So You Want to Own Your Own Practice? An Honest Guide to Going Independent

The Australasian Sonographers Association asked me to talk about practice ownership at their Gold Coast conference this year, which is not something I would normally put my hand up for. It pushed me well out of my comfort zone. But Paula Canane is persuasive, so here we are. Thanks, Paula.

What follows is the honest version, adapted from that talk, which I called "Boss of your own probe". For a lot of us who built a career on technical skill, owning a practice has always sat somewhere between a distant dream and an outright nightmare, depending on your wiring. The good news is that thanks to teleradiology and changes to the Medicare rules, it is probably closer to reach than you think. The less good news is that it is one of the hardest things I have done.

Here is the analogy I keep coming back to. Owning a practice is like jumping out of a plane. You can be well prepared and strapped to a good parachute, but once you jump there are only two outcomes. One is euphoria, gliding gently into the landing zone. The other is a lot less fun. I want to walk you through enough of the hurdles, costs and surprises that you can decide whether you want to jump at all.

One thing before we start: any numbers I mention are very broad and are not financial advice. Treat them as a feel for the scale, not a budget.

First, Is It Really for You?

We all have different risk profiles, stress tolerances and ideas of a comfortable workload. So before you fall in love with an opportunity, sit with a slightly uncomfortable question: what actually brings you joy, professionally and personally?

I ask because the day job changes. There have been plenty of times when all I wanted was to walk into a scanning room, look after the patient in front of me, and scan with no distractions. As a founder, that quiet focus gets rarer. The effort it takes to run a practice at a high level is total. You will think about work constantly. Artie, one of the other speakers, and I were comparing notes on exactly that before the session. The 38-hour week becomes something closer to 60 or 70. You are always on, and even when you give it everything, the outcome is not guaranteed.

None of that is meant to scare you off. It is meant to make sure that if you jump, you jump with your eyes open.

Is There a Real Opportunity?

The first real step is to work out whether the opportunity genuinely exists, or whether it just feels exciting. Artie ran through a SWOT analysis in his talk earlier in the day, so I will only touch on it: that old-school SWOT (strengths, weaknesses, opportunities, threats) is still one of the quickest ways to see an idea clearly. Use AI to help if you like, but the act of laying it out is the point, and you can keep circling back to add to it.

Opportunities show up in different shapes. It might be a regional town with no radiology or ultrasound service at all. It might be a level of service you know you could lift somewhere you already work. And, like a real estate agent, I have to say it: location matters.

What is interesting is how often location is both a strength and a weakness at once. A city site might be weak because of fierce competition for patients, yet strong because staff are easier to find. A regional site flips that around. So weigh up population growth, your referral base, the competition, parking, public access, the cost of rent or buying, and above all your point of difference.

Demand is on your side. An ageing population and referrers leaning more on medical imaging keep the work coming. But competition is real, especially in bigger centres with slick corporate providers. Plenty of independent clinics still thrive in crowded markets, and they do it on the strength of an outstanding experience for referrers and patients. Differentiation and smart positioning are how you win.

The Business Plan and the Money

Once you have made an honest assessment of both the opportunity and yourself, it is time for a business plan. Pulling one together can feel daunting, but starting is easy, and there is a wealth of templates and resources online.

Then comes the part that keeps founders awake. Imaging is capital intensive. Depending on the modalities you choose, setting up can cost anywhere from around $500,000 up to $5 million. Unless you are buying the building, the imaging equipment is your biggest cost, with the fit-out close behind.

There are firms that build radiology practices for a living, and they are worth engaging. They have seen most situations and will lean on past projects to find the best solution for you.

One thing that rarely comes to mind first, but really matters, is your business structure. Get the entity wrong at the start, whether sole trader, partnership, company, joint venture or trust, and the financial consequences can be harsh. Spend the money, sit down with an accountant, and run your shiny new enthusiasm past them before you commit.

Most owners need funding, and financial stress is the one that tends to keep you up at night. My advice: do not overcommit. There is no shame in starting small and growing. You want to be able to go to bed knowing the financial side is under control. To get finance you will need a strong business plan covering your services, revenue and cost projections, funding strategy, a read on the market, and an exit plan if it does not work out. Be ready for the lender to want collateral, which can mean putting your home on the line.

And please, erase any vision of immediate financial opulence. People imagine practice ownership looks like a McLaren in the driveway. In the early days it is more like my trusty Toyota Corolla, and me cleaning the clinic myself on a weekend.

The Regulatory Maze

Now for the riveting part. Imaging is heavily regulated, but the first thing I want you to sit with is not the imaging rules. As a director or owner, you carry legal obligations and responsibilities to your employees and the public. If something goes wrong, those responsibilities are real, and they can carry financial penalties and worse. Talk them through with an accountant and a lawyer, because they are easy to overlook.

That is also why comprehensive insurance is non-negotiable: building and contents, public liability, practice indemnity, the work cover equivalent, and cyber. It is expensive, and it is worth every cent.

On the imaging side, accreditation under the Diagnostic Imaging Accreditation Scheme is what lets you bill Medicare, alongside radiation licensing. No imaging practice can trade without it. How hard that is depends a lot on what you offer.

If you go down the radiation path, you will need a radiation possession licence, granted only after you submit a radiation safety and protection plan. That plan can take months to get right, because it has to speak the language of radiation legislation and best practice. Give yourself a good three months for the whole process. Until it is granted, you cannot acquire radiation equipment, and you cannot trade. If this is unfamiliar territory, get help early. Full disclosure: I am not that helpful here myself.

You will also meet your new favourite government portals, PRODA (Provider Digital Access) and HPOS (Health Professional Online Services). If you have ever wrestled with myGov, you know the feeling. These are how you talk to the health departments, and they need to be set up before you open. Through HPOS you get a location-specific provider number (an LSPN), list your equipment and reporting radiologist, and connect to My Health Record. They are fiddly at first, and I will be honest, I am hopeless with them. My co-founder Usmi, on the other hand, is very good at it. Consider this me making you aware they exist, so the first encounter is less of a shock.

Your Team and Your Referrers

Here is the bit I feel most strongly about. Without a great team, there is no practice. Your team is everything, and it should be treated that way: acknowledged, respected, heard, fairly paid, and given real chances to grow professionally and personally. There are a lot of other opportunities out there for good sonographers. Your team will mirror how you behave, so treat people the way you would want to be treated, and they will return it.

You can have the best receptionist, a brilliant technical crew, fancy lights, beautiful art and five-star Google reviews. But referrers judge you on three things: the quality of the report, the turnaround time, and how well your practice talks to theirs. Radiology is a referral business, so looking after referrers is everything.

Which brings me to radiologists. Sourcing or partnering with one can be the single biggest hurdle you face. Good ones are not easy to come by, and the relationship between your crew, your referrers and your radiologist has to work. You want someone approachable, who will pick up the phone and speak with a referrer or a team member with a smile. As a rough guide, expect to pay somewhere around 25% to 35% of revenue toward a radiologist.

The practical side of referrals matters too. Referrers need to be able to pick your practice as their preferred provider inside their practice software, which then generates an e-referral straight to your admin team. Accessibility, communication and fast reporting are your real differentiators. In my experience marketing helps, but strong relationships with GPs and specialists drive most of the work, because the referrer quietly decides the narrative every time they choose your practice or someone else's.

Get the basics right around that: an easy, informative, direct website is your online business card, keep your Google business profile current, and use social media for targeted pushes when you have something to promote. And if you are in a regional centre, get genuinely involved in the community. Back local events and sporting clubs, because out there word of mouth and reputation are everything.

Risk, Growth and Real Success

I will not pretend the risk away. The capital is confronting, you will often need collateral to secure finance, and even with a well-built plan, sound advice and real financial discipline, there is no guarantee of success. You can do everything right to reduce the risk and still have no promise at the end of it.

A practice owner once told me that if you are not growing the number of clinics you have, you are failing. I think that is too blunt, and I do not believe it. You can grow in so many other ways: in your team, in their responsibilities, in revenue and hopefully profit, in expertise, in equipment and in the modalities you can offer. The long-term keys are clinical excellence and reliability, an efficient practice, a supported and empowered team, financial discipline, and a willingness to keep re-evaluating and to take an opportunity when it appears.

Most of all, only you can define success. Do not measure yourself against anyone else. A successful practice takes many forms, and it does not have to mean a huge profit. One of my proudest achievements is simply making more medical imaging available where I work. Bringing MRI to Emerald was a genuine turning point for that community, and the difference it has made to health outcomes there means more to me than any number on a spreadsheet.

So if you are weighing this up, take real time to think about the hours, the stress, and the financial pressure. (Just look at my hair.) If you are at peace with all of that, build a well-documented business plan you can take to an accountant and a finance broker, be ready to offer collateral, and give yourself the time the licensing demands. Look after your patients, your referrers and your team, and they will look after you.

It is a hard road. It can also be deeply rewarding, professionally, personally and, if you are fortunate, financially. Nothing changes without change, and most challenges are just opportunities waiting for a solution.