Startup

Starting a medical practice: the complete first-year plan

Starting an independent medical practice is a 9–12 month project pre-open and a 12-month operational shakedown post-open. Front-load credentialing (starts month 10) and real estate (starts month 9) — those are the two paths most likely to slip and delay opening. See our /resources/practice-startup-checklist for the full task list.

By Jordan Alderman, MBA, CMPE · Reviewed by Rania Hassan, JD, CHC · Last reviewed July 23, 2026 · Methodology

Disclosure: Independent editorial. No pay-for-placement, no affiliate rankings. Full editorial standards.

This guide provides the strategic overview and milestones that go with the tactical startup checklist.

Pre-launch (months 12–1)

Six workstreams run in parallel: entity/legal, credentialing, real estate + build-out, technology stack, staffing, and marketing. Any one slipping delays the whole project. Weekly project review with all workstream owners is non-negotiable.

First 90 days post-open

Reduced schedule week 1 (50%), week 2 (75%), week 3 (100%)
Daily huddle first 30 days with issue log
Weekly financial review with billing partner
Patient experience audit (mystery shopper) month 2
First 60-day KPI vs plan review at day 90

Months 4–12: from open to stable

Referral network activation (top 20 physicians)
First cost-per-acquisition analysis by channel
First provider comp true-up
Vendor performance review (billing, EHR, IT)
12-month P&L vs plan + next-year forecast

Related buyer guide

Deeper vendor evaluation: consulting →

About the author

Jordan Alderman · MBA, CMPE

Lead Editor, Revenue Cycle & Credentialing

Former practice administrator with a decade of operating experience running multi-provider primary care and behavioral health groups. Led billing vendor transitions, credentialing programs across 30+ payers, and EHR migrations before joining The Practice Vendor Review as lead editor for revenue cycle and credentialing coverage.

Areas of focus

In-house vs outsourced billing decisions
Payer contract negotiation
Credentialing and re-credentialing workflows
Denials management

Disclosure: Holds no vendor equity. Does not accept vendor consulting, referral, or speaking fees. Past employment includes clinical operations roles at independent practice groups; no current advisory relationships with vendors in categories covered on this site.