October 6, 2025 • 20 mins
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How do you know you're ready to hire a new physician in your private practice?Â
This is a question that I am asked a lot, and it is so important to answer, because when it is done wrong, it can create unbelievable stress, strain, and chaos in what was once a very calm and successful private practice. So, before you make that potentially detrimental hire, ask yourself whether your practice is really ready for that kind of growth.Â
In this episode, I’m walking you through the five critical warning signs that tell you it’s not the right time to expand and explaining how to set yourself up for success in the future.Â
Tune in!Â
—
Key Takeaways:Â
- 00:00 Intro
- 03:47 Your schedule is not full
- 05:16 Your cash flow is inconsistent
- 07:10 You don’t have a predictable patient acquisition system
- 11:33 You don’t know your numbers
- 13:20 You haven't embraced your role as a leader
- 16:07 Project-based approach to practice improvement
- 19:32 Outro
Additional Resources:
- Learn more about my 12-month program.
- Interested in 1-on-1 coaching? Apply here.
- Grab a copy of the "The EntreMD Method" book.
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- EntreMD Business School Accelerator - If you are looking to make a 180 turnaround in your business in 90 days, this is the program for you.
- EntreMD Business School Grow - This is our year-long program with a track record of producing physician entrepreneurs who are building 6, 7 and 7+ figure businesses. They do this while building their dream lives!
- EntreMD Business School Scale - This is our high-level mastermind for physicians who have crossed the seven figure milestone and want to build their businesses to be well oiled machines that can run without them.
To get on a call with my team to determine your next best step, go here ...
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
Am I saying you're not ready because something's
(00:01):
wrong with your practice?
No, because I don't want you tobring a doctor into your office
and go completely upside down.
Doesn't matter whether you'rejust starting or you're a
multi-seven-finger practicebecause if you don't have the
foundation, you don't have thefoundation.
And this is why multipleseven-finger practices go out of
business.
SPEAKER_00 (00:17):
Hi dogs.
Welcome to the Untream Dpodcast, where it's all about
helping amazing physicians justlike you embrace
entrepreneurship so you can havethe freedom to live life and
practice medicine on your terms.
I'm your host, Dr.
Imna.
SPEAKER_01 (00:36):
How do you know you're ready to hire a new
physician in your privatepractice?
All right.
This is a question that I getasked a lot.
And this is a question that isso important to answer because
when this is done wrong, it cancreate unbelievable stress and
strain and chaos in what wasonce a very calm and successful
(00:58):
private practice.
So today I'm going to show youfive signs you're not ready to
hire another doctor.
Okay.
All right.
So I have been in privatepractice for the last 15 years.
I have hired doctors like frommy second year in private
practice.
And I've had to look at when isthe right time to hire, when is
not the right time to hire.
How do I do this in such a waythat my cash flow doesn't get
(01:20):
upside down and all of thosethings?
And so I guess I can say thatI'm taking 15 years of wisdom
and study and putting it,condensed it into this episode.
But really, what I want to showyou here is five signs you're
not ready.
Five signs you need to put someother things in order before you
do that.
And you may say, Dr.
Una, but you don't get it.
I'm really burned out.
My schedule is full.
(01:40):
I'm so stressed out.
The solution here is to hireanother doctor.
And you may be right, but youmay not be ready.
There may be some things thatneed to go in place before you
do that.
And you might say, Well, I'mjust going to do it anyway.
And so I want to put a cautionhere and tell you why this is so
important.
I have met a lot of doctors whohave had private practices.
(02:00):
Maybe it was just them and theywere doing well.
Okay.
So they had come to this place,like, oh my goodness, you know,
I left my employed physician, myemployed physician.
I didn't know I could start aprivate practice.
I started this private practice,and here we are, you know, we're
we're bringing in, you know,good money, we're taking care of
a ton of patients, we're doingall of these things, and we just
want to get this good thing tokeep going.
So we're going to add anotherdoctor.
(02:21):
And they did not look at whatI'm telling you about now.
And they went from that to apractice where they started
having financial pressure.
We're talking the lead doctorhad to go get a locum job to pay
the to meet the payroll for theteam that they they already had.
And because that was upsidedown, the patient experience
(02:42):
started going upside down.
Team members started sensingthat there may be some financial
stuff going on here.
They started looking for greenerpastures.
And the doctor, the owner, hadso much burnout and so much
fatigue that they were ready tothrow the whole thing away.
Okay.
And all the profit they hadcompletely disappeared.
Let's talk about it.
Okay.
(03:03):
How do you know?
And does that mean if you're notready, you can never hire?
No, it just means, like, youknow, you flip what this is and
you turn that into a project andyou fix those things and you're
ready to go.
It's kind of the, you know, likeif you were going to sell your
home, chances are you're goingto do some repairs here and
there because it will increasethe value of your home and
you're going to touch up painthere and those kind of things.
(03:23):
Just kind of rehab the place, ifyou will.
This is giving you direction forrehabbing your practice.
Okay.
And if you're watching this andyou're like, wow, I hired
somebody, maybe I shouldn'thave.
It was too early or whatever.
You can still tell now by basedon what we talk about, what is
wrong.
So you can go fix those thingsand then it'll be okay.
All right.
So Dr.
(03:44):
Luna is here.
I'm on your side.
Okay.
So five signs you're not ready.
Number one, your schedule is notfull.
Okay.
I cannot tell you how many timesI meet somebody, their schedule
is at 50% or 60% of capacity,but they decide as a physician
owner, I'm tired, so I'm goingto get another physician.
Okay.
But if your schedule is notfull, chances are like your
practice may not be profitableor it's marginally profitable.
(04:08):
Right.
And when I say your schedule isnot full, this could be you as a
solo doc.
This could be as a doc with sixdocs already looking to bring on
a seventh, but your six docs arenot at capacity, right?
And so which means your overheadto your profit margin is slimmer
than it needs to be.
And when you have five doctors,that's even more risk, right?
(04:29):
Because if if five doctors'schedules drop, that is even
more risk.
And then you bring on another.
Like that's just asking fortrouble, right?
Okay, so your schedule's notfull.
And if your schedule is notfull, I would typically say fill
it up.
Fill it up and then hire.
And now, of course, when you'reat 80% or you know, 90%, you
can, you know, you can startlooking, you're doing all of
(04:51):
those things, but you're veryclear on when this person is
coming on board.
You know, it would take you aminute, right?
Like so you you can by the timeyou're at 100, you have the
person you need, and you canstart looking if the other
things are in place, then youcan start getting that person on
board.
But if your schedule is notfull, do you need to hire
another doctor?
Maybe, but not just yet.
Fill the schedule first.
(05:12):
Yeah, fill the schedule first.
Okay, so that's the first thing.
Okay, that's the first thing isfill up your schedule.
The second sign that you're notready is that your cash flow is
inconsistent.
Okay, your cash flow isinconsistent.
And a lot of times this can betraced to what is happening with
your billing department.
Part of it could be number one,which is that your schedule is
not full.
You know, some days you have 50%capacity, some other times you
(05:34):
have 70% capacity.
So it's kind of like we we'reseeing what's coming, like we'll
see what comes, which is notgood to add another multiple
six-figure thing to your payrollwhen you're not sure about that,
right?
But when I talk about your cashflow being inconsistent, one of
the things I'm referring to isyour billing department.
And so it could be that you havea billing department that is
inconsistent.
(05:54):
So they do their job, you know,when they want to do their job,
and if they went away on aconference, then everything
stops.
Or if they have financialpressure, their personal
financial pressure, they workyour stuff and when they don't,
they don't, right?
So it could be something, itcould be something like that.
So you just have the wrongcompany, or maybe your billing
is in-house and you have animproperly led biller.
(06:16):
You know, the billing happenssometimes, billing doesn't
happen all the time.
Or you may have an officemanager who runs your office and
it's a very busy office and alsodoes your billing.
And so it's an item on the to-dolist.
It's not somebody's soleresponsibility.
And so it gets done sometimesand it doesn't get done
sometimes.
So you have this big swing, andyou can have the same number of
(06:39):
patients, but you're gettingpaid like ginormously different
amounts of money and stuff likethat.
And when you can predict, again,adding multiple six figures to
your payroll expense, if youwill.
You know, we we call it aninvestment if you're doing it
right.
And so if you bring in anotherdoc, what you're doing is you're
multiplying chaos.
(06:59):
You're better off figuring outlike how can we get a handle on
what's happening with ourbilling and fix that and then
take it from there, right?
Okay, so that's the second thingI would look at.
That's the second sign.
The third sign is that you don'thave a predictable patient
acquisition system.
And I'll explain what I mean bythat.
When I talk about a predictablepatient acquisition system, what
(07:20):
I'm referring to is whateverengine you've put in place to
control the way you want yourschedule to look.
So during COVID, one of thecommon things I heard people say
is my phones are not ringing.
People are not calling toschedule appointments.
I'm like, your phone is notthere to ring.
Your phone is there for eitherpeople to call you or you to
(07:42):
call them and make appointmentshappen.
If they're not calling you, youcall them.
The phone didn't go away.
You know what I mean?
And so is this whole concept ofbeing able to proactively fill
your schedule, for you to look,you know, two months out, a
month out, a week out, a day outand say, huh, what's going on
with our schedule here?
And you know exactly what to doto fill it up.
(08:02):
Now, some of them will belong-term strategies, some of
them will be short-termstrategies.
For instance, your strategycould be, you know, we work our
referral sources, we show up onsocial media, we email our
patients, we ask our patients tosend us more patients and we ask
for reviews, we run ads.
You may have these, you know,three, five, seven activities
(08:25):
that is kind of like a formulafor filling up your schedule.
And you've worked this andyou've tested it and you've
experimented with it, and itworks.
You know what to do to fill yourschedule.
The reason why that is importantis one, because you can fill up
your schedules and your docschedules, the doctors you have
now.
And then when you bring somebodyelse in, you know what to do to
(08:46):
fill their schedule.
You're not saying I brought themin, I was hoping the phone would
ring.
I was hoping people will makeappointments online.
You know what to do.
So if you don't have that, thenyou kind of want to work on
that.
Okay.
One of the things we're we'vedone is that, you know, we've
created a number of resourcesfor private practice owners
(09:07):
because we want to see privatepractice owners win.
So for instance, one of theresources we have is the
Profitable Private PracticePlaybook, and which is a book
where we're like, if you readthe book and do the book, your
practice will be profitable.
Like, really, we just put, youknow, over the last 15 years,
the best stuff that I had.
I'm like, what can I put in abook that if they can just
follow the book, they can win,right?
(09:28):
Now we all know that inaddition, we know a lot of
things that we're not doing.
Okay.
And I said, okay, what issomething that every private
practice owner can have thatwould help them implement these
things?
And that is the profitableprivate practice movement.
So it's on trimd.com forwardslash movement, where we get
together every Thursday to workon our practices, right?
(09:49):
We know this concept of workingin your business versus working
on your business.
This is what we do to work onour businesses, to work on our
private practices.
And so one of the things weteach there is the seven-figure
marketing system, theseven-figure referral system.
So you can build that system andstart testing it for your
practice.
Now, when we do these things,what is the number one thing
(10:11):
that leads to patient visits?
Number two, number three, right?
And so you can put the rightamount of energy and money and
team behind that to continue tocreate those results.
And you know, when we do this inthis combination, this is what
our schedule looks like, right?
And so if you're not part of themovement, this is the best$197
(10:32):
you can spend in your practicelike ever, right?
Because you get world-classstrategy and no, there's no
fluff.
We we really focus on threethings.
How do you fill your schedule?
How do you get paid for the workyou do?
How do you build a profitableteam?
Knowing that if you have thesethree things, chances are you're
working on the all the conceptsin this book.
And if you do it, your practicewill work.
(10:53):
Now, you may want to take you tothe next level.
We have all kinds of differentprograms for different things,
but this doesn't matter whetheryou're just starting or you're a
multi-seven-figure practice,because if you don't have the
foundation, you don't have thefoundation.
And this is why multipleseven-figure practices go out of
business, right?
So if you're not a part of it,if you're like, I don't have a
predictable patient acquisitionsystem, this can be a historical
(11:15):
fact.
All you have to do is is jointhe movement.
So on trademd.com forward slashmovement.
Okay.
So that's the third sign.
You don't have that.
That's the third sign thatyou're not ready.
Okay.
Now I'm saying you're not readybecause something's wrong with
their practice.
No, because I don't want you tobring a doctor into your office
and go completely upside down.
Okay.
All right.
Number four, you don't know yournumbers.
(11:36):
You don't know your numbers.
I hope nobody perceives this asI'm judging you.
Like, I'm not, because I've donemany of these things, right?
Like at a point, I did all ofthese things.
Okay.
I know what it's like to lookat, you know, what is revenue
per patient visit?
What's your, you know, yourpatient volume, what's your
break-even point, what's yourprofit and loss?
(11:57):
Oh, and I'm like, Rrrr.
I literally, okay.
So my husband is an accountantby training, right?
In the earlier years of mypractice, and when I say
earlier, I mean like the firstsix or seven years.
I'm not even saying, I'm noteven saying like early, like the
first year.
When it would be time to meetwith the accountant, go over
numbers and all of that stuff.
Do you know what I did?
I would tell my husband, like,this sounds like a you problem.
(12:18):
Like, you could have a meetingwith the I see the patients, I
run the operations, and I havebabies.
Okay.
I birth four babies.
You can meet with theaccountant.
I'm not gonna do that.
And literally, I would skip themeeting.
I get that.
But you see, as entrepreneurs,we have to understand the money.
We don't have to like it.
I'm not like crazy, like, ooh,let's go look at numbers.
(12:38):
Like, I'm not crazy about it,but I have to look at it.
And so I look at it.
And I look at it as often as Ineed to look at it, right?
To make the right decisions andto know what exactly is going on
and put my, you know, mypractice and my other businesses
in the best position to thrive.
Okay.
So I have to know the numbers.
At baseline, right?
What is our revenue per patientvisit, right?
(12:59):
For insurance-based practices?
What is our volume?
What is our break-even point?
Like, how many patients would mydog need to see to cover their
salary?
Maybe cover their overhead,maybe cover, you see what I'm
saying?
Like when they see this numberof patients, what does that mean
for salary, overhead, and profitfor the practice?
Like, we have to know thesenumbers.
Okay.
And if you don't know them, youcan know them.
That's the point.
You can know them.
(13:20):
Okay, number five.
Number five, the fifth signyou're not ready is you haven't
embraced the role of a leader.
Now, this one, this one righthere is huge.
And because a lot of physiciansstart here where, yes, I own a
practice.
Yes, I have team members.
No, I will not meet with them.
No, I will not hold themaccountable.
No, I'll not de-hire them if Ineed to.
No, I'm not going to give themfeedback.
(13:40):
I'm not going to do any of that.
I'm just going to pay theirpayroll and hope they do good
work.
A lot of times that's where westart from.
Now we may have gotten to thepoint where, like, oh, we can
lead like our MAs and our frontdesk and all of that, but we're
not talking to the officemanager.
We're definitely not talking tothe doctors.
And your practice needs a leaderwho will lead everybody.
(14:02):
Your practice needs a leaderthat will lead the entire team.
If you're going to bring adoctor on and you're going to
enjoy that relationship, you aregoing to need to lead them.
You're going to need to leadthem, right?
And so what that means is, youknow, you want to embrace the
role of a leader, which meansyou're going to define these are
(14:24):
the outcomes that this doctor isresponsible for.
When you interview them, you'regoing to tell them these are the
outcomes you're responsible for.
When it's time to onboard them,you are not going to shy away
from it and say, oh, the doctorknows everything.
Like they know a lot of things,but they don't know your
company.
You're going to onboard them.
Which also means, like, when itis time to give them the gift of
(14:46):
accountability and to give themfeedback, you're going to do
that.
Like you're going to do that.
You want to embrace that.
You want to own that so you canlead your doctors.
And leading is notmicromanaging, right?
Every great organization needs aleader.
And the leaders need a strongleader.
And you may think you're like,that's it.
(15:06):
I just don't need to hirebecause I'm not a strong leader.
No, leadership is a skill.
You can develop it.
You can develop it.
You've done so many things.
You've replaced hearts.
You've memorized the Krebscycle.
You started a business.
You got it profitable.
You're doing all of thesethings.
Of course, you can lead others.
You can lead physicians.
You can lead office managers.
You can lead all these people,right?
But it's a skill.
(15:27):
You learn it.
You learn to delegate.
You learn to hold accountable.
You learn to give the gift ofaccountability.
You learn to do all of thosethings.
I started off as a super shy,socially awkward introvert who
was phlegmatic at her core,which meant that I would do
anything to avoid conflict.
Do you see how this is not awinning recipe for
entrepreneurship?
When you say that you want aprofitable, thriving,
(15:47):
seven-figure, multipleseven-figure practice, what
you're also saying is I'm goingto be a great entrepreneur.
I'm going to be a great leader.
I'm good.
Like that's what you're saying.
You're saying yes to thesethings.
You're saying yes to leading ateam.
And you can learn it.
If I could learn it, you canlearn it.
And I'm not saying that to becute or to make you feel better,
but it's the truth.
I know where it started from.
So let's look at this.
(16:08):
What are the signs?
Let's go over the signs realquick.
Okay.
Your schedule is not full.
And the reason why I want us togo over this again is because I
want you to think about it.
There's nothing we've talkedabout here that is a problem.
It's not a problem, it's aproject.
It's not a problem.
It's a project.
So my schedule is not full.
Means I'm not ready right thismoment to hire.
But it does mean I have aproject.
(16:28):
I need to fill up my schedule.
I need to figure out how to dothat.
I need help actually I'm comingto the profitable private
practice movement with Dr.
Una so I can start working onthat.
Okay?
All right.
Cash flow is inconsistent.
Maybe you've never met with yourbiller.
Maybe they just send you randomreports and tell you everything
is good.
And because there's enough moneyin the bank to meet payroll, you
don't even bother about it.
Now you start meeting with thebiller.
(16:49):
Maybe you start learning whatthose numbers mean.
You start learning what are thefive metrics I should track
every month and all of thosethings.
And then start that process andstart paying attention to your
cash flow.
See, you we don't idolize money,we don't worship money, we don't
say money is the number onething.
We don't do any of those.
But as an entrepreneur, you arerequired to respect money.
(17:09):
We don't just like, oh, I don'ttalk, I don't do anything with
the money.
No, we don't we don't get to dothat.
Okay.
We have to respect the money.
So we pay attention to where itis, where it's flowing to, is it
flowing in the right amounts,all those things.
Okay.
Okay.
Number three.
So we again just make it aproject.
Number three, we don't have apredictable patient acquisition
system.
Okay.
(17:30):
And you're like, okay, I don'thave a predictable system.
I just take whoever comes.
I think we're just going by wordof mouth and all of those
things.
Great.
Now we're gonna flip it andwe're going to make this a
system.
So when our schedules are notfull, we know what to dial up to
fill it up.
When we bring on a new doctor,we know what to dial up to fill
it up.
Number four, you don't know yournumbers.
You don't know your numbers.
(17:50):
Again, this is just a project.
What numbers do I need to know?
Let me go start knowing them.
Okay, revenue per visit, mypatient followings.
Well, that looks like mybreak-even point.
Take a look at my profit andloss state and start looking at
those things, start knowing mynumbers.
Okay.
Again, it's a project, it's nota problem.
There's no problem.
We have not discussed a singleproblem on this episode.
Number five, you haven'tembraced the role of a leader.
(18:10):
And then you're like, okay, Ihave a project.
I'm going to embrace the role ofa leader.
Notice I did not say you havenot become a perfect leader or
you have not become the greatestof the great leaders, right?
You start that process.
So what does that mean?
I never meet with my team.
Now it's time to meet my team.
I need to start casting vision.
I've never held my teamaccountable.
It's now time to meet themaccountable.
I have never given them metricsthat this is how you know you're
(18:31):
doing a good job.
Now it's time for me to do that.
Again, these are all things thatwe do in the profitable private
practice movement.
So if you're like, I don't evenknow where to start, I will tell
you exercise on training.comforward slash movement.
Start, come join us.
Okay.
So these are the things that youlook at.
And you can start with a simple90-day project and you're like,
you know what?
I'm going to do these things,whichever ones are missing.
(18:51):
I'm going to work on these forthe next 90 days and put us in
the best possible position tostart bringing a doctor on,
especially if you're burned out,you're tired.
I just need another doctor andall.
Let's get this stuff taken careof.
And the truth of the matter isas you take care of this, you
will feel less burnout.
You'll feel much happier.
You'll be in a much better stateto bring this doctor on.
And then you can put out that adand start getting ready to bring
a doc on.
(19:11):
But please, please, please,please, please get yourself in
the best position to bring a docin, to get their schedule full,
to get ready.
And because when you do it thatway, you can get your doctor
busier faster.
You can protect your cash flowas you bring the doctor in.
And then you can create morecash flow as they do what they
(19:32):
need to do.
So I'm rooting for you, rootingfor you, like unbelievably,
because of course you can dothis.
So many people have, and you cando it too.
If you need support from my teamand for like, how can you guys
work with me to help me pullthis off on traind.com forward
slash call?
We'll be happy to walk youthrough everything we do.
And of course, we do not do highpressure sales or anything like
(19:52):
that.
Okay.
So create your project.
And this is really the picture Iwant you to hold.
I want you to hold this pictureof your schedule being full, of
cash flow being good, of youleading your team, of you
understanding your numbers, ofyou having a system that creates
patience, like you know how tocontrol your schedule.
Like just imagine that.
(20:14):
And then you bring a new doctorinto this match.
Just think about that.
So I want to hold that pictureas you do this work, this 90 day
project to get your practicewhere you want it to be.
Okay.
Don't believe the lies, youcan't do this.
Of course, you can.
Am I saying you're not ready because something's
(00:01):
wrong with your practice?
No, because I don't want you tobring a doctor into your office
and go completely upside down.
Doesn't matter whether you'rejust starting or you're a
multi-seven-finger practicebecause if you don't have the
foundation, you don't have thefoundation.
And this is why multipleseven-finger practices go out of
business.
SPEAKER_00 (00:17):
Hi dogs.
Welcome to the Untream Dpodcast, where it's all about
helping amazing physicians justlike you embrace
entrepreneurship so you can havethe freedom to live life and
practice medicine on your terms.
I'm your host, Dr.
Imna.
SPEAKER_01 (00:36):
How do you know you're ready to hire a new
physician in your privatepractice?
All right.
This is a question that I getasked a lot.
And this is a question that isso important to answer because
when this is done wrong, it cancreate unbelievable stress and
strain and chaos in what wasonce a very calm and successful
(00:58):
private practice.
So today I'm going to show youfive signs you're not ready to
hire another doctor.
Okay.
All right.
So I have been in privatepractice for the last 15 years.
I have hired doctors like frommy second year in private
practice.
And I've had to look at when isthe right time to hire, when is
not the right time to hire.
How do I do this in such a waythat my cash flow doesn't get
(01:20):
upside down and all of thosethings?
And so I guess I can say thatI'm taking 15 years of wisdom
and study and putting it,condensed it into this episode.
But really, what I want to showyou here is five signs you're
not ready.
Five signs you need to put someother things in order before you
do that.
And you may say, Dr.
Una, but you don't get it.
I'm really burned out.
My schedule is full.
(01:40):
I'm so stressed out.
The solution here is to hireanother doctor.
And you may be right, but youmay not be ready.
There may be some things thatneed to go in place before you
do that.
And you might say, Well, I'mjust going to do it anyway.
And so I want to put a cautionhere and tell you why this is so
important.
I have met a lot of doctors whohave had private practices.
(02:00):
Maybe it was just them and theywere doing well.
Okay.
So they had come to this place,like, oh my goodness, you know,
I left my employed physician, myemployed physician.
I didn't know I could start aprivate practice.
I started this private practice,and here we are, you know, we're
we're bringing in, you know,good money, we're taking care of
a ton of patients, we're doingall of these things, and we just
want to get this good thing tokeep going.
So we're going to add anotherdoctor.
(02:21):
And they did not look at whatI'm telling you about now.
And they went from that to apractice where they started
having financial pressure.
We're talking the lead doctorhad to go get a locum job to pay
the to meet the payroll for theteam that they they already had.
And because that was upsidedown, the patient experience
(02:42):
started going upside down.
Team members started sensingthat there may be some financial
stuff going on here.
They started looking for greenerpastures.
And the doctor, the owner, hadso much burnout and so much
fatigue that they were ready tothrow the whole thing away.
Okay.
And all the profit they hadcompletely disappeared.
Let's talk about it.
Okay.
(03:03):
How do you know?
And does that mean if you're notready, you can never hire?
No, it just means, like, youknow, you flip what this is and
you turn that into a project andyou fix those things and you're
ready to go.
It's kind of the, you know, likeif you were going to sell your
home, chances are you're goingto do some repairs here and
there because it will increasethe value of your home and
you're going to touch up painthere and those kind of things.
(03:23):
Just kind of rehab the place, ifyou will.
This is giving you direction forrehabbing your practice.
Okay.
And if you're watching this andyou're like, wow, I hired
somebody, maybe I shouldn'thave.
It was too early or whatever.
You can still tell now by basedon what we talk about, what is
wrong.
So you can go fix those thingsand then it'll be okay.
All right.
So Dr.
(03:44):
Luna is here.
I'm on your side.
Okay.
So five signs you're not ready.
Number one, your schedule is notfull.
Okay.
I cannot tell you how many timesI meet somebody, their schedule
is at 50% or 60% of capacity,but they decide as a physician
owner, I'm tired, so I'm goingto get another physician.
Okay.
But if your schedule is notfull, chances are like your
practice may not be profitableor it's marginally profitable.
(04:08):
Right.
And when I say your schedule isnot full, this could be you as a
solo doc.
This could be as a doc with sixdocs already looking to bring on
a seventh, but your six docs arenot at capacity, right?
And so which means your overheadto your profit margin is slimmer
than it needs to be.
And when you have five doctors,that's even more risk, right?
(04:29):
Because if if five doctors'schedules drop, that is even
more risk.
And then you bring on another.
Like that's just asking fortrouble, right?
Okay, so your schedule's notfull.
And if your schedule is notfull, I would typically say fill
it up.
Fill it up and then hire.
And now, of course, when you'reat 80% or you know, 90%, you
can, you know, you can startlooking, you're doing all of
(04:51):
those things, but you're veryclear on when this person is
coming on board.
You know, it would take you aminute, right?
Like so you you can by the timeyou're at 100, you have the
person you need, and you canstart looking if the other
things are in place, then youcan start getting that person on
board.
But if your schedule is notfull, do you need to hire
another doctor?
Maybe, but not just yet.
Fill the schedule first.
(05:12):
Yeah, fill the schedule first.
Okay, so that's the first thing.
Okay, that's the first thing isfill up your schedule.
The second sign that you're notready is that your cash flow is
inconsistent.
Okay, your cash flow isinconsistent.
And a lot of times this can betraced to what is happening with
your billing department.
Part of it could be number one,which is that your schedule is
not full.
You know, some days you have 50%capacity, some other times you
(05:34):
have 70% capacity.
So it's kind of like we we'reseeing what's coming, like we'll
see what comes, which is notgood to add another multiple
six-figure thing to your payrollwhen you're not sure about that,
right?
But when I talk about your cashflow being inconsistent, one of
the things I'm referring to isyour billing department.
And so it could be that you havea billing department that is
inconsistent.
(05:54):
So they do their job, you know,when they want to do their job,
and if they went away on aconference, then everything
stops.
Or if they have financialpressure, their personal
financial pressure, they workyour stuff and when they don't,
they don't, right?
So it could be something, itcould be something like that.
So you just have the wrongcompany, or maybe your billing
is in-house and you have animproperly led biller.
(06:16):
You know, the billing happenssometimes, billing doesn't
happen all the time.
Or you may have an officemanager who runs your office and
it's a very busy office and alsodoes your billing.
And so it's an item on the to-dolist.
It's not somebody's soleresponsibility.
And so it gets done sometimesand it doesn't get done
sometimes.
So you have this big swing, andyou can have the same number of
(06:39):
patients, but you're gettingpaid like ginormously different
amounts of money and stuff likethat.
And when you can predict, again,adding multiple six figures to
your payroll expense, if youwill.
You know, we we call it aninvestment if you're doing it
right.
And so if you bring in anotherdoc, what you're doing is you're
multiplying chaos.
(06:59):
You're better off figuring outlike how can we get a handle on
what's happening with ourbilling and fix that and then
take it from there, right?
Okay, so that's the second thingI would look at.
That's the second sign.
The third sign is that you don'thave a predictable patient
acquisition system.
And I'll explain what I mean bythat.
When I talk about a predictablepatient acquisition system, what
(07:20):
I'm referring to is whateverengine you've put in place to
control the way you want yourschedule to look.
So during COVID, one of thecommon things I heard people say
is my phones are not ringing.
People are not calling toschedule appointments.
I'm like, your phone is notthere to ring.
Your phone is there for eitherpeople to call you or you to
(07:42):
call them and make appointmentshappen.
If they're not calling you, youcall them.
The phone didn't go away.
You know what I mean?
And so is this whole concept ofbeing able to proactively fill
your schedule, for you to look,you know, two months out, a
month out, a week out, a day outand say, huh, what's going on
with our schedule here?
And you know exactly what to doto fill it up.
(08:02):
Now, some of them will belong-term strategies, some of
them will be short-termstrategies.
For instance, your strategycould be, you know, we work our
referral sources, we show up onsocial media, we email our
patients, we ask our patients tosend us more patients and we ask
for reviews, we run ads.
You may have these, you know,three, five, seven activities
(08:25):
that is kind of like a formulafor filling up your schedule.
And you've worked this andyou've tested it and you've
experimented with it, and itworks.
You know what to do to fill yourschedule.
The reason why that is importantis one, because you can fill up
your schedules and your docschedules, the doctors you have
now.
And then when you bring somebodyelse in, you know what to do to
(08:46):
fill their schedule.
You're not saying I brought themin, I was hoping the phone would
ring.
I was hoping people will makeappointments online.
You know what to do.
So if you don't have that, thenyou kind of want to work on
that.
Okay.
One of the things we're we'vedone is that, you know, we've
created a number of resourcesfor private practice owners
(09:07):
because we want to see privatepractice owners win.
So for instance, one of theresources we have is the
Profitable Private PracticePlaybook, and which is a book
where we're like, if you readthe book and do the book, your
practice will be profitable.
Like, really, we just put, youknow, over the last 15 years,
the best stuff that I had.
I'm like, what can I put in abook that if they can just
follow the book, they can win,right?
(09:28):
Now we all know that inaddition, we know a lot of
things that we're not doing.
Okay.
And I said, okay, what issomething that every private
practice owner can have thatwould help them implement these
things?
And that is the profitableprivate practice movement.
So it's on trimd.com forwardslash movement, where we get
together every Thursday to workon our practices, right?
(09:49):
We know this concept of workingin your business versus working
on your business.
This is what we do to work onour businesses, to work on our
private practices.
And so one of the things weteach there is the seven-figure
marketing system, theseven-figure referral system.
So you can build that system andstart testing it for your
practice.
Now, when we do these things,what is the number one thing
(10:11):
that leads to patient visits?
Number two, number three, right?
And so you can put the rightamount of energy and money and
team behind that to continue tocreate those results.
And you know, when we do this inthis combination, this is what
our schedule looks like, right?
And so if you're not part of themovement, this is the best$197
(10:32):
you can spend in your practicelike ever, right?
Because you get world-classstrategy and no, there's no
fluff.
We we really focus on threethings.
How do you fill your schedule?
How do you get paid for the workyou do?
How do you build a profitableteam?
Knowing that if you have thesethree things, chances are you're
working on the all the conceptsin this book.
And if you do it, your practicewill work.
(10:53):
Now, you may want to take you tothe next level.
We have all kinds of differentprograms for different things,
but this doesn't matter whetheryou're just starting or you're a
multi-seven-figure practice,because if you don't have the
foundation, you don't have thefoundation.
And this is why multipleseven-figure practices go out of
business, right?
So if you're not a part of it,if you're like, I don't have a
predictable patient acquisitionsystem, this can be a historical
(11:15):
fact.
All you have to do is is jointhe movement.
So on trademd.com forward slashmovement.
Okay.
So that's the third sign.
You don't have that.
That's the third sign thatyou're not ready.
Okay.
Now I'm saying you're not readybecause something's wrong with
their practice.
No, because I don't want you tobring a doctor into your office
and go completely upside down.
Okay.
All right.
Number four, you don't know yournumbers.
(11:36):
You don't know your numbers.
I hope nobody perceives this asI'm judging you.
Like, I'm not, because I've donemany of these things, right?
Like at a point, I did all ofthese things.
Okay.
I know what it's like to lookat, you know, what is revenue
per patient visit?
What's your, you know, yourpatient volume, what's your
break-even point, what's yourprofit and loss?
(11:57):
Oh, and I'm like, Rrrr.
I literally, okay.
So my husband is an accountantby training, right?
In the earlier years of mypractice, and when I say
earlier, I mean like the firstsix or seven years.
I'm not even saying, I'm noteven saying like early, like the
first year.
When it would be time to meetwith the accountant, go over
numbers and all of that stuff.
Do you know what I did?
I would tell my husband, like,this sounds like a you problem.
(12:18):
Like, you could have a meetingwith the I see the patients, I
run the operations, and I havebabies.
Okay.
I birth four babies.
You can meet with theaccountant.
I'm not gonna do that.
And literally, I would skip themeeting.
I get that.
But you see, as entrepreneurs,we have to understand the money.
We don't have to like it.
I'm not like crazy, like, ooh,let's go look at numbers.
(12:38):
Like, I'm not crazy about it,but I have to look at it.
And so I look at it.
And I look at it as often as Ineed to look at it, right?
To make the right decisions andto know what exactly is going on
and put my, you know, mypractice and my other businesses
in the best position to thrive.
Okay.
So I have to know the numbers.
At baseline, right?
What is our revenue per patientvisit, right?
(12:59):
For insurance-based practices?
What is our volume?
What is our break-even point?
Like, how many patients would mydog need to see to cover their
salary?
Maybe cover their overhead,maybe cover, you see what I'm
saying?
Like when they see this numberof patients, what does that mean
for salary, overhead, and profitfor the practice?
Like, we have to know thesenumbers.
Okay.
And if you don't know them, youcan know them.
That's the point.
You can know them.
(13:20):
Okay, number five.
Number five, the fifth signyou're not ready is you haven't
embraced the role of a leader.
Now, this one, this one righthere is huge.
And because a lot of physiciansstart here where, yes, I own a
practice.
Yes, I have team members.
No, I will not meet with them.
No, I will not hold themaccountable.
No, I'll not de-hire them if Ineed to.
No, I'm not going to give themfeedback.
(13:40):
I'm not going to do any of that.
I'm just going to pay theirpayroll and hope they do good
work.
A lot of times that's where westart from.
Now we may have gotten to thepoint where, like, oh, we can
lead like our MAs and our frontdesk and all of that, but we're
not talking to the officemanager.
We're definitely not talking tothe doctors.
And your practice needs a leaderwho will lead everybody.
(14:02):
Your practice needs a leaderthat will lead the entire team.
If you're going to bring adoctor on and you're going to
enjoy that relationship, you aregoing to need to lead them.
You're going to need to leadthem, right?
And so what that means is, youknow, you want to embrace the
role of a leader, which meansyou're going to define these are
(14:24):
the outcomes that this doctor isresponsible for.
When you interview them, you'regoing to tell them these are the
outcomes you're responsible for.
When it's time to onboard them,you are not going to shy away
from it and say, oh, the doctorknows everything.
Like they know a lot of things,but they don't know your
company.
You're going to onboard them.
Which also means, like, when itis time to give them the gift of
(14:46):
accountability and to give themfeedback, you're going to do
that.
Like you're going to do that.
You want to embrace that.
You want to own that so you canlead your doctors.
And leading is notmicromanaging, right?
Every great organization needs aleader.
And the leaders need a strongleader.
And you may think you're like,that's it.
(15:06):
I just don't need to hirebecause I'm not a strong leader.
No, leadership is a skill.
You can develop it.
You can develop it.
You've done so many things.
You've replaced hearts.
You've memorized the Krebscycle.
You started a business.
You got it profitable.
You're doing all of thesethings.
Of course, you can lead others.
You can lead physicians.
You can lead office managers.
You can lead all these people,right?
But it's a skill.
(15:27):
You learn it.
You learn to delegate.
You learn to hold accountable.
You learn to give the gift ofaccountability.
You learn to do all of thosethings.
I started off as a super shy,socially awkward introvert who
was phlegmatic at her core,which meant that I would do
anything to avoid conflict.
Do you see how this is not awinning recipe for
entrepreneurship?
When you say that you want aprofitable, thriving,
(15:47):
seven-figure, multipleseven-figure practice, what
you're also saying is I'm goingto be a great entrepreneur.
I'm going to be a great leader.
I'm good.
Like that's what you're saying.
You're saying yes to thesethings.
You're saying yes to leading ateam.
And you can learn it.
If I could learn it, you canlearn it.
And I'm not saying that to becute or to make you feel better,
but it's the truth.
I know where it started from.
So let's look at this.
(16:08):
What are the signs?
Let's go over the signs realquick.
Okay.
Your schedule is not full.
And the reason why I want us togo over this again is because I
want you to think about it.
There's nothing we've talkedabout here that is a problem.
It's not a problem, it's aproject.
It's not a problem.
It's a project.
So my schedule is not full.
Means I'm not ready right thismoment to hire.
But it does mean I have aproject.
(16:28):
I need to fill up my schedule.
I need to figure out how to dothat.
I need help actually I'm comingto the profitable private
practice movement with Dr.
Una so I can start working onthat.
Okay?
All right.
Cash flow is inconsistent.
Maybe you've never met with yourbiller.
Maybe they just send you randomreports and tell you everything
is good.
And because there's enough moneyin the bank to meet payroll, you
don't even bother about it.
Now you start meeting with thebiller.
(16:49):
Maybe you start learning whatthose numbers mean.
You start learning what are thefive metrics I should track
every month and all of thosethings.
And then start that process andstart paying attention to your
cash flow.
See, you we don't idolize money,we don't worship money, we don't
say money is the number onething.
We don't do any of those.
But as an entrepreneur, you arerequired to respect money.
(17:09):
We don't just like, oh, I don'ttalk, I don't do anything with
the money.
No, we don't we don't get to dothat.
Okay.
We have to respect the money.
So we pay attention to where itis, where it's flowing to, is it
flowing in the right amounts,all those things.
Okay.
Okay.
Number three.
So we again just make it aproject.
Number three, we don't have apredictable patient acquisition
system.
Okay.
(17:30):
And you're like, okay, I don'thave a predictable system.
I just take whoever comes.
I think we're just going by wordof mouth and all of those
things.
Great.
Now we're gonna flip it andwe're going to make this a
system.
So when our schedules are notfull, we know what to dial up to
fill it up.
When we bring on a new doctor,we know what to dial up to fill
it up.
Number four, you don't know yournumbers.
You don't know your numbers.
(17:50):
Again, this is just a project.
What numbers do I need to know?
Let me go start knowing them.
Okay, revenue per visit, mypatient followings.
Well, that looks like mybreak-even point.
Take a look at my profit andloss state and start looking at
those things, start knowing mynumbers.
Okay.
Again, it's a project, it's nota problem.
There's no problem.
We have not discussed a singleproblem on this episode.
Number five, you haven'tembraced the role of a leader.
(18:10):
And then you're like, okay, Ihave a project.
I'm going to embrace the role ofa leader.
Notice I did not say you havenot become a perfect leader or
you have not become the greatestof the great leaders, right?
You start that process.
So what does that mean?
I never meet with my team.
Now it's time to meet my team.
I need to start casting vision.
I've never held my teamaccountable.
It's now time to meet themaccountable.
I have never given them metricsthat this is how you know you're
(18:31):
doing a good job.
Now it's time for me to do that.
Again, these are all things thatwe do in the profitable private
practice movement.
So if you're like, I don't evenknow where to start, I will tell
you exercise on training.comforward slash movement.
Start, come join us.
Okay.
So these are the things that youlook at.
And you can start with a simple90-day project and you're like,
you know what?
I'm going to do these things,whichever ones are missing.
(18:51):
I'm going to work on these forthe next 90 days and put us in
the best possible position tostart bringing a doctor on,
especially if you're burned out,you're tired.
I just need another doctor andall.
Let's get this stuff taken careof.
And the truth of the matter isas you take care of this, you
will feel less burnout.
You'll feel much happier.
You'll be in a much better stateto bring this doctor on.
And then you can put out that adand start getting ready to bring
a doc on.
(19:11):
But please, please, please,please, please get yourself in
the best position to bring a docin, to get their schedule full,
to get ready.
And because when you do it thatway, you can get your doctor
busier faster.
You can protect your cash flowas you bring the doctor in.
And then you can create morecash flow as they do what they
(19:32):
need to do.
So I'm rooting for you, rootingfor you, like unbelievably,
because of course you can dothis.
So many people have, and you cando it too.
If you need support from my teamand for like, how can you guys
work with me to help me pullthis off on traind.com forward
slash call?
We'll be happy to walk youthrough everything we do.
And of course, we do not do highpressure sales or anything like
(19:52):
that.
Okay.
So create your project.
And this is really the picture Iwant you to hold.
I want you to hold this pictureof your schedule being full, of
cash flow being good, of youleading your team, of you
understanding your numbers, ofyou having a system that creates
patience, like you know how tocontrol your schedule.
Like just imagine that.
(20:14):
And then you bring a new doctorinto this match.
Just think about that.
So I want to hold that pictureas you do this work, this 90 day
project to get your practicewhere you want it to be.
Okay.
Don't believe the lies, youcan't do this.
Of course, you can.
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