26. 5 Truths About Patient Boundaries in Private Practice

Thinking about starting your own practice, but worried a tsunami of patients will demand your attention at all hours?

Many physicians worry that leaving corporate medicine means losing the buffer of administrative support and being constantly prodded by patients at all hours.

But most of this anxiety is inherited from corporate, insurance-based medicine—not from reality. When you own your clinic, you have far more control than you’ve been led to believe.

Here are five ways that actually plays out.

1. You start small 

When you open your own practice, you are not instantly overwhelmed. You’re starting from zero. Especially if you’re cash-based or direct pay, there is no insurance network quietly funneling patients your way.

Early on, your biggest challenge is usually growth (not fending people off). You’re building a panel deliberately, over time, which means patient volume is manageable by design.

The imagined “flood” simply doesn’t show up.

2. Your patient panel is dramatically smaller

Many physicians coming from corporate medicine are used to panels of 2,500–4,000 patients. That alone explains a lot of the exhaustion.

In private practice, panel sizes are typically a fraction of that:

• Direct care practices may start around 150–300 patients
  
  
• Even insurance-based private practices are far smaller than corporate panels

Fewer patients means fewer messages, fewer interruptions, and a workload that actually makes sense.

3. You set the expectations (and reinforce them)

In your own practice, you control the patient agreement, the onboarding conversation, and the messaging around access and communication.

That means you can be explicit about:

• When and how patients can contact you
  
  
• What constitutes an emergency (and where emergencies should go)
  
  
• What happens after hours, on weekends, or during holidays

Clear expectations upfront prevent most boundary issues later. Patients generally follow the rules when the rules are clear.

4. You choose who gets to stay

This part surprises a lot of physicians: you are not obligated to keep every patient forever.

If someone is consistently disrespectful, demanding, or a poor fit, you can let them go—professionally and appropriately. Over time, many clinicians also add brief meet-and-greet or discovery calls to screen for fit before accepting new patients.

In other words, you don’t just get patients. You choose them.

5. You can change the business if something isn’t working

If patient communication starts to feel heavy, you’re not stuck. As the owner, you can adjust:

• Your policies
  
• Your pricing
  
• Your care model (for example, moving from per-visit to membership)

Many clinicians find that membership models naturally attract patients who are more respectful of boundaries and more invested in their care. And if something still isn’t working? You can change it again.

That flexibility simply doesn’t exist in corporate medicine.

Owning your own practice doesn’t mean being on call forever or surrendering your time. It means designing a clinic that works for you: your energy, your boundaries, and your version of good medicine.

Yes, the occasional after-hours message will still happen. But when it does, you get to decide how it’s handled. And that’s what makes all the difference.

If this perspective was helpful, especially the idea that starting your own practice doesn’t have to mean chaos or constant overwhelm, you may already be thinking about what independence could actually look like for you.

If leaving corporate medicine is on your horizon, my 90-Day Clinic Launch Blueprint is designed to help you build an independent practice in a clear, structured way—without panic or burnout. It walks you step by step through setting up your clinic in 90 days, covering the legal setup, systems, patient acquisition, and launch.

It’s designed to work alongside a full-time job, so you can build a solid foundation before you make the leap. The program includes video lessons, templates, an action workbook, and monthly Q&A calls with me.

Learn more about the Blueprint and get on the waitlist here!