Establishing private medical practice is one of the biggest entrepreneurial decisions a doctor makes in their professional life. Months of intense preparation lie between licensing procedures, location analysis, financing, recruitment, and IT infrastructure. This guide summarizes what prospective practice owners need to know in 2026 — from the initial location check to the opening.

Setting up a practice is different from launching a traditional business. The regulatory hurdles are higher, the lead times are longer, and the investments are substantial. At the same time, establishing a private practice is the natural career step for many doctors after several years in a hospital or as employees — and in 2026, the conditions in many specialties are more favorable than they have been in a long time: demographically, numerous practice owners are retiring, patient demand is rising, and digital tools make running a practice more efficient than ever before.

This guide walks through all the essential steps of setting up a practice in Germany. It does not replace individual advice from a tax consultant, lawyer, or practice consultant — but it provides a clear overview of what needs to be done when.

The two basic paths: New establishment or takeover

Anyone looking to run a medical practice basically has two options:

Path 1 — New establishment: Building a completely new practice from scratch. This path is realistic for private doctors and, in underserved planning areas, for statutory health insurance (SHI) doctors. In restricted planning areas (which affect most urban regions), establishing a new practice as an SHI physician is only possible in exceptional cases.

Path 2 — Practice takeover: Taking over an existing practice. In restricted planning areas, this is practically the only path to SHI activity. The advantage: the patient base, premises, and usually also the staff are already there. The disadvantage: you also inherit old structures, outdated software, and potentially a cumbersome database.

In practice, takeover is the more common route. According to KBV data, around 5,000 medical seats are handed over in Germany every year. Contract negotiations often take months, and the purchase price ranges from 50,000 to over 500,000 euros for the intangible value (patient base and goodwill), depending on the specialty and location.

Step 1: Clarify specialty and form of care

Before location and financing come into focus, two strategic decisions must be made.

Which specialty? In most cases, this is determined by your own specialist training. But within the specialist field, there is room for maneuver — for example, in orthopedic practices, the question of specializations like sports medicine, manual therapy, shockwave therapy, or surgical interventions.

Which form of care? There are several options here:

• Purely private practice: No SHI association (KV) authorization required. Patients pay according to GOÄ. Higher fees per service, but a limited number of patients. Ideal for certain specialties such as dermatology, orthopedics, plastic surgery, and aesthetic medicine. Also for private doctors with a clearly positioned range of services.

• SHI-accredited practice (with KV authorization): Full care for publicly insured patients, regulated by the KV. Higher patient throughput, but regulated fees. Prerequisite: a vacant seat in the planning area or takeover.

• Private practice with participation in public healthcare: Hybrid models, for example via selective contracts or DMP programs. Complex, but economically attractive for some specialties.

• MVZ employment or MVZ establishment: Doctors work in a Medical Care Center (MVZ), either as employees or as partners. Shared risk, shared responsibility.

The decision influences everything that follows — from physical location to financing and IT infrastructure.

Step 2: Location analysis and premises

The physical location is one of the decisive success factors of a practice. A careful analysis covers at least four dimensions:

KV capacity planning: For SHI seats, the capacity planning of the respective Association of Statutory Health Insurance Physicians (KV) is the first point of contact. This divides planning areas by level of care — from "underserved" to "clearly overserved." Setting up in underserved areas is often supported by funding programs.

Demographic analysis: What is the age structure of the population in the catchment area? Where do the target patients live? For a private dermatology practice, high-income urban districts are crucial — for a family practice, rural regions with an older population.

Competitor analysis: How many practices of the same specialty already exist in the surrounding area? Who are the main competitors, and how are they positioned? The waiting times for an appointment in nearby practices are a good indicator: if they are over six weeks, there is demand.

Premises requirements: A doctor's practice needs more than just a consultation room. Reception area, waiting room, treatment room, examination rooms, sterilization/supply room, staff room, archive, and sanitary facilities. The space required is between 100 and 300 square meters, depending on the specialty. Accessibility has increasingly become standard since the UN Convention on the Rights of Persons with Disabilities and is mandatory in many building regulations.

When signing the lease, the term should match the investment planning — for investments in construction and furnishings, terms of ten years or more are common.

Step 3: Licensing and legal foundations

The regulatory steps are complex and differ depending on the form of care.

For purely private practices:

• License to practice medicine (Approbation) and specialist recognition must be present

• Entry into the medical register at the Medical Association

• Registration with the tax office (freelance activity)

• Professional liability insurance

• Business registration is generally not necessary (liberal profession)

For SHI physicians, operating additionally:

• Approval by the Licensing Committee of the KV

• Entry into the medical register

• KV membership

• In the event of a practice takeover: succession procedure with other applicants

Practical aspects that are often overlooked:

• Hygiene plan and inspection by the health department

• Connection to the telematics infrastructure (TI)

• Appointing a data protection officer (mandatory above a certain practice size)

• Contracts with laboratories, pharmacies, suppliers

The entire licensing process takes 6 to 18 months depending on the region and specialty. Early planning is crucial.

Step 4: Financing — what a practice really costs

The investments required to set up a practice can be roughly divided into four areas.

Practice purchase or goodwill (in the case of takeover): 50,000–500,000 euros depending on the specialty, location, and patient base. For new setups, this block is omitted, but current start-up costs are higher.

Equipment and medical devices: 50,000–300,000 euros depending on the specialty. The range is wide — a purely private general practice can manage with significantly less than an orthopedic practice with sonography, X-ray, and shockwave equipment, or a dermatology practice with laser technology.

IT infrastructure, practice management software, TI connection: Highly variable depending on the chosen software solution. The decision of cloud vs. local server is central here — cloud solutions reduce initial investment significantly because no server hardware needs to be purchased.

Start-up and working capital reserve: In the first 6–12 months after opening, a practice rarely covers its costs. A financial reserve for ongoing fixed costs (rent, staff, insurance) should be included in the calculation.

The total investment typically ranges between 200,000 euros (small private practice) and over 1 million euros (specialist practice with expensive equipment). Standard financing routes are:

• KfW program "ERP-Gründerkredit"

• Apothekerbank, Deutsche Ärzte- und Apothekerbank, other specialized banks

• State funding programs, especially when establishing in underserved areas

• KV subsidies (e.g. establishment grants in rural regions)

A bank requires a detailed business plan with investment calculation, liquidity planning, and sales projections. Early contact with a tax consultant specializing in medical professions pays off here.

Step 5: Recruitment and team building

A medical practice usually needs at least two medical assistants (MFAs) — during full operation often three to five, depending on the specialty and patient throughput. Recruiting staff is one of the biggest challenges in 2026: vacant MFA positions remain unfilled for months in many regions.

Three strategic consequences for practice planning:

First — calculate staff costs realistically. An MFA position costs a practice significantly more than the gross salary, including wages, social security contributions, vacation, and sick leave. Practices typically calculate with 1.5 times the gross salary.

Second — recruit early. Recruitment should begin at least 4 to 6 months before the practice opens. Anyone who starts looking only after opening will face operational stability issues from the start.

Third — digitalization as a staffing strategy. If an AI telephone assistant handles routine calls, digital intake replaces manual record keeping, and automated medical reports eliminate typing work, a practice may be able to manage with one less MFA. By 2026, this is no longer a theoretical consideration — it is reality in many private practices that have chosen modern practice software.

Step 6: IT infrastructure and practice management software

Choosing practice management software (PMS) is one of the most important decisions when starting out — and at the same time, one that many founders leave until the last minute. This is risky because the software will shape daily practice operations for years.

What modern practice software should offer in 2026:

• Cloud-based or at least cloud-ready (no expensive local servers)

• Integrated online appointment booking

• Digital anamnesis intake prior to the appointment

• AI-supported documentation (real-time dictation/transcription)

• Automated doctor letter generation

• GOÄ and EBM billing with AI assistance

• Interfacing existing devices via GDT, LDT, DICOM

• Telematics infrastructure integration (eGK, eAU, e-prescription, ePA)

• GDPR-compliant hosting in Germany

Important: The initial decision for a software system has a shelf life of 5–10 years. Switching later is possible, but cumbersome — data migration, staff training, transition phases. Careful selection at the beginning saves a lot of trouble.

Private practices should pay close attention to ensuring that the software is optimized for private billing and not overloaded with features specific to statutory health insurance. Specialized solutions like ClinicOS have a structural advantage here.

Step 7: Marketing and attracting your first patients

In a practice takeover, the patient base is already there. With a new establishment, it must be built — and that works differently than it did 10 years ago.

What works in 2026:

• A modern, mobile-optimized practice website. Patients increasingly look for doctors online; a website without online appointment scheduling looks outdated.

• Online appointment booking. Reduces phone workload and makes the practice available 24/7.

• Google Business Profile. Patients find practices primarily via local Google searches.

• Patient reviews. Active review management strategy on platforms like Jameda and Google.

• Local networking. Family practitioners, pharmacies, and other specialist colleagues as referral partners.

What works less in 2026:

• Traditional print advertisements (except in highly regional target markets)

• Simple "opening announcements"

• Marketing without a digital component

For private practices, marketing is regulatory-wise even easier: the strict advertising restrictions of professional conduct rules apply, but factual information about the practice and its services is permitted.

How ClinicOS supports you when setting up your practice

ClinicOS was developed out of an actual private medical practice — the unique demands of establishing a practice have directly shaped the product. Specifically, ClinicOS supports a new setup in several ways:

Low initial investment: As a cloud solution, there is no need to purchase your own servers. The software runs in the browser, on any device — significantly lowering IT infrastructure costs for opening day.

Fast setup: ClinicOS can be set up in 2–4 weeks, including connecting the TI, bridging devices via GDT/LDT/DICOM, and training the practice team.

Staff efficiency from day one: With integrated AI telephone, digital intake, automated medical reports, and AI-supported billing, a new setup can often manage with fewer MFA positions than traditional practices of a comparable size would need.

Special private practice version: Private doctors do not need to work with public system functions that clutter other platforms. ClinicOS offers a dedicated version containing only the features private practices actually need.

Personal advice: Rather than going through a generic demo, practice founders get an individual initial consultation to discuss the specific requirements of the planned practice.

Anyone planning to set up a practice and wanting to see how modern software facilitates the build-up can book a free initial consultation with a live demo.

Frequently asked questions on establishing a practice

How long does it take to establish a practice? Realistically, it takes 9 to 18 months from the first location check to the opening. In a practice takeover, negotiations and licensing procedures can take longer. Anyone planning a new establishment should plan with at least a year lead time.

Do I need a KV license for a private practice? No. Private practices can be operated without statutory health insurance accreditation, provided that publicly insured patients are not treated regularly. A purely private practice is possible even in restricted planning areas.

How much does it cost to set up a medical practice? The total investment typically ranges from 200,000 euros for a small private practice to well over 1 million euros for a specialized practice with high equipment needs. The largest cost items are goodwill/practice purchase, medical devices, and furnishings. An individual calculation with a tax consultant specializing in healthcare professions is essential.

Is a private practice financially viable? Generally, yes, if the location and specialty match. Private practices generate significantly higher fees per patient contact than SHI practices, but they also have lower patient numbers. Which variant is more lucrative depends heavily on the specialty and region.

Which practice software is best suited for founders? Cloud-based, AI-supported solutions are structurally the best choice in 2026. They have lower initial investments, better efficiency, and are technically future-proof. When choosing, private practices should look specifically for private-practice-optimized versions.

What happens if I want to sell the practice later? A professionally structured practice has resale value. The intangible value (patient base) is typically 30 to 100 percent of annual sales, depending on the specialty. Working digitally and systematically from the start is an advantage when selling — clean digital patient files and transparent billing ease the transition and increase the practice's value.

Can I run a practice as a side business? In principle, yes, but this is simpler for private practices than for SHI-accredited ones. With a KV license, there are minimum consultation hour requirements. Counseling with the Medical Chamber and the KV prior to planning is important.