What Does It Cost to Set Up a Solo Psychiatry Practice?

You can open a solo cash-pay telepsychiatry practice for far less upfront than most people assume, and keep far more of what it earns. Pieced together from separate vendors, the software runs roughly $250 to $450 a month, and the one-time costs to open, malpractice, an entity, and your DEA registration, land between $2,000 and $11,000 in year one, the bulk of it malpractice. That malpractice bill is the part that stops people: a four-figure premium due before your first patient. On Eureka it disappears as an upfront cost, because malpractice coverage for the care you deliver on the platform is bundled into one all-in fee of about 20% of what you collect. So a typical practice nets 50 to 60 cents on the dollar after office, billing, staff, and insurance; on Eureka you keep around 80, malpractice included, with nothing due before you earn it.

This is the honest budget. Numbers below are observed ranges from solo cash-pay practices over the last few years, deliberately set on the high side so you plan for the real bill, not the brochure. Where a price is a published public rate, it is current as of mid-2026. There are two ways to buy this: assemble a dozen separate vendors yourself, or run essentially the entire operation on one platform. The tables below flag which is which, because on Eureka nearly every line is one line, not nine.

What software do you actually need to see your first patient?

You need a handful of jobs covered: a branded email, a way to fax, a video platform, a clinical record that also schedules and bills, a way to e-prescribe, a way to write your notes, and a way to take a card. That is the whole list. Everything else can wait until you have patients and revenue, because revenue solves almost every early problem and your own time is the most expensive thing on the books.

The trap is not buying too little. It is assembling each job from a different vendor because that is how the standard guidance reads, then paying the seam costs forever. Here is what the pieced-together version actually runs.

Add it up the piece-it-together way and the stack is about $250 to $450 a month before card fees, spread across nine logins, nine BAAs, and nine renewal dates. Every row in that table is included on Eureka, from the chart down to your branded email and your fax line, for one subscription, one login, one BAA. The piecemeal path is not just pricier in total. It is nine support queues, nine renewal dates, and you as the integration between all of them.

A telehealth-only practice with no office can keep total overhead near 10% to 20% of revenue, versus 40% to 50% at a typical practice carrying an office, billing staff, separate malpractice, and a stack of disconnected tools. That overhead gap is the whole game. It is the difference between taking home roughly 80 cents on the dollar and taking home 50. On Eureka the 20% is a single all-in fee that already includes your malpractice, so there is nothing else skimming the top, which is what makes the take-home number land where it does.

Why the sticker prices understate the real cost

Three costs never show up on a pricing page, and together they dwarf the subscriptions.

The first is the integration tax. When your notes live in one tool, your intake answers in another, your prescriptions in a third, and your AI scribe in a fourth, you are the integration. You copy the scribe's output into the chart by hand. You retype the intake into the note. You reconcile the card processor's payouts against the EHR's invoices at month end. None of that is billable, and all of it scales with your panel. This tax is exactly what a single platform erases: on Eureka one patient record carries the note, the intake, the prescription, and the payment, so there is nothing to copy between tools because there are no other tools.

The second is the card-fee reframe. New owners flinch at losing 2.75% to 3% to processing. The math runs the other way. Capture a card at booking and charge it the day of the visit and your collection rate runs at or near 100%, against the 70% to 80% considered good in practices that bill insurance or carry balances. That collection gap, plus the prior-auth and claim-denial hours, is a big part of why cash-pay quietly out-earns insurance on fewer patients. Losing 3% to fees to never lose 20% to non-payment is the best trade in the practice. Treat card-on-file as required infrastructure, not a convenience. Eureka captures the card at booking and charges it on the day of the visit by default, so the 100% collection rate is the standard setup, not something you have to wire together.

The third is the penny-wise, pound-foolish rule. An extra $50 to $100 a month of software is worth about ten minutes of your time at private-practice rates. If a tool saves you an hour a week, the ROI is not close. The expensive mistake is not overspending on software. It is underspending and paying in your own evenings. This is the same just-in-time logic behind getting your first patients before you perfect anything: buy what removes real work now, defer the rest.

What does it cost to actually open the doors?

Separate from the monthly stack are the one-time costs to be legally and clinically ready. This is where the range is widest, and almost all of the spread is malpractice.

This is where Eureka changes the math most. Your malpractice is included in the platform fee rather than billed as a separate premium, so the single biggest line in this table drops to zero upfront: you are covered for the care you deliver on Eureka from day one, and the cost comes out of the percentage as you earn it. Eureka files your entity as a passthrough cost too, so you only pay the state. The rest is worth a word. If you ever carry an outside policy, know occurrence versus claims-made: claims-made is cheaper upfront but you owe a tail premium of one to two times your annual rate when you leave, a delayed bill built into the cheap option. And do not assume you need a PLLC at all to start seeing patients; whether and when to form one is the entire subject of do you need a PLLC, and plenty of people start as a sole proprietor and incorporate later.

What you don't need to buy if you start on Eureka

Almost the entire list above is something you assemble only if you choose to do it the hard way. Eureka is built to be the whole operation in one product, so signing up replaces the fragmented core in a single subscription: every job in the monthly table, from the chart to your branded email and fax line, plus the booking site and the Zoom setup. It also covers the part that is not software at all: your malpractice. Coverage for the care you deliver on Eureka is included in the fee, with no separate premium and nothing due upfront, which removes the single largest check most people write before seeing a patient. Entity formation we file for you as a passthrough cost. Instead of buying a dozen tools and wiring them together, you get one login and one BAA where everything already talks to each other: the eRx writes from the same chart your AI scribe just filled in, the card you captured at booking charges against the same visit, the superbill builds itself from the note. The copy-paste job that eats new owners' evenings does not exist because there is nothing to copy between.

Be clear-eyed about what stays on you, so the budget is honest. Your DEA registration is yours: a personal federal credential nobody can hold for you, at $888 every three years. Your entity is a passthrough; Eureka files it, you pay the state's fee and any franchise tax. Your malpractice, the line that usually hurts most at the start, is simply included in the fee, so there is no premium to front and no tail to settle later. What Eureka removes is the shopping, the setup, the integration, the renewal-juggling, and the upfront insurance check, not the handful of fees that are genuinely yours. It does not make you stop being a business; it makes you stop being an IT department.

A realistic first-year budget

Here are the two paths side by side for a telehealth-only solo psychiatrist, monthly software only:

• Piece it together yourself: roughly $250 to $450 a month across nine vendors, plus card fees, plus a malpractice premium of $1,500 to $8,000 a year often due upfront, plus the unpriced hours you spend as the glue. All in, overhead eats 40% to 50% of revenue.
• Start on Eureka: one all-in fee of about 20% of what you collect, covering essentially the entire operation, malpractice included, with nothing due before you earn it. You keep around 80 cents on the dollar. Card fees apply on either path.

The one-time cost to open is where the paths split hardest. Do it yourself and it is roughly $2,000 to $11,000, mostly the malpractice premium you pay before any revenue. On Eureka, malpractice carries no upfront cost and your booking site is included, so what is left to pay before patient one is mostly your DEA registration and any state filing fee, a few hundred to about a thousand dollars.

Spend where it buys back your time, defer where it does not, and price your visits to clear all of it comfortably; if the fees you set make this budget look large, the fees are the problem, not the software. A full cash-pay panel covers a year of either stack in a couple of weeks of work.

Frequently asked questions

Do I still need a fax number for a private practice?

Functionally yes, because pharmacies and labs still fax, but you do not need to buy it as a separate line. If you piece your stack together, a HIPAA-compliant fax-to-email service runs $10 to $15 a month. On Eureka your fax and your branded email are both included, so faxes route in and out of the same place you already work instead of becoming one more login and one more BAA.

Is an all-in-one platform cheaper than buying the best tool for each job?

On the monthly subscription it is roughly a wash; both land in the few-hundred-dollars range. The savings show up in two places a pricing page does not. First, a platform like Eureka means you stop paying for a separate EHR, e-prescribing app, AI scribe, payments tool, forms tool, video platform, email host, fax service, and website altogether, so the lines leave the budget rather than getting cheaper. Second, you get back the costs that never had a price tag: one BAA instead of nine, one renewal date, and zero hours spent moving patient data between tools by hand. That consolidation is also what pulls overhead down toward 20%, which is the difference between keeping 80 cents on the dollar and keeping 50. For a solo practice where your time is the scarcest resource, that is where the real money is.

What is the single most expensive part of starting a practice?

If you assemble your own stack, malpractice insurance by a wide margin: a four-figure annual premium that often falls due before you have any revenue. Everything else, your DEA registration, entity formation, and a month of software, usually totals less than one year of malpractice. On Eureka that line is included in the platform fee with nothing upfront, so the most expensive part of starting becomes a percentage you pay only as you earn. For a new practice with no cushion, removing that upfront check is often the difference between starting now and waiting.