Everyone has an opinion when you're opening a practice. Your bank wants to give you a loan. EHR vendors want a multi-year contract. Your landlord wants you in a big space. A well-meaning colleague tells you what worked for them five years ago.

Most of it will cost you time or money you don't have yet.

Here's what actually matters.

The wrong EHR will follow you for years.

Budget systems seem fine until you're losing revenue to miscoded visits, missing add-on codes, and billing errors you can't see. The cheapest option and the right option are rarely the same. Talk to NPs who are two years in, not vendors with a demo.

Credentialing done wrong eats time you'll never get back.

Start 4–6 months before you open. One typo, one missed NPI detail, one enrollment submitted in the wrong order, and you're waiting another 90 days to get paid by Medicare. Get someone who's done this before, not someone learning on your timeline.

You don't need a loan. You need a small space.

Sublet a room. Co-locate with another provider. The practices that struggle most opened too big, too fast, with fixed costs that panicked them into bad decisions. You can always grow into space. You can't shrink from debt.

Your first 90 days are free marketing — use them.

Before all your contracts are live, see everyone you can. Cash pay, low-cost visits, pro bono if someone needs it. Every early patient is a long-term patient, a review, a referral. You're not losing money. You're building your panel.

Hold off on the decor.

Patients aren't coming for the furniture. They're coming because someone they trust told them about you, or because you showed up in their community before you needed them. You are the draw. Act like it.

Don't hire until you have to.

The temptation is to staff up early — it feels like growth. It isn't. Hiring to offload admin work before your panel is built is how practices sink. Lean operations float. You hire when you can't handle the patient load anymore, not before. Every salary you add before that point is pressure you don't need.

The practices that launch well don't have the best equipment or the nicest offices. They have the right setup from day one — and a community at their backs who've been there before.