No Medical Degree? No Problem. You Can Still Own a Health Clinic

By Sean Goldsmith

Structural Elements lets investors own wellness clinics while practitioners run their own franchises. Sean Goldsmith examines the opportunities and risks.

Tell someone they can own a health clinic without being medically qualified and you're likely to get a raised eyebrow. Tell them the people treating patients are also franchisees, and the arrangement sounds even more unusual. Yet there's a good argument that Structural Elements, an American orthopaedic wellness franchise, has developed a sensible way of bringing together people with different skills.

The idea is that one franchisee owns and manages the clinic while licensed practitioners operate their own businesses inside it. The investor looks after the premises, administration and commercial operation, leaving the professionals to concentrate on treating patients. Both are independent business owners, working under the same franchise brand.

I can understand why some people might be uncomfortable with an investor owning a healthcare business without clinical qualifications. Healthcare carries responsibilities that go well beyond ordinary customer service. But ownership and professional practice are already separate in many businesses, and the important issue is whether qualified people retain responsibility for the treatment they provide.

Two Franchisees With Different Responsibilities

Structural Elements was founded in Maryland in 2013 by Douglas Bertram, a licensed acupuncturist. It began franchising in 2016 and introduced its practitioner micro-franchise programme in 2019. Its clinics provide orthopedic wellness services, including physical therapy, acupuncture and other treatments delivered by qualified professionals.

The clinic franchisee manages the premises, reception, appointments, billing and marketing. Practitioners sign separate three-year franchise agreements and run independent practices within the same location. The company provides shared facilities and business systems, along with assistance in recruiting practitioners.

For a therapist considering independent practice, the arrangement could remove some of the difficulties associated with opening a conventional clinic. Finding suitable premises, employing administrative staff and managing business systems can be expensive and time-consuming. Structural Elements allows practitioners to share those resources while retaining ownership of their own businesses.

The clinic investor benefits from a different arrangement. Rather than employing every practitioner, the business receives monthly space fees and can generate additional revenue through recovery memberships, retail products, workshops and corporate wellness services. The financial interests of the clinic owner and its practitioners are therefore closely connected.

Good Practitioners Aren't Always Interested in Running Buildings

One of the challenges facing professionals who want to work independently is that being excellent at their chosen occupation doesn't necessarily prepare them to run a business. A skilled therapist may have spent years developing clinical expertise without ever having to negotiate a commercial lease, manage reception staff or organise marketing.

Some practitioners will enjoy those responsibilities, but others would prefer to concentrate on their patients. Structural Elements offers them an opportunity to own a practice without taking on every expense and administrative obligation associated with a standalone clinic.

That's an interesting use of franchising. The system provides a commercial structure that allows qualified professionals to work independently while sharing facilities and support. It may give practitioners who would otherwise remain employees a more manageable route into business ownership.

Of course, the arrangement still needs to make financial sense. Practitioners must understand their franchise fees, space charges and contractual obligations, along with the income they can reasonably expect to earn. The attraction of shared facilities is considerably reduced if the cost of participating leaves too little money for the person providing the treatment.

The Investor Is Taking a Substantial Risk

Structural Elements estimates that opening a clinic costs between $703,450 and $1,458,815, including a $65,000 initial franchise fee. Its typical premises occupy between 5,000 and 7,000 square feet, making this a substantial investment in property, equipment and ongoing operating costs.

The clinic owner needs enough practitioners to occupy the treatment rooms and generate income. A building with several empty rooms still has rent, staff costs and maintenance expenses, regardless of how attractive the business model appears in a franchise presentation.

Structural Elements says it helps recruit practitioners and replace those who leave. The three-year micro-franchise agreements may also encourage continuity, although they cannot guarantee that every practitioner will remain successful or renew their agreement.

Before investing this amount of money, I would want to understand how many practitioners are needed for a clinic to cover its costs, how long recruitment normally takes and what happens when someone leaves. The company has not published sufficient individual clinic financial results to establish how profitable the arrangement is, so prospective buyers would need to examine the available disclosure information carefully.

Healthcare Still Requires Professional Independence

The involvement of a non-clinical investor doesn't automatically create a problem, but it does make the division of responsibility particularly important. A clinic owner may manage appointments, billing and the premises, while clinical decisions must remain with appropriately qualified practitioners.

Healthcare ownership and professional practice rules vary between American states. The arrangements used by Structural Elements therefore need to comply with the requirements applying to each location and the services offered there.

Patients also need clarity about who is providing their treatment and who is responsible for clinical matters. If a practitioner leaves, there must be appropriate arrangements for records, continuing care and any outstanding concerns. These responsibilities cannot simply be treated as ordinary franchise administration.

I would argue that a properly organised franchise can help make those responsibilities clearer by establishing consistent procedures and defined roles. The important point is that commercial ownership should support professional care rather than interfere with it.

A Good Idea Faces a Difficult Expansion Test

Structural Elements currently reports clinics in Maryland and Wisconsin, together with 11 practitioner micro-franchise owners. In October 2026, it announced plans to recruit experienced multi-unit investors, with an ambition to reach 125 clinics within five years.

That's a substantial expansion target for a relatively small network. The company must recruit investors capable of financing and managing large clinics, while also attracting qualified practitioners who want to establish their own businesses within those premises.

The two recruitment efforts cannot be considered separately. Opening clinics without enough practitioners would leave investors carrying substantial costs, while recruiting practitioners into locations without sufficient patient demand could put their businesses under financial pressure.

What interests me about Structural Elements is the opportunity it creates for people who bring different abilities to the same business. An experienced investor can manage a clinic without claiming to understand clinical treatment, while a qualified practitioner can own a business without having to finance and operate an entire healthcare facility.

There is still a great deal for the company to prove as it expands, particularly around clinic profitability and practitioner retention. But the underlying arrangement deserves attention because it offers a practical example of how franchising can help professionals become business owners without requiring them to do everything themselves.

What We Can Learn From This

Structural Elements demonstrates how franchising can bring together investors and qualified professionals who have different responsibilities but a shared interest in running a successful clinic. Investors should examine practitioner occupancy, recruitment costs and clinic profitability before committing substantial capital, while practitioners need to understand their fees and contractual obligations. Clear responsibility for clinical decisions and patient care is essential. If the company can demonstrate sustainable returns for both groups, its approach could offer a useful example for other professional service franchises.

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