Starting a practice with friends can sound like the ideal arrangement. You already trust each other. You may share clinical values. You may even have a similar vision for the kind of care you want to provide.

But that does not mean you are aligned on how to run a business together.

One of the biggest mistakes new partners make is spending too much time talking about the idea for the practice and not enough time talking about ownership, authority, money, long-term goals, and conflict. Those are the conversations that often determine whether the business stays healthy once it becomes real.

Questions to Ask Before Starting a Private Practice Together

A practical starter list of questions to discuss before moving forward looks like this:

Are you going to be for-profit or nonprofit?
If you are for-profit, what is the business structure and ownership?
How long are people planning to practice?
Who will be on the board of directors for the business?
Who will the clinic directors be?
If a private equity group offers to buy part or all of the business, would the owners be interested?
How will disputes among owners be addressed?

Get Aligned on Ownership, Goals, and Business Structure

Before opening a practice together, partners need to align on more than the mission of the business. They need to be clear on who owns what, who decides what, what each person wants from the business, and what happens when circumstances change.

That starts with structural questions. Will the practice be for-profit or nonprofit? Will ownership be split evenly, or will it reflect each person’s money, time, role, or risk? How long does each person expect to stay in the business? What is the long-term plan if the practice succeeds?

The answers shape everything that follows. If one person wants a stable small practice and another wants aggressive growth, that difference needs to surface early. If the business becomes profitable, do the owners want to distribute that money to themselves or reinvest it and grow? These are not side issues. They are central to whether the partnership actually works.

Decide Who Will Run the Practice and How Decisions Will Be Made

Friendship is not a governance model.

Someone still needs to run the practice. Someone still needs authority over operations. Someone still needs responsibility for leadership decisions, whether that involves staffing, systems, or clinical oversight.

A small group of founders may initially serve as the board and divide leadership responsibilities among themselves. One person may take the lead on operations. Another may oversee clinical services. Another may handle administration or strategy. But titles alone are not enough. Partners also need to decide how decisions can be challenged, who has voting power, and what happens if the person in charge is no longer doing the job well.

That is why it is important to agree up front on how decisions will be made. Some groups may use majority ownership. Others may rely on board voting. The exact structure can vary. What matters is that it exists before conflict appears. Otherwise, every disagreement becomes harder because there is no shared process for resolving it.

Plan for Ownership Changes, Reduced Workloads, and Exit Scenarios

Business partners should assume that real life will affect the practice.

Someone may want to reduce their hours. Someone may want to retire earlier than expected. Someone may decide they no longer want the same level of responsibility.

If ownership is tied to active work in the business, those changes may need to affect ownership too. Some groups may choose a structure where people work for their shares in the early years, then move to a different model once the company is more established.

The same goes for exit scenarios. If one partner leaves, do they keep their shares? Do they have to sell them back to the company? If there is a buyback, is it based on the original amount paid or fair market value? Those decisions should not be made in the middle of stress or resentment. They should already be part of the agreement.

A strong partnership does not assume nothing will change. It builds around the reality that things probably will.

Have the Hard Conversations About Money, Growth, and Life Changes

The hardest conversations are usually the most important ones.

Partners often avoid talking about effort level, future family changes, retirement timing, profits, ambition, and worst-case scenarios because those topics feel awkward or too personal. But those are exactly the topics that can create the biggest strain later.

For example, if the practice has a strong second year, do the owners want to take home the profits or use them to open another location? How big does each person want the business to become? How much time does each person realistically want to devote to it over the next five years? What happens if someone’s life priorities shift?

Friends often assume they already know each other well enough to skip these conversations. That is a mistake. Knowing someone personally is not the same as knowing how they think about ownership, money, risk, growth, or sacrifice. Friendship does not automatically create business alignment.

There is also one more overlooked factor: a spouse or family can be affected by ownership decisions too. Ownership is not always an issue that stays neatly between the founders. If one business partner is married, their spouse may have a legal or financial connection to that ownership interest, depending on the structure of the business and the laws in their state. That means decisions about equity, buyouts, and succession can affect more than just the person sitting at the table. In some cases, those conversations may need to go beyond the founders themselves because ownership can affect a household, an estate, and what happens if someone dies unexpectedly. Thinking through those scenarios early can help prevent painful confusion later.

Conclusion: Talk Through the Hard Questions Before You Open Your Practice

Starting a practice with friends can work well. But good intentions and trust are not enough.

Before opening a practice together, partners need to get aligned on ownership, leadership, profits, growth, conflict, and exit plans. They need to talk honestly about work, money, ambition, and life changes before those issues become urgent. They need a structure that can hold up when circumstances get more complicated.

Those conversations may feel uncomfortable early on. But they are far easier than trying to sort everything out after the business is open, money is involved, and the relationship is already under strain.

If you’re in the early stages of starting a practice, we’ve created a free course that walks through how to set up everything, all in under two hours.

Learn more at ripsytech.com/practice.

Have a question or topic you’d like us to explore? Contact us at sitandstay@ripsytech.com.

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Starting a Practice With Friends? Ask These Questions First