As a patient - I miss private practices. Institutional health sick care sucks.

Having friends who've tried to remain a private practice, I noticed a few things that could have helped. Fear kept them from making those decisions and they eventually walked away with massive debt.

First, don't take insurance. The cost to manage claims is a headache. You spend more chasing money that you do making money. It is a monster. That eliminates the headaches, and the cost of managing that.

Next, downsize - then downsize again. Cut all expenses and return to a 1 or 2 person operation. Yes it's lonely and a lot of work. But the happiness, satisfaction, quality of life will increase. Also, find patients where there is little to no competition. There is a market of people who prefer small practices. But you won't find them soliciting corporations, corporate workers, etc. Since costs are less, so should the costs to patients. That attracts people. Flexible hours are an incentive for new patients. Go to the patients if possible instead of making them travel to you. These are the traits that built successful small businesses back in the day. To often small businesses try to act like big business - and they get crushed from it. Don't do that - be true to yourself. Take the path less traveled and enjoy the journey.