The Problem
A physician leaving a hospital-employed position wanted to open an independent internal medicine practice. They had clinical experience but had never run a business—and the list of things to figure out was overwhelming.
Credentialing with insurance companies. Choosing and setting up an electronic health record system. Hiring a medical assistant, front desk person, and biller. Setting up scheduling. Ordering supplies. Building a patient intake workflow. Getting the phones and website up. Figuring out billing. All of this while still working full-time at their current position.
The physician had signed a lease but didn't know what to do next. The typical timeline for opening a new practice is 4–6 months. They wanted to be seeing patients in 2.
The Approach
Credentialing and insurance
- Started insurance credentialing applications immediately—this is the longest lead time item and most new practices wait too long to begin
- Filed with the 5 highest-volume payors in the area simultaneously, tracked every application weekly, and followed up proactively to avoid delays
- Set up the practice's billing system and created a fee schedule based on local market rates
Electronic health records and systems
- Evaluated and selected an electronic health record system based on the provider's specialty, workflow preferences, and budget
- Built the charting templates, note structures, and order sets before the practice opened so the provider wasn't configuring the system while seeing patients
- Set up the scheduling system with appointment types, durations, and an online booking option for patients
Hiring and training
- Posted positions for medical assistant, front desk, and biller using a structured job posting and interview process
- Hired all three within 3 weeks, with start dates staggered so each person could be trained before the next arrived
- Created a simple training manual covering the daily workflow: opening procedures, patient check-in, charting support, end-of-day close-out, and billing submission
Patient intake and workflow
- Designed the full patient experience from first phone call to post-visit follow-up
- Built intake forms, consent documents, and a new patient welcome packet
- Set up automated appointment confirmations and reminders from day one
- Created a referral tracking system so incoming referrals didn't get lost
Operations foundation
- Set up basic financial tracking so the provider could see revenue, expenses, and patient volume weekly
- Created a supply ordering schedule and vendor list
- Built a simple operations checklist the team could follow daily without the provider having to manage every detail
What Made It Work
The biggest factor was starting credentialing on day one. Most new practices lose 2–3 months because they don't file with insurance companies until the office is ready. By running credentialing in parallel with everything else, the practice had 5 payors live by opening day.
The second factor was pre-building all the systems before the doors opened. The electronic health record templates, scheduling system, intake forms, and staff training were all done before the first patient walked in. The provider's first week felt like week three—not a chaotic scramble.
What This Means for Your Practice
If you're thinking about opening your own practice, the timeline doesn't have to be 6 months. With a clear checklist and the right sequencing—especially starting credentialing early and building systems before you open—you can be seeing patients in 6–8 weeks. The key is not doing it alone and not figuring it out as you go.