“I once worked with a practice where every single purchase order had to go through the physician owner.
Every one. Big or small.
They were still seeing a full schedule of patients. And when they were out of the office, staff still had to track them down to get approval.
You can imagine what that did to the place. Orders waited. Staff stopped making small decisions because they knew they’d be second-guessed. And the physician, who I’m sure believed they were protecting the practice, became its biggest bottleneck.
I’m not saying every owner is like this. Most aren’t, at least not to that degree.
But I’ve learned to treat one thing as a reliable warning sign:
When everything flows back to the physician, something in the organization is broken.
Usually it means nobody else has real decision-making power. Roles exist on paper, but authority doesn’t. So every question, big or small, travels uphill to the one person who’s also supposed to be seeing patients.
The fix isn’t for the physician to care less. It’s to decide, deliberately, what they actually need to approve, and give everyone else clear authority over the rest.
If you left your practice for a week, how many decisions would sit in your inbox waiting for you?”
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