The Rise of the Micro-Practice

 As overhead costs continue to soar and hospital consolidation hits a fever pitch, some doctors are mulling over the benefits of opening a micro-practice.

These hyper-niche, solo practices — run by doctors with zero staff — charge patients a flat monthly fee and don’t bill insurance companies, which eliminates the administrative burden physicians face, said Sonia Singh, MD, who opened Juniper Modern Primary Care, a micro-practice in Houston, 5 years ago.

“A micro-practice is a lean and efficient model doctors should consider,” said Singh, who sees her patients in a 700-square-foot office. “The reason it’s possible to make this work is that your overhead is low — you won’t need any staff to handle administrative and clinical tasks.”

And, while some are critical of the model, Singh argues that it’s cost-effective for her patients and her — by her second year, she earned the same amount she did working at an insurance-based practice.

“People say micro-practices are only for the 1%, but my patients are gig workers, they’re restaurant workers, they’re people who don’t have good insurance,” Singh told Medscape Medical News. She has 170 patients who pay an average of $200 per month for 24/7 access and currently has a waiting list.

For Nadia Sirdar, MD, who started seeing patients at her micro-practice in Bethesda, Maryland, this past summer, the model has led to greater job satisfaction.

“I’m able to practice medicine on my terms,” she said, adding that her practice is geared towards women in midlife. “This means I can take the time and energy I need to learn the patient’s history, and I have control over the environment they walk into, which means I have curated the experience so that the waiting room feels like you are visiting a friend’s home. I have my own tea blends, so we can share a cup of tea while I discuss the patient’s history and all of the things they want to talk to a doctor about but may have never had the time and space to do so.”

During that 45-minute to hour-long chat, taking place with her laptop open and a note-taking assistant charting for her, Sirdar isn’t pressured to type her notes, which creates space for full eye contact, enabling doctor and patient to build a relationship as health partners.

“By the time we’re in the exam room, going through the ritual of vitals and a full physical exam, we’ve spent a relatively relaxed period of time together, and the exam is more forthcoming,” she says. “The patient might say, ‘Can you look at this?’ or ‘I was embarrassed to ask about this before, but now I feel comfortable.’”

Misconceptions Prevent Opening Micro-Practices

For Sirdar, one of the things that has been most surprising is that some of her colleagues tend to think that starting a micro-practice takes a lot of capital. While there are few official statistics on start-up costs, micro-practices can be opened with as little as $10,000 and cost less than traditional practices. They can also be opened far more quickly than a traditional private practice.

“I self-funded my micro-practice, and, yes, I paid a lot in terms of sweat, tears, and grit, but I believe it’s worth it,” she says, adding that she continued to work as an employed physician while she built her own business. “I was able to generate a patient list outside of my employment by letting people in my community know early on that this was my dream.”

Despite the micro-practice trend continuing to proliferate, some doctors still assume it is barely viable.

“They tend to believe that without scaling, staff, and high patient volume, the practice can’t be profitable or sustainable,” said Sylvie Stacy, MD, author of 50 Nonclinical Careers for Physicians: Fulfilling, Meaningful, and Lucrative Alternatives to Direct Patient Care. “But this tends to overlook the major role of overhead costs. When overhead drops from roughly 60%-20% to 35% or even lower (which is what I’d expect for most micro-practices), the break-even point changes. Your income may be lower than in traditional practice, but profitability can arrive faster, and there’s less financial risk, no debt, and more predictable cash flow.”

Less Equipment, Better Care

In addition, it’s a fallacy to think that micro-practices deliver inferior care because they lack staff, fancy equipment, or expansive office space. 

“More infrastructure doesn’t automatically mean better medicine,” Stacy added. “Micro-practices deliberately have a narrow scope of patients. This usually leads to more continuity, more access, and better relationships, and these are all things that improve care and patient satisfaction.”

As for the challenges, the one thing physicians in micro-practices are right to focus on is the safety concerns related to working solo. 

“Having a chaperone in the exam room when a patient requires, say, a gynecologic exam, is one of the biggest challenges when you’re running a micro-practice,” Singh concedes. “But there are many options. For example, if your office is in a space with other medical practices, you can pay a healthcare professional a per diem when you need to do those exams.”

Being transparent about the way clinical exams will be conducted is also critical.

“I tell patients up front that I’m working alone, that I will do my best to arrange a chaperone if needed, and that I don’t do sensitive appointments on male patients,” Singh said. “However, since I spend at least an hour with my patients before we do any exam, by the time I’m doing an intimate exam, there’s a trust there. This is very different from a traditional practice where you have thousands of patients coming through the door.”

Finally, the lack of colleagues can also have an upside, Singh said.

“The tradeoff is that although I don’t see other doctors in my workplace, I have more time and flexibility to meet colleagues for lunch. I’m also in touch with specialists all the time in my work, coordinating care for my patients.”

https://www.medscape.com/viewarticle/rise-micro-practice-2026a10004av