How independent physicians are making it work

Dr. Mollie James was embarrassed when her functional medicine practice filed for bankruptcy in 2019. She felt like a complete failure.

“I thought it was the worst thing that could happen,” James said. “I’m the ‘A’ student, the valedictorian, all those things. I didn’t want anybody to know. ”

Fast-forward seven years, and James is the owner of a multimillion-dollar concierge practice with two locations in Iowa, a third in Missouri and a fourth slated to open in Texas later this year. She also offers virtual care services.

Owning an independent practice is a daunting prospect financially. Physicians invest their savings and retirement accounts into a practice or take out business loans, but they often lack the know-how to operate a successful business. Clinics typically take years to become profitable, which may not be aviable option for doctors saddled with student loan debt.

Joining a large system or physician group that handles back-office operations and offers a steady paycheck is the easier path. However, some physicians say there is still a place for independentmedicine, despite the challenges.

Here’s what four practices have done to make it work.

Start small

James’ second act, James Clinic, launched in 2021 to treat a range of conditions through integrative medicine, including cancer, neuropathy and hormonal imbalances. It serves about 1,500 to 2,000 patients each year.

James decided to avoid past missteps and start small after the bankruptcy.

Her former practice struggled with high overhead costs. This time around, her first office in Chariton, Iowa, rented for $400 per month. James also transitioned to a self-pay model.

Branding was another hurdle to overcome. James said she developed a marketing strategy that focuses on patient needs, rather than selling products.

James wants others to avoid her mistakes. Later this year, James is launching Maverick Medical Ventures, which will support physicians who want to leave a health system and build their own practice.

Find additional income

Dr. Steve Furr, co-owner of Family Medical Clinic in Jackson, Alabama, has practiced independently for decades. His practice, which includes two other physicians and three nurse practitioners, is a designated rural health clinic.

Several years ago, the clinic launched a chronic care management program. Staff members regularly check in on patients to see if they are staying on their medications, need referrals or have any changes to report since their last appointment. Furr said the program brings in additional income and helps the clinic stay connected with patients.

Running a practice requires tough decisions, he said. Owners must assess whether patient volumes will support investments in new equipment, technology or services. In general, an investment only makes sense if the practice can at least break even on it, he said.

“As things have gotten tighter and tighter over time, you just can’t have things in your practice that you lose money on,” Furr said. “You do like any other business. You try and look and see where you can cut costs, where you can lower your overhead to try and maximize your income.”

Connect with other physicians

Dr. Stacey Bartell, owner of iTest Health Family Medicine in Livonia, Michigan, needed a change after the COVID-19 pandemic. She left a local health system in 2022 to start her practice. A decade-long stint as a medical director at a former employer meant she understood the business side of medicine.

Bartell said one of her biggest challenges is getting paid — ensuring the right codes are submitted to insurers and following up on claims denials and prior authorizations. Her practice, which serves nearly 1,500 patients, is starting to see people drop Medicaid coverage.

“There are days where I just run out of energy, ” she said. “We’re doing the best we can.” Bartell said it is helpful to collaborate with other private physicians and share resources when payment challenges arise.

Keep it lean

Dr. David Schechter built his family and sports medicine practice incrementally — developing a patient panel part time while working at other practices and teaching a residency program. He went full-time as an independent physician in 2002.

Schechter has a lean operating model. He is the sole clinician at the Los Angeles-area practice. There is one front-office employee and another employee, often a gap-year student, who takes vital signs and helps with other clinical tasks. Billing is outsourced. The practice’s expense ratio hovers at 35% to 40%, he said.

“My whole philosophy has been easing your way into private practice rather than necessarily jumping in, ” Schechter said. Schechter also specializes in chronic pain management through mind-body medicine, which attracts more patients and sets him apart from other primary care practices.

He also has reduced the number of insurance contracts and moved toward self-pay. For the remaining contracts, the practice is part of an independent physician association, which brings physicians together to increase bargaining power and secure higher reimbursement rates.

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Virginia’s Amended Reporting Requirements and Penalties: What Hospitals, Health Systems, and Health Care Providers Need to Know About the 2026 Amendments to Va. Code § 63.2-1509

The Virginia General Assembly has enacted significant amendments to Virginia’s mandatory child abuse and neglect reporting statute, Va. Code § 63.2-1509, effective July 1, 2026 (2026 Va. Acts ch. 845). The amendments tighten timelines, strengthen penalties, and impose heightened criminal liability on institutional actors — including hospitals and other facilities providing care and treatment to children – and mandatory reporters who fail to timely report suspected child abuse or neglect within 24 hours. Health care providers, hospital administrators, and compliance officers should review and update their reporting policies and training programs immediately, as appropriate, to ensure all covered employees are aware of the new requirements and penalties.

Existing Hospital Reporting Requirements for Health Professionals

For many years, Virginia law has required the Chief Executive Officer and Chief of Staff of every hospital or other health care institution in the Commonwealth to report to the Director of the Department of Health Professions (“DHP”) certain information about licensed, certified, or registered health professionals, multistate nursing privilege holders, and applicants. The primary reporting statute is summarized below; note that additional statutory reporting requirements also exist. See, e.g., Virginia Code 54.1-2909.

Va. Code § 54.1-2400.6: Key Hospital Reporting Requirements

Hospitals are required to report to the DHP the following concerns regarding professional conduct, impairment, and disciplinary matters:

  • Five-day window for reporting for certain admissions: Report within five days after learning of a health professional’s involuntary admission for treatment of substance abuse or psychiatric illness. A report is also required after the 30-day period following a voluntary admission for substance abuse or psychiatric illness, unless the treating physician, physician assistant, or nurse practitioner provides written confirmation that the professional is no longer believed to be a danger to self, the public, or patients.
  • Thirty-day window for reporting reasonable-belief determinations: Report within 30 days after the CEO, chief of staff, director, or administrator determines, after appropriate review, investigation, or consultation with internal boards or committees, that there is a reasonable belief the health professional may have engaged in unethical, fraudulent, or unprofessional conduct.
  • Thirty-day window for reporting certain disciplinary proceedings: Report within 30 days after written notice to the health professional that the institution has begun a disciplinary proceeding involving intentional or negligent conduct causing or likely to cause patient injury, professional ethics, professional incompetence, moral turpitude, or substance abuse.
  • Thirty-day window for reporting specified disciplinary actions: Report within 30 days after written notice of disciplinary action taken during or at the conclusion of proceedings, or while under investigation, including denial or termination of employment, denial or termination of privileges, or restriction of privileges resulting from the specified categories of conduct.
  • Reports for resignations or privilege restrictions while under review: Report voluntary resignation from staff, voluntary restriction of privileges, or expiration of privileges while the health professional is under investigation or subject to disciplinary proceedings for matters related to patient injury risk, medical incompetence, unprofessional conduct, moral turpitude, mental or physical impairment, or substance abuse.

Required report contents and Immunity

Reports must be in writing and include the subject professional’s name, address, and date of birth; a full description of the circumstances; the names and contact information of individuals with knowledge and of individuals consulted to substantiate the facts; relevant medical records when patient care or the professional’s health status is at issue; and notice if the hospital has submitted an NPDB report. The health professional must be provided a copy of the report. Good-faith reporters and participants in related investigations or proceedings receive civil immunity absent bad faith or malicious intent. However, immunity is a defense that must be proven, and it does not bar a lawsuit from being filed. Failure to make a required report may result in a civil penalty of up to $25,000 and may affect licensure, certification, or renewal until the penalty is paid.

Peer review privilege preserved

Compliance with the reporting statute does not waive or limit Virginia’s peer review privilege under Va. Code § 8.01-581.17. The privilege does not bar required reports or requested medical records necessary to investigate reportable unprofessional conduct but privileged materials may be withheld. Hospitals and health systems should confirm that their practitioner health, medical staff, credentialing, peer review, human resources, and compliance processes identify when a matter triggers reporting under Va. Code § 54.1-2400.6 and other reporting statutes, in addition to the child abuse reporting requirements addressed in this advisory. Written policies should be updated to reflect the amendments to the revised child abuse reporting requirements outlined below.

ACTION REQUIRED: Review and understand the amendments to Virginia Code § 63.2-1509.In the new subsection F, a required reporter (identified in subsection A) must report suspected child abuse or neglect within 24 hours of having reason to suspect a reportable offense. Under the new subsection C, a reason for suspicion includes any suspected violation of §§ 18.2-370 through 18.2-370.6 or § 18.2-374.3 involving a child. The statute’s requirements are further summarized below.

1.  “Who is required to report suspected child abuse or neglect in Virginia?”

Overview: A Broad Mandatory Reporting Framework

Virginia’s mandatory reporting statute, Va. Code § 63.2-1509, requires a wide range of professionals who, in their professional or official capacity, have reason to suspect a child is abused or neglected to report immediately to the local department of social services or to the Department’s toll-free child abuse and neglect hotline. The list of mandatory reporters is extensive and includes:

  • Any person licensed to practice medicine or any of the healing arts
  • Any hospital resident or intern, and any person employed in the nursing profession
  • Any person employed as a social worker or family-services specialist
  • Any mental health professional
  • Any professional staff person employed by a private or state-operated hospital, institution, or facility to which children have been placed for care and treatment or committed
  • Any person 18 years of age or older associated with or employed by any public or private organization responsible for the care, custody, or control of children
  • Emergency medical services providers certified by the Board of Health
  • Any person who engages in the practice of behavior analysis, as defined in § 54.1-2900

This is not an exhaustive list. For health care institutions, virtually all clinical and support staff with patient contact — including physicians, nurses, therapists, social workers, and EMS personnel — may be mandatory reporters under Virginia law.

2.  “What triggers a reporting obligation?”

Standard: Reason to Suspect

A reporting obligation arises when a covered professional has “reason to suspect” a child is abused or neglected. The current statute defines this standard as extending to three clinical scenarios:

  • Substance-affected newborns: A health care provider finding within six weeks of birth that the child was born affected by substance abuse or experiencing withdrawal symptoms from in utero drug exposure.
  • Substance-related diagnoses: A diagnosis made within four years of birth that the child has an illness, disease, or condition attributable to maternal abuse of a controlled substance during pregnancy.
  • Fetal Alcohol Spectrum Disorders: A diagnosis made within four years of birth that the child has a fetal alcohol spectrum disorder attributable to in utero alcohol exposure.

When “reason to suspect” is based on one of these clinical findings, that fact must be included in the report. Critically, such reports do not constitute a per se finding of child abuse or neglect.

The amended statute has expanded the definition of a “reason to suspect that a child is an abused or neglected child” to include any suspected violation of the offenses defined in Va. Code §§ 18.2-370 through 18.2-370.6 or § 18.2-374.3 involving a child.[1]

3.  “How quickly must a report be made?”

The 24-Hour Reporting Deadline

Reports must be made as soon as possible, and not later than 24 hours after the covered professional has reason to suspect a reportable offense. A report not made within 24 hours may create compliance risk if the delay cannot be shown to be reasonable under the circumstances. The initial report may be oral but must be reduced to writing by the child abuse coordinator of the local department on a form prescribed by the Board of Social Services.

For employees of hospitals or similar institutions, a covered employee may, in lieu of making a direct report, immediately notify the person in charge of the institution or a designated person in charge, who must then make the report “forthwith.” If this internal notification route is used, the person in charge must:

  • Notify the original reporter when the report is made to the local department or the hotline
  • Provide the name of the individual who received the report
  • Forward any resulting communications, including information about actions taken, to the original reporter

All mandatory reporters who maintain records on the child must cooperate with investigating agencies and make related records available, subject to applicable federal law (including FERPA). Health care providers’ provision of such records is not prohibited by Virginia’s privacy statute in Va. Code § 8.01-399.

4.  “What are the penalties for failing to report — and what changed in 2026?”

New Rule: Significantly Strengthened Criminal Penalties

The 2026 amendments added new penalty provisions to Va. Code § 63.2-1509 specifically targeting hospitals and similar facilities. The penalty structure is now as follows:

General Failures to Report (Subsection D/E):

  • First failure to timely report: civil fine of not more than $500
  • Subsequent failures: civil fine of not less than $1,000
  • Knowing and intentional failure where the reportable offense involves rape, sodomy, aggravated sexual battery, or object sexual penetration: Class 1 misdemeanor

NEW — Potential Healthcare Institutional Criminal Liability (New Subsection F): New subsection F, arguably the most significant addition to the statute, imposes heightened criminal liability specifically where the alleged abuse or neglect occurred at a private or state-operated hospital, institution, or facility to which children have been committed or placed for care and treatment as follows:

  • Failure to report as soon as possible and not longer than 24 hours after having reason to suspect a reportable offense: Class 1 misdemeanor (punishable by up to 12 months in jail and/or a $2,500 fine)
  • Second or subsequent conviction under this subsection: Class 6 felony (punishable by 1–5 years in prison, or up to 12 months in jail and/or a $2,500 fine at the court’s discretion)

This is a material escalation from prior law. Hospitals and other covered facilities should treat any employee’s failure to file a timely report as a potential criminal matter warranting immediate review by legal counsel.

5.  “Are there protections for good-faith reporters?”

Immunity for Good-Faith Reports

Virginia law provides broad immunity for mandatory reporters. Under Va. Code § 63.2-1509(D) — renumbered in the 2026 amendments but preserved— any person who:

  • makes a report or provides records or information pursuant to the statute, or
  • testifies in any judicial proceeding arising from such report, records, or information

shall be immune from any civil or criminal liability or administrative penalty or sanction on account of such report, records, information, or testimony, unless the person acted in bad faith or with malicious purpose.

This immunity should be communicated clearly to all mandatory reporters within an institution to encourage timely and complete reporting.

6.  “Are there any exceptions to the reporting obligation?”

Limited Exception: Actual Knowledge of Prior Report

Under the statute, no person is required to make a report if the person has actual knowledge that the same matter has already been reported to the local department or the Department’s toll-free child abuse and neglect hotline.[2] This exception is narrow: constructive knowledge or a general belief that someone else “likely reported” is insufficient. Institutions should not rely on this exception unless they can confirm that a specific, prior report has actually been filed.

Hospital and Health System Action Items

  • Immediately review and update internal mandatory reporting policies to reflect the new institutional penalty provisions (new Subsection F) and 24-hour deadline.
  • Train all clinical and administrative staff on who is a mandatory reporter, what triggers a reporting obligation, and how to make and document a report.
  • Designate and confirm reporting contacts (persons in charge or their designees) and ensure those individuals understand their obligation to report forthwith and notify the original reporter.
  • Educate staff of the broad immunity protection for good-faith reports.
  • Review any policies that might delay or discourage reporting and revise as appropriate to reduce potential criminal exposure for reporting delays.

Consult legal counsel immediately if a reporting failure is discovered at your institution, given the new Class 1 misdemeanor and Class 6 felony exposure.

References

[1] Va. Code § 63.2-1509(C), as amended by 2026 Va. Acts ch. 845 (H.B. 1414).
[2] Va. Code § 63.2-1509(G) (formerly subsection E), as amended by 2026 Va. Acts ch. 845.

For questions about this advisory, please contact the Hancock Daniel & Johnson, LLC team at (804) 967-9604 or visit hancockdaniel.com.

The information contained in this advisory is for general educational purposes only. It is presented with the understanding that neither the author nor Hancock, Daniel & Johnson LLC, is offering any legal or other professional services. Since the law in many areas is complex and can change rapidly, this information may not apply to a given factual situation and can become outdated. Individuals desiring legal advice should consult legal counsel for up-to-date and fact-specific advice. Under no circumstances will the author or Hancock, Daniel & Johnson LLC be liable for any direct, indirect, or consequential damages resulting from the use of this material.

HIV and Syphilis Updates for Virginia Providers

Dear Colleague:

This letter provides updates on Virginia’s recent HIV trends, testing recommendations, prevention measures, care resources, and an update to Virginia’s syphilis screening recommendations.

HIV Trends, Testing Recommendations, and Informational Resources

Virginia’s HIV surveillance trends indicate increases in HIV diagnoses in 2024 among:

  • Youth (15–19 years – all races/ethnicities)
  • Hispanic/Latino populations (all age groups)

HIV infections are rebounding after the COVID-19 pandemic. Please help us ensure HIV testing and prevention recommendations are reaching all patients who may benefit.

Please be aware of CDC’s current HIV testing guidelines and recommendations. Some important recommendations from the CDC STI Treatment Guidelines include:

  • Screen all pregnant women, including those in labor with unknown HIV status.
  • Screen all adolescents and adults aged 1565 years, screen younger adolescents and older adults at risk.
  • Test for HIV all persons seeking sexually transmitted infection (STI) evaluation who are not already known to have HIV infection. Testing should be routine/opt-out, regardless of reported risk.
  • Screen higher-risk groups (sexually active gay, bisexual, and other men who have sex with men) at least annually. Work collaboratively to assess their individual risk and the benefits of more frequent screening (every 3–6 months).
  • Discuss prevention options like HIV Pre-Exposure Prophylaxis (PrEP) and Comprehensive Harm Reduction (CHR) with all sexually active patients. Consider doxycycline as post-exposure prophylaxis (DoxyPEP) to prevent bacterial STIs that increase the risk of HIV.

If you have patients who test positive for HIV and need care resources, the Virginia MedicationAssistance Program (VA MAP) provides HIV/other medications, assistance with insurance premiums, or medication co-payments, for low-income patients who meet eligibility requirements. Please visit our website to view the Ryan White Part B: Unified Eligibility Assessment locations by region.

Updated Syphilis Screening Guidelines

Syphilis diagnoses in Virginia and across the nation have reached historic heights. Over the past decade, cases among women have risen significantly, leading to a sharp increase in babies born with congenital syphilis.

VDH recently revised its syphilis screening recommendations for sexually active people aged 15–44 based on recent Virginia data. The guidelines now use rates of all stages of syphilis among women 15–44, instead of only primary and secondary cases.

Why the Change?

Congenital syphilis can occur from infection at any stage during pregnancy. In Virginia, most women are diagnosed in later stages — only 21% of cases in 2024 were early stages. Including all stages gives a more accurate picture of high-risk areas and ensures counties with congenital syphilis cases are not overlooked.

What This Means for Providers:

  • Continue screening all pregnant women for syphilis at first trimester, third trimester, and delivery, regardless of location.
  • Using the updated screening recommendations map
    • In counties/cities where the rate of syphilis of all stages among women aged 15–44 years was greater than 4.6 per 100,000 in 2024, offer syphilis testing to all sexually active people aged 15–44 years.
    • In counties/cities where the rate of syphilis of all stages among women aged 15–44 years was less than or equal to 4.6 per 100,000 in 2024, providers should continue to assess individual risk factors to determine testing needs as outlined in the CDC screening guidelines.
  • Consider point-of-care (POC) syphilis testing in settings where immediate results can improve timely treatment and reduce congenital syphilis risk (emergency rooms, urgent care, correctional facilities, substance use treatment programs, comprehensive harm reduction sites, rural areas, shelters).
  • Discuss doxycycline for STI prevention (DoxyPEP) with male patients who have female sexual partners and have been previously diagnosed with HIV or a bacterial STI, or who report multiple sexual partners in the past year.
  • Refer to the Virginia Syphilis resource page for more information.

Thank you for your continued partnership in keeping Virginians healthy.

Sincerely,

B. Cameron Webb, MD, JD

State Health Commissioner

2024 Virginia Medical News MSV Member Magazine

The 2024 issue of the Virginia Medical News MSV Member Magazine is available here.

2024 Virginia Medical News magazine cover

Articles cover topics such as:

  • child mental health care in Virginia
  • medical students and mentorship
  • what to expect during the 2025 Virginia General Assembly session
  • physician and PA advocacy efforts

 

 

 

 

 

What Makes a Strong Healthcare Team?

Today’s healthcare teams face a growing need for interprofessional collaboration, creative problem solving, and impactful leadership training to drive organizational performance.

The healthcare work environment is changing every day. Across the board, healthcare providers are expected to do more – more paperwork, more reporting, more meetings, see more patients. At the same time, providers are feeling further isolated and less supported. The House of Medicine needs strong, dedicated leaders and effective healthcare teams more than ever.

The SYNC program is an innovative, team-based learning experience that teaches collaboration and leadership through hands-on problem solving. SYNC helps develop your leadership and teamwork skills by having you work on a capstone project to be presented at the end of the session. As a hospitalist, we chose to focus our SYNC Capstone on patients in the acute care setting. Our project focused on educating patients at high risk for stroke, in hopes of reinforcing compliance and ultimately decreasing their risk for stroke. Our team included physicians and nurses, and we reached out to pharmacists, social workers, and hospital leadership throughout the project. We initially sought to identify patients with new onset atrial fibrillation, however, upon reviewing the data, we realized the population size was too small and we had to widen our focus. As our project evolved, we faced challenges that forced us to make other changes. We reviewed social determinants of health, looking for patterns and areas where we could help patients. It forced us to look outside the lens of the hospital setting and more at proactive prevention rather than reactive treatment.

SYNC is facilitated by successful leaders who understand the necessary qualities for the entire healthcare team – communication, collaboration, and flexibility.

Communication is a key component in healthcare. Patients are relying on you to help them through some of the toughest times of their lives. In order to best serve your patients, you must have an open line of communication with your coworkers. Be open and honest with your team members. Check in with each other. Be present in conversations. The SYNC Capstone project creates a line for open and necessary communication with other members of the healthcare team.

Collaboration is necessary for success. This is the keystone of SYNC. If your team is not on the same wavelength or encouraged to share ideas, they will be less motivated to succeed. Being in an environment that encourages professional growth and allows ideas to flow freely ensures positive outcomes for patients. During our project, we learned from each other, each bringing different skills to the table.

Flexibility is required of all members of the healthcare team. By signing up for SYNC, participants are taking their first step into accepting and participating in the unplanned. The leadership role in the team is dynamic and changes depending on the needs and each other’s expertise.

The SYNC program teaches the foundation of effective interprofessional collaboration. Participants leave with a different understanding of what it means to be a part of the healthcare team. While our project started out small, we are working on expanding it to include more patients and involving new team members.

Denise G. Alcantara, M.D.
Sentara Hospital Medicine Physicians
SYNC Cohort 5

Participants have used SYNC to develop or build on programs that are critical for patients. Some of these programs include-

  • Stroke Education in High Risk Populations for Primary Prevention – Sentara Princess Anne Hospital – Cohort 5
    Project Goal: Implement a program identifying non-stroke patients admitted to hospital who are at high risk for stroke. Once identified, the focus will be to complete targeted stroke reduction education and follow the patient post acute-care.
  • Barriers to Breast Cancer Screening – Valley Health – Winchester Medical Center – Cohort 2
    Project Goal: Improve access and streamline delivery of breast cancer screening, identify barriers that make access difficult, and eliminate travel and distance between service delivery settings and target populations.
  • Improving Communication & Handoffs During Transitions of Care for ICU Patients – Centra Health – Inpatient Team – Cohort 1
    Project Goal: Decrease the amount of time until a patient is seen by a receiving physician after an ICU transfer, decrease rate of “bounce back” to ICU and eliminate unnecessary medications upon transfer.
  • Diabetes Prevention – A Public Health Collaborative – Mason and Partners Clinic & Prince William Health District – Cohort 1
    Project Goal: Identify pre-diabetic patients in the Mason and Partners Clinic and refer them to the lifestyle change program to improve overall health.  The project involved utilizing Community Health Workers in patient care and connecting patients to a medical home.

The House of Medicine is critical to keeping patients and communities healthy. With the changing landscape of healthcare and the added pressures of healthcare professionals, there has never been better time to sign up and become a part of SYNC.

If you have questions about SYNC conact Amy Swierczewski, Assistant Director of Intrastate Accreditation and MSVF Programs, at [email protected]