Employee vs. Clinic Owner: When Does It Make Sense for a PA to Take the Leap?

As a seasoned physician assistant/associate (PA), you may find yourself at a career crossroads. Perhaps the physician you’ve worked with for years is retiring and offering you the opportunity to take over the clinic. Maybe a partnership buy-in has been floated your way. The question looms large: Should you remain an employee or step into the role of clinic owner?

The answer isn’t simple. Both paths come with distinct benefits and risks. To make an informed decision, you must evaluate key financial considerations, lifestyle impacts, and long-term career goals. Let’s explore when it makes sense to stay employed and when owning a clinic is the right move.

The Employee Path: Stability with Fewer Headaches

Remaining a PA employee offers a level of stability and predictability that ownership does not. Here are some key benefits:

1. Financial Security

• Steady Income: As an employee, you receive a predictable salary. Often, there are additional benefits like health insurance, malpractice coverage, and retirement contributions.
• Lower Financial Risk: You’re not responsible for overhead costs, payroll, or revenue fluctuations. Your paycheck arrives whether the clinic has a slow month or not.
• No Debt Obligations: Buying a clinic often involves loans, which means financial risk. Staying employed avoids this burden.

And then there’s the unmatched job security. Despite some uncertainty in the profession, PAs are here to stay. According to a systematic review published in PLOS ONE, primary care PAs can perform approximately 85% of the tasks done by physicians. They often do so at a lower cost, making them a cost-effective choice in many settings.

2. Work-Life Balance

• Defined Work Hours: You show up, see patients, and go home. You don’t have to deal with the stress of managing staff, balancing the books, or handling insurance negotiations.
• Fewer Administrative Duties: Most of your time remains focused on patient care rather than business operations. How are you at firing people?

A narrative review in JAAPA found that autonomy, responsibility, and competitive wages significantly impact PA job satisfaction. Clinic owners are not known for clocking out at five o’clock.

3. Career Flexibility

• Easier to Change Jobs: If you want to relocate or switch specialties, it’s much easier to do so as an employee than as a clinic owner tied to a business.
• Less Liability: While PAs carry malpractice risk, business ownership adds another layer of potential legal exposure.

When Staying an Employee Makes Sense

• You value work-life balance and prefer to focus on clinical care rather than business operations.
• You don’t want the financial risk associated with owning a clinic.
• You want the flexibility to change jobs or work in different settings.

The Clinic Owner Path: Control, Profit Potential, and Legacy

Owning a clinic is an entirely different challenge with skills you probably didn’t acquire in your PA training. It requires a business mindset, financial acumen, and a willingness to take on risk. A lot of risk. However, it can be highly rewarding.

1. Higher Income Potential

• Profit Beyond a Salary: As an owner, you’re no longer capped by a set salary. You earn from the clinic’s profits, and if managed well, your income can far exceed what you’d make as an employee. Perhaps even by several multiples.
• Building Equity: When you own a clinic, you’re not just earning a paycheck—you’re building a valuable asset. If successful, you can sell it later for a significant sum.

Research on the economic assessment of PAs suggests they generate about 2.4 times their salary in revenue, reinforcing the financial viability of clinic ownership. The real potential, however, would be in hiring other clinicians, even physicians, to work for you. Then, if you’re able to open a second, and perhaps a third location, your earning potential would be staggering.

PAs are workhorses. In this national survey of family medicine practices, PA productivity exceeded that of both nurse practitioners (NPs) and physicians in physician-owned practices. Go hire a few to build your nest egg for you.

2. Autonomy and Control

• Decision-Making Power: You decide which patients to see, what services to offer, and how to structure your clinic’s workflow. You don’t like the patient portal? Shut that baby down!
• No More Middle Management: Many PAs grow frustrated with administrative oversight in corporate healthcare settings. As an owner, you set the rules. Practice as you see fit.

3. Long-Term Stability and Legacy

• Owning Your Future: If you buy an existing clinic, you inherit an established patient base, reducing startup risk.
• Exit Strategy: Later in your career, you can sell the clinic or bring in partners to sustain the business while you transition into retirement.

When Owning a Clinic Makes Sense

• You’re willing to take financial risks for higher long-term rewards.
• You enjoy the business side of medicine and want control over clinic operations.
• You plan to stay in one location for the long haul.

Think You’re Ready to Own a Clinic? Double-Check This List

1. Can You Afford It?

• Buying a Clinic: Expect to pay anywhere from 50% to 150% of annual revenue, depending on profitability and market conditions.
• Partnership Buy-In: This varies but often requires a substantial upfront investment.
• Loans and Debt: Can you secure financing with reasonable terms? Consider SBA loans, private lenders, or seller financing.

Starting a medical practice could range from $70,000 to more than $100,000. Be ready to spend at least $6,000 per month to keep going. Ouch.

2. What’s the Revenue Model?

• Fee-for-Service vs. Value-Based Care: Understand the clinic’s primary revenue stream.
• Traditional insurance or Cash Based? Direct Primary Care (DPC) is the way of the future! Health insurance is a scam.
• Payer Mix: A high percentage of Medicare/Medicaid/Tricare patients can impact reimbursement stability.
• Ancillary Services: Does the clinic offer additional revenue streams like lab testing, physical therapy, counseling, nutrition, or aesthetics?

3. What Are the Overhead Costs?

• Payroll (including your own salary)
• Rent and utilities
• Malpractice and business insurance
• EMR and billing systems
• Marketing and patient acquisition costs
• Exam room equipment and supplies

Practical Steps to Become a Clinic Owner

1. Perform a Personal Financial Assessment
   • Do you have the financial stability to take on debt if needed?
   • Can you withstand a slow start while growing the business? It may take 18-24 months before you have anything that looks like a full schedule. And that depends on your specialty.
2. Evaluate an Existing Clinic’s Financials
   • Request three years of profit/loss statements and tax returns.
   • Analyze patient volume and revenue trends.
   • Identify potential red flags, such as high staff turnover or pending legal issues.
3. Seek Professional Guidance
   • Consult with a CPA who specializes in medical practices.
   • Speak with a healthcare attorney to review contracts and liabilities.
   • Consider a business mentor who has successfully transitioned from PA to owner.

Final Thoughts: Which Path is Right for You?

Choosing between being a PA employee and a clinic owner comes down to personal preference, financial readiness, and career aspirations. If you prioritize stability, predictable income, and a focus on patient care, remaining an employee is the safer choice. However, if you seek greater autonomy, you must be willing to embrace the challenges of business ownership. Higher earning potential comes with these responsibilities. Running a clinic can be incredibly rewarding, but you’ll never work harder in your life.

No path is inherently better—it’s about what aligns with your long-term vision. Weigh the pros and cons carefully. Seek expert advice. Make a strategic decision that serves both your career and personal goals.