Solo practice

Solo practice overview

Solo dermatology practice offers full autonomy and control for physicians who want to run and manage their own clinic. While this model presents challenges, especially in today’s environment of practice consolidation, it remains a viable and rewarding path for dermatologists who value flexibility, long-term patient relationships, and entrepreneurial freedom.

Why dermatologists choose this

• Full clinical and operational autonomy, from scheduling to treatment protocols.

• Ability to individualize patient care without group or hospital constraints.

• Personal connection with patients across the entire care continuum.

• Freedom to explore new services and treatment areas (lasers, cosmetics).

• Opportunity to create a custom work culture and patient-centered environment.

• Potential for higher long-term earnings with well-managed operations.

How this model works

Ownership and structure

The dermatologist owns and operates the practice independently, making all decisions regarding clinical care, staffing, operations, and finances. This model offers maximum autonomy but also places full responsibility for compliance, hiring, payroll, and strategy on the physician.

Patient care model

Care is highly personalized, with the physician having full control over scheduling, prioritization of acute cases, and continuity of care. The environment can feel more “home-like” and allows for deeper patient relationships.

Administrative support

Solo practitioners manage or outsource all administrative duties including billing, HR, credentialing, compliance, and marketing. They have the ability to hire any number of medical assistants to streamline documentation and patient flow, allowing them to see more patients and boost revenue.

Compensation and incentives

Income is closely linked to practice efficiency, patient volume, and the mix of services offered. While rising overhead and declining reimbursements can be challenging, joining a group purchasing organization (GPO) — a network that negotiates bulk pricing for supplies and services — can help lower costs and improve margins. Solo practices may also consider participating in an independent practice association (IPA), which is a network of independent physicians that negotiates insurance contracts collectively. An IPA may help solo practices secure stronger reimbursement rates without giving up ownership or autonomy.

Practice setup

In areas with many existing doctors, insurance companies may delay or limit new contracts, making it harder for a new solo practice to be in-network and slowing patient access. Dermatologists must decide whether to lease or buy space, often requiring significant startup capital or loans (SBA loans). Hospitals in underserved areas may offer support such as subsidized space or income guarantees.

Technology and operations

The owner must manage EHR systems, compliance, and marketing efforts like website upkeep, patient portals, and social media. Digital communication expectations and documentation demands add significant non-clinical workload.

Career growth

Career development in solo practice is self-directed. Physicians typically gain full ownership from the start, with complete control over services, schedules, and strategy. Long-term financial growth depends on operational efficiency and patient retention, but successful practices can yield higher income and potential sale value than employed models. As the practice grows, the dermatologist can choose to expand service offerings, bring on partners, or sell the business. Solo practice also builds leadership and business management skills, as the dermatologist oversees all aspects of operations, branding, and growth.

When this model makes sense

• For those who value full control over how their practice runs.

• Ideal for building long-term relationships with patients.

• Suited to offering a broad mix of services including medical, surgical, pediatric, and cosmetic.

• A good fit for those interested in the business side of medicine.

• Allows for quick decision-making and testing new ideas.

• Best for physicians comfortable with some financial risk in exchange for independence.

Success factors

• Always accept new patients to maintain growth, because closing the doors can damage your reputation and stagnate the business.

• Hire medical assistants for each room to boost patient volume and revenue.

• Join a GPO or IPA to lower supply costs and negotiate better contracts.

• Use digital marketing and social media to promote services and maintain visibility.

• Consider cosmetic dermatology (injectables, lasers, skincare) to diversify revenue.

• Invest in training and staff development for smooth practice operations.

• Get help with credentialing early, especially in urban areas where payers may be selective.

Potential challenges

• Full responsibility for compliance, billing, staffing, and administration.

• Credentialing delays with insurance providers.

• Greater financial burden and risk as startup and operational costs must be managed carefully.

• Requires knowledge of business, HR, marketing, and accounting.

• Time-consuming EHRs and increasing payer oversight can cut into patient care.

• Managing and retaining quality staff can be challenging without corporate HR support.

• Marketing work (website upkeep, online reviews, social media presence) can be time-intensive but essential.

Real-world example

Marc Darst, MD, FAAD, maintains a thriving solo practice through a combination of operational savvy and patient-centered care. He emphasizes the importance of always accepting new patients to sustain practice growth and reputation. To maintain efficiency, he hires a medical assistant for each exam room, allowing him to increase patient volume. He also participates in a GPO to reduce overhead costs and has built a “homey” office culture that reflects his values.

After years in a growing group practice, Julie A. Hodge, MD, MPH, FAAD, transitioned to solo practice to regain control over her schedule, clinical decisions, and care philosophy. She values being able to see acute cases promptly and provide continuity throughout a patient’s care journey. While she enjoys the independence, she notes that solo practice requires balancing administrative responsibilities, HR challenges, and increasing pressure from EHR and marketing demands.

Early career advice

• Many physicians early in their careers are not well positioned to open a solo practice. However, it’s an attainable goal in time.

• Choose this path if autonomy, patient continuity, and flexibility are top priorities.

• Be realistic about the personal time and energy required to run the business side of the practice.

• Explore SBA loans or hospital-subsidized space if startup capital is a barrier.

• Think through how you’ll handle the administrative challenges of solo practice, including staffing, compliance, technology, and marketing.

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.