Physicians writing on KevinMD about their own money and the business of practice: student loans and forgiveness, disability and life insurance, index funds and retirement accounts, whether to hire an advisor, financial independence and retiring early, side income and real estate, contracts and negotiation, selling a practice to private equity, and leaving insurance for direct primary care. Three maintained records draw on this archive: Physician personal finance: what physicians say about their own money, in their own words, Private equity and corporate medicine: what physicians say, in their own words, and Direct primary care: what physicians say, in their own words.
When I started earning a real income as a surgeon, I was thirty-two years old and financially illiterate. Nobody had taught me anything about money. Not medical school. Not my mentors. Not the hospital. Not the senior surgeons I admired.
I knew how to stop bleeding. I did not know how compound interest worked.
That personal anecdote is not the point. The point is that it is not personal at all. It …
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The physician financial literacy gap nobody addresses
Whenever I speak to physician groups about health care investing, I get the same reaction. Interest first, then a pause. Then someone says, “That sounds great, but I’m not about to quit my practice and become a venture capitalist.”
They don’t have to.
The biggest misconception about physician involvement in health care investing is that it requires a career change. It doesn’t. Over the past seven years, I’ve built a network of …
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5 ways physicians can shape health care investing
When an independent practice evaluates a billing company, the diligence usually concentrates on three questions: what it costs, how clean the claims are, and how fast someone answers the phone. Those are the right questions for choosing between vendors that exist. They say nothing about the scenario practices plan for least and recover from worst: The vendor stops existing. That scenario sounds like an edge case. The data says it …
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1 in 12 medical billing companies just vanished
A conference table. Six to ten people around it. A health care startup is being evaluated for a multimillion-dollar investment. The people in the room are smart, with MBAs from top programs, former management consultants, ex-bankers who pivoted into health care venture capital. They have built financial models, analyzed market sizing data, and stress-tested the company’s revenue projections.
They are about to commit capital to a product designed for use inside …
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Health care investing needs a doctor in the room
Most people find a new doctor by asking their friends and family who they go to. When you’ve got a solid referral or testimonial, a type of pseudo-trust is established.
But when a person does not live in the same area, or doesn’t have a referral from someone they trust, they start searching online. They compare websites, look at photos, read some pages, and possibly see the photos of the waiting …
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Branding a medical practice is not vanity, it is trust
In primary care, practice overhead is commonly described as 50 to 60 percent of collections. That range is repeated in continuing education, in vendor marketing, and in the operational frameworks new practice owners are handed when they ask what normal looks like. The range is not wrong. It is just too broad to be operationally useful.
A primary care practice running at 58 percent overhead might be perfectly stable, undercompensating its …
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Why your overhead percentage is the wrong benchmark
A physician in our network was having dinner with a group of entrepreneurs. None of them worked in health care. But one mentioned a former health IT executive who had built a technology platform for hospital operations. The physician, who spent his days inside hospitals and immediately recognized the problem the product was solving, picked up his phone, called me, and said, “You need to look at this.”
That call led …
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Why physician-led deal sourcing beats traditional VC
Most independent practices treat HIPAA as a documentation exercise. The policy binder sits on a shelf, the privacy notice is posted, the staff training certificate is in the file, and the assumption is that the practice is covered. Enforcement patterns over the last several years suggest a different exposure model. The settlements that reach small practices are rarely about the policies that were missing on paper. They are about the …
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Why HIPAA settlements hit independent practices
She was 42, uninsured, and had been avoiding the doctor for three years. By the time she showed up in my hospital, her diabetes was uncontrolled, her blood pressure was dangerously elevated, and she had early signs of kidney disease. Everything about her case was preventable. She knew it. I knew it. And neither of us could do much about the system that made it happen.
I was an inpatient hospitalist …
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Why physicians make the best health care investors
A typical commercial payer contract for an independent practice gets signed once, usually under time pressure during credentialing, and then sits untouched for three to five years. The practice receives annual fee schedule updates from the payer, treats them as the new floor, and moves on. The contract is filed and rarely opened again.
This is the diagnostic gap that costs independent practices more recurring revenue than any operational issue except …
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Payer contract renegotiation costs independent practices
Most of the time in my work as a financial planner, my job is to help fellow physicians think long-game so they can craft a sustainable career and life they love. Today is different. We are going to focus on the short game and introduce a financial concept I call the “Courage Fund.” If you are hoping to create a more flexible career, and you cannot wait years to develop …
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Unlocking career flexibility with a Courage Fund
I graduated residency with over 100 peer-reviewed publications, an EB-1A visa for extraordinary ability in medicine, and zero understanding of how health care capital works.
Nobody taught me what a term sheet was. Nobody explained how venture capital flowed into the companies building the devices, drugs, and software I used on patients every day. Nobody mentioned that the same analytical rigor I applied to systematic reviews, defining a question, evaluating evidence, …
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Physicians belong in health care venture capital
Before treating a patient, you review their history, run diagnostics, and verify every detail. Have you done the same before trusting your financial advisor with your wealth?
Most medical professionals do not know if their advisor is truly acting in their best interest, or what they are really paying in fees, conflicts of interest, and hidden incentives.
I spent years working with financial advisors managing $20 million to more than $3 billion …
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15 financial advisor questions for medical professionals
Policy changes eventually become operating decisions
Most coverage of Medicare payment changes stops at reimbursement. A practice reads that a rule changes payment for certain services, then asks the obvious question: How much revenue is at risk?
That question matters, but it is not the only operator question. Medicare practice expense and related Physician Fee Schedule changes also affect the billing-service decision. If the practice outsources billing, the policy change does not …
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How Medicare changes affect medical billing contracts
There were many tax code changes in the One Big Beautiful Bill Act (OBBBA) when it was signed into law in 2025. Many of these changes affected taxpayers at different income levels, and with so many changes, it can be a challenge to know which items can best benefit physicians and their families. One of the provisions in OBBBA was an update to the SALT deduction, a change that can …
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SALT deduction for physicians: the $500,000 magic number
Nobody in my residency program would have predicted I’d end up in venture capital. Certainly not me.
I immigrated to the United States from India with a straightforward plan: become the best physician-scientist I could and build a career in academic medicine. For the first chapter of my professional life, that’s exactly what I did. I trained in internal medicine, published over 100 peer-reviewed papers including in the New England Journal …
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Physicians in venture capital see what others miss
The extra 90 days is not a rounding error
A 90-day credentialing timeline and a 180-day credentialing timeline can sound like two versions of the same problem. They are not. The second version can mean another quarter of rent, software, malpractice coverage, staff time, loan payments, marketing spend, and owner compensation before the practice can bill a major payer.
For a typical primary care startup, 90 additional days of fixed costs can …
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3 reasons credentialing delays push past 90 days
I used to think health care finance was mostly about numbers. Then I worked inside the financial operations of a health care organization and realized how much patient care depends on systems most people never see. One experience has stayed with me ever since.
A claim for care that had already been provided was sitting in a billing backlog, approaching the payer’s filing deadline. The treatment had been completed. The staff …
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Missed claims filing deadlines threaten patient care
A cash symptom can have several causes
A practice owner notices the same warning signs: collections are lower than expected, the bank balance feels tighter, and the billing report shows money still sitting unpaid. The first conclusion is usually simple. Billing is the problem.
Sometimes that is true. More often, the word “billing” is covering several different problems that require different fixes. A slow front desk, a coding issue, payer delays, denial …
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Accounts receivable days hide four billing problems
