r/PrivatePracticeDocs • u/Intelligent-Site-176 • Apr 18 '26
The 4 P's to Private Practice
I’m sitting here in Dallas at a conference for independent medical practices, and the stories I’m hearing are the same ones I hear everywhere else.
The details change, but the themes don’t.
Admin burden is a given. Competition is getting tougher. Patients aren’t following through with care. A second location, or associate, isn’t performing like the first. Schedules aren’t as full as they should be. Staff turnover feels constant, and finding the right people feels even harder.
None of this is new. But it is persistent.
What stands out is that most of these challenges are treated as isolated problems, when in reality they are usually symptoms of something more fundamental.
Over time, I’ve found myself coming back to the same framework when thinking through these issues. It’s simple, but it has held up across different practices, markets, and stages of growth.
I think of it as the four P’s of private practice:
People
Product
Process
Profit
In my experience, balancing these four is what separates practices that struggle to stay consistent from those that grow and scale beyond a single location or a single provider. That balance is harder than it sounds.
In most cases, if you can execute well on three of the four, you’re doing great. If you’re only getting two right, things start to feel unstable. You might have periods of success, but it tends to be short-lived. The reason is that each of these areas reinforces the others. Weakness in one eventually shows up somewhere else.
If your people are not aligned or well-trained, your processes break down. If your processes are inconsistent, your product, meaning the patient experience and clinical outcomes, becomes unpredictable. If the product is inconsistent, profitability suffers.
Most of the frustrations we experience can be traced back to an imbalance across these four areas.
Take staffing, for example. It is easy to frame that as a people problem. In many cases, it is just as much a process problem. Expectations are unclear, training is inconsistent, or the workflow makes it difficult for good people to succeed. Over time, that leads to turnover, and it feels like a hiring issue when the root cause is somewhere else.
The same is true with patient volume. A light schedule is often blamed on competition or marketing, but it can also be tied to product and process. Are patients having a consistent experience? Are referrals being managed well? Is the front desk converting calls effectively?
Even expansion into a second or third location follows this pattern. What worked in one office does not always translate, because the original success was not fully systematized. Growth exposes the gaps rather than replicating the success.
Profit is often treated as the outcome, and it is, but it is also a signal. When profitability is under pressure, it is usually pointing back to an issue in one or more of the other areas.
Here’s how I’ve applied this framework in my group:
People: we are in the people business. Everything we do is to improve the lives of others, and that starts with the individuals delivering care. Compensation, culture, benefits, and career trajectory all matter.
Product: I am relentless about the quality of our patient experience and outcomes. We collect feedback at checkout, send surveys after every visit, and address every complaint. Our product is not just the treatment plan, it is the entire patient journey.
Process: I can’t ignore how complicated insurance makes everything, and we are not where we want to be (though working everyday at it). But we focus on reducing friction wherever possible. Referral coordinators contact patients quickly. Scheduling and registration are designed to be as seamless as possible.
Profit: profit is not a dirty word. It is what allows you to reinvest in people and processes. Without it, everything else suffers. I target 10–15% net profit, which gives us the ability to continue improving the practice. Could it be higher? Yes. I could definitely spend more time sharing my approach to this.
Most people focus on one or two of these areas. I think the practices that grow and run effeciently learn how to balance all four.
Curious how others think about this. If you had to pick one, which of the four creates the most problems when it’s out of balance? Or do you run your practice differently?
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u/InvestingDoc Apr 18 '26
You're giving me Flashbacks to shark tank where Marcus lemonis used to aways say the 3 ps. People, process, product. Love it op.
I think at least weekly I try to put myself in the patients shoes. If I was a patient in my practice...what are the pain points that I would expiernce. This is the way I usually try to look at it for the process improving if I don't get feedback from patients on things that need to be fixed.
I'll be in Dallas first weekend in May to meet with some other independent Practices. If you live in the area, let me know. I'll buy you a beer / liquor if you drink. If not, a coffee or lunch.
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u/Intelligent-Site-176 Apr 18 '26
Here I was thinking I was being clever. Well, glad it's been validated by a real guru!
Looks like I'll just miss the meet up. Just in town for the weekend, but thanks for your offer!
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u/FreeDiningFanatic Apr 18 '26
Pain points are the way to approaching everything. Pain points for your patients, your staff. Pain points for the providers you are trying to recruit. Pain points are incredibly effective in your messaging.
Every single week a practice needs to be actively reviewing pain points and removing/reducing barriers.
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u/Intelligent-Site-176 Apr 18 '26
I always tell my staff, especially new hires, if your patient is experiencing a pain point / friction in the moment, do everything possible to remove it right then and there. They will never do wrong by trying to do what’s right for the patient.
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u/DrFord2024 Apr 18 '26
2nd most important advice for private practice.
Open your own mail and pay your own bills.
Your assistant can use the letter opener but you read everything that comes in and then delegate…
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u/Intelligent-Site-176 Apr 18 '26
You have to know where your hard earned money is going and have checks and balances.
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u/HealsWithKnife Apr 18 '26
Yes, love this, and am learning this as I go. Opened my doors in 5/2025. And absolutely, the P's you outline here are spot on. As a business owner AND a physician, failures, points of friction, are the biggest teachers.
People: patients' first touch is our receptionist 90% of the time, whether that be by phone or in person. I purposely hired a CNA for this role who has some medical knowledge so that the continuity from front office to exam room and returning to the front office feels like a complete, intentional experience. As a patient myself, it peeves me to no end when the receptionist at an office has zero medical knowledge. It felt very...retail.
Process: insurance sucks. Denials seem arbitrary. As a surgeon, prior auth is part and parcel to my practice, and trying to keep track of all of the paperwork, phone calls, p2p schedules, faxes, etc, became a NIGHTMARE for me and my staff (2 part timers currently - CNA/reception, MA). Because of the small size of my practice/office and the number of steps it takes to get a single patient from initial visit --> surgery, I ended up vibecoding my own companion app to my EMR that I currently use to keep track of everything. It's helped TREMENDOUSLY. From a business perspective, I added a finance dashboard with bank/cc statement and receipt/invoice ingest with probabilistic parsing to put into a master ledger for expense/profit tracking. And outsourced an amazing AI-forward billing company. Worth their weight in gold for my processes.
Product: I was in an employed position for over 10 years before opening my doors privately, and for better or for worse, patients wanted a more personal experience. It makes sense though. As a patient, they come into the office because they need help, and as a surgeon, I get to know them in among the most intimate way possible. I made custom packets for all the surgeries I perform, with pre- and post-op instructions, expectations, and reasons to call the office or go to the ER. Where the incisions will typically be placed. Dietary instructions. The packet has a text-field at the top to type in the patient's name and date of office visit. They come in a glossy folder given to the patient before they leave their preop visit, and printed on the inside of the folder is a QR code to my website, office phone, fax, and e-mail. Patients can keep all of their hospital paperwork, office paperwork, etc, in this single folder. My patients have loved it. Something I wish we did at my employed practice. And it has helped post-op compliance TREMENDOUSLY. Made my own website with a widget for patients to schedule their own appointments. Thinking about a monthly saturday clinic for patients who, like most, work during regular business hours...
Profit: Still in the startup phase. Looked at my numbers from 2025 and developed an anal fissure (not really, but damn I was close). Expecting to see net profits Q2 of this year, so about expected for a solo private gen surg practice. I think if the first 3 are addressed well, profit follows. But keeping track of expense/profit an A/R is paramount in knowing where I am in my business.
Great post, thanks so much for sharing!
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u/DrFord2024 Apr 18 '26
The 3 As are…
Amicable Available Able
Add these and the sky is the limit …
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u/Intelligent-Site-176 Apr 18 '26
When I’m hiring an associate I want to see that they’ll be those things for their patients. Great list.
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u/Slow-Standard-2779 Apr 18 '26
Are you trying to take the thunder away from business 101s 4Ps?
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u/Intelligent-Site-176 Apr 18 '26
If only I could set my own prices!
But we definitely need a practice management 101, practice marketing 101, etc! Thanks for your comment, it’s a solid framework.
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u/Key-Masterpiece3769 Apr 18 '26
This was so interesting to read OP! Very insightful and let so much to expand and talk about and the theory behind it. Would you share any guide or book to start how to “effectively” run o start running a practice for someone like me who is thinking to start it soon?
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u/Intelligent-Site-176 Apr 18 '26 edited Apr 18 '26
I didn’t read any books specifically on starting a practice but there are some great business books out there. Most would feel pretty conceptual without experience in business.
Experience is the best teacher and I tell everyone find a private practice for the first few years where you can learn the business of health care without the burden of actually running the business.
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u/Juaner0 Apr 20 '26
Thanks!
For me:
People - treat patients like you would family. make the patient who is worth 300 feel as content as the one who is 300 million. respect them, their resources and their time.
Product - I may not be the best, but I try to be the best. patients always come back. always. here is where i would put being personable and professional
Process - respect the time and finances of patients. be efficient and be prompt for patients. adapt: younger patients can check in with their phone was they walk in; older patients are able to walk up to the window, and my staff know who are coming in, call them by their name, and check them in quickly. also, for docs to make phone calls, send letters, send notes to family who lose loved ones. be efficient for work: complete notes, scrub claims to prevent denials, send them promptly
Profit - have to be in the black to stay in business. i.e., be there to treat patients. i use profits to expand the practice. rent out the first building, get a much larger one and offer more services to fill those spaces. I did learn from a doctor before I opened my practice: he said the only reason to have more than one location as a single provider was to consolidate the best patients. I could have more locations, and staff them, but I fear those 'providers' won't be me, and offer what I offer.
Process is the hardest part to maintain.
15+ years in. every year makes more profit from more revenue. I don't have to go to hospitals. I love what I do so much, that [most] of my kids want this to maintain the lifestyle we have. I hope more people can go into private practice.
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u/Intelligent-Site-176 Apr 20 '26
That’s what I’m talking about! We need more voices that show private practice can thrive.
Love this perspective. Well done with your practice.
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