Is Fear of Money Conversations Sabotaging Your Private Practice?

Let’s be honest — if you’ve come from the NHS into private practice, the word selling probably makes you squirm, because it feels at odds with why you chose medicine in the first place. You’re used to patients turning up because they’ve been referred, not because you’ve convinced them to choose you. And deep down, you might still believe that putting a price on your expertise feels… wrong.

Here’s the truth: you are selling. Every day in your clinical life, you’re in the game of persuasion with patients. You may be persuading them that they need to be patient whilst you take them through a diagnostic journey. You may be persuading them that they need to engage in lifestyle changes or undergo what could potentially be an uncomfortable and protracted recovery after a significant surgery. And you are negotiating with them in terms of mutual expectations.

When it comes to providing treatment in the private sector, you are effectively selling your skills, your experience, and your ability to get patients better, faster, and with more attention than they’d get elsewhere. And that’s not grubby or unethical — it’s just business. If you can’t talk confidently about the value you provide, you’ll forever be at the mercy of insurers and hospital admin teams, praying they keep sending patients your way.

The Big Insurance Problem

Many clinicians in private practice lean far too heavily on Bupa, AXA, and other big insurers to feed them work. That’s fine until it’s not.

In London (and other competitive areas), I’ve seen insurers suddenly drop clinicians from their list, cut fees to the bone, or send patients to the nearest clinic they’ve got a “special arrangement” with. One small change in their system, and your patient stream dries up overnight.

When you rely on an insurer’s pipeline, you’re building your practice on sand. The only real security comes from having a direct relationship with your patients — where they know your name, choose you, and are willing to pay you directly.

Stop Deciding What’s “Too Expensive” for Patients

This one’s going to sting: it’s not your job to decide what patients can and can’t afford. You don’t know their financial situation, their priorities, or what getting treated quickly might mean for them.

Take the self-employed patient who’s desperate to get back to work. For them, paying privately for surgery next week makes perfect sense if it means they’re back earning within a month, instead of waiting six months on the NHS. Another patient might decide to use a “buy now, pay later” option because, for them, getting their health back on track is worth far more than upgrading the kitchen.

For parents, the calculation is different again. Paying for a consultation and a child’s MRI might mean shelving the weekend break they’d planned — but the reassurance of knowing what’s going on with their child is priceless. Or think about the cancer patient who chooses private radioactive iodine treatment because availability in their area is poor, and every week that passes without treatment feels like wasted, dangerous time.

Even small business owners are making these kinds of choices every day. A builder with a knee injury may see private physiotherapy as a lifeline, because every day off the tools costs them money — sometimes more than the treatment itself.

The point is this: patients aren’t just weighing up pounds and pence. They’re weighing up time, peace of mind, independence, and their ability to get on with their lives. Your role is to present the options, explain the benefits, and let the patient decide.

Making assumptions isn’t just bad for private practice business — it’s patronising. Think about it. How would you feel if you were a patient and the doctor in front of you told you how you should be spending your money? Or worse still, how would you feel if a treatment option was never even mentioned, only to discover later that it could have been offered — but someone who barely knew you had already decided you couldn’t afford it?

When I first started out in private practice, I’d come from an area of the UK where many patients were on Disability Living Allowance, as it was then called. I remember catching myself Googling a patient’s postcode to try and guess whether they could afford an MRI scan if I saw they were self-funding. I felt uncomfortable discussing money, and I let my own mental baggage get in the way. I was simply inexperienced at having those conversations with patients.

The Problem With Cramming Everything Into One Consultation

A common trap in private practice is trying to “save patients money” by squeezing everything into a single appointment — assessment, imaging review, treatment planning, and next steps. While the intention is noble, the outcome is rarely a satisfying experience.

Patients are bombarded with information, haven’t had time to process your assessment, and are then pushed into making a decision on the spot. What follows is often a flurry of emails between you, the patient, and your secretary, resulting in frustration. Meanwhile, you feel rushed, risk running late for the next patient, and may even start to resent the dynamic you’ve created.

A better approach is to structure the process with breathing space. That might mean starting with an initial face-to-face appointment, followed by a virtual review. Or, if a patient is travelling a long distance and really needs everything completed in one sitting (for example, because a

relative is attending with them), you should book a double or extended appointment and charge the appropriate fee.

One sign you may be slipping into this trap is if there’s a striking imbalance between the ratio of initial and follow-up appointments for your self-funding patients, compared with your insured patients.

Paradoxically, what feels like “saving” a patient money can actually reduce the value they perceive — patients appreciate your care far more when they feel unhurried and confident in their decisions.

As my best friend (an American) would say, ‘you can still give great value without giving away the barn’.

Selling Is Serving

I know you didn’t go into medicine to become a salesperson, but think about this: if you truly believe you’re the best person to help a patient, isn’t it your duty to make sure they know that?

Selling is just communicating the value of what you do, in a way that’s clear and compelling. Patients aren’t buying an operation, a consultation, or a rehab plan — they’re buying a transformation. They want recovery, reassurance, speed, and the confidence that they’re in expert hands. That’s what you’re “selling,” whether you realise it or not.

Building Your Own Patient Pipeline

The most successful clinicians I work with all have one thing in common: they don’t wait for patients to land in their lap. They learn to:

Build visibility through a strong digital presence, their website, video, and social media.
Develop email lists to stay in touch with potential and past patients.
Get proactive with referrer relationships.
And above all – build a brand.

When you’ve got your own patient pipeline, you’re in control. Insurers are an option, not a lifeline. And when you’re in demand, you can command fees that reflect your skill — without guilt.

Your Mindset Is Your Bottleneck

If you’re feeling squeamish about “selling,” it’s time to reframe it. You’re not pushing snake oil — you’re offering a valuable service that patients want and need. You’re providing speed, skill, and continuity of care.

Bottom line: if you want a stable, profitable private practice, stop hiding and start owning your value. Patients aren’t going to think less of you for charging — they will be glad they chose to invest in their care.