At the end of 2017, I left an established functional medicine practice and started my own. At the time, I was living in Austin, TX. I looked into positions at other established functional medicine clinics, but the salaries were abysmal (i.e. most paid hourly at $50 an hour, yet charged patients $500 an hour to see a non-physician practitioner). I briefly considered moving to work in a different state with a very well-known physician, but instead stayed in Texas and took a chance as a medical entrepreneur.

So, after a lot of planning, I took the leap and created “Center for Collaborative Medicine” (CCM) with the mission to provide affordable and cost-efficient care functional medicine care.

The First 6 Months

In Texas, a physician assistant cannot be a majority owner of a medical business. To own a practice, l needed to have physician co-owner. Six months before I started CCM, I had serendipitously connected with a physician who had been practicing in the integrative space for over 30 years. He was already co-owning a practice near Austin, and believed in my mission. The agreement was that he’d be a business partner on paper, complying with state laws, and he’d get a percentage of profits from my practice. Beyond that, he’d stay at his current practice and allow me the freedom to create and run the clinic.

The first few months were slow. I was respectful of the more established practice where I was working before starting CCM, and had only informed my patients that I was leaving and that their care was going to be transferred to the doctor. Unbeknownst to me, after I left, the practice would not share where I went with patients who called or inquired about my whereabouts, and even told people I was no longer in Austin. From this experience, I learned a big lesson:

Establish sources for patients to find you (website, social medial)… before starting your own practice.

At my current practice (Parsley Health), many of my patients find me because of blog articles I’ve written or they follow me on Instagram. Those blog articles, by the way, were originally written to solidify what I was learning about in the functional medicine space, to turn my newly obtained information into shareable knowledge. I still use the articles as a way to educate current patients (especially when I don’t have time to explain a condition or symptom during an appointment), or as a reference for my own review.

Build trust with prospective (and current) patients by providing additional resources. Patients especially like to know how YOU would help them, so base resources around frequently asked questions.

Running a Business

Within the first 6 months of being a new business owner, my physician business partner left his practice to join CCM, followed a few months later by another practitioner needing to move on from the same practice. Normally, many would celebrate this growth! However, the business wasn’t ready for this. My job title rapidly grew from practitioner and business owner, to being both of these AND an office manager, accountant, content creator for social media and email newsletters, marketing agent, and administrative assistant. I luckily had some help with the phone and scheduling, but I was still working 7 days a week, 12 hours a day, trying to keep everyone happy plus build a profitable business.

When starting out, keep your practice simple. Set boundaries, hire help for the business side, establish operations before growing, and take at least 1 day off a week (no exceptions!).

Closing the Business

Like many, I was forced to go virtual during Covid in 2020. Word had spread about the cost and efficacy of CCM, my patient load had grown, and I was at a point where I was making a good profit (even when I was “only” charging $225 an hour for my services). But I was burned out and unhappy.

In 2020, I received an email from Parsley Health asking if I was interested in joining the company. I had originally learned of the company at a conference, and felt they were in line with my goal of providing affordable functional medicine care (they are even currently trialing use of insurance to cover our services in New York and California!). After growing up with a parent who prioritized work over everything else, and who worked 7 days a week, I did not want to follow in that path. So I pursued the job opportunity.

When I made it through the interview process, and was offered a job, I took it! My supervising physician at CCM agreed to dissolve the business, and we went our separate ways. I admittedly struggled with the decision, but knew it was for the best.

Starting and running a business takes a lot of courage! Closing a business does not make one a failure – especially if doing so prioritizes good health and happiness.

What I’d Do Differently

I receive messages from fellow practitioners almost weekly now, asking for advice on pursing functional medicine or starting their own practice. While I can’t say whether or not I will ever own or run my own business again, the following are some of the things I would do differently.

• Invest in help
  • Join a mastermind (there are a small handful of good options in the functional medicine space – consider purchasing the guidebook I put together on education and business resources for more information). Besides the information you gain, you will be surrounded by like-minded entrepreneurs who are a source of support and even business referrals!
    • Note: I was wary of investing thousands into a business-building program for many reasons, but after spending hundreds of hours on non-clinical tasks, I now recognize that my time is valuable and better spent on patient care.
  • Consider having a contract or part-time administrative support via a virtual assistant. There are a lot of online freelance options such Upwork and Fiverr.
  • Take out a loan for the business (I put a lot of my savings into the business – not recommended!)
• Even if you’re an introvert, prospective patients need to know and trust you. Get yourself “out there” via a website, social media, or via local events and free talks.
  • Create content via blog articles, YouTube videos, and/or Instagram posts (i.e. establish your knowledge and give a glimpse of your approach to care). Part of my personal approach as a practitioner is “less is more” (see “What I’m Most Excited to Bring to Parsley Health members“). Many of my current patients are attracted to this approach, but they wouldn’t know that I practice this way if I didn’t mention it!
  • Start with a niche – and get really good at it! For ideas, the most common symptoms that I see in practice are bloating and fatigue followed by acne, IBS, weight gain, brain fog, and PMS/PMDD/endometriosis. If you need courses that can help you expand knowledge on a particular topic, consider the resource guide I put together on functional medicine education options.
• Know you basic financial needs
  • Determine monthly personal needs (for mortgage, health insurance, food, etc).
  • Determine monthly business costs (phone, internet, EMR, etc).
• When paying a physician as a business partner, focus on profits not revenue
  • Start with paying for the physician’s additional liability insurance that is required for collaborating with a PA/NP (and get a copy of this for your records)
  • If you are a PA or NP and require a collaborating physician, the two most common ways to pay a physician are by either a percentage of profits (per quarter, month, or even by visit) or to have a set monthly fee. In my business venture, I went with percentage of profits. However in our contract, this wasn’t well-defined and my partner interpreted it as a percentage of revenue, which didn’t take into account living or business expenses. It’s a lot more difficult to use percentage of profits, so I recommend a set fee.
  • An example of a set fee option: If the business profit is between $1000 and $5000 (beyond what is needed for personal and business costs), the physician would get a fee of $500. So if personal/business costs amount to $3000 a month, once the business reaches $4000 in revenue (i.e. $1000 profit), the physician would be paid.
  • If using the set fee model, determine milestones for the business revenue, at which point the physician would get an increase in monthly profits.
  • For more information on this, and for places where you may find a collaborating physician, join the private PA and NP Owned Practices group on Facebook.

• Establish a virtual practice as a good way to “get your feet wet”
  • This approach keeps overhead costs low and accesses larger geographical area of potential patients (especially if you live in a city/town where there are either a lot of functional medicine practitioners or there are patients who are not likely to invest in functional medicine).
  • If patients want to meet in person, you can often rent out a room from a local massage, acupuncture, or chiropractor.
• Have back up financial support
  • My business was my only source of revenue, and I didn’t have a spouse to help with costs. This put a lot of stress on me, so having additional streams of income while establishing the business is recommended (even if this means working part time in urgent care, at a local coffee shop, or driving for Lyft/Uber).

Final tip: Start paying attention to your current practice, and how the business works. Note what works well and what doesn’t (e.g. EMR templates or shortcuts, handouts, how administrative support interacts with patients, etc).

Summary

Running and owning a health-oriented business is both challenged and rewarding. I loved getting to choose my own hours, prices, and schedule while following my mission as a practitioner. And there are tax benefits that you learn to appreciate immensely! If you’re thinking about starting a functional medicine business, get prepared, create a checklist of what goes into creating a business in advance, and take the leap!

Exciting things are in the works! Coming soon, I’ll be launching a new website and paid mentorship designed for licensed medical practitioners that want to work on the art of practicing functional medicine. Stay tuned for how to sign up for updates to this!