Considerations for Aspiring PA Entrepreneurs

September 26, 2025

While challenging, starting your own business can be totally worth it. Just ask Kathryn Werner, PA-C, who founded and serves as owner and CEO of White Pine Mental Health & Wellness, a telehealth psychiatry practice serving patients in Florida, Idaho, and Alabama.  “The ownership and freedom the practice provides…with time, finances, and autonomy,” PA Werner said, “is something I could not live without at this point.”  

PA Werner is not alone in this pursuit. A quick scroll of social media reveals a growing number of PAs asking about, implementing, or marketing PA-owned businesses covering a wide variety of specialties and patient populations ranging from mental health and pediatrics to aesthetics and consulting. Unfortunately, guidance specific to PAs looking to take their own leap into practice entrepreneurship can be hard to find. That’s why AAPA has developed a checklist to act as a guide to PA Practice ownership that will help PAs begin their business ownership journey.  

Initial Planning 

Prior to hanging a shingle and opening clinic doors, a PA interested in practice ownership must complete some critical background work. Effective business owners often engage in rigorous initial planning, drafting items such as a business plan outlining a description of services to be provided, the type of practice being pursued (solo, group, etc.), a SWOT  (strengths, weaknesses, opportunities, and threats) analysis including market competition, a marketing and advertising plan, the estimated start-up and annual expenses and revenue projections, and for those currently in an employment arrangement, whether any non-compete agreements are in place that could impact how you solicit patients for your business. For PAs, this should also include a detailed review of state practice laws to determine whether a PA is eligible to own the type of business you plan to pursue. Depending on what state(s) the practice ultimately operates in, PAs may need to consider physician supervision or collaboration requirements and how to remain compliant. For PA Werner’s multi-state business, this was top of mind: “From a practice standpoint, supervision and prescribing laws are different in each state […] so we have to set up our practice to function efficiently within those limitations.” Business planning can also be an important prerequisite to securing start-up funding, whether through grants, loans, or business lines of credit.  

Start-Up & Preparations 

Even after brainstorming and putting together a business plan, initiating the first steps remains challenging. Successfully launching a business may require some professional support such as legal or financial expertise that aims to help prevent future setbacks. Expert help can provide guidance on state practice laws and determine what, if any, business structure best fits the PA’s entrepreneurial aspirations (sole proprietorship, limited liability companies, etc.). This can sometimes be challenging for PAs as even some experts lack awareness of the PA profession. PA entrepreneur and AAPA Board member Kris Pyles-Sweet knows all too well: “Every attorney I spoke to stated PAs could not own practices, however, I knew of several PAs that did.” Leveraging her professional network helped find the right support for structuring her business. Additionally, the practice itself may need its own National Provider Identifier (NPI) and, depending on what services are provided, federal and state-controlled substance identifiers. PAs may need to secure not only malpractice insurance, but business liability and/or building insurance to cover for unexpected losses (such as structural damage, cybersecurity breach, or theft).  

For in-person practices, PAs will need to consider how to acquire a business location (whether buying, renting, or sharing), potential workspace buildout needs, and maintenance services, such as cleaning services, utilities, and security. Start-up costs may also include items like general office supplies, medical and PPE supplies (TIP: research medical supply companies to be sure they will sell equipment to a PA owned practice), office technology (computers, phones), furniture, and any special equipment needed based on services provided, like refrigeration or locked storage for vaccine and medication safekeeping.   

Choosing Critical Software 

One of the most important decisions a new PA practice owner will need to consider is which electronic health record (EHR) system to use. If anyone knows the ins and outs of an EHR system, its Patti Cuartas, DMSc, MBA, PA-C, PMP, FACHE, ACHIP, Executive Director of Information Technology and Associate Chief Medical Information Officer (CMIO) for the Mount Sinai Health System in New York, NY. “EHRs are now more than ever a utility, on par with electricity and water… they are not a luxury item.” However, PAs have choices and may choose to explore potential shared services agreements with large health providers (like a hospital or large practice) to help reduce the surprisingly high costs of initial EHR license purchasing and gain the support of the organization’s existing technical support team. PAs will also have to consider what features their EHR may need in order to remain compliant with both federal mandates as well as any quality or value-based care requirements set forth in insurance payer contracts (see below), says PA Cuartas. Important factors like meaningful use and interoperability may be required as a condition of participation or payment of services, especially if seeing patients on Medicare. Equally important is the PA business owner’s choice in practice management software, special programs that facilitate patient booking, schedules, and billing or invoicing services. “There are EHRs on the market that are fully integrated, helping the PA to avoid managing multiple contracts or vendors… this would be the best bet” advises PA Cuartas. For any EHR vendor, a PA business owner should engage in discussions focused on support, training, and project management resources prior to signing a contract.

Billing and Revenue Management 

For those looking to build a medical practice, healthcare legal and business experts can guide PAs in deciding how their business will secure revenue, whether through a cash-only payment system, billing of insurances, or a combination of both. Given the volume of different insurance companies and insurance plans, PAs choosing to bill insurances would be wise to seek assistance in navigating payer contracts to help maximize not only their reimbursement rates, but the breadth of patients covered under these plans that PAs can open their services to. Another type of useful assistance may be the use of certified billers and coders. Allowing experts to focus on sending out claims correctly and collecting reimbursements permits a PA to focus on the core of their business.

Human Resources (HR) 

Solo entrepreneurship, while an option, may not be the model for every aspiring PA business owner. Those looking to open a practice with the help of support staff need to add human resources (HR) considerations to their business planning. The most basic HR needs would include hiring, onboarding, staff scheduling, and payroll, but could also extend to benefit offerings and management depending on the business size and state labor laws. Potential additional costs could include workers’ compensation insurance, background checks services, and, if hiring additional clinical staff, credentialing and enrollment fees with insurance providers (or hospitals if your business model includes inpatient consults and management). Lastly, according to Andrea Cox, Senior Vice President, Head of People & Culture at Recycle Track Systems, an environmental services company with offices in New York, NY and Vancouver, Canada, as a business owner you will need to consider local employment and labor laws that could vary based on where your staff live and/or work. One potential resource for small business owners that could manage this is a professional employer organization (PEO). “A PEO will be able to take on most of the legal liability of having employees and will be a guide for all things HR/compliance” says Ms. Cox. It of course would be an added cost, but likely less expensive than separately hiring “an HR compliance specialist, payroll specialist, benefits specialist, and an HR manager.” It will also be good practice to have company policies and procedures in place to ensure fair and transparent operations, which you may need to rely on for employee performance issues.  

Is Entrepreneurship for You?  

Business ownership is not for everyone and choosing whether to pursue entrepreneurship requires personal evaluation and self-reflection. Medicine is one of the most heavily regulated economic activities and starting up a business can be a big risk in any industry. However, for PAs with grit, determination, and patience, high risk comes with high reward potential. When asked if she would do it all over again given the opportunity, PA Werner doesn’t hesitate, “[a] million times over.”  

While AAPA cannot provide specific legal or business advice to PA entrepreneurs, this new Checklist for PA Practice Ownership may help aspiring PA business owners in their initial business planning process. For up-to-date information on PA reimbursement issues, visit the AAPA’s Reimbursement website.  

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