How can I open a medical practice in Switzerland?
Opening a medical practice in Switzerland is not something you can improvise. The process can take several months, and you'll need to follow a number of administrative procedures and legal requirements before you can operate. Whether you are planning to set up a private clinic, a medical analysis laboratory or a medical-social establishment, this article will guide you through the essential steps to help you launch your healthcare institution in Geneva, from obtaining your operating license to declaring any changes to your establishment.
Defining the project
Before launching a healthcare institution in Geneva, it is essential to define your project. This first phase of reflection will influence all subsequent steps.
Determining the area
The choice of location is a strategic decision. You need to select an area that meets several criteria: accessibility for patients (public transport, central location, etc.), as well as the proximity to other competing healthcare infrastructures.
The chosen area must also be in line with the population needs and the specifics of the institution you wish to open (medical practice, laboratory, clinic, etc.).
Choice of services
The type of services you offer will depend on your specialty (and/or those of your associates) and the needs of the community. It's important to define from the outset whether you want to offer outpatient care, hospitalization, orthodontics, or even specialized services such as medical analysis, home assistance and emergency services.
The choice of services will directly influence the type of institution to declare, and therefore the competent service (cantonal doctor, cantonal pharmacist, care network) to which you should apply for authorizations.
Budgeting
Drawing up a provisional budget is a key stage in your project. This budget must include not only the initial costs (renovation or conversion of premises, obtaining authorizations, purchase of medical equipment), but also recurring costs (salaries, rent, operating costs).
It is also necessary to provide a reserve for unforeseen events, such as additional costs associated with inspections or compliance with current health regulations. A financial plan will not only allow you to control expenses, but also to present a solid case when the time comes to request the authorization to practice, or when applying for credit.
Choosing a legal form
The choice of legal form for your healthcare institution will have an impact on the structural of your company, your financial responsibility and your administrative obligations. In Switzerland, three main legal forms are generally considered for opening a medical practice or other health institution:
- Public limited company (SA)
- Limited liability company (Sàrl)
- Sole proprietorship (RI)
Limited Company (SA)
The public limited company is a legal form often chosen for healthcare institutions of large size, or when several shareholders are involved in the project. The SA, like the Sàrl, is a capital company. The specific features of the SA are as follows:
- Shareholders' liability is limited to the amount of their shareholding.
- It makes it easier to attract investors, as the shares of a public limited company are easily transferable.
- A high level of start-up capital is required, i.e. a minimum of CHF 100,000, of which at least CHF 50,000 (50%) must be paid in.
- Creation and management costs are higher.
Limited liability company (Sàrl)
The LLC is a legal form that is flexible and suitable for small to medium-sized institutions. It is often chosen by small groups of healthcare professionals who wish to limit their liability , as well as to make a smaller capital contribution than the SA. Here are the particularities of the Sàrl:
- As with the SA, the liability of associates is limited to their capital contributions.
- The starting capital requirement is CHF 20,000, making it a more affordable option.
- Partners are not anonymous: their names appear in the Commercial Register.
- Membership shares are less easily transferable than shares in a public limited company.
Sole proprietorship (RI)
The sole proprietorship is the easiest and fastest to set up, often chosen by healthcare professionals wishing to practice alone, like general practitioners or specialists. The characteristics of the sole proprietorship are as follows:
- Set-up is simple, fast and inexpensive: the business can be started immediately.
- There is no minimum capital requirement.
- Accounting and administrative obligations are light.
- The professional is fully liable for the institution's debts and obligations, which involves his or her personal assets.
- This form is not suitable if you are planning to expand or if you want to bring in partners or investors in the medium term.
Entry in the Commercial Register
The entry in the Commercial Register formalizes setting up your healthcare institution in Switzerland. It gives your company a legal existence, and is required to obtain the necessary operating permits. To register your healthcare institution in the Commercial Register, contact the Commercial Register Office in your canton.
Obtaining a registration certificate
Once your institution has been registered, you will receive an extract from the Commercial Register, which will serve as a proof of your company's existence. Once validated, you will receive a official extract.
This document is essential for a number of subsequent administrative procedures, including the application to the cantonal health authorities for an operating license, and for bank contracts. This document can be consulted at any time in the central index of swiss business names.
Choice of premises
The choice of premises for your medical practice will not only influence the quality of care, but also respect for health regulations and safety. Premises must be functional, comply with legal requirements, and offer a welcoming environment for patients. You can search for premises for rent on several online platforms, such as:
If you're a sole trader, you might consider rent a workstation in a practice that has already installed the necessary medical equipment. This can be an advantageous and less risky way of starting your own business.
Installation of medical equipment
The choice of premises for your medical practice will not only influence the quality of care, but also respect for health regulations and safety. The premises must be functional, comply with legal requirements, and offer a welcoming environment for patients.
Once you've chosen your premises, you'll need to equip them depending on the services you wish to offer. Each medical specialty has its own specific equipment requirements, and it is essential that these meet the current standards.
Patient reception facilities
The layout of the premises must also offer comfortable environment and reassuring for patients. The layout must also comply with safety and accessibility standards for all.
A waiting room and reception are a must. What's more, in Switzerland, the standards for accessibility must be strictly adhered to. The premises must be equipped with ramps, elevators (if several floors), and toilets adapted for people with reduced mobility.
Each room must be adapted to the services offered, be well-lit and ventilated, and guarantee patient privacy. Hygiene standards must be respected, with easy-to-clean materials and disinfection equipment within easy reach.
Obtain the necessary authorizations
To open a healthcare institution in Switzerland, you need to obtain several authorizations from the relevant authorities.
Application for authorization to operate
An operating license is a prerequisite for any healthcare institution, whether a medical practice, clinic or pharmacy. This authorization is issued by the competent service depending on the type of institution (cantonal doctor, cantonal pharmacist, care network).
You will need to submit an online form via the e-démarches portal, enclosing your company's extract from the Trade Register, a description of the premises and facilities, a list of medical staff and their qualifications, as well as the institution's mission statement and the contact details of the (co)manager(s).
If the premises are being built, you will also need to enclose a building permit and a document from the Building Permits Office validating the construction/conversion project.
Inspection of premises
Before receiving the final authorization to operate, a site inspection is carried out by the cantonal health authorities. The purpose of this inspection is to check that the premises comply with legal requirements and safety standards.
If the plant meets all the requirements, a positive report is issued, allowing you to finalize the operating permit. If non-conformities are found, modifications will have to be made before a new inspection is scheduled.
Amount of the procedure
In the canton of Geneva, any healthcare establishment wishing to obtain an operating license must pay a fee of CHF 1'650 to carry out the procedure (except for pharmacies, for which the amount is CHF 300.)
Administrative and tax management
The administrative and tax management encompasses many aspects, from human resources management to compliance with tax and social security obligations.
Personnel management (payroll and HR)
You must ensure that the salaries are paid regularly and in accordance with collective bargaining agreements or industry practices. This includes compulsory deductions (AVS, LPP, etc.) and payment of social security contributions.
The management of employment contracts, permanent and fixed-term employment contracts, ongoing training obligations, and regular performance reviews included play a big part.
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Bookkeeping
In the Limited Company and the LLC, the accounting must be held according to the Swiss Code of Obligations , i.e., in a professional and detailed manner, according to the rules in force. Financial flows, including patient payments, operating expenses and medical equipment purchases, must be up to date.
At the end of each accounting period, you must produce financial statements (balance sheet, income statement) that enable us to assess the institution's financial situation and comply with legal tax reporting obligations.
Revision obligation
According to the size and legal form of your institution, an annual audit may be necessary. You also need to make sure that your accounting records are available to anyone who needs them. Tax audits can also take place..
Internal administrative management
It is crucial to use a reliable billing system. This is particularly important if you deal with several health insurers or paying agencies. Invoicing must be clear and in line with tariff standards, such as TARMED for medical consultations.
The appointment management must be seamless, via dedicated software, to avoid scheduling conflicts and ensure an optimal patient experience. What's more, if you offer services such as surgery or specialized care, you'll need to provide detailed quotes before starting treatment.
VAT registration
In Switzerland, most medical services are exempt from VAT. However, certain services (such as consulting or aesthetic medicine) may be subject to VAT. If your sales exceeds CHF 100,000 per year for services subject to VAT, you are obliged to register for VAT with the Federal Tax Administration (FTA).
If you are subject to VAT, you will have to submit regular declarations and pay the corresponding amount to the FTA.
Social security registration
As an employer and potential employee in Switzerland, you are required to register with and contribute to various social insurances. These include AVS, LPP, unemployment insurance, accident insurance and maternity/paternity insurance.
Frequently Asked Questions
How long does it take to open a medical practice in Switzerland?
The time required to open a medical practice in Switzerland will depend on many factors, such as
- legal form
- number of employees
- space conversion requirements
- equipment installation
- obtaining authorization
On average, you should expect to pay between 3 to 6 months to open a medical practice.
Can I do the accounting for my medical practice on my own?
Yes, it's possible to do your bookkeeping yourself if you're self-employed and don't plan to exceed the CHF 500,000 of sales per year. However, you'll need to learn the basics of bookkeeping, and that can be complex and time-consuming.
Above this threshold, or in the case of a limited liability company (SA/Sàrl), it is not recommended to do your own bookkeeping. Bookkeeping must be carried out in accordance with the legal standards governed by the Swiss Code of Obligations. Numerous tax and administrative regulations and procedures are involved. So it's best to be accompanied by a fiduciary on this side.
Should I take over a medical practice?
Take over a medical practice can be an excellent opportunity if you want to benefit from an existing patient base, an existing infrastructure, and an established network of partners.
As with any business acquisition, it is important to check the financial statements , reputation, current contracts, and the condition of equipment and premises.
How to finance the opening of a medical practice?
In Switzerland, it is possible to withdraw your 2nd pillar for starting a self-employed activity. Alternatively, it is also possible (and recommended) to use a bank loan for project launch. You will be asked to submit a business plan.
