The Surgeon Entrepreneur: Setting Up Private Practice

Transitioning from the structured, salaried environment of the public hospital system to the "wild west" of private practice is the most significant culture shock in a surgeon's career. You have spent 15 years learning to be a master technician, but likely 0 days learning to be a CEO. And make no mistake—a private practice is a small business, and you are the Chief Executive Officer.

This guide outlines the critical pillars of setting up a successful, sustainable private practice.

Visual Element: A "Startup Roadmap" infographic showing the timeline from Fellowship to First Patient.

1. Structural Foundations

Before you print a business card, you need a legal and financial identity.

The Provider Number

You need a separate Medicare Provider Number for every location you work (rooms, hospitals). Apply early; bureaucracy is slow.

Legal Structure

How will you trade?

1. Sole Trader: Simple. Cheap. You are personally liable. Hard to tax plan.
2. Company (Pty Ltd): Limited liability. Better tax rate (corporate rate). Higher setup/admin costs.
3. Service Trust: The Gold Standard for many.
   • The Concept: You form a "Family Trust" (The Service Entity) that employs your staff, owns the equipment, and rents the rooms.
   • The Flow: Your medical company earns the fees. It pays a "Service Fee" to the Trust (market rate + margin). The Trust distributes profits to family beneficiaries (tax effective).
   • Warning: This is complex. You need a specialist medical accountant.

2. Location Strategy

Where will you hang your shingle?

The "Hub and Spoke" Model

• The Hub: Your main rooms. Where your secretary sits, files are kept, and you spend 60% of your time.
• The Spokes: Satellite consulting locations (e.g., in GP clinics or outer suburbs).
• Strategy: Spokes are loss-leaders. You go there to capture a catchment area and feed surgery back to your main hospital.

Rooms Options

• Squatting: Renting a session (4 hours) in someone else's rooms. Low risk, low cost. Great for starting.
• Associateship: Joining a group. Instant referrals, shared call, mentorship. You pay a % of receipts (usually 30-40%) to the group service company.
• Solo: High risk, high reward. Total control, but you pay for the toilet paper.

3. The Dream Team

Your staff make or break you. A patient will forgive a 5-minute delay from you, but they will never forgive a rude receptionist.

The Practice Manager (PM)

Do not hire a junior. Hire an experienced PM who knows Medicare, Eclipse, and HR law. They are expensive, but they pay for themselves by preventing billing leaks and staffing crises.

The Virtual Option

For the first 6 months, consider a "Virtual Office" service. They answer phones and book appointments remotely. Saves the cost of a full-time salary until volume picks up.

4. Financial Systems

Billing Policy

You must decide your brand.

• Premium: High gap fees. "I am the best." Risk: Volume may be slow.
• Accessible: Known Gap / No Gap schemes. Volume is high, but margin is lower.
• Informed Financial Consent (IFC): The law. Patients MUST receive a written estimate of fees before surgery. "Bill shock" is the #1 cause of complaints to health regulators.

Tech Stack

• PMS (Practice Management Software): Genie, Gentu, Clinic to Cloud. Go Cloud-based. Being able to check your schedule on your iPhone is mandatory.
• Dictation: AI dictation (e.g., Heidi, Lyrebird) is revolutionizing letters. Instant turnover.
• Accounting: Xero. Integrate it with your bank feeds.

5. Marketing: The "Hustle"

Patients (and GPs) need to know you exist.

The GP Network

GPs are your customers.

• The Visit: Go to their clinics. Bring lunch. Do a short educational talk ("5 tips for managing knee pain").
• The Letter: Your letter back to the GP is your best marketing tool. It shows your competence, thoroughness, and tone. "Dear John" vs "Dear Dr Smith."
• Accessibility: Give key GPs your mobile number. "Call me anytime" is a powerful promise (if you keep it).

Digital Presence

• Website: Mobile optimized. Fast. Bio, Photo (professional headshot), Specialties, "Book Now" button.
• SEO: You want to own the keyword "Ortho Surgeon [Your Suburb]".
• Socials: LinkedIn for professional networking. Instagram/Facebook for patient education (be careful with AHPRA testimonials rules—they are strict).

6. The Trap: Burnout

In the first year, you will say "Yes" to everything. Every fractured finger, every late consult, every Saturday list.

• The Danger: You are building a business, operating, and managing staff.
• The Fix: Schedule "Admin Time." Do not operate 5 days a week. You need 0.5-1 day for business management.

Conclusion

Private practice is rewarding. You choose your team, your equipment, and your schedule. But it is a business. Treat it with the same rigorous planning you apply to a complex revision arthroplasty.

Advice: Find a mentor. A surgeon 10 years your senior who has "made it." Buy them dinner. Ask about their mistakes. That dinner will save you $50,000.