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9 Things I Wish Someone Had Told Me About Starting a Private Practice

Are you interested in starting your own private practice?  

starting private practice

Today’s post is a guest post from Dr. William Albright, a plastic surgeon in San Antonio, and his wife/bad-ass practice manager, Juli.

A little over 2 years ago, they opened a solo private practice in San Antonio, Texas. At Alamo Plastic Surgery, William specializes in breast and body contouring procedures.  Recently we were voted #1 in San Antonio for Cosmetic Surgery.  

They have a very unique perspective and offer amazing advice about starting a private practice. Really, the advice is applicable to anyone in practice at all.

So enjoy!

Are you interested in starting a private practice?

These are my learnings from the last few years.  

It is focused on what I wish someone had told me.  

I am very grateful to the people who have helped and mentored me, and I would love to help others in the same way.  

Let’s get into it – 9 things I wish someone had told me about starting a private practice!

1. What is your Why? 

(I love that William and Juli put this first! Figuring out your “why” is the most important step in most journeys, including your personal, professional, and financial ones!)

For me this has been easy.  It is to provide great results to my patients.  

This is very helpful as it drives hiring, website content, branding, marketing.  

It also drives continuous improvement where I am in constant competition with myself to improve results.  

With this guiding why, it was easy to refer patients to another facial plastic surgeon who specializes in facial plastic surgery.  

2. Insurance  

I expected to have a 50% insurance / 50% cosmetic practice.  

When I started the insurance contract process (start at least 6 months in advance), many of the major commercial insurance carriers in San Antonio were offering par Medicare or lower in-network reimbursement rates.  

This was not enough to cover a basic overhead much less the extensive time required for an insurance biller.  

One major carrier even refused to offer a contract, citing “adequate in-network coverage for plastic surgery.” 

Initially and with much trepidation, we decided to proceed as out-of-network and ~1 year into the practice we transitioned to only cash pay.  

This experience may be singular to Texas, but I fear it is becoming more common.

3. Social Media

Don’t wait!  

Social media is not going away, and it is a great way for patients to see your recent work, your personality, and interact with you before a consultation and even after.  

Pick a name for your practice or just start one with your name (most doctors seem to do something similar to drwilliamalbright).  Facebook, Instagram, SnapChat and TikTok are all great channels.  Have your friends follow you and start experimenting with creating content.  

We use three main tools to create posts (Canva, Adobe Photoshop, and Figma).

Also, follow other plastic surgeons to see how they show their content.

4. Before and Afters

If you are a resident or employed, you need to carefully review the policies associated with your employment.  Even if the patients sign a photo consent most likely your employer owns the photos.  In some cases, your employer may permit posting to RealSelf or another online platform which would permit you to show your future patients those photos.  Regardless you may want to start taking before and afters to learn how to best do it, and it is great way to analyze your work.

This may be more applicable to plastic surgeons. But there are corollaries with all specialties.

Related Post:
What Does A Plastic Surgeon Actually Do?

5. Reviews

These are critical.  

We recommend you set up the Healthgrades, Realself, and even Google Business Account under your name.  

Only ask patients at the right time and when you know they have had a five star experience.  These will then transition with you to a solo private practice. 

6. Website

Review your employment contract carefully, but we think in most cases you can set up personal website. We recommend you do this as soon as possible.  

Google / search engine optimization works best with time.  

If you are slowly building your website over a few years it should help you rank well when starting a private practice. I did not know to do this, and it probably took ~6 months before Google even recognized our website.  

This does not need to be expensive.  We recommend you look for websites you like and hire a designer / developer to execute a similar design.  

7. Location

With the large investment of starting your practice, most likely you will not have the freedom to change locations.  

We recommend choosing a location that will work for you in all stages of life.  In our case, we have family near San Antonio and there is significant population to support plastic surgery yet it was not over saturated with plastic surgeons.  

So far it has been a good decision

8. Business Plan

This is your business plan.  

Not only will the banks require a business plan for a loan but you need to determine if the investment of time, money, and effort is worth it.  

Speak with others who have started a private practice and hear about their learnings.  

We have a Google Drive of our business plan to share if you wish.  

9. Books

Many folks ask me the best books to read before starting a practice.  If I just chose one book, it is the The Business of Plastic Surgery by Joshua M. Korman.  

Others I found helpful are below:

  • Practice Bootcamp
    • This is not a book but a series of lectures offered at the ASPS annual meetings.  I highly recommend it.
  • Start with Why
  • The E-Myth Revisited: Why Most Small Businesses Don’t Work and What to Do About It
    • This book is about the common pitfalls of starting your business and how to avoid them.  It was very helpful.  
  • Traction: Get a Grip on Your Business
    • Although tough to implement all the recommendations, this book has great worksheets to organize your business and goals. We highly recommend the worksheets for a mission statement, core values, SWOT Analysis, 1 year, 3 years, and 10-year plans. We also find quarterly goals and monthly meetings to be very helpful. 
  • 101 Tough Conversations to Have with Employees
    • Recently we have realized we hire employees who understand our why and conversations are easy.  If they don’t, we find honestly and compassion to be the best tools to help guide conversations with employees.  

You can all reach out to William and/or Juli via their website:

What do you think? What do you wish you knew before starting practice? Are you in a private practice? Are you considering moving to private practice? Why or why not? Let us know in the comments below!

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    5 thoughts on “9 Things I Wish Someone Had Told Me About Starting a Private Practice”

      • thank you for sharing this. Nicely put 9 points.

        Did not get the gist of the website thing:
        If you are slowly building your website over a few years it should help you rank well when starting a private practice. I did not know to do this, and it probably took ~6 months before Google even recognized our website.

        If building the website the last moment will take time to be recognized from Google.

    1. Thanks for sharing these. As a young plastic surgeon it’s priceless learning the business side of private practice from more experienced surgeons as we don’t get any training during residency.


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