flexibility in care models: Natural childbirth focus, midwifery integration, women’s wellness clinics, concierge/Membership models, fertility-oriented practices, and more.

For residents eyeing the obstetrics match and planning long-term, it’s essential to think about private practice vs employment not as “good vs bad,” but as distinct career paths with different risk, control, and lifestyle profiles.

A good starting framework:

• Early career (0–5 years): Many OB GYNs choose employment first to stabilize income and refine clinical skills, then transition later to private practice or partnership.
• Mid-career (5–15 years): More physicians consider opening medical practice or joining small groups once they understand what they value most in daily work.
• Late career: Private practice ownership can provide both exit opportunities (selling your practice) and a tailored work schedule (cutting back on OB, focusing on GYN, etc.).

If you’re determined to build your own OB GYN practice, start during residency: learn the business, understand your market, and build relationships. The more intentional you are now, the smoother your path after residency or fellowship.

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Planning and Strategy: From Vision to Viable Business

Before signing a lease or ordering an ultrasound machine, you need a clear plan. Think like both a clinician and an entrepreneur.

Step 1: Define Your Vision and Scope

Ask yourself:

• OB vs GYN mix: Do you want a full-scope OB GYN residency-style practice (prenatal care, deliveries, surgery, office GYN), or will you emphasize GYN-only or limited OB?
• Target population:
  • Young, low-risk obstetric population?
  • Menopause and complex GYN?
  • Underserved communities?
  • Highly insured, suburban market?
• Unique value proposition (UVP): Why would patients choose you over competing practices or hospital-based clinics?

Examples of UVPs in OB GYN private practice:

• Low-intervention, family-centered obstetrics with continuity of care and midwifery support.
• Office-based minimally invasive surgery focus, reducing hospital time.
• Integrated women’s wellness (OB GYN + mental health + pelvic PT).
• Bilingual practice with strong community outreach.

Step 2: Market Analysis

Thorough market research is a critical step before starting a private practice:

• Geographic saturation:
  • How many OB GYNs are in your area?
  • What is the wait time for new appointments?
• Hospital relationships:
  • Which hospitals need more OB coverage?
  • Is there a Level II or III NICU nearby?
• Demographics:
  • Age distribution of women in the region
  • Insurance mix (Medicaid, commercial, uninsured)
• Competitor profiles:
  • Are there mostly large groups and hospital systems, or also small independent practices?
  • Do competitors emphasize specific niches (e.g., high-risk OB, infertility)?

Use:

• County or state health department data
• AMA and ACOG regional data
• Hospital medical staff offices (for community needs assessments)
• Conversations with local OB GYNs, family physicians, and midwives

Step 3: Choose a Practice Model

Your model should align with both your clinical goals and your risk tolerance.

Common models in OB GYN:

1. Solo private practice

   • Full control, but higher call burden and financial risk.
   • Works best with strong hospitalist support or call-sharing arrangements.

2. Small group partnership (OB GYN-only)

   • Shared call, shared overhead.
   • Often a buy-in over time, with an established patient base.

3. Multispecialty group

   • Shared administrative infrastructure.
   • Less autonomy in policies and sometimes in scheduling or compensation.

4. Hybrid models

   • OB hospitalist (laborist) shifts plus an outpatient GYN practice.
   • Concierge or membership-based women’s health practice (often GYN-forward).

When comparing private practice vs employment, consider:

• Income predictability: Employed positions may offer higher initial stability; private practice offers more upside after ramp-up.
• Call and lifestyle: A group with 6–8 physicians can share call effectively; solo OB-heavy practice can be exhausting.
• Governance and culture: In your own practice, you make the rules, but you also shoulder the consequences.

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Legal, Financial, and Operational Foundations

Once your strategy is clear, you must build a solid legal and financial base. This is the unglamorous but essential side of opening medical practice in OB GYN.

Legal Structure and Licensing

1. Choose a business entity

   • Common options: Professional Corporation (PC), Professional Limited Liability Company (PLLC), or LLC/Corporation where allowed by your state.
   • Goals: Liability protection (where applicable), tax efficiency, compliance with state professional corporation rules.
   • Consult a healthcare attorney and a CPA familiar with your state laws.

2. Obtain necessary IDs and registrations

   • Employer Identification Number (EIN)
   • National Provider Identifier (NPI) for you and the group
   • State medical license and any state facility or radiation licenses (e.g., for ultrasound, if required)
   • DEA registration and state controlled substance registration

3. Malpractice coverage

   • OB GYN malpractice is often among the highest premium specialties.
   • Choose between claims-made or occurrence-based coverage.
     • Claims-made: cheaper initially but needs tail coverage when you leave.
     • Occurrence: more expensive annual premium but no tail.
   • Ensure coverage includes obstetrics, surgical procedures you perform, and office procedures (e.g., in-office hysteroscopy, LEEP).

4. Contracts and compliance

   • Hospital privileges and call coverage agreements.
   • Collaborative agreements if working with nurse practitioners, PAs, or midwives (if required in your state).
   • Compliance program: HIPAA policies, OSHA safety measures, billing and coding compliance.

Start-Up Costs and Financing

OB GYN private practice is capital-intensive, particularly if you plan to deliver babies and offer in-office procedures.

Typical major start-up costs:

• Legal and consulting fees
• Office build-out or renovation
• Lease deposit and initial rent
• EMR system and IT infrastructure
• Medical equipment:
  • Exam tables, colposcope, LEEP machine
  • Ultrasound machines (often 2D and possibly 3D/4D)
  • Autoclave, instruments, minor procedure equipment
• Furniture and décor
• Initial staff recruitment and training
• Marketing and website development
• Malpractice and other insurances

It’s not unusual for OB GYN start-up costs to range from $250,000 to $750,000+, depending on:

• Location and size
• New build vs existing clinic
• Equipment (new vs refurbished; number of ultrasound units)
• Scope of services at launch

Financing options:

• Bank small business or medical practice loans
• Lines of credit
• Equipment leases
• Personal savings or partner capital contributions

Your business plan should include:

• 3–5 year pro forma financials
• Volume assumptions (new OB starts per month, annual GYN visits)
• Payer mix and anticipated reimbursement
• Overhead percentages and break-even analysis

Many physicians underestimate how long it takes to reach full panel. For OB, it’s often 12–24 months to hit a stable delivery volume, since pregnancy is a 9–10 month cycle; GYN-only may ramp faster depending on referral patterns.

Insurance Participation and Revenue Cycle

An early decision: Will you be in-network, out-of-network, cash-based, or hybrid?

• Traditional insurance-based practice:

  • Highest volume potential.
  • Requires credentialing with multiple payers (which can take 3–6 months).
  • Must master OB global billing, GYN surgical coding, preventive vs problem visit coding.

• Membership/concierge or cash-based practice (more common for GYN-only or boutique women’s health):

  • Lower volume, higher per-patient revenue.
  • Requires strong patient education and niche positioning.
  • May still contract for facility-based services or labs.

For most early-career OB GYNs, starting in-network with major commercial payers, Medicare (for GYN-only practice), and Medicaid (depending on your population) provides the broadest access.

Establish:

• Robust billing and coding processes (in-house biller vs outsourced vendor).
• Clear policies for:
  • Global OB packages, payment plans, and uncovered services (e.g., some genetic tests).
  • No-show fees and late cancellations.
  • Self-pay and uninsured patients.

Your revenue cycle management (RCM) is the backbone of financial stability; sloppy coding and denied claims are a fast path to burnout and financial strain.

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Designing Your OB GYN Practice: Facilities, Workflow, and Staffing

Your physical environment and day-to-day workflow heavily influence both patient experience and your own satisfaction.

Selecting a Location and Facility

Key considerations:

• Proximity to affiliated hospitals for deliveries and surgeries.
• Demographics: Near neighborhoods where your target patient base lives and works.
• Accessibility:
  • Public transportation, parking, and ADA compliance.
  • Safety and comfort of the surrounding area, especially for evening visits.

Think about:

• Size: For a single OB GYN physician starting out, 3–4 exam rooms is often sufficient, with space to grow.
• Growth potential: Can you add associates or partners later without relocating?
• On-site services:
  • Ultrasound rooms
  • Procedure room for colposcopy, LEEP, IUD/implant insertion, endometrial biopsy
  • Phlebotomy or lab draw station (if allowed)

Layout should optimize patient flow:

• Reception → waiting → vitals → exam → check-out → scheduling.
• Separate clean/dirty areas and secure medication storage.
• Consider privacy and trauma-informed design (comfortable gowns, warm lighting, respectful draping in pelvic exam rooms).

Technology and EMR Considerations

For an OB GYN residency graduate starting private practice, your EMR is one of your most critical decisions.

Priorities:

• Obstetric functionality:
  • Prenatal flow sheets
  • Fetal monitoring documentation
  • Integration with hospital labor and delivery (if possible)
• GYN and procedure templates:
  • Pap and HPV tracking
  • Colposcopy and biopsy documentation
  • Surgical consents and pre-op/post-op templates
• Patient portal for:
  • Lab results and prenatal test communication
  • Appointment requests
  • Secure messaging

Also plan for:

• E-prescribing
• Telehealth capability (e.g., contraception counseling, follow-ups)
• Integrated ultrasound reporting or image storage (PACS) if feasible

Avoid over-customizing early; build a core library of standardized templates for routine OB visits, annual exams, abnormal bleeding workup, prenatal counseling, etc.

Building the Right Team

Staffing decisions can make or break your daily experience. Typically, a new solo OB GYN practice might start with:

• 1–2 Front desk staff (check-in, phone calls, scheduling)
• 1 Medical assistant or nurse per provider
• 1 Practice manager or cross-trained senior staff member (billing, HR, operations)
• Optional: in-house biller vs outsourced billing service

As you grow, consider:

• Sonographer (for in-office ultrasound)
• Additional MAs/RNs
• Part-time or full-time midwife or NP/PA to expand access and services

Invest in:

• Thorough onboarding and training
• Clear protocols for:
  • OB triage calls and after-hours coverage
  • Medication refills
  • Result notification (e.g., abnormal Pap management)
  • Emergency procedures in the office (e.g., vasovagal reactions, anaphylaxis)

In OB GYN, where intimate and often emotionally charged situations are routine, staff culture matters deeply. Hire for empathy, discretion, and communication skills—not just technical competency.

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Clinical Operations: Obstetrics, GYN, and On-Call Realities

Once the doors open, the clinical model you design will determine how sustainable and satisfying your practice is.

Structuring OB Care in Private Practice

Consider these elements when planning obstetric services:

• OB volume and call strategy

  • How many deliveries per month are sustainable for you?
  • Do you share call with other private OB GYNs, or is there an OB hospitalist program?
  • Will you be on-call for your own patients 24/7, or participate in a group call pool?

• Prenatal care model

  • Visit schedule, including virtual vs in-person options.
  • Pathways for low-risk vs high-risk patients (e.g., referral to MFM).
  • Integration of labs, ultrasounds, and genetic testing.

• L&D logistics

  • Hospital preference(s) for deliveries—facility policies, anesthesia availability, NICU level.
  • Scheduled induction and C-section block times.
  • Processes for patients presenting in triage (who is called, how you’re contacted).

• OB global billing

  • Understand bundling of prenatal care, delivery, and postpartum visit into a global fee.
  • Separate billing for complications or additional visits beyond standard bundles.

From a wellness standpoint, evaluate whether you want to do full-scope OB indefinitely. Some private practice OB GYNs gradually transition to:

• GYN-only after a set number of years.
• Reduced OB with midwives or laborists covering in-hospital births.
• Shift-based laborist roles plus part-time outpatient GYN.

GYN and Procedural Services

GYN services are typically the financial and scheduling backbone of private OB GYN practices.

Key elements:

• Preventive care: Annual exams, Pap/HPV screening, contraception counseling.
• Office procedures: IUD and implant insertion/removal, endometrial biopsies, colposcopies, office hysteroscopy, vulvar biopsies.
• Surgical procedures: Laparoscopy, hysteroscopy, hysterectomy, urogynecologic procedures, depending on your training.

Think intentionally about:

• Which GYN surgeries you want to offer and at what hospital/ASC.
• Whether you’ll pursue additional training in minimally invasive surgery, urogynecology techniques, or fertility procedures.
• Partnerships with pelvic floor physical therapy, primary care, endocrinology, or mental health for complex cases.

After-Hours, Triage, and Work-Life Boundaries

Private practice in OB GYN can blur the line between work and home if you’re not proactive.

Strategies to protect your time and sanity:

• Use an after-hours answering service with clear triage protocols.
• Create standardized triage algorithms for common issues:
  • First trimester bleeding
  • Decreased fetal movement
  • Post-op questions
  • Contraception side effects
• Decide early how you’ll manage:
  • Non-urgent messages (handled next business day).
  • Prescription refills (time frames, controlled substances).
  • Follow-up of critical results after hours.

If you are in solo practice, think carefully about backup coverage for vacations, illness, and parental leave. Many OB GYNs share cross-coverage agreements with nearby independent physicians or join a call group that supports each other’s practices.

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Marketing, Growth, and Long-Term Strategy

Once you’ve navigated the early months of opening medical practice, you’ll need a strategy for sustainable growth and eventual transition or expansion.

Building Your Patient Panel

In the digital era, word-of-mouth is amplified by online presence.

Key marketing elements:

• Professional website

  • Online scheduling and portal access.
  • Clear description of services, physician bios, and practice philosophy.
  • Search engine optimization (SEO) around terms like “OB GYN near me,” “women’s health clinic [city],” and “OB GYN residency trained [subspecialty skills].”

• Online reputation management

  • Google Business profile, Healthgrades, Zocdoc, etc.
  • Encourage satisfied patients to leave honest reviews.
  • Respond professionally and briefly to reviews when appropriate.

• Community engagement

  • Talks at prenatal classes, community centers, or churches.
  • Collaborations with doulas, midwives, and childbirth educators.
  • Relationships with primary care physicians who may refer GYN patients.

• Brand identity

  • Consider your practice name, logo, and messaging.
  • Ensure cultural and linguistic sensitivity to your target population.

Scaling: Adding Partners, Services, or Locations

As your practice grows, you may:

• Add associate physicians.
• Bring on midwives, NPs, or PAs to expand access.
• Offer new services:
  • In-office minimally invasive procedures
  • Cosmetic gynecology (if aligned with your values and local demand)
  • Menopause and sexual health clinics
  • Fertility evaluations (possible gateway to REI collaboration)

When adding partners, define:

• Buy-in structure and timeline.
• Ownership percentages and governance.
• Call distribution and scheduling fairness.
• Exit or retirement terms.

Planning for Transitions and Exit

From the outset, think of your practice as an asset that might be:

• Sold to another OB GYN or group.
• Merged with a larger multispecialty group.
• Transitioned to younger partners as you step back.

Keep your practice attractive to potential buyers by:

• Maintaining clean financials and compliant coding.
• Building efficient, documented workflows.
• Cultivating a loyal patient base and positive reputation.
• Investing in up-to-date technology.

Doing so converts your years of effort into both professional fulfillment and financial value at the end of your practice life cycle.

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FAQs: Starting a Private Practice in OB GYN

1. Should I go straight into private practice after OB GYN residency, or work as an employee first?
Both paths are viable. Many new graduates opt for an employed role for 2–5 years to solidify skills, pay down debt, and understand real-world practice patterns. During that time, you can study the business side and plan your own practice. Going directly into private practice is possible, but requires strong mentorship, a solid financial plan, and comfort with risk.

2. How different is private practice vs employment in day-to-day life?
In an employed setting, much of the infrastructure—billing, HR, scheduling systems—is handled for you, but your autonomy over schedule, patient volume, and practice style may be limited. In private practice, you gain control over these aspects, but you also assume responsibility for payroll, staffing issues, equipment costs, and compliance. The trade-off is more control and potential long-term financial upside versus immediate stability and fewer non-clinical responsibilities.

3. Is it realistic to have work-life balance in private practice OB GYN, especially with obstetrics?
Yes, but it must be designed intentionally. Balance is more difficult in solo full-scope OB practice without call-sharing. Group practices with 6–8 physicians, or models that integrate midwives and/or OB hospitalists, can spread the burden and create predictable off-call time. Some OB GYNs choose to limit or eventually stop obstetrics, focusing on GYN and office procedures to improve lifestyle.

4. What’s the biggest mistake new OB GYNs make when starting private practice?
Common pitfalls include underestimating start-up costs and time to profitability, choosing an EMR that doesn’t support OB-specific workflows, neglecting revenue cycle management, and failing to clearly define the practice’s niche and patient base. Working with experienced healthcare attorneys, CPAs, and practice consultants—and talking candidly with independent OB GYNs in your region—can help you avoid these errors.

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Starting a private practice in Obstetrics & Gynecology is a demanding but deeply rewarding path. By approaching it with the same rigor you brought to your OB GYN residency—studying the landscape, planning carefully, building a strong team, and continually refining your systems—you can create a practice that serves your patients, your community, and your own long-term career goals.