Recent trends point toward a decline in solo and small business medical practices, yet, the need and demand still exists for this model of health care. The purpose of this case study was to explore effective approaches to help physicians in solo practice and small medical group primary care practitioners (PCPs) retain their small business medical practices. The study included purposive sampling and face-to-face interviews: 11 physicians, predominately primary care practitioners, in the Baltimore-Washington metropolitan region, were interviewed until data saturation was reached. A component of systems theory (strategic thinking) and the dynamic capabilities concept were used to frame the study. Audio recordings were transcribed and analyzed to identify themes regarding effective competitive approaches to help small medical group physicians retain their practices. Four major themes emerged: need for flexibility and adaptability, need for higher levels of business acumen, need to fully embrace automation, and a focus on pursuing financial stability before pursuing growth and expansion of the medical practice. Results may benefit society by preserving and strengthening a source of patient-centered, effective, affordable health care for communities served by small business medical practices. Implications for social change include presenting methods to enhance stability and organizational sustainability of small business medical practices.