After 15 years of working in outpatient endocrinology, Ashlyn Smith, PA-C, was ready for change. She considered opening her own business so she could practice how she wanted but had no idea how to get started.
A chance encounter with a CM&F Group panel discussion on physician associate (PA) entrepreneurship was the motivation she needed. “I had been talking with my husband for months about different options, and when I was at AAPA, I walked past a literal sign for what I should do next,” says Smith.
Minutes into the discussion, Smith was tearing up from feeling so connected with the PAs and their stories about why they became entrepreneurs. She knew opening a new endocrinology practice was next.
That workshop was also an opportunity to meet an expert in small-practice compliance, Phoebe Gutierrez, who provided the support Smith needed to get started. The idea she’d been circling for months suddenly felt real.
Why Physician Associates Are Leaving Traditional Practice to Start Their Own
Across the country, many experienced PAs are reaching a similar inflection point. Factors like burnout, a lack of autonomy and a lack of work-life balance are causing clinicians to consider finding new ways to practice medicine. Around 43% of PAs reported suffering from burnout, according to a report from the National Commission on Certification of Physician Assistants.
Some are leaving the profession entirely. Others are finding new ways to practice.
For Smith, quiet frustration nagged at her for years. Her outpatient work left her feeling constrained by a system that prioritized volume over depth. The kind of whole-person, lifestyle-focused care she valued was becoming harder to deliver. “I wasn’t able to practice the type of medicine I wanted, and it started affecting my work and my family,” she says.
How PA Entrepreneur Communities Are Changing the Path to Private Practice
Smith began her entrepreneurial journey by building a community of fellow PA entrepreneurs. She and Gutierrez gathered a group of PAs interested in working together to launch new practices. That loose network became an official collective, IPAC, that Smith and Gutierrez cofounded. They provide educational webinars with expert guests, monthly sessions and a private community of women PAs ready to build a practice without having to navigate alone.
That support proved critical, both emotionally and strategically. “There were moments where I wondered why I’m doing this, and the other PAs would be there telling me to keep going,” says Smith.
How to Open a PA Private Practice in 6 Months: A Step-by-Step Timeline
Smith set an ambitious goal to launch her practice in six months, opening January 1, 2026. She came close, seeing her first patients just days later.
She was fortunate that her savings and a side hustle as a consultant enabled her to quit her day job and focus full-time on building her practice. Smith acknowledges that the process likely would have taken longer if she had been working full-time.
Smith’s timeline was tight but realistic. With the help of Gutierrez and peers in the collective, Smith focused on one task at a time, such as finding a collaborating doc, meeting compliance requirements, purchasing insurance and marketing her new practice. “I’m a little competitive, but I also was hearing from people to give it at least 6 months to set up a practice,” she says.
Even with her rushed timeline, Smith says it took her time to start earning income. “I don’t recommend that everybody just quit their day job. For many clinicians, part-time work or PRN shifts is a better path,” she says.
What PA School Doesn’t Teach You About Running a Medical Practice
Like many clinicians, Smith found her steepest learning curve was operational. “I had to learn all the things I wasn’t taught in PA school about building a practice,” she says.
But Smith also considered this process as an opportunity. The PA mindset translates well to entrepreneurship, once the right resources and support are in place. “We don’t want to outsource if it’s something we can do ourselves, so I think PAs are really uniquely positioned to be able to learn new things,” she says.
Why More PAs Are Choosing a Direct-Pay or Cash-Based Practice Model
One of Smith’s most intentional decisions was adopting a direct-pay model. She saw firsthand how low reimbursement rates in endocrinology often force providers into high-volume schedules. That tradeoff limits time with patients and reduces care quality. It also quickly leads to burnout.
By removing insurance constraints, Smith created a different model:
- Longer visits (often 30 minutes or more)
- Deeper patient relationships
- A focus on sustainable, lifestyle-based outcomes
The cash-based PA practice model is a major reason Smith feels she’s delivering the quality of care she set out to provide in the first place.
How to Start a PA-Owned Practice: Advice from a PA Who Did It
Looking back, Smith offers practical advice to PAs considering entrepreneurship.
- Find a support network
Whether it’s a business coach or a group of like-minded entrepreneurs, community was Smith’s source of information and motivation.
- Don’t wait for perfect
It’s tempting to delay opening your practice while you attempt to make it perfect. Smith recommends putting it out there and pivoting as you go.
- Take the leap
Starting a practice comes with risk, but staying in a misaligned job carries risk, too, of burnout, limited growth and reduced control over your work.
For Smith, PA entrepreneurship has offered more than independence. It’s allowed her to build a practice that delivers the quality of care she set out to provide as a PA.
Ready to take the first step toward practice ownership? Learn how CM&F can help protect your new PA practice, navigate compliance and support your growth.
Frequently Asked Questions
- Can a physician associate (PA) open their own private practice? Yes. PAs can open and operate their own practices, though the process requires meeting state-specific collaboration or supervision requirements, securing professional liability insurance, and navigating operational tasks like credentialing, compliance, and marketing. Many PAs have successfully launched independent or direct-pay practices by leveraging peer networks, business coaches, and compliance experts to fill the gaps that PA school doesn’t cover.
- How long does it take a PA to open a private practice? With focused effort and the right support, some PAs have launched a practice in as little as six months. Key steps include finding a collaborating physician if required by your state, meeting compliance requirements, purchasing malpractice insurance, and building a patient base. PAs who are working full-time may need additional runway. Most experts recommend allowing at least six months for setup before seeing your first patients.
- What is a direct-pay or cash-based PA practice model? A direct-pay practice is one that operates outside of insurance reimbursement, charging patients directly for services. This model allows PAs to set their own visit lengths, reduce administrative burden, and focus on quality of care rather than volume. It is especially common in specialties like endocrinology, where low insurance reimbursement rates can otherwise force high-volume, time-limited patient encounters that contribute to clinician burnout.
