What You’ll Take Home From a Solo Practice

Hey Nomads,

I get this question constantly: “Dr. Mo, I’m thinking about going solo in a brick and mortar physical practice when I get back stateside. What will I actually make?”

The internet is full of clickbait articles promising “$400K as a family doc!” or posts claiming private practice is dead.

Let’s do some real math using current Los Angeles numbers (June 2025) because, frankly, if you can make it work in LA, you can make it work anywhere. Plus, many of you digital nomads are California-based anyway. These numbers are for an insurance-based private outpatient medical practice – mostly primary care, but this would work well for many other specialties.

The Back-of-the-Envelope Practice Calculation

1. Patient Volume = Butts in Chairs

The data is pretty consistent across surveys and EHR analytics. Your typical full-time primary care doc works 220-250 days a year and sees 15-22 patients daily. Average? About 20 patients per day.

Math check: 20 patients/day × 240 working days = 4,800 visits annually.

That’s assuming you take four weeks off, which is the bare minimum.

2. Revenue = What Each Visit Pays

Your payer mix is everything, and in LA, here’s what a typical breakdown looks like:

Add another 5-10% for ancillary services (vaccines, joint injections, ECGs), and you’re looking at roughly $575,000 gross collections.

3. Overhead = Keeping the Lights On

National data consistently shows that primary care practices run 60-70% practice overhead. In LA, your typical solo practice budget looks like this:

• Staff (1 MA + 1 front desk + payroll taxes): ~$140K
  • I consider this the bare minimum
• Rent (1,600 sq ft medical suite): ~$50K
• Malpractice insurance: ~$15K
• Everything else (billing, EMR, supplies, billing, utilities, business insurance): ~$130K

Total overhead: ~$335K (about 58% of that $575K we collected)

4. Your Bottom Line = Actual Take-Home

$575K collections – $335K overhead = $240K

That’s what’s left to pay yourself, fund your retirement, and cover self-employment taxes.

Here’s what happens when you move the big levers:

The Levers That Affect Profits

Payer Mix

Every 10-point swing from Medi-Cal to commercial PPO adds about $15K annually. This is why location matters so much and why some of you might want to think twice about that “give back to the community” clinic in a low-income area, at least until you’ve built some financial cushion.

No parking = no PPO. And if you MA is a bit rough around the edges, you might lose that Medicare Advantage patient and eventually the contract.

Coding Pays Off

Document appropriately for 99214s instead of 99213s, and you’re looking at an extra $30 per visit. Over 4,800 visits, that’s $60-70K annually. Yes, it takes more time per chart, but the math works.

If you’re hiring a billing company, remember that there are good and terrible billing companies. You have to have oversight, otherwise you’ll lose a lot to collections and underbilling. Of course, overbill and you’ll go to Medicare jail. No joke.

Ancillary Revenue Streams

CLIA-waived labs, weight loss meds, some cash-pay options, these can add 5-15% to your revenue with minimal overhead increase. Easier said than done, but after about 3 years in practice, these won’t be tough for you to add.

Many docs bring on an RN who can do a few cash-based aesthetic procedures 1 day a week.

Staff Efficiency

Going from 2.0 to 1.5 FTE support staff saves $35-40K annually. Sharing an MA with a partner practice can work wonders for your overhead percentage.

Since you are insurance-based, marketing may not matter too much, neither does signage. So you can locate your practice in a large medical office building and share resources with an ortho or endocrine doc.

Real Estate Strategy

Buying your medical condo and paying rent to yourself swaps expense for equity building. Not very “nomadic,” I know, but it’s a legitimate wealth-building strategy.

I don’t think it’s a good idea to go into this unless you’re a seasoned real estate investor.

Private Practice vs. Employment

The latest MGMA data shows median W-2 salary for employed Southern California family docs at $265K. Our “20 patients/day, 60% overhead” scenario produces almost exactly that.

So you’re essentially trading steady paychecks and benefits for control, equity, and upside potential. Whether that trade-off makes sense depends on your risk tolerance and entrepreneurial drive.

The Digital Nomad Angle

Here’s what the traditional practice management consultants won’t tell you: once you’ve built a stable practice, telemedicine and hiring a PA or NP create opportunities to maintain revenue streams while traveling. I’ve seen nomad docs successfully run “hybrid” practices, like a brick-and-mortar base with significant virtual components that allow for extended travel.

But you need to nail the fundamentals first. Master the 3 knobs (volume, payer mix, overhead) before you start getting creative with location independence.

I personally don’t have any experience yet running my own physical practice, so there is no way I could nomadize it until I’ve learned the ins and outs of staff management.

Bottom Line for 2025

With normal LA payer mix and 20 visits daily, expect to clear $230-260K annually as a solo primary care doc. Push yourself to 24 patients/day, optimize your payer mix, and trim overhead, and you can break $300K. Accept heavy Medi-Cal panels or work part-time, and you might dip under $180K.

It’s not a cash-based practice and it’s not passive income. You’re buying yourself a job with upside and autonomy might be worth everything. You have the option to bring on more docs or APC in the future.

The numbers don’t lie, it’s totally doable. The question is whether you want to do it, and whether you’re prepared for the realities of small business ownership.

-Dr. Mo

Want more real talk about the business of medicine? Join our private Digital Nomad Physicians community where we discuss everything from practice management to international tax strategies. Because your career should enable your adventures, not constrain them. Book a consult with me and if you’re the right fit, I’ll add you to the group.

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