I’ve made something new in medicine, adjusting for the technological times in which we live. It is also, I believe, something old, when everything we needed fit into a black bag that we used to make house calls. Let me explain.

I am a serial entrepreneur.

In 2011, I was tired of being an employee, and I said to myself, whatever lies ahead is better than what lies behind. It was a real jump. I opened from scratch with no experience, no employees, a shared waiting room, and a tiny office space. I was front desk, I was check-in and check-out, and I was the biller. I was also the doctor. I learned painstakingly and slowly and at maximum cost, but I learned. Slowly, I replaced myself with a staff member in each position. I felt it was a great day when I finally had a full medical staff. I was a real practice.

Then I grew . . . and grew some more. By the time I sold to private equity in 2023, it was a multi-office, multi-doctor group. I stayed with this group as an employee once again. I did this for a while and then wanted something different. I wanted something that just made me feel happy, fulfilled, and joyful in the practice of medicine every day, a feeling I had not had in quite a few years.

Now, what could that be?

I did a bit of meditation, and I tried to assess my feelings over the long span of my career. I had been an employee twice before opening my own practice in 2011. After that, I was a solo owner for more than a decade. But what made me the happiest was that brief period when I ran the whole show. I controlled everything: did the QuickBooks, rescheduled the patients, filed the bills, and posted the earnings. I just kind of enjoyed hovering above and performing the whole process A to Z.

So, I resigned from my job as an employee in the company I used to own and started a new company. I had a very simple philosophy. I would aim to see one new patient a day and handle all the administrative tasks that attended to one patient.

What 1 New Patient Per Day Gets You

As you read this, many of you will pause. Let me keep your eyes moving along the page with some simple math. I am an ophthalmologist. One new patient equals two eyes. Two new eyes a day equals 10 cataract surgeries a week. If you isolate your practice to cataract referrals, 10 cataracts a week on the surgical schedule is a living.

In 2024, I began just that. It was just me in a micro surgical practice, aiming for one new patient a day. And then something happened I did not expect. Technology hit a turning point, and tasks that occurred on a computer screen began to have the possibility of being automated. In 2011, I rejoiced when I gave each of my tasks to a newly hired staff member. In 2025, I rejoiced when I created an automation for each.

How did it happen, you ask?

One by one, really. I was motivated by removing the most annoying tasks first, and as it turns out, the more routine and mindless a task is, the easier it is to automate. I began with fax transmissions. It was so tedious scanning through a received fax on a new patient referral and, one by one, copying and pasting details from there into the intake fields on my computer: DOB, Name, Address, etc.

I searched for a HIPAA-compliant program that would do it for me. I found one called Keragon, and I began to automate things away. [AUTHOR’S NOTE: Keragon has since become an affiliate partner of mine.] Once the new patient faxes entered themselves, I moved on to new patient voicemails. It was just the right time.

For me, billing was the next big-ticket item to get off my plate. Though I had hired a billing company for posting and appeals, insurance verification and patient responsibility calculation were still big pieces that remained my responsibility in part or in full. If only there were a HIPAA-compliant intelligence I could dump insurance summaries into, I thought. It turns out there is. It is called Doximity Ask. I wrote the routine that gathers insurance information from my EMR, batch-deposits it into insurance websites, and then prompts Doximity Ask to give me the number a patient owes today. Yes, in dollars and cents.

Now I have two jobs really, maybe three, which is way more manageable than the dozen or more I used to juggle. The first is to be a concierge-style clinic that gives full physician attention to one patient at a time and provides the highest degree of care imaginable, while accepting insurance and without demanding concierge fees. I am an easy choice for referrals. No one else can even imagine delivering that type of care. My second job is an innovator. Every day, the foremost question on my mind as I type on my computer is, how can I make this happen on its own?

More information here:

Something New in Medicine and Something Old

I said I am doing something new in medicine and something old. Imagine this for a moment. It is the early 1900s, and you are a physician. Your equipment fits in a black bag. Any note you make is a memory aid for yourself alone. There are no structures around you to which you are beholden other than your connection to the patient. No obligations surround you other than their well-being. You are autonomous in every respect, and the only burden you carry is the sacred: patient care.

What would a return to that look like in the modern era? Insurance providers and the mountains of work they bring are not going anywhere, and neither are regulatory, medico-legal, or staffing compliance obligations. So, how do we turn on the time machine to return to this era? Is it even possible?

I want to tell you a brief story. Shortly after 2011, when I started my solo practice, I put myself on call to emergency departments. I thought that any new patient was, well, a new patient. I had just hired my first staff members, and I needed the revenue to start flowing. I was in a precarious position as my new office manager had left abruptly due to a family emergency. One night, I had to do payroll for the first time. It is a big deal. I did a quick search and found that not paying your staff on time could be a felony offense. I had to get this done. And then the call came in from the ED. I would need to be in surgery for a ruptured globe immediately.

When you are an employee, you have protections from labor laws. There are limits to what an employer can demand. Presumably these limits derive from basic limitations recognized in the human physical and mental embodiment. In a sense, the law forbids inhumane treatment of fellow humans.

Yet this doesn’t apply to entrepreneurs. We are left to the will of the winds, and no one, no one, will intercede on your behalf when the impossible is demanded. We exist outside the basic writ doctrine of empathy enshrined in law.

No one cared that I was tired enough after emergency surgery to choose a hospital on-call room to sleep rather than drive home. No one cared that rather than sleep I called ADP’s help line, found someone to answer a call at 3am, and ran payroll. No one cared that in an hour I would have to go back to work, smile, and listen to patients with a warm and open heart. I was fulfilling my societal obligations, while society happily ignored any obligation to me.

And maybe from here arrives my third job. It’s a more unusual job, but it is a job we have all done. All physicians are teachers by default. Medical school is not just a process of learning. It’s teaching as well. Perhaps it is time for me to teach. I have held every position there is to hold from employee to owner, and I have worn every hat there is to wear in an office from manager to checkout, twice. Perhaps it is time for me to reach out to my peers, my colleagues, and especially the younger generation.

How I Run My Practice, How Much It Costs, and How Much I Earn

Medicine is a hard road. You will accept responsibility upon yourself that no other field does. Entrepreneurialism is congruent. A limitless list of tasks now falls into the realm of what you must do, and it is additive to medicine. If there were any further salt to pour on this wound, it would be the choice of solo practice. Now do it all . . . alone.

And yet, this trifecta of work and responsibility offers one gem, one glimmering jewel that can be found nowhere else: control. Control your own destiny and guide the ship into calmer seas. It will be choppy at first, but the horizon is clear, glassy blue waters lit by a rising sun.

I run a solo practice with no employees. I alone control the direction of the practice. If I want it to be a practice that focuses on only those tasks that are beneficial to me and that I want to do . . . poof! There it is. The practice exists to allow me to feel happy and fulfilled. It doesn’t exist for any other reason. If I feel something is not to my liking, it goes on the cutting block. I don’t have a boss—other than time and the bottom line—and I like it that way. I like spending more time with patients. I like each patient to feel like they got everything they needed from the doctor. I go home feeling good about my day.

Now, let’s do the thing that is on everybody’s mind and ignore that it is gauche. Let’s talk about money. Surely, you must think I am living in poverty with my decision to see one new patient a day. Let’s talk about it. I’ve already given you your anatomy lesson of the day. One patient equals two eyes (you didn’t even need to be an ophthalmologist to know that), and 10 cataract surgeries a week will be the rule, as things get moving. I’m not quite there yet; small practices build slowly. As I write this, I’ve hit four or five a week but continue to add and expect to be at capacity by December 2026.

What will it look like to perform 10 cataracts a week from a practice with no employees? Math-leets, put on your thinking caps; for those without mathematical acumen, I’ll keep the numbers round. Ten cataracts at $600 average per cataract is $6,000. Each cataract needs a one-day post-op visit and a one-week visit, and testing during those visits is permissible and covered under most insurance. Patients often opt for a refraction (glasses check); we charge $75 for that. Let’s say $100 per post-op at 20 post-ops; that is $2,000.

Most cataract patients get a laser at three months that averages around $450-$500 depending on eye and testing. Let’s say $5,000 to keep things rounded. Plus, initial exams for five patients a week with testing is about $1,500. Throw in a patient or two for miscellaneous reasons to hit $2,000. That is $15,000 a week. That is $750,000 over a 50-week period. That is just from insured procedures from one new patient a day.

Now, in ophthalmology, we offer premium add-ons, special lenses we can implant to reduce the need for glasses after surgery, where patients pay out of pocket. I won’t torture you with more mathematics, but it is a small step up to $1 million in gross revenue.

And the costs? What does it cost to run a clinic with no employees? It is absurdly cheap compared to its staffed equivalent. Rent, EMR, and billing services add up to about $9,000 a month. Add in equipment leases and miscellaneous items, and my basic costs are about $12,000 a month. That is about $150,000 a year. Of course, this would vary widely by specialty, by how you financed equipment, and a host of other details, but I am just telling you my situation. If I hit $1 million in gross revenue and subtract $150,000, that is a salary rivaling the busiest physicians in the most venerated practices.

In the best years of my large practice, I’d spend $2 million to make $3 million and walk away with similar take-home pay. And now I’d be doing it all on my own, in a small office, leaving at 3:30pm most days.

More information here:

The Bottom Line

As I said, I am doing something new in medicine, and as I said, my third job might be to teach about it. I don’t like what I am seeing in medicine. I’m hearing thoughts we likely never had when our whole world fit into a black bag we carried with us. I hear conversations about burnout and conversations about overwork, and to me, these are conversations about despair.

Yet, they are also conversations that have failed to look outside the box we were placed in. Yes, the box is pretty awful, and as I said, no one will save you. No one will even feel sympathy for you. I had contemplated leaving myself—more than once. But I didn’t leave. I twisted and turned until I found something that fit me. It’s a narrow gap in the gate that holds us here, hiding where you would least expect it to be.

Through the gateways of maximum responsibility, on the other side of the hard work and patience, a world exists outside the box that is ready for physicians to be independent and in control again. It’s visible if you look carefully. Do you see me now? That is my flashlight waving on the other side of the tunnel.

Follow me. It’s this way.

If you’ve ever dreamed about opening your own medical practice, WCI has several resources for you. Check out our Practice Management Resources page to see how we can help you grow and manage your practice.

Would it be sustainable for you to run a practice without any employees? Would you enjoy that autonomy and freedom? Or is it just too much risk?

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