Group practice without walls (GPWW)

GPWW overview

A group practice without walls (GPWW) is a collaborative model where independent dermatology practices operate under a shared tax ID number, combining financial and administrative operations while maintaining clinical autonomy. Unlike full mergers or acquisitions, GPWWs allow dermatologists to keep their separate office locations and patient relationships, while benefiting from shared infrastructure and collective strength. This hybrid approach offers the independence of solo practice with the economies of scale and support of a larger group.

Why dermatologists choose this

• Maintains clinical autonomy while reducing administrative burden.

• Provides protection against financial losses through shared risk.

• Offers purchasing power and lower costs through shared supply and service expenses.

• Enables group negotiations with insurers and access to ancillary services.

• Supports a collaborative structure without full practice integration.

How this model works

Practice structure

Independent dermatology offices form a legal entity under one tax identification number but retain control over clinical operations. The model combines separate locations with centralized business management.

Reimbursement model

All practices bill under the same TIN, allowing for improved payer negotiations and shared access to services. Financial risk and reward are distributed across the group.

Patient care model

Practices maintain their own patient panels and care delivery approaches. However, many GPWWs develop shared clinical protocols to improve consistency, reduce waste, and increase efficiency.

Administrative support

Non-clinical functions like HR, billing, compliance, and IT are jointly managed. This reduces the workload on individual practices and allows more focus on patient care.

Compensation and benefits

Income is typically determined at the individual practice level, but shared costs and risk pooling may increase profitability. Benefits structures vary, but collective operations can reduce overhead and enhance financial stability.

Technology and operations

Some GPWWs use shared EHRs or purchasing platforms. Standardizing operations across practices can lead to improved efficiency and shared learning opportunities.

Career growth

Opportunities exist in leadership, operations, or group strategy for physicians interested in shaping the future of the collective.

When this model makes sense

• For those seeking autonomy without full solo practice burdens.

• Ideal for practices looking to lower overhead and increase buying power.

• A strong fit for dermatologists who value shared infrastructure but independent care.

• Well-suited to those interested in offering ancillary services while remaining Stark Law-compliant.

• Best for groups seeking operational support without ceding full control.

Success factors

• Choose partners with compatible clinical philosophies and operational goals.

• Develop shared standards to improve care quality and reduce variability.

• Establish clear governance and servant-style leadership to avoid conflicts.

• Leverage group purchasing and payer negotiations for financial advantage.

• Maintain open communication across practices to stay aligned.

Potential challenges

• Shared financial rewards can lead to smaller earnings per dermatologist.

• Requires compromise and shared decision-making among independently minded physicians.

• Success depends on strong, unifying leadership to manage diverse practices.

• Differences in office operations or culture can create friction.

• Not ideal for those who prefer full control or minimal collaboration.

Real-world example

William Davey, MD, FAAD, a long-time dermatologist in Lexington, Kentucky, joined a GPWW for help with administrative burden while maintaining control over his clinical practice. By sharing HR, contracting, and purchasing systems with peers, he reduces costs and boosts efficiency. He emphasizes the importance of aligned values and strong leadership to make the model sustainable.

Early career advice

• Inquire about how clinical autonomy is preserved within the group structure.

• Learn how profits, costs, and decision-making are shared.

• Clarify how the group handles governance, leadership, and dispute resolution.

• Look for groups with consistent care standards and compatible clinical philosophies.

• Choose this model if you want independent practice with group-level financial and operational advantages.

Related AAD resources

• Practice types: See our full menu of resources on practice types, from solo to institutional.

• Get started: Access our guide to getting started in practice, with resources on practice types and policies and procedures.

• Employment guide: See all our resources on contracts, questions for employers, and more.

This content was created with the particular needs of early-career dermatologists in mind. See the rest of our Career Launch resources for young physicians.