Flying solo

By Allison Evans, Assistant Managing Editor, August 1, 2025

Physicians are less likely to work in private practice today than 10 years ago due to economic, administrative, and regulatory burdens. According to a 2022 AAD practice profile survey, 27% of Academy members report being in solo practice — down from 38% in 2012.

Dermatologists in solo practice, however, believe that the practice model is not yet dead, and in fact, may provide a compelling solution to address several current hurdles in health care.

It’s likely that many dermatologists did not exit residency feeling confident in marketing a practice, purchasing equipment and supplies, acquiring the right loans, hiring and firing staff, and the like. There may be an underlying assumption that to run a solo practice you need business chops, a large amount of upfront capital, and no work-life balance.

While solo practice may not be the right career choice for some, these assumptions and worries shouldn’t stop dermatologists from seriously exploring the option and all its potential advantages.

“Sometimes, you only know what you know,” said Suzanne McGoey, MD, MsPH, FAAD, owner of McGoey Dermatology in Sheboygan, Wisconsin. “It’s only when you get a chance to see what else is out there and that other people have done it that you start building your confidence to move forward.”

Dr. McGoey, who started her practice two-and-a-half years ago, began her post-residency career employed by a large not-for-profit multispecialty group. “I perceived the employed model as easier and more simplistic, and I thought I could just focus on being a dermatologist.”

“The aches and pains of medicine affect you no matter where you work,” she continued. “The question is what level of control do you want to have over finding solutions.”

The why

For many dermatologists in solo practice, autonomy is one of, if not the greatest, perk. “I wanted more control over the patient experience and over the decisions that affected my practice on a day-to-day basis. I wanted to be able to hire the staff that I needed when I needed them and to set my own schedule, no questions asked,” Dr. McGoey said.

“I couldn’t live my life the way that I do if I was employed. I don’t ask permission to set my schedule. I don’t have to standardize my work hours. I hire a medical assistant when I want to hire a medical assistant, instead of needing to increase my productivity to prove that I need another medical assistant,” Dr. McGoey remarked.

Ronda Farah, MD, FAAD, associate professor of dermatology at the University of Minnesota, recently opened a solo practice in Minneapolis. “I started to look at private practice as a way to grow my leadership skills and be able to improve systems easily with fewer hurdles.”

For dermatologists who enjoy research, solo practice does not mean your research interests are sidelined. “Over the past decade, I found that there are many successful researchers within dermatology in solo practice. I realized that I might be able to further my research career at a faster pace than I could at an institution,” she added.

Manasi Ladrigan, MD, FAAD, who is board-certified in pediatrics, dermatology, and Mohs surgery, and in solo practice in Rochester, New York, graduated from residency in 2011 and opened her own practice in 2012. Before starting residency, she gave birth to her first child, who had complex needs. “When I completed training it was really important for me to have a career with a lot of flexibility. But more than anything, I wanted to feel connected to patients.”

Dr. Ladrigan wanted to be able to treat and perform procedures across the spectrum of dermatology. “At a larger practice, you don’t want to step on people’s toes, so you may not be able to do Mohs and general dermatology and peds because they already have people dedicated to that.”

Getting started

“First, figure out what kind of practice you are going to open,” recommended Dr. Farah. “Is it going to medical or aesthetic, or both? Is it going to be more surgery? Is there going to be a lab? Then you can start identifying the size and the cost of the space.”

The biggest challenge is taking those first steps. “Think about all the things you touch each day; that’s literally what you need. You need a facility: Are you going to buy or lease space? What tools do you use? What kind of support do you need? What do you need for documentation? Are you going to do telemedicine? While these are all issues to be solved, you don’t have to have all the answers immediately,” Dr. McGoey said.

“I’d recommend writing down the basic supplies you use daily, getting your procedure log, figuring out your top 25 codes, doing all the grunt work so you can later train your staff on how to do it,” she advised.

“Once I decided that I wanted to start my own practice, I turned to other solo dermatologists,” Dr. McGoey said. “I turned to the AAD for practice management support, my state medical society, and other private practice physicians. I pieced together the information from other people who had gone before me.”

The American Medical Association has a series of highly recommended podcasts that cover how to start a medical practice. Dr. Farah also recommended reading The Business of Dermatology (Dover and Mariwalla), which provides guidance on setting up, organizing, managing, and optimizing a practice. “Join social media groups that are focused on dermatology and private practice and read about what problems they’re having and what recommendations they have.”

“My colleagues, especially at meetings and through social media, were really supportive. They were willing to share paperwork, protocols, and provide recommendations for companies they use,” Dr. Farah said.

Also, consider if you plan to offer teledermatology. Dr. Farah started doing video visits well before she opened her brick-and-mortar practice. “I’m able to see patients virtually, bill, and use my EMR.” View the Academy’s teledermatology resources.

Location

Determining your location is key. While many dermatologists may choose to practice in communities close to family and friends or in places with amenities they desire, it’s important to consider how much your future community needs dermatology care or what the market demand is for a dermatologist. How many patients are in the area compared with the number of dermatologists available?

“You should also consider whether it makes sense to lease or purchase,” Dr. Farah said. “For people coming right out of residency, it can be difficult to purchase property. If you can purchase, it’s probably best. If you’ve been working for a while and you’re considering starting a solo practice in the upcoming years, it’s important to start saving money now.”

Looking at the financials

Looking at potential expenses and revenue, it’s important to create a business plan. “You need to figure out how much revenue your business can generate, and if it can cover its expenses, including the cost to prepare the space,” Dr. Farah said.

“If you’re leasing space, the company may renovate the space in clinic form for you, so you’re not responsible for quite as much,” she added. “If you’re purchasing a space, you’ll typically be responsible for the renovation.” Dr. Farah recommended allowing at least six months for renovations.

As far as financing, there are options available like the Small Business Administration. “There are national banks that have specific doctors’ loans for specific specialties,” Dr. McGoey said. “I’m still paying off my student loans, but it did not prevent me from opening my own practice.”

Starting a dermatology practice does not necessarily require a substantial amount of upfront capital. “‘Bread and butter’ dermatology doesn’t require a lot of tools apart from your skill set,” Dr. McGoey noted.

Name and mission statement

Some of the early steps include creating a name and an entity; getting a phone number, an employer identification number, and an address; and owning your name on Google. “I have the website rondafarah.com, which is a holding page that links to my practice website, because once you leave your previous location, patients will go searching for you,” Dr. Farah said. Make sure that the name you want is available in your state by accessing the secretary of state’s office. Check the domain name and social media handles to ensure they are available.

Developing a mission statement is another important step in establishing your practice’s identity. “This is a short statement or paragraph that states the goals of the practice and the way it will accomplish them. This is an integral foundation for your staff and your branding,” stated Drs. Skaggs and Coldiron in Dermatologic Clinics (doi: 10.1016/j.det.2023.04.001).

Credentialing

If you plan on taking insurance payments, you must go through the credentialing process. At a minimum, you need a physical address, a National Practitioner Identification (NPI) number, a Drug Enforcement Agency (DEA) number, a state medical license number, malpractice insurance, and a phone number so that an insurance company can verify your business is legitimate. These processes can be time-consuming, so it’s recommended to allow at least six months to obtain these credentials (doi: 10.1016/j.det.2023.04.001).

When Dr. Ladrigan started her practice 13 years ago, she decided on a few prominent insurers in the area, looked up their phone numbers, and called. “I explained that I was starting a new practice and asked what I needed to do. They sent me the credentialing paperwork, and I read through the contract and decided whether I wanted to be in-network or not. Over time, reception would let me know that a lot of people would be asking about a particular insurance company and then we would get credentialed.” If you’re going to get credentialed with Medicare, allow between 60 to 90 days, she added.

“I started the credentialing process myself but it became too overwhelming, so I had somebody take over for the last half,” Dr. Farah said.

Staffing

No matter how exceptional of a physician you are, a patient’s first impression of a practice is the person who answers the phone or email. Employees in a small solo practice have a heightened responsibility of making a patient’s experience positive.

People often say that they don’t want to run their own practice because they don’t want to deal with HR. “You deal with HR every day. The question is do you want to select the people you work with,” Dr. McGoey said. “You often spend more time with the people at work than you do with your own family,” she added.

For Dr. Ladrigan, talent management was her biggest obstacle. “You have to find people who like what they do with you. You can find people who are really good at what they do but don’t fit the team. You can have a great nurse, but if they don’t like doing surgeries all day, then they shouldn’t be working with me. It’s a slow acquisition of people who wanted to work with me, who were good at what they did, and were happy with what I could offer them.”

“For pediatric dermatology specifically, you need to surround yourself with a team of people that feel comfortable answering parents’ concerns and can be empathetic when parents are bringing you concerns. Picking that team was important to me.”

Initially, Dr. Ladrigan would ask all job applicants to include their favorite color. “The people who are genuinely interested read the job description and put their favorite color in the reply. Now, we ask that their reply include a phone number. If the application doesn’t include that, they don’t get a callback.”

After a 30-minute in-person interview, Dr. Ladrigan will have the applicant come back for four hours. “In that time span we’re going to see how much they pull out their phone, how they talk to other people in the office, if they can stand in a room and not yawn.”

Outsourcing

“One of my biggest mistakes was not shopping around enough for various services or negotiating more,” Dr. McGoey said.

She recommended learning how to tackle processes in-house because dermatologists will learn a lot. “It’s tempting to hire someone else who knows how to do the things that dermatologists may be uncomfortable with. You can always ask for help.”

“If you submit a claim and it’s denied, you can fix it and resubmit it, which is contrary to how we’re used to functioning in medicine. In some ways, that’s why the business part is easier — because you can fix things,” Dr. McGoey said.

For some, having a hardworking, honest, and accessible third-party billing service is invaluable. Dr. Farah chose to outsource her billing. “I didn’t want to deal with that in the office.”

“In the beginning, you’re motivated to tackle everything yourself because you’re looking to save a few dollars,” Dr. Ladrigan said. “For some, saving money may not be worth the hassle of running around. Sometimes it’s helpful to pay for expertise.”

Marketing strategy

When starting a practice from scratch, marketing is crucial. You must find a way to let patients know what you do, where you are, and that you are available to help them. Consider your patient population and how they interact with advertisements. “You need to know if your patients are young versus old, rural versus urban, and what their exposures are,” Dr. McGoey said.

Have a practice website ready before starting to market with your phone number on it, Dr. Farah recommended. Patients can be scheduled several months in advance of the actual opening. Ideally, most of the information collection can be done online; however, in an older population, you will likely be using the phone. The “hold” message could be an opportune time to tell patients of the additional services you offer.

Social and digital media allow you to target specific populations or create content to direct web traffic to your practice website or social media profile. If you have a social media following, use it to your advantage. “I have people who have found me on social media and booked appointments,” Dr. Farah said. “Create a wait list before you open, even if you don’t know the exact open date. Once you get closer to the date you can call and schedule them.”

Billboards, radio ads, and television are additional ways to make yourself known, depending on your budget and target audience. “I invested in a huge sign outside the clinic,” Dr. Farah said.

Perhaps the best form of advertisement is through physician and patient referrals. Patients trust referrals from their primary care physicians. If you can gain the trust of a primary care physician, you may find yourself with a steady stream of patients.

Dr. Ladrigan made appointments with as many physicians in town as she could. “I told them that I could get their patients in quickly because that’s what people want for dermatology — ease of entry. I also keep time open for urgent appointments.”

Challenges and advice from solo dermatologists

“I opened my practice when I had an almost two-year-old and a nine-month-old and had a third child one year into my practice,” Dr. McGoey said. “I want parents of young children to know not only can you do this with young children, but it can be the best time.”

“When I had gaps in my schedule, I went home and ate lunch with my kids since they weren’t in school. I closed my schedule for school drop-offs or field trips, and I took vacations and traveled with my family,” Dr. McGoey continued.

One of the biggest challenges for Dr. Farah was getting started with a new electronic medical record system. “It a feat to launch a new EMR. A lot of these companies have significant training that is required of you and your staff. It could easily be three to four months before you can use their medical record after you sign the contract.”

You don’t have to do everything all at once, Dr. McGoey said, like buying a building and purchasing expensive equipment. “You can start small and build as you go. You don’t need a lot of staff. You don’t necessarily need a lot of rooms, and you don’t have to offer all the services from the day you open your doors.”

“In my first week in solo practice, I think I saw 11 patients the entire week,” Dr. Ladrigan said.

Dr. Farah recommends delaying device purchases. “I purchased devices thinking I’d be using them within 16 weeks, but it was closer to six months. If you’re getting a great deal, then it may be worth it to purchase, otherwise it’s probably best to wait until your doors are open.”

It’s okay to make mistakes, Dr. Farah said. “With the day-to-day practice, there’s no right way to do things. You can try out different methods and adjust course when needed. Things are fixable. You shouldn’t be afraid of failure because you’re infinitely employable.”

Dermatologists do not need a specific background in business to succeed. “Everything that makes you a good dermatologist sets you up for success when operating a solo practice,” Dr. McGoey said. “Humor, being humble, a willingness to learn and ask questions, enjoying people, knowing when and where to go for help — these are all qualities that would make for a successful solo practitioner. You need a sense of adventure, flexibility, and a desire to be in control.”

“I went into medicine to take care of patients, and I feel like I’m returning to that core by opening my own practice. I want to give my patients a specific, personalized experience.” Dr. Farah said. “If you would look back at your life and regret not taking the risk, then you should go for it.”

“If fear of not doing well is holding you back, don’t let it because so many of us have successfully accomplished it,” Dr. Ladrigan said.

Additional DermWorld Resources