It’s not easy being a physician-owner of a practice. There’s the increased scrutiny from the government, not to mention the cost of malpractice insurance and the need to document patient care in the electronic health record. That’s why it would just make sense to throw in your lot with the local hospital as an employee. But that wasn’t the path chosen by a District of Columbia-based orthopedic surgeon who now leads one of the country’s largest physician practices.

Discontent with having to work his way through the ranks of a local hospital to secure his professional future, Louis Levitt, M.D., an orthopedic surgeon, decided to strike out on his own 33 years ago, reports The Washington Post.

What’s really put him over the top is organizing the Centers for Advanced Orthopaedics, a 174 doctor-owned practice that’s one of the country’s largest. Launched three years ago and expected to gross approximately $200 million in revenue next year, Levitt’s practice has 1,500 employees, which include 300 nurses, physician assistants and physical therapists. The Centers for Advanced Orthopaedics also ranks 62 out of the recent top 100 largest private companies in the D.C. area.

Some of the secrets of Levitt’s success include:

Read the writing on the wall. Healthcare reform requires increased government scrutiny and the number of baby boomers who need to have their joints and bones fixed is only going to grow.

Achieve economics of scale. Whether it’s malpractice insurance or syringes, Levitt’s group secures the best possible volume discounts with suppliers. His group also has centralized billing, scheduling and a bill-payment system that receives nearly $3 million each day, according to the article.

Carve out time to lead the practice. During the evenings and on Fridays, Levitt actually runs the practice. It’s during this time that he takes seriously the fact that, while his doctors often live in D.C., many staff members don’t.