Nobody tells you that the day you open your own practice, you stop being only a clinician.
I could manage a crashing patient. I’d spent years in emergency medicine and on hospital floors. Nobody had ever shown me how to read a P&L, set a price that actually paid me, or tell the difference between a busy month and a profitable one.
I started my first business in 2017 with one goal: an extra $500 a month for my family. Today I own IV Lounge CT in South Windsor, Connecticut. Almost everything I know about the business side, I learned by getting it wrong first, with my own money. Here’s what I wish someone had told me at the start.
1. Your clinical skill is not your business model
Being good at what you do gets a patient in the door once. A business is what brings her back. Those are two different skills. The first took me years of training. Nobody offered training in the second, so I learned it with my own money. You can learn it for less.
2. Offering ongoing care is part of patient care
Nurse practitioners are trained to serve, and most of us flinch at the word "selling." I did too. But if a patient needs ongoing care and you never offer it, you haven't protected her. You've left her to figure it out alone. Recommending a plan is a clinical conversation. Treat it like one.
3. Look hard at your processes before you have to
For years my income started over at zero every month. It depended on who booked that week. In 2025 I stepped back, looked at how my practice really ran, and rebuilt it around recurring revenue: memberships built on care my patients already needed. Do that review in a calm month, not a desperate one. Write down your pricing, your systems and your checklists before you need them.
4. Compliance is not optional, and it changes
Scope of practice, collaborating physician agreements, Good Faith Exams, how you advertise. The rules vary by state, and they change. Check yours every year, not just the year you open.
5. You don't have to figure it out by yourself
The hardest part of owning a practice is how often you're the only one making the call. If you're tired and quietly wondering whether you're doing it wrong, you're in good company. Most of us were.
Where to start
If you want to see where your practice stands right now, book a Practice Vitals session. We meet once, and you leave with a written plan for what to fix first. If you'd rather work through it on your own, the Medicine First Roadmap covers scope, Good Faith Exams, pricing, hiring and the ten mistakes I made, so you don't have to make them yourself.
