Let me say something clearly, because it gets lost in a lot of conversations about physician practices:
Physicians are not the problem.
They’re some of the smartest people I’ve ever worked with. Nobody gets through medical school and residency by accident.
So when an independent practice struggles as a business, it’s almost never about intelligence.
In my experience, it comes down to two things.
The first is bandwidth.
Do the math. You’re seeing patients 40 hours a week. Running the business takes another 20, if you’re lucky. And then there’s the strategy work: where the practice is going, what to build, what to stop, who leads next.
Where exactly does that fit?
The second is expertise.
I’ve been doing the operations and strategy side for 20 to 30 years. There’s real technique to it, the same way there’s technique to a surgical procedure. A surgeon doesn’t learn it from a book. You don’t learn how to run a multi-site practice from one either.
Put those together and you get very smart people making big business decisions in whatever time is left over, without the reps that make those decisions easier.
That’s not a character flaw. It’s a design flaw.
The fix isn’t “work harder.” It’s to stop asking one person to be the clinician, the operator and the strategist all at once.
Owners: how many hours a week do you actually spend running the business? And how many do you spend on where it’s going?
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