Nobody taught you this in medical school: the business of running a medical practice

Medical school teaches you to be a good clinician, not an employer or business owner, says Dr Bernard Shiu, a GP who runs four practices in Geelong and author of The General Practice Playbook. 

"The moment you hire your first staff member, you step into a completely different ballgame — and often we're not prepared for it."

Here’s what you need to know about GP practice management. 

Get your people strategy right

The right team can make or break a practice — and it goes well beyond hiring. 

Running a medical practice means also managing onboarding, training, rostering and performance under the Health Professionals and Support Services Award, which sets minimum pay, overtime and leave entitlements. Rates change regularly, and penalties for getting it wrong are significant.

Shiu estimates HR takes up most of his non-clinical time. 

"The Award is very complex and classification creep catches out many owners as employees' roles evolve — suddenly we're not paying them correctly. That creates underpayment, which becomes a liability, and affects morale too."

Dr Margaret Bryce, a GP and owner of two practices in Sydney, suggests talking to fellow owners, a lawyer or HR consultant, and using Fair Work's Pay Calculator and the AMA's resources.

And remember — staff cost way more than just wages, she says. Factor in superannuation, penalties, payroll tax in some states, and leave liability.

Staff turnover in general practice can be expensive, while regional areas face extra pressure in attracting and retaining staff.

Dr Nicole Higgins, who runs a practice in Mackay and must compete with mining and government healthcare pay, offers her staff flexibility and support.

"I'm supportive of their responsibilities outside work, I offer upskilling opportunities and autonomy to practice the way they're trained."

Choose a billing model that works

The decision to bulk bill, mixed bill or charge privately shapes a practice's patient load and revenue. Bulk billing ties revenue entirely to the Medicare Benefits Schedule (MBS) rebate, making volume the only lever; mixed billing creates more financial headroom and time per patient.

To encourage bulk billing, the government's Bulk Billing Practice Incentive Program adds a 12.5% loading on every MBS dollar for practices that bulk bill all patients, scaling higher in regional, rural and remote areas.

Since these changes, fully bulk-billing clinics have nearly doubled to 40.2% nationally, per Cleanbill's 2026 Blue Report. Most others run mixed billing — often bulk billing children, concession holders and cases of genuine need while staying financially viable.

Sally Parsons, clinical director at Pro Healthcare Stirling and medical advisor at Avant Mutual, believes bulk billing improves access but doesn't offset rising practice costs.

Her clinic offers long consults for mental health, antenatal and complex elderly care — work she says wouldn't be sustainable under bulk billing. 

"Doctors want the best for their patients. We want care to be affordable and accessible. But we also need to be able to provide that quality service," she says.

Higgins suggests finding a GP billing model that meets the needs of your community. Her clinic bulk bills around 60% of patients and also offers longer, 20-minute appointments.

"I'd rather spend longer with someone and get the care right, so they come back less often," she says.

Stay efficient — and compliant

Most GP practices run on tight margins, so controlling costs and keeping processes efficient is essential. Rent, wages, software, consumables and insurance are all rising — financial viability depends on watching those outgoings closely.

Medical practice compliance and risk management is a constant task. RACGP accreditation occurs every three years — a process Shiu says can be time and resource-intensive.

Owners must also verify AHPRA registration requirements and comply with Work Health and Safety (WHS) obligations on-site.

It comes down to good governance from day one, says Parsons.

"Patient care depends as much on how a practice operates as on clinical decisions — so don't overlook employment, billing, privacy, cyber and regulatory obligations, and don't assume someone else is managing the risk."

Higgins says oversight of clinical standards matters just as much as the financials. 

"This might be immunisations, diabetes targets and care for Aboriginal and Torres Strait Islander patients. It's this, alongside financial management, that keeps a practice sustainable and safe."

Invest in IT

Practice operations — scheduling, billing, staffing and data security — rely on practice management software: Best Practice and MedicalDirector are most used, alongside Cubiko and Oracle for data analytics, Xero for accounting, and Hot Docs for patient communications, with AI scribes now common too.

Few practices are large enough for an in-house IT team, so most outsource to an IT provider or health-tech consultant.

Cybersecurity is non-negotiable. Every practice must comply with the Privacy Act 1988, covering how patient information is collected, stored, used and shared. A data breach is a legal and reputational risk and under the Notifiable Data Breaches scheme, serious breaches must be reported to patients and the OAIC.

Build in the basics from the start: get consent right, control access, enable multi-factor authentication, train staff, test backups and prepare a breach response plan.

Some practices are now building their own AI tools in-house for workflow and communications, work that once took a developer weeks, says Shiu. 

"Practices still running on spreadsheets, memory or goodwill will fall behind," he says.

Avoid burnout

Practice owner burnout is common — but there's plenty you can do to improve your work-life balance.

The single best investment, says Shiu, is a strong practice manager. 

"Find someone who fits the team and the culture — they'll build the right team for you." 

Ownership can be lonely, adds Bryce, who suggests sharing the load with a partner, and building self-care — hobbies, exercise, sleep — into practice culture."

"You can't ask your team to do it if you're not doing it yourself. Also, join a network of GPs with whom you can share your difficulties and wins."

"Surround yourself with great mentors and advisors, because you can't do everything," adds Higgins. "And be kind to yourself — done is better than perfect." 

Enjoy the journey

While running a GP practice is demanding, it's also immensely rewarding.

Higgins says the experience has given her confidence. 

"Business ownership in general practice is a learned skill that opens doors, whether in governance, boards or elsewhere."

Bryce revels in being an educator as well as a doctor. 

"Running a practice, you're supporting your GPs, both as people and as clinicians," she says. "It's beautiful to see that growth. You're building the next generation."