Opening a medical practice in Switzerland: permits, structure and budget

Which authorisations should you check before setting up?

Start with your own professional position, then assess the entity that will operate the practice.

For foreign qualifications, the procedure depends on the country of issue and the applicant’s circumstances. Recording a qualification and formally recognising it are not interchangeable. Permission to work under supervision is also different from authorisation to practise under your own professional responsibility.

Check the required language skills. MedReg records professional information; registration alone is not a universal licence to open a practice. Ask the health authority in the canton where you will provide care to confirm the exact route.

Why is admission to bill compulsory health insurance a separate step?

Admission determines whether the relevant services may be charged to Switzerland’s compulsory health insurance scheme, known as AOS in French. Geneva expressly states that an authorisation to practise does not guarantee this admission.

Requirements for doctors include quality standards, appropriate language skills, affiliation with a certified electronic patient record community and, in principle, at least three years of full-time work in a recognised Swiss postgraduate training institution in the specialty concerned. Check how experience is counted and whether any exception applies to your specific application.

Cantonal admission restrictions can vary by specialty and may change. Do not base your financing plan on an assumption that available premises or a retiring colleague automatically creates an entitlement to admission. When taking over a practice, check the position of both the incoming doctor and the operating entity.

Confirm the procedure, expected processing time and relevant conditions before committing to substantial fixed costs. Billing identifiers are another part of the process; obtaining one does not replace a required cantonal decision.

Sole proprietorship, LLC or company limited by shares?

A sole proprietorship lets you operate in your own name without a statutory minimum capital. You remain personally liable for business debts. The AHV/AVS compensation office assesses self-employed status from the actual working arrangements.

An LLC (Sàrl/GmbH) requires CHF 20,000 of fully paid-in capital. A company limited by shares (SA/AG) requires at least CHF 100,000 of share capital; at least 20% of the nominal value of each share and at least CHF 50,000 in total must be paid in. This capital belongs to the company. It is not an incorporation fee.

An LLC or SA answers for its debts with its assets. The company’s liability is not capped at the nominal amount of its capital. Incorporation also does not eliminate a doctor’s potential personal liability for professional acts or the duties of company officers.

Compare the options against the number of practitioners, decision-making arrangements, recruitment plans, investment, succession and personal remuneration needs. There is no universal annual profit level above which an LLC becomes more tax-efficient. Salary, retained profit, distributions and pension planning need to be modelled together.

Our comparison of Swiss business structures explains the differences. For a liberal profession carried on as a sole proprietorship, also have the commercial register requirements assessed against the way the activity is organised. Avoid assuming registration is “always optional”.

What budget should you prepare for opening or taking over a practice?

The budget depends heavily on the specialty, equipment and premises. A single overall estimate can hide costs that arise before the first patient invoices are paid.

For a takeover, review historical accounts alongside the contracts: whether the lease can be transferred, maintenance obligations, equipment leases, staff arrangements and the basis of the asking price. Past turnover does not guarantee revenue for the incoming practitioner.

Prepare a cautious scenario with fewer consultations at the start, additional investment and slower payments. Work out how many months of costs your available funding will cover. A business plan helps test these assumptions and discuss them with lenders. A separate cash-flow forecast shows when the money is needed.

Accounting and VAT: what should a medical practice anticipate?

An LLC or SA must keep full accounts. For a sole proprietorship with turnover below CHF 500,000 in the previous financial year, simplified bookkeeping must cover at least income, expenses and assets. Even under this simplified regime, tracking receivables, investments and commitments remains essential for managing the practice.

Assess VAT service by service

Medical treatment can be exempt from VAT without input tax credit when the legal conditions are met. Whether health insurance reimburses a service is not, by itself, the VAT test. The nature of the service, the provider and the relevant authorisations must be examined.

Product sales, certain non-therapeutic services, expert assessments and charges between separate entities may require a different treatment. Where taxable activities exist, assess VAT registration and input tax recovery. Do not automatically reclaim the VAT on all equipment used for exempt care.

In a shared practice, define who invoices patients, who employs the team and how common costs are allocated. Payments between doctors or companies must correspond to the contractual arrangements. Our article explaining how Swiss VAT works covers the general principles; the practice’s actual configuration needs a specific assessment.

Prepare the systems, insurance and team

Before opening, test the complete workflow: appointment booking, patient information, medical records, treatment, invoicing and payment collection. Health information is sensitive. Plan restricted access, appropriate authentication, tested backups and clear agreements with service providers.

Give your accountant access to the financial information needed without unnecessarily sharing clinical content. Keep accounting evidence separate from patient records.

Confirm the required professional indemnity insurance and its scope: insured people, declared activities, coverage limits and continuity of cover. Arrange protection against inability to work and the required insurance and affiliations for staff. Hiring a medical assistant creates employer obligations that are separate from your own professional authorisation. Include employer social security costs in the payroll budget.

A useful final checklist includes authorisations received, premises ready, insurance effective, contracts signed, payroll configured, billing tested and cash available. Assign an owner and a check date to each item.

Frequently asked questions