Starting Your Own Practice (Ft. Dr. Patrick Ryan)
How to Leave a Large Medical Group and Succeed in Solo Practice: Lessons from Dr. Patrick Ryan
Hi everyone, Dr. Rob Beck here from The Interesting MD. If you’re a physician who has ever thought, “Maybe there’s more to medicine than this?” or you’ve debated whether to leave your big group, you’re definitely not alone. In our latest episode, I had an absolutely fascinating (and honest!) conversation with my good friend and Nashville vascular surgeon, Dr. Patrick Ryan. Patrick shared his journey—warts and all—leaving a massive multi-specialty group and building a thriving solo vascular surgery practice from the ground up. If you’re looking for advice on starting your own practice, navigating burnout, or just curious what it takes to be independent in medicine today, this is for you.
Let me take you behind the scenes on what we learned, the risks (and rewards) Dr. Ryan faced, and the secrets to making solo (or small group) practice work—whether you’re a surgeon or in any medical specialty.
1. Why Leave a Big Medical Group in the First Place?
Patrick and I go way back—Aerosmith concerts and all!—so I know he’s not a guy who makes rash decisions. He’d been in his group for nearly a decade, starting as surgeon number 12 out of what would grow to 25+. Sounds successful, right?
But here’s the not-so-secret reality: with every additional partner, you gain a new set of opinions—25 doctors, 25 ways of wanting to do things. Herding cats is an understatement. In Patrick’s words, “Surgeons are often stubborn, type A, and fiercely independent by nature. Try getting everyone to agree on what ‘the right thing’ is, and you might as well schedule a root canal for fun.”
The frustration hit a peak when it took him a year—a year!—to get the group to adopt a policy on timely operative notes (for you non-surgeons: if you don’t write or dictate the op note ASAP, you’re playing with fire, liability-wise). Even after enormous effort, the rule was never enforced and things slid back to “the way things always were.”
For Patrick, it became clear: the group dynamic wasn’t a fit, and no amount of “doing the right thing” was going to change the culture.
Takeaway: If you’re continually frustrated, spending more time politicking than practicing, and using up all your “personal capital” just getting the basics enforced, it might be time for a change.
2. The Leap: Starting Your Own Practice
Maybe you’ve wondered—How do people just walk out and start their own thing? Here’s the honest truth from Patrick’s experience:
Step 1: Plan Quietly, Prepare Fully He started laying groundwork months before anyone knew—setting up an LLC, thinking about office space, and quietly talking to trusted team members (shout out to his nurse practitioner Tisha and loyal MAs, who literally walked out with him when the time came).
Step 2: Accept the Uncertainty He only had 17 days from his notice to opening the new practice. At one nerve-wracking moment, two MAs were literally escorted out of the old office for declaring their loyalty. Ever seen Jerry Maguire? Yeah—like that, but scarier because real families and paychecks are on the line.
Step 3: Use Your Relationships Don’t underestimate those connections. Patrick called up HCA’s Centennial hospital for office space and got fast-tracked; a radiology friend helped him secure essential lab time.
3. The Hidden Challenges: It’s Not Just Medicine
Let’s get real: Knowing your way around a scalpel isn’t enough to run a successful practice.
Billing & Collections Six weeks into the new business, they literally didn’t know how to collect a copay (“Sugar boogie, don’t worry about it”—his wife Susan as the front desk learned on the fly!). It took time—and a billing grandma warrior, Mary Alice, to get paid.
Cash Flow Patrick lived on trailing payments from his old group, savings from a good prior year, and a no-questions-asked $300K loan from a local banker. Don’t get me started on how crucial those private banking relationships are—if you don’t have one, get one!
Staffing Having the right people is everything. His team, from the MAs to his office manager Renee to scheduler Ashley, became the glue.
4. Top Tips for Doctors Thinking About Going Solo
If you take nothing else from this episode, here are Patrick’s must-knows:
You must have an interest in how things work. Coding, billing, insurance, workflow—be the expert or get someone in who is.
Be prepared to lead. You’re the boss now.
Surround yourself with the right people. Skills can be taught; reliability and loyalty can’t.
Know your numbers. Track your AR (accounts receivable), know your cash flow, and invest in the right infrastructure.
Leverage mentorship and networks. Don’t go it totally alone, especially if you’re just out of training.
5. Why Do It? The Joys of Independence
After all that risk and chaos… why do it? Here’s what Patrick loves:
Immediate decision-making: If something needs to change, he decides and his team implements—no committees.
Everyone has a voice: His team can veto “harebrained” ideas (and does!).
Quality focus: He could invest in things like the Vascular Quality Initiative (VQI), which big groups resisted.
Rapid innovation: New procedures can be trialed and implemented as soon as he’s ready.
Flexible scheduling and control of clinical load.
But here’s what really gets him: seeing his team every morning, building a great place to work, and being in control of his own destiny.
6. Burnout, Bureaucracy, and How to Survive
Here’s the kicker: Private practice didn’t free him from paperwork and hassle—it just changed the nature of the grind. Now, the burnout comes from endless appeals, peer-to-peers with insurance companies over things that should be routine, and the increasing resistance of payers to, y’know, pay for actual life- and limb-saving surgery.
How does he handle it? By “firing” the biggest offenders (sorry, Humana), muting those that are too big to dump, and focusing on what he loves: patient care and his team.
7. Should Every Doctor Do This?
If you’re a new grad dreaming of cutting all ties and opening shop, Patrick says, “Not so fast.” Mentorship matters—a ton. Early career doctors need that safety net. But as you grow, if you crave autonomy and have the right disposition, it might just be for you.
Conclusion: Is Going Solo the Cure for Burnout?
Not a cure, but for many, the autonomy and ability to create the kind of practice you believe in is medicine for the soul.
If you’re considering a leap out of big-group medicine—or simply want a behind-the-scenes look at what it really takes—watch or listen to IMD Episode 8 with Dr. Patrick Ryan. And if you have ideas, experiences, or questions, reach out! This space is for us to learn, to vent, and to be better.
Let’s keep medicine interesting.
— Dr. Rob Beck
Host, The Interesting MD