Every healthcare technology company seems to claim they are solving physician burnout or reducing the administrative burden in healthcare. Most of them are targeting hospital systems, because hospital systems have large technology budgets and enterprise procurement teams. The result is a market where the loudest innovation is happening at the top of the institutional hierarchy, in places that already have the most resources, while the physicians who work the hardest and have the least support go largely unserved.
We started Scribemarrow for independent outpatient practices. This piece explains why - not as a marketing statement but as the actual reasoning we went through when we decided where to focus.
The observation that started it
In early 2024, David was doing operational consulting work for a small family medicine practice in East Nashville - three physicians, one nurse practitioner, a front-desk coordinator, and a practice manager. The practice ran two EHR-connected computers per exam room, had a scheduling system, and was doing roughly 250 visits a week. By any reasonable measure, it was a well-run, technology-equipped practice.
The lead physician was routinely finishing chart notes between 7 and 9pm, four nights a week. Not because she was slow or disorganized. Because a clinic day of 20 patients generates a documentation load that does not fit inside a clinic day, with any EHR, for any physician who types at average speed. The math doesn't work.
When David asked what documentation tools they had tried, the answer was predictable: voice dictation (discontinued because editing the output took almost as long as typing from scratch), a transcription service (too expensive per note at independent practice scale), and a tool designed for large health systems that required IT implementation support they didn't have. Nothing had materially changed the two-hour evening charting block.
Why independent outpatient practices specifically
The documentation burden per provider is higher at independent outpatient practices than at most other care settings, for structural reasons.
First, visit volume is high. A primary care physician in an independent practice may see 20 to 25 patients per day - higher than average for employed physicians in health systems, where panel size management is sometimes more tightly controlled. More visits means more documentation events.
Second, administrative support is thinner. Large health system employed practices often have documentation support - dedicated coders, documentation specialists, or shared services teams that handle some of the administrative work. Independent practices have what they can afford to hire, which is usually the minimum.
Third, technology purchasing is different. Independent practices buy tools on a per-provider subscription basis, not through enterprise procurement. They need tools that work immediately, require minimal implementation support, and deliver visible value in weeks rather than months. The sales cycle and implementation complexity designed for a large health system deployment doesn't fit this buyer.
Fourth, they have no leverage with EHR vendors. When an independent practice wants a workflow improvement in their EHR, they submit a feature request and wait. They don't have the account size to drive vendor prioritization. If the EHR isn't doing what they need, they need a tool that works alongside it.
What we built for this market
Scribemarrow was designed from the start around the constraints of the independent outpatient practice buyer. Onboarding that a practice can complete in under 30 minutes, without IT support. Integration with the EHRs that independent practices actually run: Epic for those who chose it, Athenahealth (the most common EHR in this market by practice count), Cerner, eClinicalWorks, ModMed. Per-provider pricing that a 3-physician practice can evaluate without a procurement committee.
And a product that is honest about what it does: it generates note drafts for the physician to review and sign. It doesn't diagnose. It doesn't make clinical decisions. It doesn't replace the physician's judgment. It takes the mechanical production of clinical documentation off the physician's plate so that the physician's time and attention can go to the clinical work.
Why we are bootstrapped
The independent outpatient market is not the market that attracts the most institutional capital. Venture firms tend to prefer healthcare technology companies targeting hospital systems - larger contracts, bigger average contract values, names that go on case studies. The independent practice market is fragmented, lower average contract value, and requires a different sales motion.
We bootstrapped Scribemarrow because we didn't want to be pushed toward the hospital system market before we had built and proved the product for the market we care about. A practice that is spending two hours every night charting and gets that back has been helped in a concrete and meaningful way. We wanted to be able to say that about real practices before we talked to anyone about capital.
The market we are building for is large - 220,000 independent outpatient practices in the US, representing hundreds of thousands of physicians who are doing exactly what the physician in East Nashville was doing when we first observed it. The problem is common, the solution is knowable, and the practices that need it don't need an enterprise. They need something that works.