Everything a physician needs to go independent — clearly explained.

Every physician who goes independent encounters the valley. It's the period — typically 90 to 180 days — when you're working but not yet being paid by the insurance companies you credentialed with. During this time your expenses continue (malpractice, rent, staff, supplies) but your revenue is near zero.

The valley isn't a failure mode. It's a structural feature of how insurance credentialing works. Understanding it in advance — and modeling it specifically for your salary level and payer mix — is the difference between a planned transition and a financial crisis.

What drives the valley deeper

• Higher salary — a specialist billing $600k/year has a correspondingly larger gap per month than a primary care physician billing $250k.
• Commercial insurance concentration — Medicare and Medicaid credential faster (60–90 days) than most commercial plans (90–150 days).
• Sequencing credentialing applications — submitting one payer at a time lets each payer's window stack on top of the last. Parallel submission is almost always better.
• Starting late — applications filed after resignation can't complete before the gap begins. Starting CAQH and payer applications before giving notice is standard practice.

How physicians manage the valley

The most common approaches: (1) bridge savings or a home equity line, sized to the modeled gap; (2) locum tenens work during credentialing to generate income; (3) a line of credit secured before leaving (lenders prefer employed income); (4) accepting cash-pay or direct-pay patients while awaiting credentialing. Most physicians use a combination.

What makes the valley manageable isn't eliminating it — it's modeling it. A gap you've sized and planned for is a project. The same gap arriving as a surprise is a crisis.

Estimate your valley →

Credentialing is the process by which insurance companies verify your qualifications and approve you to bill them for services. It's the single biggest source of delay in a physician's transition — and the most misunderstood.

The common claim that "credentialing takes 90 days" is optimistic for most payers and dangerously wrong for some. The real range, by payer type, is:

• Medicare Part B (CMS) — 60–90 days from complete application. The fastest payer, and often the first to approve. Can bill from "pending" status in many states.
• Medicaid (fee-for-service) — 60–120 days. Varies heavily by state; some Medicaid managed-care plans are faster than the fee-for-service program.
• BCBS (most markets) — 90–150 days. BCBS plans are independently operated; BCBS Alabama and BCBS California are entirely different credentialing experiences.
• Aetna, Cigna, United — 90–150 days in most markets. Aetna currently runs faster (90–120 days) in most regions; United is notoriously variable.
• Medicare Advantage plans — 120–165 days. These are the slowest because each MA plan runs its own credentialing process separate from Medicare Part B.

The CAQH profile is the single most important upstream step

CAQH ProView is a central repository that most commercial payers pull from when evaluating your application. If your CAQH profile is incomplete, expired, or hasn't been attested recently, every payer's clock stops until it's corrected. Creating and attesting your CAQH profile before you give notice is one of the highest-leverage actions in the entire timeline.

The other critical upstream step: confirm your malpractice tail coverage is in place and that your DEA registration is at your new practice address. Both are required by most payers, and both take time to update.

Check your readiness →

Non-compete clauses in physician employment contracts are common, often enforced to some degree, and almost always more negotiable than they appear. Understanding the clause in your contract — not a generic version of it — is the essential first step.

Most physician non-competes restrict three things: geographic radius (typically 5–20 miles from each practice location), duration (typically 12–24 months after termination), and scope (usually defined by specialty or practice type, not just employer competitors).

Enforcement varies significantly by state

As of 2024, California, Minnesota, North Dakota, and Oklahoma do not enforce physician non-competes. Several other states (Massachusetts, Illinois, Virginia) have recent legislation limiting their scope or requiring increased compensation for their enforcement. New York restricts enforcement against physicians who are the primary care providers for patients. The FTC's proposed nationwide ban on non-competes is under ongoing legal challenge.

In states that enforce them, courts typically apply a "reasonableness" test: Is the restriction narrowly tailored? Does it harm the public's access to care? Courts routinely modify — not void — non-competes that are overly broad, which is why working with a healthcare-employment attorney before the clause is triggered is so important.

What to look for in your contract

• Practice locations included — does the radius apply to every location you practice at, or only your primary location? Multi-site contracts dramatically expand the effective restricted zone.
• Triggering events — does the clock start at termination date, or at the date you stop seeing patients? Some contracts use the latter, extending the non-compete clock.
• Patient notification clauses — these are often in a separate section from the non-compete; they restrict what you can say to patients about your departure.
• Tail insurance obligations — some contracts require the physician to purchase tail at termination; others carve out employer fault or constructive dismissal. Know which applies before you give notice.

PracticeElf is not a substitute for a healthcare-employment attorney on your specific contract. What Elf can do is map the key clauses, explain what they typically mean in practice, and help you formulate the right questions before your attorney consultation.

You cannot credential with most payers as an individual. You need a legal entity — and payers need to know its EIN, its NPI (the entity NPI, called a Type 2 NPI), and its physical address before your application can be processed.

Getting this right early — before you apply to payers — saves weeks compared to correcting payer applications mid-process when information changes.

PLLC vs. PC: state law decides

Most states require physicians to practice through a Professional Corporation (PC) or Professional Limited Liability Company (PLLC), not a standard LLC. The distinction matters for credentialing because some payers verify the entity type against state licensing records. Using the wrong entity type can cause application rejections that take weeks to unwind.

In general: if your state allows PLLCs for physicians, a PLLC is simpler to maintain (fewer formalities than a PC). Some states (California, for example) require a PC for physicians and do not permit PLLCs. Check your state's medical board guidance, not just the Secretary of State's general business filing rules.

The four steps, in order

• 1. File the entity — PLLC or PC in your state. Cost: $50–500 depending on state. Turnaround: 1–10 business days (expedited available in most states).
• 2. Get the EIN — Apply online at IRS.gov. Issued immediately. This is what payers use for tax purposes; don't start payer applications without it.
• 3. Get the Type 2 (entity) NPI — Apply at NPPES. Issued within 1–2 weeks. Required for group billing; many solo practitioners skip this and then can't bill certain payers.
• 4. Set the DEA address — If you prescribe controlled substances, your DEA registration must reflect your new practice address before you apply to any payer. Address changes take 2–4 weeks to process.

Once these four steps are complete, you can submit payer applications. The order matters because payer applications ask for EIN, entity NPI, and DEA address — incomplete applications stall or get rejected.

Check your entity checklist →