The PA Private Practice Rollercoaster: Takeaways from Our AAPA 2026 MedTalk

When the panel asked how many people in the room were seriously considering opening their own practice in the next year or two, roughly half the hands went up. For a profession that spent decades defined by employment and supervision, that’s a remarkable shift, and it captured exactly why CM&F Group sponsored “The PA Private Practice Rollercoaster” at AAPA 2026. 

The session brought together three perspectives on the journey from employed PA to independent practice owner: Ashlyn Smith, PA-C, founder of ELM (Endocrinology & Lifestyle Medicine) and co-founder of the Independent PA Collective; Phoebe Gutierrez, compliance consultant, founder of Camino Strategy Group, and IPAC co-founder; and William Sullivan, EVP and Chief Underwriting Officer at CM&F Group. What followed was less a lecture and more an honest conversation about fear, autonomy, and what it actually takes to build something of your own. 

Here are the takeaways worth carrying home from that room. 

The Journey Has Stages, and It Starts with a Spark 

The panel framed the path from employed PA to practice owner as a continual journey with distinct stages: the spark (why this matters), the doubt (can I really do this?), the plan (mapping the path), the structure (entity and compliance), the model (offer and brand), visibility (marketing and network), feedback (adjusting and refining), and growth (scaling and evolving). 

What stood out is that the doubt stage comes second, right after the spark. Nobody moves from “I have an idea” to “I have a business” without passing through “can I actually do this?” The panelists were candid that the doubt never fully disappears. It just becomes something you learn to move through rather than something that stops you. 

Why Are You Doing This? Start There. 

Before the LLC, before the website, before any of the operational pieces, the panel kept returning to one question: why? 

Gutierrez was direct about it. The first thing she asks anyone considering independent practice isn’t about business structure. It’s about motivation. If the answer is “I want to make a lot of money,” she suggested there are easier paths. Independent practice is hard. There are good days and bad days. The thing that carries an owner through the bad days is a genuine connection to why they started. 

Smith’s story illustrated the point. A year before the panel, she was at AAPA completely burned out, doing rushed visits, feeling like she wasn’t practicing the kind of medicine she trained for. She described pouring her time and energy into a system that, if she walked away tomorrow, would simply replace her. That realization was the spark. A year later, she described better work-life balance, more time with her kids, and the sense that she was finally delivering the patient care she’d always intended to. 

The lesson the panel kept reinforcing: the “why” isn’t a soft, feel-good exercise. It’s the practical foundation that determines whether you push through the hard parts or give up when the business side gets difficult. 

Can PAs Actually Open Their Own Practice? 

This was the question that drew the most energy in the room, and the panel’s answer was unambiguous: yes, in all 50 states. 

Gutierrez made the case plainly. PAs can build independent practices in every state. Some states make it harder than others, and she named a few that require more navigation, but none make it impossible. She pointed to the reality that large telehealth companies operate within the same regulatory frameworks that individual PAs have to work within. If those companies can find a compliant path, so can an individual practitioner. 

The key first step, both Smith and Gutierrez emphasized, is understanding your state’s laws. Practice authority, entity formation rules, and the structure of physician collaboration or supervision all vary significantly by state. What’s possible in Arizona looks different from what’s possible in another state, and knowing your specific framework before you build is essential. 

When an orthopedic PA in the audience asked how PAs can open their own practice if they’re required to work with a supervising physician, Smith walked through her own setup as an example. In Arizona, based on her years of experience, she was able to form a PLLC and operate under a collaborative practice agreement rather than a supervisory one. Her collaborating physician, who runs her own telehealth business from another state, also serves as the practice’s medical director. The specifics depend entirely on state law, which is exactly why the panel kept returning to that first step. 

The Hardest Part Isn’t the Medicine. It’s the Business. 

One of the most useful reframes from the session was about where the real difficulty lies. 

PAs tend to assume the hard part of independent practice is the business entity itself: forming the LLC, building the website, setting up the infrastructure. The panel pushed back on that. Those tasks are relatively mechanical. The genuinely hard pivot is the mindset shift to thinking like a business owner: leaning into your passion as a service you market, figuring out pricing, building visibility, and managing the parts of running a business that clinical training never covered. 

Gutierrez noted that PAs are well suited to this because they want to do the heavy lifting themselves. They don’t want someone to build the business for them. They want guidance, tools, and a community, and then they want to run it. Her own model reflects that. As a solo consultant who doesn’t subcontract, she can’t build a practice for anyone. She can guide, provide the data and tools, and point the way, but the practitioner does the work. In her experience, PAs prefer it that way. 

Independence Means You Get to Decide 

A recurring theme was autonomy, but the panel was careful to frame it as a double-edged benefit. 

As an owner, you decide who you work with. You choose the collaborating or supervising physician who fits your specialty. You choose the EMR you actually like instead of the one a hospital imposed on you. You choose how to allocate your time and your resources. Smith described the shift from paying a company thousands of dollars to set everything up (and paying again every time something needed to change) to being able to choose where her resources went as her practice generated revenue. That control, she said, was a meaningful part of the empowerment. 

But Sullivan noted the other side of that autonomy: with the freedom to decide comes the obligation to do the diligence. When you’re the owner, nobody hands you the answers. You’re responsible for assembling the right team, making compliant choices, and building something scalable. He framed the goal not as maximizing income but as maximizing impact: building something that serves patients well and, if you’re successful, creates room for others to join you. 

What Scares PAs Most About Going Independent? 

When the panel turned the mic to the room, the fears were familiar to anyone who has considered the leap. But Smith’s answer to “what was the scariest part?” cut to the core of it. 

The scariest moment, she said, wasn’t any of the operational challenges. It was simply starting. Saying yes to something she hadn’t trained for over the previous decade and a half. Committing to the unknown. Once she was past that initial decision, the challenges that followed were difficult but rewarding. The fear lived almost entirely in the moment before the commitment. 

That insight matters for any PA sitting in the doubt stage. The thing that feels most frightening, the decision to begin, is often the hardest part of the entire journey. What comes after is hard work, but it’s hard work you can navigate with the right support. 

What This Means for Your Coverage 

Moving from employed PA to practice owner changes your professional liability picture in ways that are easy to overlook in the excitement of building something new. 

As an employed PA, your employer carried entity-level coverage and you may have had some protection under it. The moment you become an owner, that changes. You need individual professional liability coverage that reflects your practice. If you form an entity and bring on other providers or staff, you need group coverage for the business. Depending on your setup, you may also need general liability for your physical space and cyber liability for patient data. 

Your collaborating or supervising physician’s role matters here too. If a physician serves as your collaborator or medical director, their involvement should be accounted for in your coverage planning. And because practice authority and entity structure vary so much by state, confirming that your coverage matches your specific practice model is part of the diligence the panel kept emphasizing. 

For a full walkthrough of the insurance decisions involved in opening a practice, our guide on how to start a PA-owned practice covers the coverage layers in detail. CM&F has been insuring PAs since 1919 and has partnered with the AAPA for over 30 years, which means we’ve supported PAs through exactly this kind of transition for decades. 

Key Takeaways 

The shift toward PA practice ownership is real and accelerating. When asked, roughly half the room was seriously considering opening a practice within the next two years. 

Start with your why. The motivation behind the move is what carries an owner through the hard days, and it’s the practical foundation of a sustainable practice, not a soft afterthought. 

PAs can build independent practices in all 50 states. Some states require more navigation than others, but none make it impossible. The essential first step is understanding your state’s specific laws on practice authority and entity formation. 

The hardest part of independent practice isn’t the medicine or even the legal structure. It’s the mindset shift to thinking like a business owner: marketing, pricing, visibility, and the operational decisions clinical training never covered. 

Autonomy comes with responsibility. As an owner, you decide your team, your tools, and your resources, but you also carry the obligation to do the diligence and build something compliant and scalable. 

And if you’re in the doubt stage: the scariest part is often just starting. What comes after is hard but navigable with the right guidance, community, and support.