Ask a physician what the biggest business risk to their practice is, and most will land somewhere familiar. A lawsuit. A bad payer contract. A denial spike that guts a quarter’s revenue.
It is none of those. For a solo or independent physician, the single biggest risk to the practice is the physician’s own unavailability. Not the clinical kind anyone insures against. The plain fact of not being there to run things.
That is not a hypothetical scare tactic. It is common enough that medical boards and colleges across multiple jurisdictions have turned it into a formal requirement. Not a suggestion. A standard that physicians are expected to meet.
The rule that shouldn’t need to exist
The College of Physicians and Surgeons of New Brunswick spells it out in its professional standard on closing or leaving a practice: physicians must proactively plan for an unexpected closure, including identifying a designate who can notify patients and arrange for the storage of medical records.
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The West Virginia Board of Medicine takes the same position, noting that independent practitioners and small groups need safeguards in place because a physician’s sudden unavailability, from illness, incapacitation, or anything else, can carry real consequences for patients. Planning ahead, the board says, is often the only way an unexpected departure gets managed without harm.
Regulators do not usually write standards around things that almost never happen. A board does not build a requirement unless the event behind it is common enough, and damaging enough left unmanaged, to need one. The rule existing at all is the evidence.
And here is what makes it strange. Physicians are exceptionally good at offloading risk they cannot carry alone. Tail coverage exists because a malpractice claim can surface years after a practice closes, and no physician tries to self-insure against that. Disability riders exist because an income cannot depend on one person’s health lasting indefinitely.
In both cases, the physician recognized a risk too large to manage personally and paid someone else to carry it. The exact same logic never got applied to the risk of simply not being there. That one, physicians have been carrying solo, with no backup and no plan, the whole time.
Why it never registers as a risk
Medical training does not just teach clinical skills. It teaches physicians to be the last check on everything, the backstop whose judgment is what actually catches the mistake. Over the years, that instinct stops feeling like a skill and starts feeling like an identity. Being the one person who can handle it is not just useful anymore. It is the whole point of being good at the job.
That is why the risk hides in plain sight. A physician will hand off inventory, scheduling, even eligibility checks without a second thought, because none of that touches the part of the job that feels like them.
But the idea of someone else knowing how the practice actually runs, where things are, who to call, what to do first, lands differently. That is not administrative overhead in their head. That is the thing that makes them irreplaceable, and handing it off can feel like giving that up.
It is worth holding two things at once here. Patients do want the doctor who remembers their history, who has been present through years of a chronic condition. Continuity of that relationship is real, and no one should want physicians to care less about being that person.
The problem was never that the instinct is wrong. It is that it never gets treated as a risk with a shape, the way tail coverage and disability riders did. It just sits there as a point of pride, unmanaged, because managing it never occurred to anyone as something separate from the instinct itself.
What actually happens when there’s no plan
A risk-management consultant who fields these calls for a living described one that comes in more often than physicians would assume: a colleague suffers a stroke, and the office manager spends the next several days trying to find anyone who can see that week’s patients. What usually comes out in the scramble is that no one else knew the voicemail password, how to get into the scheduling system, or who was supposed to cover what.
From there, the damage follows a pattern. Records that only one person could access. Prescriptions that cannot be renewed because renewal takes a decision, not a signature. Referrals stalling because no one has the authority to redirect them. Staff who could help, in theory, except that acting outside their own licensure is not a gray area they are willing to test.
None of that requires a worst case. A two-week medical leave produces the same gaps as something permanent. The practice does not pause gracefully when the one person running it is out. It stops unevenly, in whichever spots nobody thought to plan for, which is usually most of them.
The question worth asking this week
Being the one your practice cannot run without was never the failing. It is the same instinct that makes you good at the job. What is missing is what you already gave every other risk you carry: a plan that does not depend on you being the one who executes it.
The practices that solve this do not rely on the owner documenting everything in their spare time, because that never happens and everyone knows it. They build in someone who is briefed and ready before the gap opens, and they keep the operational knowledge somewhere other than one person’s head. It is the same move as tail coverage. You take a risk too big to carry alone and you hand it to a plan, instead of hoping you are always there to absorb it yourself.
The specific shape of that depends on the practice. But the question worth sitting with this week is not abstract. It is exactly this: what stops if you are out for two weeks starting tomorrow, and who else could actually carry it. If the answer is not clean, that is the gap. And it is the same kind of gap tail coverage was built to close. It just never got its own policy.
Karan Kanwar is the CEO of Central AI and Wing Assistant. Central AI provides an AI operating system for appointment-driven medical practices, handling calls, texts, web chat, and messages around the clock, qualifying patients and booking appointments directly into a practice’s existing systems. It is HIPAA compliant and designed to complement the tools practices already use.
Wing Assistant pairs that technology with skilled virtual assistants who take on the administrative work that pulls teams away from patient care. Kanwar writes on where automation and human support meet in health care operations, and how practice leaders can adopt both effectively. He shares updates on LinkedIn.
