Starting Your Practice: Time to Move Forward or Time to Move On?

Months of precious time: researching, studying books and courses… but you’re still not sure.

For years you’ve had this dream of starting your own practice; it’s what you’ve wanted to do for a long time.

Yet you keep asking yourself: “Is this the right thing to do?

For some reason, you just can’t make the decision… should you move forward with your own practice or stay in your job.

You are STUCK…

And it’s a tough decision. Why would anyone get started if not 100% sure, right?

Well, I don’t think you’ll ever have 100% certainty. Chances are there will always be some degree of doubt. However, doubt need not keep you from moving forward.

Going through a time of indecision is normal when you’re facing a big decision. And starting your practice, going out on your own is right up there.

So it’s no surprise the decision can be challenging. But this doesn’t have to be a negative; in fact, it may turn out to be a positive for you.

Because your uncertainty might give you the extra push to:

  • do a bit more research
  • look for a better lease
  • find less expensive equipment
  • run the numbers just one more time

And all of it helps build a stronger practice.

But what if you’re stuck, really stuck?

Well, that’s a different story altogether.

The question is what do you need to do to make your decision once and for all? How do you get unstuck so you can either move forward or let go of your dream?

Here are a few suggestions to help you “get unstuck,” so you can decide to either move forward or simply move on. 

Whose Dream?

Ask yourself if starting your practice was your own idea, something you’ve wanted all along? Or is it an idea you somehow picked up along the way?

Perhaps you have friends or colleagues who’ve discussed private practice or who’ve even started their own?

At times we’re influenced by the words and actions of others without being completely aware of it. Additionally, the enthusiasm of others tends to influence and sweep us along.

Consequently, it’s possible to make a decision or set a goal that’s not entirely our own. And when “push comes to shove” we find we’re not as committed as we thought we would be.

The Big Why

Let’s assume you’re following your own dream. Next, ask yourself what your main reasons for starting a practice are? What’s your “Big Why” for wanting to go out on your own?

  • Is it to enjoy greater freedom in your work?
  • Is it the possibility of more income?
  • Is it to create an asset?
  • Is it to give back to your community, leave a legacy?

Whatever your reasons for starting a practice, are they important enough for you? Will they carry you through the rough spots and sustain your commitment for the long term?

If your big reasons are not all that important to you, you may experience difficulties making decisions and following through. 

Aligned With Core Values?

If there is ongoing ambivalence and you struggle with coming to a decision, take a close look at your values. Ask yourself if owning a practice is in alignment with your values.

Some have a deep-seated belief that owning a business and making a profit is “bad.” Others view making a profit and being a healthcare provider as incompatible. And some NPs think that healthcare should mostly be free.

All too often, these values operate under the surface. They are strong enough to influence and hold us back.

If owning a practice or generating profit are against your core values, you have a problem. Chances are you’ll experience difficulties until you work through your beliefs.

Is It Burnout?

If you find yourself struggling with making the decision to start a practice, could it be because of burnout?

Ask yourself if you’re facing general burnout from healthcare? Or are you frustrated with your job and ready for a change?

If you are burned out from working in healthcare overall, starting your own practice will likely not resolve the problem; if anything, it will magnify it.

You may be better off starting a non-clinical business or switching to another career.

And if you’re burned out from your job, starting a practice may not be the best solution either.

You see, starting and running a practice can be stressful. It may take long hours to get your practice off the ground. And, you may find yourself dealing with problems you’ve never come across in your job.

So think twice before you trade one headache for another! 

Done Your Research?

Are you saying to yourself: “If I would only know; if I could only have these answers?”

If that’s the case, your indecision stems from uncertainty about how a practice works. Perhaps you’re unsure about:

  • How much money do you need to start?
  • How much can you expect to bring in?
  • How do you find the space for your office?
  • How do you do the billing?
  • What will your expenses be?
  • How do you know what your income will be?

However, when you have real data to work with, indecision tends to slip away, enabling you to move forward.

So have you done your research, do you know what the real numbers are?

You must have actual numbers before you can decide. So if you’re serious about starting a practice get the numbers and your decision will be much easier. 

Will There Be Regrets?

Finally, ask yourself how you’d feel if you don’t start your practice; if you’d move away from your dream?

Will you feel like a failure, someone who gives up too fast? Will you feel embarrassed, forever second guessing yourself? And will you be haunted by regrets?

Or will you be ok?

Would you at peace with your decision? Perhaps even stay open to revisiting your dream at a later time?

In Summary

Making the decision to start a practice is not always easy. And if you experience ongoing hesitation with the decision, stop and listen to yourself.


  • Private practice is not for everyone
  • Or it may not be the right time for you to start one now

Whatever the case may be, don’t be afraid to change your mind. And don’t think you have failed because you’re changing your mind.

Ignore the voices in your head whispering you’re failing because you’re not finishing what you started. After all, it’s what many hear growing up and throughout school: “Quitter, failure, finish what you start…!”

But you and I both know there are times when NOT finishing is the right thing to do. And if that’s the case for you, don’t feel bad. And don’t think for a minute you have failed!

If you come to the conclusion that starting a practice is not the right thing for you, so be it! And just because it didn’t work out now doesn’t mean it can’t later.


Have you struggled or are you struggling now with making the decision? Leave us a comment and let us know!



By Johanna Hofmann, MBA, LAc; regular contributor to the NPBusiness blog and author of “Smart Business Planning for Clinicians.

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  1. Thank you for your insights and what you add to the advancement of the NP profession. They are right on the money.

    Having been a business owner over the past 20 years prior to venturing into medicine, I knew coming out of NP school, that practice ownership was for me. I wanted to be in control of how I delivered my services to communities.

    The thing that most surprised me with the healthcare arena is the disparities in reimbursements. What I bill, using the CMS fee schedule, and what I collect from insurers is totally different. The numbers look so good on paper until I compare my receivables with what was actually billed.

    I am having a hard time wrapping my head around this 35-45% difference in what I billed and what was collected due to the discounts applied to NPs within our contracts with insurers. Are these “contract adjustments” tax deductible as “uncollected receivables”? Thank you for your time and attention to my question.

    Peace always,

  2. Jennifer, they are not tax deductible.
    1. I am curious about your statement…”. What I bill, using the CMS fee schedule, and what I collect from insurers is totally different.” Does this mean you are billing out what CMS allows?
    2. Different commercial payers have different allowables for NPs. You can, and should negotiate to get those fees higher. However, regardless of what you bill (over the amount allowed), you will only receive the allowed amount.

    Please let me know if you have additional questions.

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