Edward J. Kroger, MD, JD, is one of the rare breed of physician-lawyers, so he gets healthcare law. Add to that, he built his own legal practice, so he also gets building a business.
“I worked for a very large law firm—made partner at a very large law firm—and wanted to leave. So in my off time and occasionally during my on time, I was imagining what I would look like as a solo practitioner,” said Dr. Kroger, who is now professor of healthcare practice at the University of Houston C.T. Bauer College of Business and also provides strategic business advice to healthcare organizations.
Dr. Kroger was a featured speaker at the AMA Independent Practice Accelerator Workshop, an in-person, two-day event designed to give physicians the essential knowledge, practical skills and confidence to launch or strengthen an independent practice, held at the AMA headquarters in Chicago in September.
A recurring event, the workshop is just one part of the AMA Career Advancement Collective, a powerful new suite of educational programs and training will help physicians develop and advance at every stage of their career. When they are available, 2027 dates for the workshop will be announced.
Dr. Kroger’s guidance for physicians looking to set up, or amp up, their private practice focused largely on one of the biggest pain points for practice owners: human resources. One key to success, he said, is visualizing how the practice will run.
“What is that going to look like when a patient walks in the door? Who's going to see the patient? What are they going to do? What people do I need? How long is the visit going to be?” he said.
He then laid out his recommendations for finding and developing team members.
Establish focus and define success
“When you're starting up a practice, money is hugely concerning,” Dr. Kroger said. “You need to figure out who you're going to hire first. It's probably your office manager and then you add people over time. When I say I built up to a 20-person law firm, it took me 20 years. That first few months I was crawling around on the floor plugging in my fax machine.
Dr. Kroger added that it is vital to set the tone for employees right from the start.
“Day one is for people, not paperwork,” he said. “That's your first day to welcome someone to your practice and include them on your team. So try to get all the paperwork stuff out of the way on day zero,” he said. “Have them come in on a day zero before their first day and just fill out some of that nonsense and then welcome them on their first day where you actually spend time introducing them around and assigning them with a buddy person."
From there, you should keep an eye on several key milestones for employee performance.
“Within the first 30 days, they should have some vague idea of what you're trying to do. [At] 60 days, they have to be able to operate with light supervision. [At] 90 days, they should be able to come to you and say, ‘Here's a really good way we could do this differently,’” he said.
The AMA STEPS Forward® Private Practice Playbook introduces foundational terms and concepts that apply to private practice. It breaks out the professional advisors who can provide invaluable guidance as you develop a business plan for day-to-day and long-term operations. It also provides lays out time-tested strategies for growing your practice.
How to deal with failure
“Probably one of the mistakes I made most often was keeping someone who did not work out,” Dr. Kroger said, adding that he eventually developed a rule for determining whether it was time to let an employee go.
“If someone was getting 3% better every month, I would usually keep them on” because they still have an upside, he said. “But if I saw someone who was at 0% improvement over three months, really it was time to start thinking about: Do I really have the right person? Is this person ever going to get better?”
If you have determined that you need to separate an employee, you need to do three things in short order.
“Be real blunt: ’I’m letting you go,’” he said. "Just get that on the table, first thing.”
The second thing is to explain that the employee and the job are simply puzzle pieces that don't fit together. “And then you wish them well, which can be heartfelt,” he said. “You want them to go out and find another job and do well.”
Dr. Kroger also provided tips on interviewing prospective employees, managing performance problems, calculating the total financial cost of each hire, working with AI and lawyers on business setup, and how to stay in compliance with employment laws.
The AMA offers excellent resources on getting started in private practice, including expert guidance on payment and contracting.
