4 APA PRACTICE ORGANIZATION

ALTERNATIVE PRACTICE MODELS

Choosing the Best Legal Structure

for Your Professional Practice

T here are a variety of legal structures you might

choose for your practice. Understanding your
options is important since these structures are often
the building blocks for alternative practice models such as
independent practice associations (IPAs) and management
service organizations (MSOs). Given the evolving health care
marketplace, it is important to know how traditional legal
business models compare to alternative practice models.
In some cases, considering the alternatives may lead you
to conclude that you simply want or need to shore up your
practice by creating a formal legal structure where none
currently exists.
company. The accompanying chart outlines key comparative
If you have a business plan (see apapracticecentral.org/ advantages and disadvantages for the models described
business/management/tips/secure/business-plan.aspx), you taking into account the factors listed above.
should consider reviewing that document to see if you need
Importantly, the requirements for different legal structures
to make any changes to your current practice model. If you
may vary by state. And not all of the models described are
are just getting started in practice, you will want to consider
available in all states. For example, the limited liability
the following factors in deciding what kind of legal structure
partnership is a relatively new concept and therefore is not
to adopt:
recognized universally. In addition, some states require that
t
The type(s) of services you offer business owners who provide licensed services – such as
t
The size of your practice, including whether you may health care services (psychology or medicine, for example),
plan to hire or jointly own the practice with other health accounting or law – set up either a professional limited
care providers (and perhaps from other licensed health liability company (PLLC) or professional corporation (PC),
disciplines) as these kinds of entities are designed to provide licensed
t
The amount of control you want to have over the professional services.
administrative operations
t
How much organizational structure you would like Yet another important consideration is that your state may
t
Tax implications for various practice models have a corporate practice of medicine statute that sets
t
Plans for the future of your practice (for example, do limitations on what other health care disciplines may be
you plan to keep it small or seek to grow the size of your integrated in your practice. For example, your state law
practice?) may not allow psychologists to set up a PC or PLLC with
t
Your desire to limit or separate your personal liability from physicians to provide psychological and medical services.
the practice’s liabilities
In light of such variability, this article provides a basic
t
The likelihood of being involved in a lawsuit reflecting
general overview of alternative practice models. Practicing
the types of services you provide or plan to provide (for
psychologists are urged to consult with a local attorney and
example, forensic work)
financial advisor to discuss important tax implications,
t
The practice’s expected profits or losses
relevant state corporate laws and other legal/regulatory
t
Your need to access capital considerations in deciding how to best structure your practice.

This article discusses six types of legal structures and

potential advantages and disadvantages of each model – sole
Sole Proprietorship
proprietorship, general partnership, limited partnership, This is the simplest and least expensive way of structuring
limited liability partnership, corporation and limited liability your professional practice. A sole proprietorship is an
 GOOD PRACTICE Fall 2014 5

unincorporated business in which you are the sole owner the tax liability “passes through” to the individual partners
with the complete authority to make all business decisions. who personally pay taxes on the partnership income.
There is no legal distinction between you and your practice.
General partners share equally in the profits and losses.
All of the practice’s assets and profits belong to you. In addition, each general partner has unlimited personal
However, you are also personally liable for all of the liability under the partnership for its debts, losses and
practice’s debts, losses and liabilities. If you have employees, liabilities. This also includes personal liability for the
you are legally liable for their actions, too. Your personal unlawful or inappropriate actions (or omissions) of another
liability is unlimited, so both your business and personal general partner and any employee(s). Unlimited personal
assets may be at risk. Your ability to access capital for your liability often makes this particular type of partnership less
practice will depend on your personal credit since a sole attractive than the other options.
proprietorship is not an incorporated business entity.
Limited Partnership (LP): A limited partnership is a more
You do not have to take any formal action to set up a sole complex structure that includes general partners and limited
proprietorship. If you are the owner of your practice, your partners. The general partners operate the partnership so
practice is automatically considered a sole proprietorship they are responsible for the decision making, whereas limited
simply by being in business. But like all businesses, you may partners have no active role in daily operations and serve
need to obtain the necessary licenses and permits. Because as investors in the partnership. While general partners are
you and your practice are one and the same for tax and legal personally liable under the partnership, limited partners
purposes, any practice income or loss is reported on your have limited personal liability for the partnership’s liabilities.
personal income tax return. As a sole proprietorship, your Limited partners’ liability is limited to their original
practice does not need to file its own tax return. investment in the partnership.

Partnership Like general partnerships, the partnership’s tax liability

passes through to the individual partners to report their
If you are interested in co-owning the practice with other respective shares of the income or losses on their personal
colleagues, you might consider a partnership. Under a income tax returns.
partnership, the partners contribute money, property, labor
and expertise to the business. There are three types of Limited Liability Partnership (LLP): Unlike general
partnerships: general partnership, limited partnership and partnerships, partners in an LLP enjoy limited personal
limited liability partnership. liability. LLP partners are not liable for acts, omissions
or negligence by another partner. However, they are still
Although there are many similarities, the three models differ personally liable for their own malpractice or incompetence
as to level of control of the business and personal liability. It or that of any employee whom they directly supervise.
is important to consult with an attorney to draft a partnership Unlike a limited partnership, however, all of the partners in
agreement in order to address how ownership and business an LLP generally can actively manage the business.
authority will be shared, how decisions will be made, how
disputes will be handled and how to deal with a buyout if a The requirements for setting up an LLP may vary from one
partner wants to leave the partnership. state to another. Even more fundamentally, in some states,
the LLP is available only to certain professions – for example,
Depending on the type of partnership, it may also need to accountants, lawyers, doctors and dentists.
be registered with the state, typically through the Secretary
of State. Further, the partnership would need to obtain any
Corporations
necessary business licenses and permits. As a partnership, the
practice may have greater access to capital since it has its own This is usually the most complicated and expensive
assets distinct from the individual partners’ personal assets. business structure to set up. A corporation is chartered by
the state and considered to be a separate legal entity from
General Partnership (GP): The basic form of partnership is the owners (shareholders). In most cases, liability for the
a general partnership where the general partners own and practice’s debts is limited to the corporation’s assets. That
manage the business together. All of the partners are involved means a shareholder is liable only to the extent of his or her
in the business decisions. Like the sole proprietorship, the investment in the corporation.
tax issues are fairly simple. Although the partnership must
file a tax return, it does not pay taxes on the income. Rather Decision making is based on stock ownership of the
6 APA PRACTICE ORGANIZATION

TYPE OF LEGAL STRUCTURE Who controls the operations? Simple to set up & operate?

Psychologist (sole proprietor)

SOLE PROPRIETORSHIP Yes
exercises complete control

GENERAL PARTNERSHIP Shared decision-making among partners Relatively easy; minimal set-up costs

Active management limited to

LIMITED PARTNERSHIP general partners; lack of active control for Relatively easy; minimal set-up costs
limited partners

May only be available to certain professions

LIMITED LIABILITY PARTNERSHIP Shared decision-making among partners
in some states; may be more difficult to set up

Management centralized in board of directors

Generally, most complicated and expensive
(PROFESSIONAL) or elected officers; decision-making based on
structure to set up; state law may limit integration
CORPORATION stock ownership
with other types of licensed health care providers

More complicated than sole proprietor-

Members may be involved in the
(PROFESSIONAL) LIMITED LIABILITY ship or partnership but most popular
decision-making or may hire someone
COMPANY option because of combined tax and
to run the company
liability advantages

shareholders. But generally, the corporation’s management is Instead, the tax liability passes through to the individual
centralized in a board of directors or elected officers. Only the shareholders on their personal income taxes – similar
corporate officers, authorized by the board of directors, may to partnerships. There are other specified criteria that a
act on behalf of the corporation and commit corporate assets. corporation must meet to qualify as an S Corporation.
The corporation continues to exist even if a shareholder sells
or transfers his or her corporate stock shares. In many states, health care practices are considered
“professional corporations” (as compared to ordinary
Additional requirements exist with regard to the business corporations) because the services provided by
establishment and operation of a corporate board of the practice require a license. The laws governing how PCs
directors, documentation and recordkeeping. Any are set up, owned, managed and operated vary by state.
practitioner considering this option is well advised to Some states require that all of a PC’s shareholders have the
consult an attorney to prepare the articles of incorporation same professional license. Other states also require that the
and other required filings. Like partnerships, the officers and directors be licensed in the same profession;
corporation would need to be registered with the state. in other words, these states do not allow multidisciplinary
practices. Unless otherwise specified in your state law, it
As a corporation, your practice would pay its own is likely that all members of your professional corporation
income taxes and file its own tax return. In addition, the must be psychologists. Currently, fewer than half of states
shareholders may pay income tax on distributed profits in the U.S. allow for some degree of integration among
that they receive as dividends. This means that corporate psychologists and physicians.
income is subject to “double taxation.”

For federal income tax purposes, you may elect to have

Limited Liability Company (LLC)
the corporation treated as an “S Corporation” (under A limited liability company is a hybrid of a corporation and
federal tax laws) to avoid “double taxation.” In most cases, a partnership. The LLC is one of the most flexible options
S Corporations do not pay taxes on income and losses. and probably the most popular because of the combined
 GOOD PRACTICE Fall 2014 7

Limited personal liability? Basic taxation issues Profits & assets shared?

Practice income & losses are reported on No - belong to psychologist

NO
your personal income tax return (proprietor)

Partnership must file a tax return but practice

NO – legally responsible for your own
income & losses are reported on each partner’s own Yes
actions and those of any partner(s)
personal income tax return

Partnership must file a tax return but practice

Yes - limited partners,
income & losses are reported on each partner’s own Yes
NO for general partners
personal income tax return

Yes for others’ negligence or malpractice BUT Partnership must file a tax return but practice
responsible for own actions or income & losses are reported on each partner’s own Yes
those of direct supervisees personal income tax return

Possible double taxation (corporation pays

Any profits would be
income tax, shareholders pay income tax on distributed
Yes distributed as dividends to
profits) but depends on the type of corporation
shareholders
so check your state laws

LLC must file a tax return but generally practice Members can decide how
Yes income & losses are reported on members’ personal to share profits per LLC
income tax returns operating agreement

liability and tax advantages. This structure offers limited of the complex and often burdensome corporate formalities.
personal liability for members (similar to a corporation’s Like partnerships or corporations, the LLC would need to
shareholders or a partnership’s partners). LLCs are not be registered with the state.
recognized by the federal government for tax purposes,
so they are taxed either as a corporation, partnership or Also similar to corporations, states may have provisions
sole proprietorship. Generally, the LLC’s income would be requiring licensed professionals seeking to set up an LLC to
reported on the members’ personal income tax returns. Even designate their company as a professional limited liability
so, it is important to consult with an accountant to determine company (PLLC). This particular kind of LLC is required for
how an LLC may elect to be taxed. the business owner who must be licensed in order to practice
his or her profession – for example, psychology, medicine
Although some states require there to be at least two and law. But, as with professional corporations, certain states
members of an LLC, other states are starting to allow single- may not allow PLLCs to be established as multidisciplinary
member LLCs. Members of an LLC can include individuals, health care practices. There may be similar state law
corporations and/or partnerships. Members of the LLC can be restrictions on integrating different disciplines into a single
involved in the decision making regardless of the size of their practice so it is important to check the laws in your state.
financial investment in the company. Alternatively, the LLC
could hire someone to run the company. Your ultimate decision about an organizational model
for your practice will have many legal and financial
As with a partnership, you should have an attorney draw implications. Therefore, you should consult with your
up the LLC’s articles of organization and a formal operating attorney and accountant/financial advisor in making
agreement for members describing how the company will the best choice for you.
be run, how profits will be shared and whether the LLC
would continue to operate if a member chooses to leave the NOTE: The information presented in this article is for
business. In general, forming an LLC is more complicated informational purposes only and does not constitute legal
than forming a partnership but avoids some or financial advice.