When Amy Patterson, PA, decided to launch her own physician associate practice in Massachusetts, she assumed the process would be relatively straightforward. She had years of clinical experience and already owned a healthcare navigation business. She has a deep understanding of patient care, prescribing and healthcare operations.
“I thought this would be easy, that I would just need to add a section to my website about my new services. That is not how it works,” says Patterson.
What Patterson underestimated about offering clinical services in addition to the consulting healthcare services she already delivered was how complicated private practice ownership could be in terms of legal compliance, corporate structure, insurance requirements and operational systems.
This is especially true in Massachusetts, where PAs can’t independently own their own practices. “Our corporate practice of medicine (CPOM) structure is a little more stringent. Massachusetts is teeming with medical facilities, and it’s one of the strongest medical regulatory environments in the country. The CPOM laws here are strict, and they don’t allow PAs to own their own practices outright,” says Patterson.
It turns out that launching a compliant medical practice requires far more than clinical and business expertise. For anyone unsure or short on time, Patterson recommends finding the right advisors, including legal, compliance and insurance support.
PA independent practice ownership: is it possible?
Patterson spent much of her career working part-time in traditional healthcare systems while raising a family. After leaving clinical practice in 2020, she launched a healthcare advocacy and navigation business to help people with complex medical needs.
That business led to supporting clients struggling with chronic Lyme disease and long COVID. She continues to offer biomagnetism, a wellness service that complements her clinical care but isn’t considered direct patient care.
At the same time, she noticed more PAs opening independent medical practices. “I didn’t know that was even viable,” she says.
Like many providers entering practice ownership, she initially focused on the clinical opportunity to support women’s health rather than on the operational realities of business.
The legal structure was her first complex hurdle. Patterson initially thought she could simply fold her new clinical services into her existing business. Instead, she learned about Massachusetts’s strict CPOM requirements, limiting how medical practices can be structured and owned.
With a lot of research and guidance from Phoebe Gutierrez, an expert in small-practice compliance and others, Patterson built a compliant (albeit complicated) structure that includes:
- A physician-owned Professional Limited Liability Company (PLLC)
- A separate management services organization (MSO)
- Two EIN numbers
- Two separate bank accounts
- Supervising physician agreements
- Legal contracts governing revenue flow and operational responsibilities
“As a PA, I can’t legally own the practice, so to make this work I had to set up two separate legal entities, the physician-owned PLLC and the management services organization to handle the business side.-
Setting that up took months of research and paperwork. Patterson began the process in September 2025 and established the business infrastructure in late February 2026. She started seeing patients in late March.
Running a private practice as a PA: operational realities
Once Patterson began treating patients, she finally landed in familiar territory. “The patient piece, while it is not always simple, it’s where I feel most at home,” she says.
The operational side of ownership, however, is still a constant source of complexity.
Everything surrounding the patient experience is new:
- EHR implementation
- Controlled substance compliance
- Insurance coverage
- DEA setup
- Technology coordination
“I have a new appreciation for IT support,” she says.
Even routine tasks are more complicated in an independent practice. For example, prescribing hormone therapies and controlled substances required additional credentialing and authentication systems that Patterson previously didn’t have to manage within larger health systems.
Legal and compliance support for PA practice owners
All the complexities of owning a practice as a PA in Massachusetts meant Patterson didn’t want to navigate the process alone. She found hands-on guidance from Guitierrez and a Massachusetts healthcare attorney familiar with CPOM regulations.
“When I was struggling with the supervising physician piece, the legality and the compliance with the state of Massachusetts, I brought additional support in,” she says.
Hiring a local healthcare attorney gave Patterson confidence that the business was properly structured and aligned with state requirements.
PA malpractice insurance for independent practice owners
With more clinicians exploring cash-pay medicine, wellness services and independent practice ownership, Patterson’s experience is shared by many PAs.
The increased opportunity to own a practice also introduces new liability exposures and regulatory obligations. Patterson’s mix of services means she must constantly separate clinical and nonclinical services, maintain appropriate malpractice coverage for both and clearly define the scope of each business.
“I’m very careful about making sure people know that I’m not practicing as a PA in my biomagnetism practice,” Patterson says.
For healthcare entrepreneurs with similar business mixes, Patterson recommends treating compliance as an ongoing operational responsibility that affects everything from entity structure to workflows and patient communication.
Finally, for other PAs considering independent practice ownership, Patterson says preparation and professional guidance are critical. “I definitely think it’s important to have somebody who understands compliance and has done it before,” she says.
Frequently Asked Questions
- Can a PA own their own practice? In many states, physician associates (PAs) cannot directly own a medical practice due to Corporate Practice of Medicine (CPOM) laws. In states like Massachusetts, PAs must use a compliant business structure — such as a physician-owned Professional Limited Liability Company (PLLC) paired with a Management Services Organization (MSO) — to legally operate an independent practice.
- What legal structure does a PA need to open an independent practice? PAs in CPOM states typically need two separate legal entities: a physician-owned PLLC to hold the clinical practice, and an MSO to handle the business and operational side. This structure requires separate EINs, bank accounts, supervising physician agreements, and legal contracts governing revenue flow — and should be set up with guidance from a healthcare attorney familiar with your state’s regulations.
- What type of malpractice insurance does a PA in private practice need? A PA operating an independent practice needs professional liability (malpractice) insurance that covers the full scope of their clinical services. If the PA also offers nonclinical services — such as wellness or health navigation — those must be covered separately, as malpractice policies only apply to direct patient care. Working with a provider that specializes in PA coverage ensures your policy matches your practice structure.
From compliance planning to professional liability protection, the right support system can help PAs build and operate a practice with confidence. Learn how CM&F helps PAs protect their practices as they grow.
