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Know your valley before you give notice.
The "valley" is the cash-flow gap between your last paycheck and your first full payer payment. For most clinicians going independent, we estimate it at roughly $90k–$450k over 90–180 days, depending on specialty, overhead, and payer mix. See your number — based on your type of practice — before you hand in your badge.
Try a scenario:
About your practice
Lease, EHR, malpractice, staff wages, telecom — before you see a single patient.
DPC, concierge, and self-pay revenue starts day one — it shrinks the valley.
Claims-made policies owe a one-time tail premium (1.5–3× your annual premium) when you leave.
Your estimated valley
cash-flow gap · practice overhead only
Estimate based on typical credentialing timelines and overhead benchmarks — not a promise or guarantee. Your real number depends on your payer mix, practice state, and actual overhead.
How Elf shortens this
- CAQH ProView prepped in the first week — not week 6
- All target payers applied simultaneously, never sequentially
- Elf tracks every payer and drafts the follow-ups — worked by our team on Done-with-you and up
- Cash-flow model updates live as each payer credentials you
Why it matters
The valley is the most common reason independent practices fail in year one.
Most clinicians underestimate it — often by months. Credentialing takes time, and payers don't pay retroactively. Here's the timeline:
Your employer income stops on your last day. Credentialing applications go out. The valley starts here — your overhead clock is running.
Payers review your application. Medicare alone takes 60–90 days. Commercial payers typically take 90–150 days. You can see patients — but you're billing into a holding pattern.
The first payer payment clears. The trough bottoms out and the ramp begins. From here, every credentialed payer adds another stream. The valley is behind you.
Elf tracks the valley so you don't have to.
Tell Elf your numbers and it builds a live, payer-by-payer cash model — and updates it as credentialing progresses. Your board shows the trough date and the funded status in real time.