As a clinical psychologist, entering private practice for the first time, I was left floundering. Navigating the complexity of running a business, billing medical aids and handling client collections was just never something I’d had to contend with. Looking back, the learning curve was steep and expensive!
South Africa’s health graduates are among the most clinically capable in the world. They can diagnose complex illnesses, perform intricate procedures, and deliver world class care. Ask many of them to read a balance sheet, cost a service, or legally market their practice and they’re left floundering.
I don’t believe it’s a failure of the individuals, but of the very institutions that trained us. Our universities are still teaching as if health practitioners will spend their careers in state hospitals, shielded from the realities of the private sector. The truth is, most will run small businesses or join private practices, yet they graduate clinically brilliant and commercially blind.
Most graduates I’ve spoken with complain that they were taught to heal & treat, but had no idea how to run a business.
Are our degrees stuck in the past?
Across MBChB and other health programmes, from physiotherapy to dietetics and psychology the story is the same. Clinical training dominates and business training barely exists.
At leading institutions like UCT, UP and Stellenbosch, students dissect cadavers, master diagnostics, and learn the intricacies of patient or client care. What they don’t learn is how to navigate a medical aid system, how to set up a practice legally, or how to market ethically. There are few, if any modules that teach business skills or prepare the clinician for a life in practice.
Even the basics of financial literacy from reading profit-and-loss statements to managing tax are absent from most curricula. Marketing, essential for any practice to survive, is often treated as taboo.
Universities assume that medical professionals across the board, will work in hospitals their entire life. The reality is that the moment when they graduate, they are effectively a business owner. Most of them completely unprepared.
Trial by fire in the real world
The result is predictable. As a new psychologist in private practice I was thrown into the deep end of private practice without the skills to stay afloat. I had to learn about tax, pricing, medical aid contracts, ethical marketing, and patient acquisition through painful trial and error. Not to mention the dreaded networking. Meeting and greeting doctors, pitching my approach and leaving business cards. As a natural introvert and a born listener, this was probably the most cringeworthy part of the entire process!
For other professionals, the problem is even starker. Without the institutional support structures that doctors sometimes enjoy, physiotherapists, occupational therapists, dieticians and psychologists often work entirely alone, managing every aspect of their business themselves and paying dearly for early missteps.
For instance, as a solo startup practitioner I could not afford a practice manager or outsource to accountants. The complexity of ICD-10 billing, reconciling with clinical notes and managing this data meant I often spent hours longer than was billable, organising, filing and ensuring my records were compliant and up to date. So much for the hourly rate!
The price of institutional neglect
The consequences extend far beyond individual frustration. Poorly run practices fail and when they do, communities lose access to care. Practitioners burdened by financial stress or regulatory missteps burn out or leave the profession altogether.
It’s an avoidable tragedy and unfortunately one that stems directly from an outdated view of what it means to be a healthcare professional in the 21st century. Clinical expertise alone is no longer enough. To survive, practitioners must be clinicians, entrepreneurs, caregivers and strategists.
Practices often collapse because of poor financial planning, and when this happens they cannot deliver care to anyone. It is therefore of utmost importance that the curriculum changes to incorporating business skills.
Time to stop treating business as a dirty word
There’s a pervasive belief in the health sciences that medicine and money don’t mix, that to talk about profit, marketing, or business strategy somehow cheapens the calling. That thinking is not noble, it’s negligent.
Every practitioner who closes their doors because they couldn’t manage cash flow is a lost resource. Every therapist who unknowingly breaks an advertising rule is a potential HPCSA case. Every graduate who burns out under admin and financial pressure is one fewer clinician serving a system already under strain.
For instance, one of the steepest learning curves for new practitioners is navigating medical aid claims, ICD-10 codes, and compliant invoicing. A small mistake can mean delayed payments, rejected claims or in extreme cases, the practitioner can face fraud charges from medical aids for incorrect billing. This puts new practices under immediate financial strain.
I wish I’d had EZMed when I was starting out. The app automates and simplifies practice management and looking at something like invoicing, I’m amazed at how easy and quick it is to invoice & submit claims directly to medical aids. The diary management is also super useful, as it makes it easy to bill and stay on top of client appointments.
Under HPCSA rules, marketing remains a minefield, but it’s essential for visibility. Social media can be our friend, and networking is still the mainstay of referrals. Those ethical rules are there for a reason and now more than ever, with the rise of fake news and AI we need to guard our profession. Personally, I like my healthcare professionals trained, educated, sharing great content and not doing dance-offs on tiktok!
Leanda M