The challenges in succession planning for solo or small-town practices

Photo By: Froggy5

In many small towns across the country, long-time doctors are retiring, leaving behind empty clinics and communities without easy access to healthcare. These physicians often run solo practices, serving generations of families. But when it’s time for them to step away, there is often no one ready to take their place. Without a clear succession plan, patients are left scrambling for care, and rural areas face growing gaps in medical services. This challenge highlights why succession planning is especially difficult for small or solo practices and what can be done to help keep healthcare local.

As one article highlights, succession planning can look different depending on the organization. Sometimes it starts with hiring people who not only meet today’s needs but also show potential to become future leaders. Other times, it involves building up the existing team by offering training, mentorship, and chances to grow professionally. No matter the approach, the goal is the same, which is to make sure the organization is prepared for the future with capable leaders who are ready to step in when needed.

Rural healthcare organizations face even greater challenges when a leader leaves. “Many rural executives wear multiple hats. No one is doing just one job, so if you’re losing them, lots of things come to a halt,” explains Erin Sullivan, Associate Professor of Healthcare Administration at Suffolk University. These organizations may also struggle to absorb the costs associated with a lengthy or difficult leadership transition. Without a strong plan in place, losing a leader can disrupt daily operations, lower staff morale, and ultimately affect patient care.

The impact on patients when key specialists leave can be devastating. Dr. Stacy Wentworth shared that in her rural community, two general surgeons recently retired, a medical oncologist moved away, and two urologists left over a year ago. This left many cancer patients wondering who would care for them. Unfortunately, this situation is far from unique. Across the country, rural communities are experiencing similar losses due to an aging physician workforce, burnout, and understaffing. As more doctors retire or relocate, patients are often forced to travel long distances for essential care or face delays in treatment. This creates additional stress and financial burdens for patients and families, and can lead to worse health outcomes, especially for those with serious or time-sensitive conditions like cancer.

Yet amid these challenges, some rural healthcare systems have managed to navigate leadership transitions successfully. One example is Horizon Health Care, where the board began preparing when their founding CEO of 38 years announced his retirement. Despite facing the uncertainties of a global pandemic and having a relatively inexperienced board, Horizon ensured a smooth transition by planning early and prioritizing stability. Their experience shows that with foresight and support, even small organizations can manage change effectively.

Unfortunately, not every rural healthcare organization is able to plan that far ahead. When leadership transitions are rushed or unplanned, the result can be confusion, emergency board meetings, costly executive searches, and stalled strategic efforts. Worse still, the loss of institutional knowledge and community trust can leave lasting damage that is difficult to repair.

To address challenges like these, Enventure, a U.S.-India based advisory and investment firm founded by Ankit Shrivastava, is stepping in to help healthcare organizations manage leadership transitions with stability. Unlike traditional private equity firms that often prioritize quick profits, Enventure is committed to preserving care continuity, community trust, and the long-standing legacy many rural clinics have built over time.

As rural healthcare systems continue to face mounting pressures from leadership turnover, physician shortages, and financial instability, the consequences remain deeply personal for the communities they serve. Supporting these institutions requires looking beyond financial numbers to focus on long-term stability and care continuity. “We’re not just looking at spreadsheets—we’re looking at lives, communities, and institutions of trust,” says Shrivastava in a company blog post. “The collapse of a clinic isn’t just a business failure. It’s a healthcare access crisis.” For many rural patients, preserving these clinics means preserving the only dependable path to care, and the time to act is now.