How to set up a practice step by step?

Jiří Nezdařil 20.02.2023

Have you successfully completed your postgraduate education, obtained your certification and now you are wondering what's next? Maybe you are thinking of starting your own practice so that you can finally provide your patients with tailored care and be your own boss? The road to independence and starting your own practice can be complicated at first. In this article, we'll explain the best path to take when setting up your own practice.

Typical examples are developers, UX designers or other freelancers in IT studios, but also marketing specialists, consultants and other external contractors who regularly provide their services or perform work.

A little introductory tip: Before you start opening your own practice, you need to apply to the Czech Medical Chamber ("ČLK") for a license to practice as a private practitioner according to the Licensing Regulations of the ČLK ↗. The regulations of the ČLK make the opening of a private practice conditional upon the issue of such a licence. However, there is no need to worry, as the requirements for the issuance of a license are usually met by every certified doctor.

You can then follow one of the following scenarios:

1. Establishing a "greenfield" practice

The administrative process required to set up your own "greenfield" practice is not easy.

Although the legal system of the Czech Republic still allows physicians to do business as natural persons, the establishment of a limited liability company is not a necessary condition for opening one's own practice. However, for accounting reasons, in consideration of easier handover in the future and also to reduce the risk of liability with their own assets, doctors today choose the form of a commercial company, most often a limited liability company, much more often.

The steps to setting up a practice are as follows:

  • establishing a suitable company (online);
  • obtaining authorisation to provide health services;
  • contracting with insurance companies.

Založení ordinace krok za krokem

1.1 Setting up a company for your practice, online

Establishing a company (LLC) is the first step towards owning your own medical practice.

Did you know that today it is possible to establish an LLC completely online without physically visiting a notary or the registry court?

The online establishment of a limited liability company requires only a guaranteed electronic signature, which all doctors who prescribe medicines in the e-prescription system are equipped with.

Necessary forms and procedures for establishing a limited liability company can be found on the website of the Notarial Chamber of the Czech Republic. ↗.

If you are interested, this website will connect you directly to a notary who is currently online and will assist you in setting up your company. In order to successfully proceed with the process of setting up your own practice, it is essential that the business of the company is the provision of health services, but there can be more than one, such as consulting services or after-school tutoring.

However, if you want to invest more than CZK 20,000 in the company, you cannot do without a visit to the bank. Therefore, for a complete online incorporation of an LLC, the share capital must be less than CZK 20,000. Then the share capital is deposited with a notary for safekeeping.

Založení s.r.o. online

1.2 Obtaining authorisation to provide health services

Once you have gone through the process of setting up your company, you will need to obtain the relevant authorisation to provide health services from the regional authority in whose territory you intend to operate your practice.

This is a more demanding step, as the application for this authorisation is accompanied by documents proving that the doctor (or the company established by him) has suitable premises, equipment and personnel to provide medical services in the chosen field.

The scope of equipment for your practice is determined by the Ministry of Health Decree No. 92/2012 Coll. ↗ and 99/2012 Coll. ↗.

At this point, it is necessary to conclude lease agreements, purchase equipment and employ staff, which entails considerable costs. However, if the relevant criteria are met, the regional authority will grant the authorisation.

1.3 Selection procedure and contracts with health insurance companies

If you plan to participate in the public health insurance system in your practice (i.e. if you want your care to be reimbursed by the health insurance company), the next step is to apply to the same regional authority for a tender under Act No 48/1997 on public health insurance. ↗.

Not only listing, but also joining

In this case, the doctor must not forget that if he or she has applied for a selection procedure and the regional authority has granted it, he or she must also join the selection procedure once it has started. An application for a competition does not automatically constitute participation in that competition.

So if you succeed in the selection procedure as a doctor, you still have not completely won, because individual health insurance companies are not obliged to conclude a contract for the provision of health services. Even if you are successful, you still have to negotiate with the individual health insurance companies to conclude the relevant contract and to pay for the specific services you will provide in your practice.

If an insurance company refuses to enter into a contract for the provision of health services, you can provide these services to its insurees for direct payment. The price for the care provided is therefore paid directly by the patient and can be determined by agreement between the doctor and the patient, but it is also important to remember that these prices are also regulated by the state (which will be the subject of a future article).

Need to set up a practice? Take a look at our range of services ↗.

2. Takeover of an existing practice

The second and significantly easier option to start providing health services independently is to takeover an existing practice. Some doctors sell their practice and you decide to take it over from them. As a physician, this avoids most of the steps outlined in the previous scenario, especially applying for licensure and participating in a selection procedure.

The takeover of an existing practice can generally take place in two ways:

  • Takeover of an existing Ltd.
  • Taking over a medical practice from a natural person running a business

2.1 Takeover of an existing Ltd. (or other company)

In this case, the doctor who has decided to pass on his practice is already running the practice in the form of a suitable business company. This is most often done in the form of a limited liability company, but in the case of larger establishments it may also be a public limited company.

In such a case, the sale of the practice takes the form of a sale of the shares in the company. The physicians enter into an uncomplicated contract, which is published in the commercial register, and the incoming physician can immediately start providing medical services as he or she wishes, since all authorisations and contracts are concluded in the name of the company they have just bought. This essentially eliminates all the paperwork and associated uncertainty.

2.2 Taking over a practice from an individual entrepreneur

A slightly more complicated situation arises when the doctor transferring the practice is a natural person. In such a case, all authorisations and contracts are directly linked to his/her person.

An elegant solution in this situation, however, is a procedure in which you set up a limited liability company (perhaps entirely online, as described above) and that company then enters into a plant sale agreement with the physician who is transferring the practice.

This agreement will thus be the basis for the transfer of individual authorisations, contracts, as well as personnel and technical equipment. If both parties want to simplify the entire handover of the practice, they can conclude a forward contract for the sale of the plant in advance.

With this future contract already in place, you can then contact the relevant regional authority in order to obtain authorisation to provide health services to the same extent as the previous doctor. You can also contact the individual health insurance companies to transfer the contracts concluded with the previous doctor to the newly established company.

Although there is no legal requirement to comply with such requests, in our experience all of these institutions generally accept the procedure.

3. Conclusion

There are several ways to set up your own practice. Some are more challenging, others easier. For example, taking over an existing practice is slightly less challenging than starting one from scratch.

Setting up a new practice involves a number of formalities, but these are well defined and it is therefore possible for anyone interested in private practice to go through the process themselves.

This is also evidenced by the number of doctors who do so each year, of which there are dozens every year. By the way, this article also serves as a guide for setting up your own practice. However, if you do not feel like doing so, we will be happy to provide you with any advice or even arrange everything for you.

Take a look at how to establish a practice with us. ↗.

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