Transitioning from employment in academia to private practice

After more than 10 years of serving in a large academic medical center in Chicago, Illinois, that was part of a national health care system, the decision to transition into private practice wasn’t one I made lightly.

Having built a rewarding career and spent over a quarter of my life in an academic medical center and a national health system, the move to starting an independent practice from scratch was both exciting and daunting. The notion of leaving behind the structure, resources, and safety of the large health system was unsettling. However, as the landscape of health care continues to evolve, with worsening large structural problems within the U.S. health care system, I realized that starting an independent gastroenterology practice — focused on trying to fix some of these large-scale problems from the start — would not only align with my professional goals but also provide the personal satisfaction I had failed to find. 

As I reflect on my journey, there are a few key lessons I learned from making this leap — lessons that helped me transition from a highly structured employed physician environment to leading a thriving independent practice focused on redesigning gastroenterology care from scratch.

Lesson 1: Autonomy Opens the Door to Innovation

One of the primary reasons I left the employed physician setting was to gain greater control over my clinical practice and decision-making processes.

In a national health care system, the goal of standardization often dictates not only clinical care, but many “back end” aspects of the entire health care experience. We often see the things that are more visible, such as what supplies/equipment you use, how your patient appointments are scheduled, how many support staff members are assigned to help your practice, what electronic health record system you use, and how shared resources (like GI lab block time or anesthesia teams) are allocated.

However, this also impacts things we don’t usually see, such as what fees are billed for care you are providing (like facility fees), communication systems that your patients need to navigate for help, human resource systems you use, and retirement/health benefits you and your other team members receive. 

Standardization has two adverse consequences: 1) it does not allow for personalization and as a result, 2) it suppresses innovation. Standard protocols can streamline processes, but they sometimes fail to account for the nuanced differences between patients, such as genetic factors, unique medical histories, or responses/failures to prior treatments. This rigidity can stifle innovation, as physicians are often bound by guidelines that may not reflect the latest advancements or allow for creative, individualized approaches to care. In the long term, an overemphasis on standardization risks turning health care into a one-size-fits-all model, undermining the potential for breakthroughs.

The transition was challenging at first, as we needed to engage our entire new practice with a different mindset now that many of us had autonomy for the first time. Instead of everyone just practicing health care the way they had done before, we took a page from Elon Musk and challenged every member of the team to ask three questions about everything they do on a daily basis:

• Is what I am doing helping a patient get healthy? (Question every requirement)

• If not, do I still need to do this? (Delete any part of the process you can)

• If so, how can I make this easier, faster, or automated? (Simplify and optimize, accelerate cycle time, and automate)

The freedom to innovate is a hallmark of independent practice. Embracing innovation in every aspect of the practice has been the most critical lesson of this journey. 

Lesson 2: Financial Stewardship is Critical for Sustainability

Running an independent practice is not just about medicine — it’s also about managing a business.

This was a stark shift from the large academic health systems, where financial decisions were handled by the “administration.” In my new role as a business owner, understanding the financial aspects of health care was crucial for success. The cost of what patients pay for health care in the United States (either directly in deductibles and coinsurance or indirectly through insurance premiums) is unsustainably high. However, inflation continues to cause substantial increases in almost all the costs of delivering care: medical supplies, salaries, benefits, IT costs, etc. It was critical to develop a financial plan that accounted for these two macro-economic trends, and ideally helped solve for both. In our case, delivering high quality care with a lower cost to patients and payers. 

We started by reevaluating our relationship with payers. Whereas being part of a large academic health system, we are often taught to look at payers as the adversary; as an independent practice looking to redesign the health care experience, it was critical for us to look to the payers as a partner in this journey. Understanding payer expectations and structuring contracts that aligned with shared goals of reducing total health care costs for patients was one of the foundations of our financial plan. 

Offering office-based endoscopy was one innovation we implemented to significantly impact both patient affordability and practice revenue. By performing procedures like colonoscopies and upper endoscopies in an office setting rather than a hospital or ambulatory surgery center, we eliminated facility fees, which are often a significant part of the total cost of care. This directly lowers out-of-pocket expenses for patients and reduces the overall financial burden on insurance companies. At the same time, it allows the practice to capture more of the revenue from these procedures, without the overhead costs associated with larger facilities. This model creates a win-win situation: patients save money while receiving the same quality of care, and the practice experiences an increase in profitability and autonomy in managing its services.

Lesson 3: Collaborative Care and Multidisciplinary Teams Can Exist Anywhere

One aspect I deeply valued in academia was the collaborative environment — having specialists across disciplines work together on challenging cases. In private practice, I was concerned that I would lose this collegial atmosphere. However, I quickly learned that building a robust network of multidisciplinary collaborators was achievable in independent practice, just like it was in a large health system.

In our practice, we established close relationships with primary care physicians, surgeons, advanced practice providers, dietitians, behavioral health specialists, and others. These partnerships were not just referral networks but integrated care teams where communication and shared decision-making were prioritized. By fostering collaboration, we could offer patients comprehensive care that addressed their physical, psychological, and nutritional needs. 

For example, managing patients with chronic conditions like inflammatory bowel disease, cirrhosis, or obesity requires more than just prescribing medications. It involves regular monitoring, dietary adjustments, psychological support, and in some cases, surgical intervention. In an academic setting, coordinating this level of care can be cumbersome due to institutional barriers and siloed departments. In our practice, some of these relationships are achieved through partnerships with other like-minded practices. In other situations, team members of other disciplines are employed directly by our practice. Being in an independent practice allowed us the flexibility to prioritize working with the right team members first, and then structuring the relationship model second. 

Lesson 4: Technology Is a Vital Tool in Redesigning Health Care

When I worked in a large academic health system, technology was often seen as an administrative burden rather than a clinical asset. Electronic health records (EHR) and a lot of the other IT systems that health care workers and patients interacted with on a regular basis were viewed as a barrier to care or a cause of time burdens instead of as tools to make health care easier. As we built our new practice from scratch, it was critical that we had an IT infrastructure that aligned with our core goals: simplify and automate the health care experience for everyone.

For our practice, we didn’t try to re-invent the wheel. Instead we copied from other industries who had already figured out a great solution for a problem we had. We wanted our patients to have a great customer service experience when interacting with our practice for scheduling, questions, refills, etc. So we implemented a unified communication system that some Fortune 100 companies, with perennial high scores for customer service, used. We wanted a great human resource system that would streamline the administrative time it would take to handle all HR needs for our practice. So we implemented an HR information system that had the best ratings for automation and integration with other business systems. At every point in the process, we reminded ourselves to focus on simplification and automation for every user of the system. 

Conclusion: A Rewarding Transition

The decision to leave academic medicine and start an independent gastroenterology practice wasn’t easy, but it was one of the most rewarding choices I have made. The lessons I’ve learned along the way — embracing autonomy, understanding financial stewardship, fostering collaboration, and leveraging technology — have helped me work toward a better total health care experience for the community.

This journey has also been deeply fulfilling on a personal level. It has allowed me to build stronger relationships with my patients, focus on long-term health outcomes, and create a practice where innovation and quality truly matter. While the challenges of running a private practice are real, the rewards — both for me and my patients — are immeasurable. If I had to do it all over again, I wouldn’t hesitate for a moment. If anything, I should have done it earlier.

Dr. Gupta is Managing Partner at Midwest Digestive Health & Nutrition, in Des Plaines, Illinois. He has reported no conflicts of interest in relation to this article.