Interview with Dr. Kara Pepper – 454

In today’s interview, Dr. Kara Pepper describes how to thrive in a micropractice and why you should follow her lead in doing so.

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A former employed internist who left a 70-physician multi-specialty practice in 2022, Kara built a cash-pay hybrid practice from a 150-square-foot office that now serves patients across 17 states. She covers the business model, staffing structure, niche development, and how she navigated a non-compete clause that nearly blocked her from seeing patients in her own city.

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Building a Micropractice from Scratch

A micropractice operates with a small patient panel, minimal overhead, and no reliance on insurance billing. Dr. Pepper’s model is cash-pay on a per-visit basis; not a retainer, and not a subscription. Avoiding insurance companies keeps the administrative burden low and eliminates the requirement for 24-hour coverage. Her current panel sits at around 650 patients across 17 states, seen through a hybrid of in-person and telemedicine appointments, five days a week, generally between 9:00 AM and 4:00 PM.

Staffing follows the same lean logic. For the first two years, she operated solo. She has since added a virtual operations manager, a nurse for clinical support, and a full-time virtual assistant who handles scheduling and phones. Her newest addition is a physician who wants to build a similar micropractice without startng from scratch. Overhead stays low, pricing stays accessible, and each hire is made deliberately rather than reactively.

Her advice: hire earlier than feels necessary.

Marketing, Niche, and Practice Growth

Dr. Pepper has been running this for years, with rapid growth and virtually no paid advertising. The model is relationship-based, building referral networks with dietitians, therapists, and other physicians through direct outreach, shadowing, and speaking engagements.

Kara believes that identifying a clear niche accelerates that process. Her practice evolved from a general eating disorder focus into a specialty clinic addressing other complex conditions.

Prepare to Thrive in a Micropractice

For physicians considering a similar path, market research matters before launch. It helps to understand the local price point, the patient demographics, and the competitive landscape.

A cash-pay model that works in a major metro may not be viable in a lower-income rural area. When leaving an employment relationship with non-compete clauses require early legal review. Kara navigated hers by launching exclusively via telemedicine in out-of-state markets before eventually returning to in-person practice after the restriction period ended.

Summary

A micropractice does not require a large team, enrollment with large payors, or a traditional overhead model to be sustainable. Dr. Pepper’s practice runs lean by design: cash-pay, hybrid in-person and telemedicine, a small panel, and a virtual support team. And it grown entirely through referrals and relationship-building.

The key decisions that made it work: identifying a clear niche, hiring deliberately, treating the practice as a real business from day one, and using the non-compete period productively to build out-of-state referral networks. For physicians considering a similar move, she runs a Micropractice Mastermind and hosts the It’s Not Just You podcast. Resources are linked below.

NOTE: Look below for a transcript of today’s episode. 

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