For Clinicians: taking your practice direct
You built the patient relationships. The platform owns the panel, sets the rates, and can change both tomorrow. Here is what going direct actually involves.
Photograph via UnsplashGoing direct means trading a platform’s filled schedule for ownership of your panel, pricing, and brand. The back office that historically made leaving impossible — charting, eRx, pharmacy, labs, multi-state compliance — is now rentable as infrastructure. Read your non-solicit terms with counsel first, start in the states you already hold licenses, and lead with the one program patients already ask you for.
The trade you are currently making
Working for a telehealth platform is a reasonable deal: they fill your schedule, you trade autonomy and margin for it. The deal sours when you realize the patients think of themselves as your patients, while contractually they belong to the platform — its brand, its records, its pricing, its right to reassign them. Clinicians with a following, a specialty, or simply a full panel eventually do the math: the platform's cut is the cost of a back office you could rent directly.
What you gain by going direct
- Your panel is yours. Patients follow your name, not a marketplace listing. No non-solicit anxiety, no reassignment.
- Your economics. You set pricing — visit fees, memberships, program bundles — instead of accepting a per-encounter rate.
- Your clinical judgment. Protocols and visit length stop being platform policy decisions.
- Your brand compounds. Every patient, review, and referral accrues to you, which is the asset a practice sale or partnership eventually prices.
What you take on — and what infrastructure absorbs
The honest list of what a solo practice needs: an EMR and charting, e-prescribing, pharmacy and lab relationships, scheduling, payments, malpractice coverage, HIPAA posture, and — if you want patients in more than your home state — the whole multi-state licensing and telehealth-rules apparatus. Historically that list is why clinicians stayed on platforms.
It is also exactly the list clinical infrastructure now rents out. On a platform like Lithos, charting, eRx, pharmacy routing, labs, refill management, and state-rule compliance run behind an API; your side is the storefront — a simple site or app with your name on it — plus the medicine. The back office stops being the reason you cannot leave.
The back office, line by line
| What a practice needs | Going direct alone | On clinical infrastructure |
|---|---|---|
| Charting / EMR | License and configure your own | Built in |
| e-Prescribing + pharmacy | Contract eRx vendor and pharmacies | Built in, routed per patient state |
| Labs | Negotiate draw-site / kit relationships | Built in |
| Refill management | Your calendar and memory | Automated with clinical gates |
| Multi-state compliance | Track every state’s rules yourself | Maintained by the platform |
| Storefront + brand | Yours either way — this is the point | |
| Malpractice + licensure | Yours — budget for both |
A realistic transition path
- Check your contract first: non-solicitation and non-compete terms decide what "bringing your patients" can legally mean. Read them with counsel before anything else.
- Start with your home state and the states where you already hold licenses; expand coverage as demand proves out.
- Keep the day job initially. Most clinicians run direct practice as evenings-and-weekends until the panel supports going full time.
- Pick one program to lead with — the thing patients already ask you for — rather than launching a general clinic on day one.
The questions to ask any infrastructure partner
- Do I remain the treating clinician of record for my patients?
- Who owns the charts — and can I export my panel's records if I leave?
- What happens when I want to add a state, a program, or another clinician?
- What is the all-in cost per patient per month, so I can price my own services?
Lithos runs the back office for independent clinicians — charting, eRx, pharmacy, refills, and the paperwork between — behind your brand. You keep 100% of the patient relationship.
Frequently asked questions
Can I take my patients with me when I leave a platform?
That depends on your contract — non-solicitation and non-compete terms control what “bringing your patients” can legally mean. Read them with counsel before making any move.
Do I need my own malpractice coverage?
Generally yes — going direct means your own policy sized to your practice, rather than riding a platform’s coverage. It is a standard, budgetable line item.
What does it cost to run a direct practice on infrastructure?
Platform and per-patient fees replace the platform’s revenue cut — ask for the all-in cost per patient per month so you can price visits, memberships, and programs with real margins.
Can I see patients in other states?
In any state where you hold a license and follow its telehealth rules. Most clinicians start with their existing licenses and add states as demand proves out.
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