The gap between "I want to go independent" and an actual functioning practice is almost never clinical skill. It's the sequence of decisions nobody walks a surgeon through: entity structure before you see a single patient, credentialing that takes months longer than anyone tells you upfront, and back office systems that either work from day one or quietly bleed the practice for years.
Entity structure comes first because it determines everything downstream, how you're taxed, what you're personally exposed to, and how clean a future sale or partnership looks. Getting this wrong early is expensive to unwind later.
Written by John M. Abrahams, MD — board-certified neurosurgeon, founder of New York Brain & Spine Surgery.
Related: Building a Private Neurosurgery Practice
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