The startup budget: line items and honest ranges

There is no single number — build a worksheet

There is no single number to quote, and any article that gives you one is selling something. What a solo practice costs to open depends on whether you rent clinical space, which EHR you choose, and how long your money has to last before payers pay you. The reliable move is the SBA's method: list every line item, assign a range to each, total it — then keep the worksheet as a living document 1Ref 1U.S. Small Business Administration (2026).Calculate your startup costs.The itemize-then-total worksheet method for startup costs, split into one-time and recurring, with specific dollar figures owned as practice norms that vary by state, specialty, and vendor..

Two totals fall out of that worksheet, and you need both:

• One-time costs — everything you pay once to open the doors: entity filing, initial equipment, deposits.
• Recurring costs — everything that repeats every month whether or not a client shows: rent, EHR subscription, insurance.

An at-a-glance map of the lines you are budgeting:

The dollar figures below are ranges many solos see, owned as practice norms — they vary widely by state, specialty, and vendor, so treat them as a starting frame for your own worksheet, not a quote 1Ref 1U.S. Small Business Administration (2026).Calculate your startup costs.The itemize-then-total worksheet method for startup costs, split into one-time and recurring, with specific dollar figures owned as practice norms that vary by state, specialty, and vendor..

The one-time costs to open the doors

The one-time line items are the ones people fixate on, and they are usually the smallest part of the picture. Forming the entity, getting an identifier, and buying the few things you cannot rent are mostly modest and mostly under your control. Start with the two that are nearly free, then add only what your setup actually requires.

Entity formation. A state PLLC or LLC filing fee is a one-time cost that varies by state; the entity-choice frame and its formation mechanics are the same everywhere even though the fee is not 2Ref 2U.S. Small Business Administration (2026).Choose a business structure.That entity formation carries a state filing cost and that PLLC/LLC formation mechanics are the same nationally even though the fee varies by state..

EIN — free. The IRS issues your EIN online at no cost, the same day 3Ref 3Internal Revenue Service (2026).Apply for an Employer Identification Number (EIN) online.That an EIN is a free, same-day online line item and is used instead of the owner's SSN on business paperwork.. It is the rare line item that is genuinely zero, and it keeps your Social Security number off your business paperwork.

Board and licensing fees. Any practice-specific registration your state or board requires beyond your individual license — some states charge a facility or practice registration on top of the personal one.

Furnishing and equipment. If you take space: a room's worth of furniture, a laptop, and a lock for records. A fully officeless start skips almost all of this.

Website and domain. A one-time build plus a small recurring hosting cost; a simple, honest site is enough to open.

Deposits. First and last month plus a security deposit if you lease, and sometimes utility deposits — easy to forget and real when the lease is signed.

CLIA, only if you test. If you will run any point-of-care test on a patient specimen — a urine drug screen, a rapid strep — even a CLIA-waived one, you need a Certificate of Waiver before you run it. It is a small but real one-time application and fee, and it is easy to overlook until an inspector asks 4Ref 4Centers for Medicare & Medicaid Services (2026).Clinical Laboratory Improvement Amendments (CLIA).That an office running point-of-care tests on human specimens, including CLIA-waived tests, needs a Certificate of Waiver — a one-time application and fee in the startup budget..

Add these up and the one-time total is usually smaller than the fear attached to it. The number that actually determines survival is the next column.

The recurring costs that decide whether you survive

The recurring costs are what actually determine whether the practice lives, because they repeat every month whether or not your schedule is full. This is the column to stress-test against a slow first quarter, not the one-time column. The usual recurring lines for a solo, each owned as a range that varies by market:

• Malpractice insurance — a starting policy for a solo commonly runs a few thousand dollars a year, lower for part-time hours and higher for prescribers; get quotes for your specialty and state, and understand claims-made versus occurrence before you pick.
• EHR and billing — a monthly subscription that many solos underestimate once clearinghouse, e-prescribing, and support add-ons are counted; the real EHR bill is rarely the sticker price.
• Rent or membership — the single largest recurring line if you lease; far smaller with a timeshare and near zero if you go officeless.
• Phone, fax, website, and domain — small individually, real in aggregate.
• Registered agent and annual state fees — modest and easy to forget until the renewal notice arrives.
• Continuing education and license renewal — a recurring professional cost that is easy to leave off a business budget but real every cycle.

Every figure here is a practice norm, not a quote. The recurring column is your survival number, so put your own real figures in the worksheet before you sign anything, and pressure-test it against a month where only half your slots fill 1Ref 1U.S. Small Business Administration (2026).Calculate your startup costs.The itemize-then-total worksheet method for startup costs, split into one-time and recurring, with specific dollar figures owned as practice norms that vary by state, specialty, and vendor.. A practice fails not because its one-time costs were high but because its monthly nut was set higher than a realistic schedule could carry.

Technology and security: the line item people underbudget

Security is a required line item, not an optional upgrade, and it is the one solos most often leave off the worksheet. The HIPAA Security Rule requires administrative, physical, and technical safeguards for electronic protected health information, scaled to the size of your practice and anchored in a written risk analysis 5Ref 5HHS Office for Civil Rights (2026).Summary of the HIPAA Security Rule.That the Security Rule requires administrative, physical, and technical safeguards for ePHI, scaled to the size of the practice and anchored in a risk analysis — making security a required budget line for a solo.. A solo is not exempt; the rule simply scales down to your size.

The useful part is that the required first step is free. ONC and OCR publish a Security Risk Assessment tool built for small practices, so the risk analysis the rule requires costs your time rather than a consultant's fee 6Ref 6Office of the National Coordinator / ASTP (2026).Security Risk Assessment Tool.That ONC/OCR publish a free Security Risk Assessment tool sized for small practices, so the required risk analysis costs the clinician's time rather than a consultant's fee.. Budget for what the analysis then tells you to buy — encrypted devices, a password manager, secure backup, a business associate agreement with each vendor — but the analysis itself is a zero-dollar line if you do it yourself 5Ref 5HHS Office for Civil Rights (2026).Summary of the HIPAA Security Rule.That the Security Rule requires administrative, physical, and technical safeguards for ePHI, scaled to the size of the practice and anchored in a risk analysis — making security a required budget line for a solo.6Ref 6Office of the National Coordinator / ASTP (2026).Security Risk Assessment Tool.That ONC/OCR publish a free Security Risk Assessment tool sized for small practices, so the required risk analysis costs the clinician's time rather than a consultant's fee..

What the technology column usually holds:

• Devices — a laptop and phone you can encrypt and lock.
• A password manager and multi-factor authentication — cheap, and the highest-leverage security you can buy.
• Secure backup — so a lost or ransomed device is an inconvenience, not a breach.
• A HIPAA-compliant telehealth platform — if you will see clients remotely at all.
• Business associate agreements — no direct cost, but real time to collect from every vendor that touches PHI.

This is the item that is cheap to do early and expensive to skip: the safeguards you install now cost far less than the response to an incident you did not plan for.

The personal runway: the biggest line nobody writes down

The largest number in an honest startup budget is usually not a practice expense at all — it is your own living costs during the months before revenue arrives. New solos routinely underprice this and run out of personal cash while the practice itself is fine. Payer credentialing and the claims cycle mean money lags the first session by months, so your budget has to carry your rent and groceries across that gap.

Many clinicians plan a personal runway of several months of household expenses, held separately from the practice, so a slow ramp is a delay rather than a crisis. The lag between your first booked session and steady deposits is real and predictable, which is why the runway line belongs at the top of the worksheet, not the bottom.

To size it, total your genuine monthly household costs — housing, food, insurance, minimum debt payments — and multiply by the number of months you expect until deposits are steady, then add a margin for the ramp being slower than hoped. Hold that amount separately from the practice, so a lean opening month draws down a cushion you planned for rather than the rent you owe. If cash is the binding constraint, the part-time launch — keeping a W-2 income while the panel fills — converts the runway problem into a slower, safer ramp instead of a countdown. For some clinicians serving in shortage areas, loan-repayment programs can ease the personal side of the ledger and stretch the runway further.

How to fund the gap between opening and getting paid

Once the worksheet has a total, the question becomes where the money comes from, and a solo practice has more options than personal savings alone. The SBA's loan programs — including 7(a) loans and microloans — guarantee small-business lending through participating lenders, and a practice startup is a standard use 7Ref 7U.S. Small Business Administration (2026).Loans.That SBA 7(a) loans and microloans guarantee small-business lending through participating lenders — a standard financing path for a practice startup.. Knowing the paths lets you match the tool to the gap:

• Personal savings — the simplest, and the reason the personal runway line matters so much.
• An SBA-backed loan or microloan — for larger one-time costs like a buildout, arranged through a participating lender 7Ref 7U.S. Small Business Administration (2026).Loans.That SBA 7(a) loans and microloans guarantee small-business lending through participating lenders — a standard financing path for a practice startup..
• A modest line of credit — sized to the recurring column, to smooth the months before deposits catch up.
• A slower ramp — the part-time launch again, which shrinks the amount you need to borrow at all.

Whatever the source, size the borrowing to the worksheet, not the other way around. Debt taken before you know your total is how a fundable practice quietly becomes an unprofitable one. The healthiest structure for most solos is a small cushion of savings for the recurring column and a specific, sized loan only for a genuine one-time investment like a buildout — not a large general-purpose loan that funds a lifestyle the practice cannot yet support.

Two budgets, same profession

The same profession can open on wildly different budgets, and seeing two honest sketches makes the ranges concrete. Neither is a quote — both are practice norms owned as such — but together they show why what does it cost has no single answer, and why the worksheet is the only real one 1Ref 1U.S. Small Business Administration (2026).Calculate your startup costs.The itemize-then-total worksheet method for startup costs, split into one-time and recurring, with specific dollar figures owned as practice norms that vary by state, specialty, and vendor.. The difference between them is almost entirely one line: space.

The lean, officeless, cash-pay solo. Entity filing and a free EIN, a modest EHR subscription, malpractice insurance, a telehealth platform, a website and phone, and the free risk analysis. No rent, no buildout, and no clearinghouse if they do not bill insurance. This practice opens for a few thousand dollars, and its recurring column is small enough that a handful of sessions a week covers it.

The leased, insurance-based solo. All of the above, plus a clinical lease with a deposit and buildout, furniture, a clearinghouse and billing setup, credentialing across several payers, and months of personal runway while those payers approve. This practice runs into five figures before the first payer deposit, and its recurring column demands a fuller schedule to break even.

Most real practices sit between these two. The worksheet is how you find where yours lands, and the personal runway line is the one that most often decides whether either version survives its first two quarters 1Ref 1U.S. Small Business Administration (2026).Calculate your startup costs.The itemize-then-total worksheet method for startup costs, split into one-time and recurring, with specific dollar figures owned as practice norms that vary by state, specialty, and vendor.. Build both a lean and a full version of your own worksheet; the gap between them is exactly the set of choices — office, billing model, ramp speed — that you actually control.

Honest ranges, and how to build yours

The honest answer to what it costs is a range with your own numbers in it, and building that range is a short exercise you can finish this week. Start from the SBA worksheet, drop in the line items above, and assign each a low and a high from real quotes rather than forum lore 1Ref 1U.S. Small Business Administration (2026).Calculate your startup costs.The itemize-then-total worksheet method for startup costs, split into one-time and recurring, with specific dollar figures owned as practice norms that vary by state, specialty, and vendor.. Two totals — one-time and recurring — plus a personal runway give you a defensible number instead of a guess.

A few framing points to keep the ranges honest:

• Officeless changes everything. The largest recurring line disappears, which is why a fully remote solo can open for a fraction of a leased practice.
• The tax code softens the one-time cost. How pre-opening costs are deducted is a real offset worth understanding before your first return, so those startup costs are not carried at full weight.
• Break-even is the number that matters most. Once you know your recurring column, your break-even — the sessions per week that cover it — tells you whether the ranges are survivable.
• The timeline drives the runway. The 12-month runway of setup and credentialing is what sets how many months of personal cash you actually need.

Build the worksheet, keep it live, and let real invoices replace estimates as they arrive 1Ref 1U.S. Small Business Administration (2026).Calculate your startup costs.The itemize-then-total worksheet method for startup costs, split into one-time and recurring, with specific dollar figures owned as practice norms that vary by state, specialty, and vendor.. The value is not the total you land on today — it is that you will know, the first slow month, exactly which line to look at and exactly how many months your cushion buys you.