March 23, 2026 • 46 mins
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You asked. Dr. Una answered.
In this episode, I'm taking real questions from physician entrepreneurs on some of the most common — and most costly — challenges in private practice. From combating no-shows in a Medicaid-heavy practice, to building a brand from scratch, to scaling past $40K a month without burning out, this Q&A covers a lot of ground with practical answers you can actually use.
I also get into how to think about time when you're juggling a practice, a side job, and a family — and why simplicity is the move every time you want to grow.
Tune in and get inspired!
Key Takeaways:
- 00:00 How to reduce no-shows in a Medicaid-heavy practice
- 02:35 Why every physician needs to build a brand
- 07:00 Google Business Profile: your most underused referral tool
- 09:55 Finding your ideal patient for a cash-based practice
- 14:25 Growth strategy for private pay practices
- 18:00 How to scale from $40K to $80K a month without burning out
- 22:05 Why complexity is the enemy of scale
- 27:55 Balancing practice, side job, and family as a physician entrepreneur
- 36:05 How to stop putting out the same fires over and over
- 43:00 Why you should hire for profitability, not affordability
Additional Resources:
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- YouTube: https://www.youtube.com/@DrUnachukwu?sub_confirmation=1
EntreMD is a podcast dedicated to all physicians who want to venture into entrepreneurship, grow their personal brands, and build wealth while doing what they love.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
When things feel overwhelming, the place you want
(00:02):
to start from is looking at whatyou're offering.
Looking at how much time it'staking.
And then looking at what wouldbe a simpler way to do it.
Why?
Complexity constraints.
Simplicity scales.
You cannot scale a complexsystem.
Hi Doc.
Welcome to the OnCham D podcast,where it's all about helping
(00:23):
amazing physicians just like youembrace entrepreneurship so you
can have the freedom to livelife and practice medicine on
your terms.
I'm your host, Dr.
Imna.
Hi, everyone.
Welcome to this Q ⁇ A session.
Super pumped we can do this.
As we got into 2026, one of ourpriorities, like the priority of
(00:47):
priorities, is to set the stageto make seven figures the new
floor for physicians everywhere.
And so that this puts us in aposition where we understand how
to thrive with all thechallenges and everything going
on.
And so we are pretty clearthat's a Herculean task, but
we're also very clear that we'reequipped for the task, right?
And so that's what we've beendoing in the entrepreneur
(01:09):
business school.
That's what we've been workingon in PPPM, all of that stuff.
And I figured, why don't we justcome here and help doctors work
through some things, create somebig wins in their businesses and
stuff.
We had a number of people whohad filled out the form that we
had to ask questions, but thisis what I will tell you.
We're not going to answereverybody's question, right?
It's just not possible to dothat in the time frame that we
(01:30):
have.
However, when a question isasked, I'm not going to answer
it for just the person.
So I want you to approach thiswith a growth mindset.
I want you to approach thiswith, I am going to get the
nugget I need to move forward inmy business.
And that's the idea, right?
We don't have to fix everythingtoday.
We can change our direction andstart moving in the right
(01:52):
direction with the mostimportant thing.
Okay.
And that's how we keep ourselvesfrom getting overwhelmed and all
of those things.
Okay.
All right.
Good stuff.
Good stuff.
All right.
So, Nikita, do you want us tostart with the questions that
people had already filled out?
SPEAKER_00 (02:03):
Dr.
Woodward said, in yourexperience, what has been the
best way to combat no-shows?
We have a huge population ofMedicaid patients, so we can't
charge them a fee for theinconvenience.
SPEAKER_01 (02:14):
This is a great question.
My first business is my privatepractice, which we've had for
about 15 years at this point.
We run between 60 and 70%Medicaid and it's
insurance-based practice.
So I feel your pain.
Okay, so this is what we havedone.
And I think the starting pointof this, which is helpful for
everyone, is realizing thatevery problem has a solution,
(02:35):
right?
Because what happens is I acceptMedicaid.
And so that means I just have tohave an empty schedule because
they know sure that's what theydo.
And so for us, we did twothings.
The first thing we did is weinstituted a policy that if you
missed three appointments, wewill dismiss you from the
practice.
And we did that because I couldhave said, I don't want to take
(02:58):
Medicaid, or I could limit, Icould have limited Medicaid and
all of that.
But you know, I for me, and I'mnot recommending this is just my
thing.
I figured I want them to haveaccess to great quality care.
And I will do that.
But if I'm going to do that,then you're going to respect my
schedule.
And so if you no-show threetimes, we would dismiss you from
the practice.
And so that way you couldn'tonly be a repeat, repeat
(03:18):
offender for so long.
So that was the first thing thatwe did.
The other thing we did is wecalculated our no-show rate and
we factor that into ourschedule.
So what that means is if Iwanted to see 25 patients and I
know between no shows andsame-day appointments, I would
need to start my day with 28 toend up with 25.
(03:39):
Then I would schedule 28.
And so when people no-show, I'mactually like, thank God, not
now my schedule is empty.
Do you see that?
Now now the reaction to thatchanged because I'm like, okay,
so we'll end at 25.
I don't have to kill myself thispatience.
Yeah, some days I saw 32 orwhatever needed to happen, but
that's the thing.
So the first is I put someconsequences.
I can't charge you, but I can dothings.
(04:00):
I have powers.
And then the second is Ifactored in the no-shows and
just increased the amount ofpeople that I scheduled on uh I
put on the schedule.
Yeah, that's what we did.
And then the third thing is thiswas more for the people who
worked with me than me, is Isold them on the idea of
flexibility.
Because sometimes the doctorwill say, Well, why are they 28
patients on my schedule?
(04:20):
And I'm like, How many timeshave you actually seen 28
patients?
You know what I mean?
And some days they'll see 28 orthey'll see 29.
And so this is the way I put it.
It's funny, but this is what Isay.
If I don't ask you for a refundon the day that you see 21
patients, you're not going tobother me the day you see 29.
Right.
So we have that flexibility,knowing that my job is to make
(04:41):
sure that your average staysyour average, but some days it
will be more, some days it willbe less.
I can guarantee the average, butI cannot guarantee day to day
because with the Medicaidpractice, you just can't.
Right.
So those are the three thingsthat we've used and it served us
really well.
SPEAKER_00 (04:55):
We did have a question in the form, and this
question says, How do I getstarted creating and building my
brand?
Which Dr.
No, you always say everyphysician needs to build a
brand.
Every physician needs a brand.
SPEAKER_01 (05:06):
Okay, so that we can probably do an hour-long
training on it.
So we'll talk about how tostart, not the whole thing.
Everyone needs a brand.
Your brand is in the simplestterms, think of it as your
reputation, right?
Especially online, yourreputation.
It doesn't matter how good youare in the mind of your patient.
Like it matters, but it doesn'tmatter how good you are in the
(05:28):
mind of your patients.
It matters how good they thinkyou are.
If you get this, you get therest of the stuff.
It doesn't matter how good youare.
It matters how good they thinkyou are.
So if you're a great physician,but they go on there and your
reviews are 2.3 stars, in theirminds, you are a 2.3 star
physician.
Even though you truthfully are afive-star physician, because you
(05:49):
know, somebody was just mad youwanted them to pay a copay
before they went in and theywent and trashed you online.
Right.
And so we can't have accidentalbrands.
We can't have cruise controlbrands.
We are great, then we curate theperception of greatness in the
minds of our patients.
And someone may say, but it'snot fair.
(06:11):
I know I do good medicine.
When they come, they'll seethat.
If they come, because if youhave 2.3 stars, they're not
coming.
You see what I'm saying?
This is you engineering theperception people have about
you.
Now, are we making up stuff?
No.
The greatness that's happeningin the exam room needs to
feature in other places wherethey can find because they're
not going to come in the examroom to see it.
(06:32):
Right.
And so if I was to say where tostart, especially if you're
trying to ramp up your practice,the first place would be your
Google business profile.
That would be a place to start.
And this is a funny thing if youthink about it.
Let's say you are in Dekula,Georgia, and you Google internal
medicine doctors, Dacuula,Georgia.
There is a chance your websitewon't come up, but your Google
(06:55):
business profile will.
Because Google is going to ranktheir stuff higher than your
stuff.
And so that's the case.
You want to control what thatsays.
That is like a website you have.
Your Google Business profile islike a website you have.
So you want to make sure youhave reviews that are there.
You want to control that.
Now, is somebody gonna go leaveyou a one-star review?
(07:16):
Yes.
They leave one-star reviews forDisney, they leave one-star
reviews for Apple, they leaveone-star reviews for everybody.
So if you get a one-star review,congratulations.
You are now human.
Okay.
So, but then again, that'ssomebody going to do that.
What of all the people who tellyou the best thing size says
sliced bread?
Do you ask them to leave youreviews?
Do you have a system for peopleleaving your reviews?
(07:37):
These things matter.
I would start there for yourdescriptions.
You want to make sure they'reSEO optimized.
So for those of you who are inthe profitable private practice
movements, we got you a tool todo that.
You want to make sure it's SEOoptimized so that way Google
becomes a true referral sourcefor you.
You can update the pictures, allof those things, but you want to
pay attention to that.
(07:58):
Okay.
So that's one thing I'll tellyou to do.
The second thing I'll tell youto do is referrals, referrals,
referrals.
You want to build a greatreputation amongst the people
who can send you all the people.
And so if you are an introvertlike me or shy or a private
person, that's awesome.
And you're an entrepreneur.
(08:18):
So you're going to buildrelationships, you're going to
talk to people.
And it's a skill.
You can do it.
You can learn to do it and youcan do it.
And so I would look to cultivatesomewhere between meaningful
relationships with someonebetween six to 12 people who can
send me people.
Those two things are things thatcan get you busy, get your name
out there, get the no trust outthere, right?
(08:40):
Because I'm a pediatrician.
And if I had six OBGYNs whopreferentially referred to me,
that's a lot.
That's a lot.
And it would matter.
And when they refer, guess whatthey're going to do?
They're going to go Google you.
And so when they Google you,they meet your optimized
business profile.
And they're like, oh, what thedoctor said is true.
Because look at what otherpeople are saying over there.
Right.
(09:00):
So I would start from there.
If you notice, I'd not sayanything about logo.
I'd not say anything aboutcollars.
I did not say anything aboutwebsite and all of those things.
All of those things arefantastic, but I wouldn't start
from there.
I would start from these twothings because these are the
things that are closest to themoney.
SPEAKER_00 (09:14):
Okay, Dr.
Ali says, what are the top threethings you would tackle and open
up a cash-based integrativemedicine practice?
So pretend you're starting allover and you're going to open up
a cash-based integrativemedicine practice, and you want
to have a full panel before youstart.
SPEAKER_01 (09:29):
Yeah, so if I were starting over and I was starting
a cash based practice, I willstart by looking for where my
ideal people are.
Now let me explain what I meanby ideal.
The ideal patient is notsomebody who needs what I do.
And I'm gonna pause and I'mgonna let that sink.
Your ideal patient is not theperson who needs what you do, is
(09:52):
the person who wants what you doand is willing to pay.
A lot of times the people whoneed what you do, they don't
want it and they will not payfor it.
So who is the person who issomewhere sitting up at night
saying, Oh my goodness, if Icould just find somebody who did
X, who is that person who hasthe pain, is aware of the pain,
(10:17):
is ready for a solution, and iswilling to pay for said
solution.
I will find out who they arewhere they are.
It's a cash bay practice.
Chances are these are people whoalready pay cash for other
things, right?
Sometimes I see people who havecash bay practices and they're
(10:38):
trying to sell people who haveinsurance on not using
insurance.
I wouldn't do that.
I wouldn't do that at all.
There are people who pay for theconvenience.
There are people who pay forseeing one doctor rather than by
being in a place with 10doctors.
They're people who will pay forthat right now.
Some of them are professionals,they're too busy to do things
other ways.
And guess what?
We are all connected to tons ofprofessionals, right?
(11:02):
So I would take the time tofigure out who that person is,
where they're gathered.
Okay, so the first is who thatperson is.
Then the question is where arethey gathered?
And so for instance, if I'm acash pay practice, well, which
other cash pay practices willrefer to me?
A lot of times the people doinginsurance will not refer to you.
Now, there's scenarios wherethey will, right?
Especially if there's a longwait time for what you do and
(11:22):
all of those things, but a lotof times they don't understand
the model.
So they won't.
Who are they already paying cashto?
It may be other cash paypractices, it may be coaches, it
may be health coaches.
Do you know?
I met a health coach thatcharges people$75,000 a year to
work with them.
Now that's somebody you want toknow, because if people are
paying$75,000, they'll pay youtoo.
(11:43):
So who are they?
Where are they gathered?
And who serves these people indifferent ways?
So I can go after that, right?
And then the things I talkedabout building a brand, I would
go all in on that.
All in on that.
Start collecting emailaddresses, sharing your journey
of starting your practice, likealmost like reality TV, not the
(12:05):
drama, but just taking people onthe journey that grows the no
like and trust factor.
So that's the way I that's theway I would do it.
But the important thing is tofind who is my person who will
throw money at me.
Like just take this, but makethis problem go away.
That's your ideal person.
SPEAKER_00 (12:20):
I think this one is kind of a piggyback on it.
This is from Dr.
Zink.
Can you tell, talk about how todo things a bit different for
cash-based practice versusinsurance-based?
My practice is private paypsychiatry.
I've been working super harddoing all the visibility,
networking, speaking, podcasts,Google Business Profile
Optimization, et cetera, etcetera.
And I would probably have a fullschedule if I took insurance.
(12:42):
I get a lot of increase frompeople who don't understand I
don't take insurance.
But I feel growth has been slow.
So I'm wondering if there's abetter strategy for cash
practices.
So I've guessed what you've saidso far, Dr.
Uno, right?
Going back to who's their idealpatient.
SPEAKER_01 (12:56):
So one again is who is my ideal person, right?
There, there's somebody whowants exactly what you do.
The people who already tell you,Dr.
Zink, that you're the best thingsince slice bread, start
studying them.
Like, why do they say that?
Are they professionals and theirtime is valuable to them or
their privacy is valuable tothem or what whatever?
Like, start paying attention tothem, your best clients, the
(13:18):
people you love working with themost, the people who they're
excited, they pay you withoutthinking about it, right?
Who are they?
And why are they saying that?
Because they're more, there'smore of them.
It's important to know who theyare.
It's very different from theinsurance model.
Now, when it comes to referrals,it's the same thing.
Where are the DPCs?
Where are the DSCs?
These are the people you want totalk to so that they can refer
(13:38):
people to you.
Again, the insurance people maybe unsure about it.
The other thing to do is itdepends on where you are.
Many places, the list to see apsychiatrist is 72,000 miles
long.
And so people cannot get in.
So now you become desirablebecause you can get people in
soon.
So look for the doctors whocould be insurance-based, but
they're hurting because theycan't find anybody to send their
(14:01):
patients to.
And you're like, I will happilysee them.
I can get them in in 48 hours orwhatever your number is.
These are my rates.
So they can wait or they canpay.
And in those circumstances, manypeople will pay, right?
And so I will pay attention tothat.
Who are my ideal people?
Who are my ideal referrals?
And where can I solve a pain,even though I'm not accepting
(14:21):
insurance?
So if you have a long wait likemany places, they will do that
too.
And not that you're going toconvince people insurance or
cash or whatever, becausethere's no convincing really.
But when people call you andthey say, Oh, I thought you took
insurance, and you can say, No,we don't take insurance, so that
(14:42):
you can have access to apsychiatrist, so we can get you
in within 48 hours.
So you can have this and so youcan have that.
And many of our patients, that'sthe why, even though they have
insurance, they will come workwith us.
Do you see what I mean?
So you want to, between you andyour team, you want to have a
way of responding.
I will invite you to dig deeper,right?
(15:03):
Like my ideal people, my idealreferrals, spread it wide, put
more urgency, put more volume,right?
And so, because in the processof doing that, it's almost like
a boil that's come to head.
You find the head, and it'sweird, but we're doctors, you
can handle it.
But you find that, right?
So keep going and keepoptimizing.
(15:24):
Even if it feels like it's thesame thing.
How can I do this better?
How can I do this morestrategic?
Who am I missing?
What angle can I try?
What language can I try?
That's the way we do it till wefind the thing.
I've been, I've run on TriMD forthe last seven years.
We'll be eight years inSeptember.
Like the things you're doing,I'm still doing.
After all these years and afterall this impact, after all this
(15:45):
revenue, it's not something yougrow out of.
It's just something you getbetter and better at.
And the better you get at it,the better the results will be.
So you got it.
SPEAKER_00 (15:53):
This is a question from online.
I am enrolling an average ofeight new members per month in
my concierge longevity practice.
But I'm the bottleneck.
I can't keep up with plancreation, team oversight, and
marketing.
What is the smartest nextstructural move to scale from
$40,000 a month to$80,000 amonth in the next eight to nine
(16:17):
months without burning out?
Is it hire a physician, apractice manager, or restructure
my offer?
SPEAKER_01 (16:24):
As we grow our businesses, as we grow our
practices, we will stumble onbottlenecks, roadblocks, and
they will seem impossible.
The good thing about growth isthat you grow.
The downside of growth is thatyou create brand new problems.
Like the reward for solvingproblems is more problems.
And so the better you get at,first of all, normalizing the
(16:47):
problems and getting better atnavigating the problems makes
your life so much better, right?
So that's the way that works.
So now if we look at this doc,she has a concierge practice and
now she's getting eight newpatients a month, which is
fantastic.
Okay.
But now it's bringing to her toa point where she's like, I
can't keep up between the plancreation, the marketing, the
(17:09):
team, managing the team.
So what do I need to do?
Okay.
So let me walk you through how Iwould think about this.
A lot of times for doctors, welove to over-deliver, which is a
great thing.
But a lot of times when we arein cash-based businesses, it
also puts us in a position wherewe start off saying, okay, I'm
(17:33):
going to offer these threethings with my concierge
package, but oh, it'd be nice ifthey get this other thing.
Oh, oh my goodness, it'll benice if they get this other
thing.
Oh, I'm going to add this othertest.
And before we know what isdoing, where what is happening,
we're doing five times the workthat we set out to do.
And so it doesn't matter if youget two patients or four
patients, I'm overwhelmed.
But of course, because it's justway too much work.
(17:54):
Way too much work.
And we don't factor in, okay,maybe I can use the team and
leverage the team to do thispart and all.
So it's not too much work forme.
And so when I see people,especially in a cash bay model,
a lot of times the first placeI'll look is how complex are the
visits?
How complex have we made them?
How much extra stuff have weadded to?
(18:15):
How many extra steps did we addto them?
Sometimes we feel, well, becauseI'm charging them this much, I
must add all these features andall these benefits and all these
bells and all these whistles.
But a lot of times all thosethings still take us to the same
place the simple stuff wouldhave taken us to.
Right?
And so the question then becomesthis person is paying me not for
(18:36):
bells, not for whistles, not forfeatures, not for benefits.
They are paying me for anoutcome.
What is the simplest, cleanest,most elegant way to get them
this outcome?
A lot of times it's lesscomplicated than what you're
doing right now.
And so when things feeloverwhelming, the place you want
to start from is looking at whatyou're offering, looking at how
(18:58):
much time is taking it, and thenlooking at what would be a
simpler way to do it.
Why?
Complexity constraints,simplicity scales.
You cannot scale a complexsystem.
You cannot.
So if someone comes in, if Iwere coming into your business
as a consultant and you're like,okay, over the next 18 months,
(19:18):
we want to bring in scale, wewant to do all of these things.
The first thing I will look foris to gut out all complexity.
Because if we don't remove that,you cannot scale.
Do you know why you can havetrees at scale?
Because it's not complex.
There's one tree, there's areproductive system in the tree.
So one tree makes another tree,that makes another tree, and
(19:40):
then that makes another tree.
Now imagine if every year theyneed to there needed to be the
creation of brand new trees fromscratch, out of nothing.
Right?
How many trees would we have?
Not many.
It's important.
Whatever your business is.
Like now, when I have new thingsto do, I'm thinking, what is the
(20:03):
simplest way I can do this?
How do I document it?
How do I do it in such a waythat I can train somebody else
to do it and be done?
Like I'm thinking that way fromthe beginning.
Okay.
And whether you're aninsurance-based practice or any
other kind of practice,simplicity, how can I make this
simpler?
How can I make this?
This is the million-dollarquestion, like literal millions.
Okay.
(20:23):
So the first place I'll look isthat how can we make it simpler?
Then two is how can we delegateaspects of it?
So we have a visit that takestwo hours.
Well, what portion of that doyou need to be there for?
What part of that couldtechnology do?
What part of that could a teammember do?
Right.
And so it doesn't have to be allyou.
And in the beginning, it's easyto say it has to be all me.
(20:44):
It doesn't have to be all you.
So that you look in it, you'relike, okay, what part can my
team do?
What part can technology do?
What could pre-filled forms takecare of?
What could like these are thequestions you're asking?
So maybe it's a two-hour visit,but it ends up being 30 minutes
of your time.
And you might say, but they'repaying me.
No, they're paying yourhealthcare system, aka your
(21:05):
practice.
If you want to have a privatepractice that helps a lot of
people while creating timefreedom and financial freedom
for yourself, you want to have apractice that is a system, not
you.
The idea is my business isgetting them a result.
It's not I am getting them aresult.
If that's the case, you cannever retire, you can never go
(21:26):
on vacation, you can never taketime off.
And whenever you're out of thebusiness, it cannot make money.
We were celebrating a doctor inthe profitable private practice
movement today who said, I am onmy seventh week of maternity
leave, and my practice is justthere making a profit.
It stayed profitable the entiretime.
So if she was the only one doingeverything, that would never
(21:47):
happen.
But here she is, she has a baby.
I was like, congrats on that.
She took the time off, congratson that.
And her practice is not dying.
Like it's still generating aprofit, it's still changing
while she's hanging out with herbaby.
So that's the second place.
I didn't even talk about a hire.
This is the team that she thedoctor already has, right?
So those are the two places Iwould look at first.
(22:10):
And then if the team isoptimized, the doctor's time is
optimized, the visit isstreamlined, then we can then
talk about who do we need tohire to take this further.
But the thing is, if you try togrow a chaotic system,
everything falls apart.
Let me backtrack on that becausesomeone said, but my business is
chaotic.
Well, your business is and willalways be a construction site,
(22:31):
so there will be an element ofchaos.
But if you every time you wantto make a big leap, you have to
stop and simplify, then leap,simplify, then leap.
That's the way that works.
And that is a good approach,whether you feel like you're the
bottleneck or not, right?
Is like, how do I simplify this?
In my practice, we have what wecall the assembly line, door to
(22:52):
door.
Somebody walks through the door,take care of them, do all the
things, they walk out the door.
We call that the assembly line.
So they come in, check-in,roomed, vitals, doctor, doctor,
postdoc, checkout, right?
We have a whole thing.
And so we're constantly going,where's the bottleneck?
Where's the roadblock?
Where can we simplify?
Why?
Because the more efficient thatis, the happier the patients
(23:14):
are.
Then we can see the number ofvisits we need to see, and the
doctors don't feel like they'vebeen on a treadmill all day.
Simplicity.
Simplicity.
SPEAKER_00 (23:22):
Dr.
Padma and Dr.
Gentil's questions are verysimilar.
So I'm kind of gonna read themtogether.
They're both about timemanagement as a physician
entrepreneur.
And I think a lot of peoplestruggle with that, right?
Dr.
Padma's question is around sheheard Dr.
Una simplicity scales.
Okay, I'm gonna simplify thisstuff.
I'm gonna do my marketing.
(23:43):
I'm gonna do all this stuff.
But then she spends the dayputting out fires.
And then Dr.
Gento says, How do I balance allof it?
Because I've got my practice, Ihave a side job that I'm working
at for more income, and I haveto try and strategize to make
this practice work.
And I have my family.
So how do you do it all, Dr.
Una?
How do you do it all?
(24:04):
How do I?
SPEAKER_01 (24:05):
First of all, hugs, private practice is no joke, but
we can win.
We can win.
But it's not a walk in the park,especially in the beginning.
It's not a walk in the park, butit's a worthy walk, really
worthy walk.
Figuring out how to thrive inprivate practice has made it
possible for me to have thefinancial freedom to pursue
starting on-trame D.
I hope you understand it'sridiculous, right?
(24:25):
The on-traMD business schools.
I was talking to Makita aboutthis, started in June of 2020.
Does anybody remember what washappening in June of 20, like in
the middle of a pandemic whereprivate practices were going out
of business left, right, andcenter?
So, and I didn't even realize itwas in 2022.
So I asked me, when did businessschool start?
I said in June of 2020, like atthe beginning of the pandemic.
(24:46):
I thought about it, like, wow,that's crazy, right?
But it gave me the freedom topursue what I believe is my
purpose, part a huge part of mypurpose, why I'm here on the
planet, and all of those things,and write the books and do the
podcast and create the programsand all of those things, and to
homeschool my kids becausethat's what I wanted to do.
It's worth it, is the point I'mtrying to make, but I'm not
going to tell you it's easybecause then I'll be lying to
(25:06):
you.
Okay.
Okay.
So let's start with, let's doDr.
Simone's first, and then we'llcome to Dr.
Podman.
So, how do you balance workingon the practice, the jobs, the
time to plan, to strategize, andall of those things?
I will tell you what I did, andI came into agreement with my
husband about this.
Okay.
In the beginning, you have torealize that the dream costs
(25:29):
what it costs.
For me, when I started myprivate practice, it was insane.
Like starting the on-trainedbusiness school in June of 2020
was crazy, but private practicewas insane because I had a
four-month-old and atwo-year-old.
And I didn't have any profitableprivate practice movement or
(25:50):
on-train-d podcast or any ofthat stuff.
I had no clue what I was doing.
Okay.
And at the same time we startedthe practice, my husband and I
started a church.
Okay.
So that means I had fourchildren.
Okay.
If you add everything together.
And we applied for loans.
I didn't go to medical school inthe US.
I went to the University ofNigeria.
And I moved here after that todo my residency.
(26:11):
I moved back.
I was born here.
But in those days, you didn'tneed to get a social security
number when you were born.
So here I came 26 years later.
I was like, I need a socialsecurity number.
Guess who gave me a socialsecurity number?
Nobody.
And so it took me forever to getthat.
So guess what?
I had no credit history.
I couldn't qualify for a loanfor my private practice.
(26:31):
I tried, nobody would give memoney.
And even the people who couldhave given me some money,
they're like, you're asking fortoo little.
Like we only do from$200,000.
And I'm like,$200,000?
That's like a house.
I'm not doing that.
And so we made the decision toself-fund the practice, which is
fancy speak for.
I did shifts at the local urgentcare.
I did that for two years, thefirst two years of my practice,
(26:53):
self-funding.
So that way we could take careof what we need to take care of
for the family and take care ofsomething it bills for the
practice until we could do whatit did.
So the decision we had to makeis we're going to self-fund
this.
And so because we're going toself-fund this and we have the
practice, we have the two littlechildren, we have the church and
all this stuff, it's going to beinteresting.
(27:15):
We're still going to prioritizeour families.
So we still had our date nightevery Tuesday.
We're still going to prioritizeour children.
So my husband was with them.
Sometimes I'm with them and allthat, but it is going to look
different.
We are going to need to dolonger hours.
We are going to need to do scarythings, right?
But the idea is because I knowthat and because I only want it
(27:37):
to be for a time frame, I don'thave time to play.
Do you understand?
I don't have time to say I'm nottalking to referral sources.
Uh uh, because every time Ispend doing that, I'm not
growing my practice.
So I have to spend more timeaway from my family.
I'm not saying I'm not gonnacollect copays and I'm not gonna
ask for reviews and all of thatbecause I'm shy or because
(27:59):
whatever.
Because I don't have time.
I have to put in the work so Ican get out of this phase.
There is a time season whereit's gonna be interesting.
But you decide it is what it is,I can make this interesting
season last a year, or thisinteresting season can last
seven years.
It all depends on how I show up.
(28:22):
So, Dr.
Simone, you are doing what Idid, it looks like, right?
You have the practice, you havethe job, working on the
business, you have the time forfamily.
What that means is you ain't gottime to play.
Okay.
You the 20% activities that youneed to do, you feel like when
people are like, I'm too scaredto do this, you just jump in and
do it because it's either I doit now and then I have all the
(28:43):
time I want in a year or in twoyears, or I wait seven years and
I'm not waiting seven years.
Okay, so you don't have time,you don't have time to play.
So what that means is when I'mat work, when it's time to see
the patients, I see thepatients.
When it's time to do thebusiness, I do the business.
I collect all my co-pays, all mydeductibles.
If I need to raise prices, ifit's cash pay, I'm raising the
(29:04):
prices, I'm leveraging my team,I'm doing all the things because
I don't have time.
If you can put your head downand do it that way, then what
that means is every month youhave more and more time.
Every month you have more andmore time.
So now I'm in a place where thepractice can work without me.
I've homeschooled my kids foryears.
I have the freedom to do fourother businesses and all of that
(29:27):
stuff.
But it costs me in thebeginning.
You treat your time like everyhour is worth a thousand
dollars.
The same way you will open yourdoor and throw out a thousand
dollars.
You don't waste an hour.
You invest the hour becauseyou're like, I need to get out
of this stuff, right?
Yeah.
The things you need to learn,learn them quickly.
Learn them quickly because youain't got time.
(29:49):
Okay, so if you're in PPPM, leaninto that.
Your EBS, lean into that.
You have the Profitable PrivatePractice Praybook, read it.
Read a chapter, do the chapter,read the chapter, do the because
you don't have time.
You need to pull yourself out ofthat so you can let go of the
job, right?
You can let go of the job, focusfull time on your practice.
You have more time for yourfamily, right?
Your children are younger now,and as they get older, you have
(30:11):
more time with them.
It would be fantastic, but youain't got time to play.
And then having said that, allthe help you can get, take it
all.
Don't be afraid to ask for help.
People ask you for help all thetime, and you say yes.
So now it's time for you to askpeople for help.
Ask people for help.
Makita will tell you when I waspregnant with my baby, Makita
stayed at stayed in my house,helped me walk with my kids, did
(30:33):
all of that stuff.
Ask for help.
There's no award for doing ityourself, especially for the
mommies.
Hear me, mommies.
There's no award.
There children don't get likeadults don't get together and
say, Did your mommy get help?
Oh shoot, what kind of mom isthat?
My mom did it all.
Nobody, nobody remembers that.
There's no award, nobodyremembers it.
Take all the help you can get.
Dr.
Padma asked a question.
(30:53):
I start my day with motivationfor marketing and all of those
things.
I feel I put out a lot of firesevery day.
Okay.
Dr.
Padma, there are a number ofthings that have helped me with
this, okay?
If you can schedule when youaddress the fires.
Except it's a true fire burningdown a building, right?
So for instance, oh, this momwas upset.
(31:15):
She needs a call back, blah,blah, blah, blah, blah, blah,
blah.
Great.
I have my flex time scheduledfor 3 p.m.
I'll call her then.
Oh, I need these five formssigned now today, blah, blah,
blah, blah, blah.
Awesome.
Hold them all, bring them to myoffice at 3 p.m.
My team knew that.
Anything you want me to do, Iwill do it at 3 p.m.
Except somebody's actuallycoding, don't get in my way.
(31:36):
So that way the fires arecontained.
Do you see what I mean?
And it doesn't feel like you'reputting fire because that's the
tyranny of the urgent.
On the other side, Dr.
Potna, if you adopt this, itwill be a game changer for you,
which is now when you put outthe fire, you ask yourself the
question, why did that firehappen?
What is broken in my system?
(31:57):
And not remember, we observe, wedon't judge.
So this is not I suck, my systemis broken.
No.
What is broken in my system thatmade this fire possible?
What do I need to do so thisdoesn't happen again?
Do you see that?
And what that will do is it'llput you in a position where in
your journey as an entrepreneur,you just get less and less
fires, or you get bigger fires,meaning you've graduated.
(32:19):
Now you're having high-levelfires, not lower level fires.
Do you see what I mean?
And so you can schedule thefires, but you want to get to
the root of the fires and startputting those out.
It will show you parts of yoursystem you can work on.
I'll give you an example.
It's not quite a fire, but letme give you an example.
In our pediatric practice, wehad started, this is many years
ago, we had started doing earpiercings and stuff like that.
(32:42):
Then my phone would read off thehook all day, people asking
questions about ear piercing.
I'm like, this is insane.
I told I went to my front deskperson, I gave her a piece of
paper, I said, write down allthe questions they're asking.
What am I doing?
I'm a systems engineer.
I'm like, what is going on here?
(33:02):
Right?
All the questions.
Okay.
And so she wrote all thequestions, according to the
answers, gave it to my websiteperson.
I said, create an FAQ for theear piercing stuff, put it
there.
The phone calls went from agazillion to one a week.
Do you see what I'm saying?
So when you see that, it's like,oh, these people don't stuff.
No, you're like, but what is thereason?
(33:22):
They got lots of questions.
And they found you, but theydidn't find the answer.
So they're gonna call you.
I don't want them calling me.
You want to do ear piercing?
Schedule your appointment.
We'll see when you get here.
Right?
So that's the idea.
When fires happen, you stop.
Like, you know, what is makingthis possible?
Simplify as much as possible.
Padma, I like the way you saidsimplifies things.
(33:44):
Dr.
Ali, they ask for help.
There is no award for doing itby yourself.
In fact, we had a doctor, shejoined the entream d business
school.
She doesn't have time, she's sostrapped for time.
We got talking and all that.
And turns out all these peoplehave been asking her to help
her.
No, I got it.
I got it.
I said, you will go to all ofthem and say, I got it not.
Okay.
I got it not.
(34:04):
Do you know within two weeks shehad bought back 10 hours of her
time?
10.
Like one, two, three, four,five, six, seven, eight, nine,
ten.
Ten.
Just by saying yes to everybodywho had been asking her, they
had been offering to help her.
There's no award for doing ityourself at all.
Okay.
So in all of our programs, youhear me talking nonstop about
(34:25):
the 20%, how to identify them,how to identify when they change
as you go higher in yourbusiness, how to have the mental
fortitude to do that, likenonstop, because it's the price
for freedom.
If you live in the 80%, I meanyou just have a ton of stuff to
do and little to show for it.
That's just the way it is.
I think every physician needswhat I do, but not everyone
wants it.
So my job is to look for thepeople who want it.
(34:47):
And I'm like, you want it?
Hey, hi, let's do it, man.
I've been practicing for you.
I've been doing this for yearsand years and years.
Let's go.
Okay.
Maximize what we have beforestarting something.
Let's talk about this a littlebit.
Okay.
There is something that I see,and I want to hug the people
that say it.
Like hug and say, okay, we'renot gonna do that.
I started private practice and Iwant to have multiple streams of
(35:08):
income.
So I want to start a side gig.
Should I tell you the truth orshould I pretend?
Should I be politically correct?
Or based on my decade and a halfof experience.
Should I tell you the truth?
Don't do it.
Multiple streams of incomerefers to streams, not trickles.
When you start a privatepractice, that is your main gig,
(35:31):
side gig, up gig, down gig, allthe gig.
It's the gig.
Now, if you're self-funding,that's different, right?
I told you my example, Iself-funded.
I'm so I'm not talking about notself-funding, but when things
get hard, we get bored with ourbusinesses.
Don't do it.
(35:52):
Because guess what you're gonnacome up against when you get to
that same point in your sidegig, you're gonna get bored
again.
Then you're gonna find anotherside gig.
I have seen people start 72,000businesses.
Of course, I'm exaggerating, butyou get the point.
Because every time they hit thatroadblock, ooh, is tough.
Oh, it looks like I need to dothe same thing over and over
again.
(36:12):
Yeah, entrepreneurship is boringin the most exciting way.
If you cannot stand to be bored,it will be tough to thrive as an
entrepreneur.
Can you have 72 businesses?
I mean, come on, we see peoplewho have hundreds of businesses,
yes.
But give the business the effortit will take to grow it, then
(36:32):
build a team, free yourself ofit somewhat, then go to the next
one.
That is how you can be a serialentrepreneur as opposed to
building something that willfall apart.
I cannot tell you how many timesI've watched this.
It breaks my heart every singletime.
Your private practice, you canself-fund it with the job with
the side thing, but usuallythese people mean starting
(36:52):
another business.
If you have twins, you cannotsay, I will feed them once.
They're two people.
You have to feed them twice, youhave to change two sets of
diapers, you have to pay for twocribs, you have to do twice the
work.
Well, most people pick up asecond business and they want to
do the same amount of work.
It doesn't work.
(37:13):
It doesn't work.
And so if you want to havebabies, many babies in the
business world, be strategicabout it.
So you don't have to have painand suffering.
I've watched somebody who builta really successful practice
violate this law and they're onthe brink of losing everything.
Why?
It was not set up in a way tohandle getting all like doing
(37:37):
all these.
Yeah.
So don't do it.
I said it, don't do it.
Dr.
Barbara, uh mindset change forme is that my business is always
a construction site.
It has always been, it willalways be a construction site.
And that's why in all of ourprograms, we push people to
celebrate wins.
(37:57):
Because most people are waitingfor it to all be okay.
That is not a thing, that is nota timeline, that is not a thing
that will happen on this side ofeternity.
There will always be somethingwrong.
And that's okay.
How many of you have somethingthat needs fixing in your
practice?
You've been working at it,you're diligent, you have all
these wins, but something needsfixing.
(38:18):
Like my hand is up.
There'll always be something tofix.
So if you wait to fix everythingbefore you celebrate, you'll
never celebrate.
That will never happen.
That will never happen.
SPEAKER_00 (38:26):
Dr.
Benoit says I have a hybridcoaching and clinical practice.
I'm currently seeing coachingclients one-on-one weekly for
three months.
For patients, it's a six-monthcommitment with monthly visits.
I decided I would place everyoneon a six-month commitment.
But after working with thecoaching clients, I think that
monthly visits for six months isnot enough time.
(38:47):
Should I make it for one year?
SPEAKER_01 (38:50):
So this is the thing.
And I'm guessing coaching wouldbe around what you do, weight
loss, and all the other things.
Usually, coaching for six monthsis not enough, not because a
coach is not a good coach, butbecause there are more results
to be had.
Right?
There are more results to behad.
(39:10):
Actually, it's really funny.
We did a survey of the doctorsin the entreamly business
school, and some of them havebeen there since 2020.
They never left.
And consistently, their resultsare much higher than those that
started in 2021.
And the ones who started in2021, their results are higher
(39:32):
than those that started in 2022.
Because let's say you built apractice and then you're like,
oh yeah, okay, now you know, Iknow to do my code base, I know
to do this, I know how to fillmy schedule and all of those
things.
Well, how about managing yourtime?
That is a whole area of mastery.
And we're talking people who didmillion-dollar practices and
took eight weeks off.
So they had more revenue, moretime off, and their happiness
(39:54):
score, which there's a worldhappiness index, their happiness
score was higher.
But across the board, that wastrue for the people who've been
there the longest.
Like it was increasing as theirlength of time was increasing.
So there's always more to do.
So could you make it a year?
Absolutely.
But you can choose how to do it.
There is no right or wrong.
If you want to do it as asix-month commitment and they
(40:15):
renew, you can do that.
If you want to make it aone-year commitment off the
back, you can do that as well.
There's no right or wrong.
Because I've had people, acoach, I was doing voice
training and she had like foursessions or something like that.
After that, she was like, okay,so it's really nice working with
you at all of that stuff.
I can't help myself.
I love people and I seepotential everywhere.
So when she was done with herspill, I was like, girlfriend,
(40:37):
you're literally telling me towalk away.
I'm willing to work with you fora year, but you're making the
assumption that for foursessions, I'm done.
And so literally, I could payyou X amount of dollars, and you
told the dollars to go away.
And I'm sure after this, you go,pray, Lord, I need more clients.
Like, how shall these things be?
So when you're coaching people,it's not about the timeline,
(40:57):
it's not about the number ofsessions, it's about the
outcome.
We're getting them the outcome.
They want more of an outcome.
I have people work who've I'veworked with in the
entrepreneurial business schoolthat came as employed
physicians.
And now they're runningmulti-million dollar practices.
Right?
We don't care about thesessions.
(41:18):
And then what more do you want?
Oh, I want to build a team sothat I can exit this.
Oh, I want to build this in sucha way I can sell this.
Oh, I want to build a wholehealthcare system.
I want to have 12 doctorsworking for me.
Whatever.
So as long as the outcome,there's still an outcome desire
that I can deliver on, we don'tneed to end the arrangement.
So absolutely, absolutely, butdon't end it.
(41:40):
And don't focus on the sessions,focus on the outcome.
That's the whole point of thecoaching.
Yeah.
Nobody pays for sessions, theypay for transformation.
SPEAKER_00 (41:51):
Dr.
Gerald is asking about familypractice MD or PA in I think
that's Prince George County,Maryland, for an affordable
price in an affordable way.
I guess that's all about hiring.
How do you find a good mid-levelor a good doc or a good yeah?
SPEAKER_01 (42:07):
Yeah, that's the whole production.
But this is what I will tellyou.
The starting point is this youneed to define what it is you
want.
How many of you needed to hire arole?
You went to the internet, you'relike job description of X or
maybe Chat GPT now, and then itgave you a thing and you copied
and pasted and you made it yourown.
(42:28):
We just take whatever we see andadapt it, right?
You want to define what it isthat you want.
So, those of you in theprofitable private practice
movement, you created an idealideal job ad template, right?
And we created that so you cancreate a job description that
attracts who you want and repelswho you do not want, right?
Okay, so that's the startingpoint.
(42:50):
Get clear on what you want.
The reason why this is importantis because of step two.
Step two is then you put that adeverywhere.
So you can put it on Indeed, youcan put it on LinkedIn, you can
put it on all your social mediaplatforms, Facebook, Instagram,
all of that stuff.
You'll see a lot of our clientsdoing it.
We're hiring.
This is why you should work withus, blah, blah, blah.
Okay.
(43:10):
So you put it on there.
You can send it to your emaillist.
Hey, if you know any rock starswho are XYZ, all the physicians
within your network, you tellthem, I am looking.
So when you don't have aproperly done ideal job ad, then
you attract a lot of people whoare not a good fit for that.
You want to have a really tightjob ad.
So that's number one.
Then number two, you want to putthat everywhere.
(43:32):
The same way you would marketfor patients is the same way you
market for a physician.
So you put it everywhere.
You tell everybody that you'relooking.
And then number three, whichcould be a one hour talk on its
own, is you may not be able tofind an affordable quote unquote
doctor, but you should find aprofitable one.
(43:52):
Which means you run your numbersand every role should create
their salary.
The overhead associated withtheir role and a profit for the
practice.
If you didn't get anything outof what we did, anyway, you got
a lot of things out of what wedid today, but don't forget
this.
It must generate a profit forthe practice, cover the overhead
(44:15):
associated with the role, andcover the doctor's salary.
So how many patients would theyneed to see, for instance, for
that to happen?
Okay.
If you're cash pay, how many,what does the panel side need to
be, size need to be for that tohappen?
So you know what to do for thisto be profitable for you.
So when they ask you for acertain amount, you can stomach
it with as long as they'reseeing that volume because it
(44:38):
will still be profitable to you.
So a nice job ad, so it canfilter, you put it everywhere,
you interview all the things,and you define the metrics for
profitability.
Okay, so we want to hire peoplewho will help us serve and earn,
not people who will serve.
This has been so much fun to do.
(45:00):
I want to challenge you to takewhat you got.
The things you've learned,they're really good, but they
create results when you do them.
And so I want to invite you todo them.
And if you're looking forsupport in doing that, you want
the accountability, you want thecommunity, you want to be around
mentorship like this on a weeklybasis.
(45:22):
We have a number of ways ofdoing that.
You can always book a call withthe team.
Akita will be the person.
So you've met her.
She's a physician ally, andactually I'm so honored that
she's on our team.
And so that's ontramd.comforward slash call.
We're happy to talk to you towork you through which program
would be the best one for you.
But as you can see, we're allabout supporting physicians and
helping you guys win.
(45:43):
Okay.
Okay, so leave us a review.
Give me some jewelry.
Okay.
Give me some jewelry.
My birthday was on Saturday.
Give me some jewelry.
And then, yes, again, for thoseof you who want that, at
ontramd.com forward slash call,we have been able to support so
many physicians and see them winin magnificent ways.
Even the movement we celebrated.
Highest revenue ever, greatestnumber of patients ever,
(46:05):
greatest referral sources ever.
Seven weeks of maturity leave,and my practice is still
profitable doing its thing.
And so we want that forphysicians.
We truly are on a mission tomake seven figure businesses,
dream business, dream life thenorm for physicians.
If you look on my vision board,that's what you'll see there.
Right?
That is the norm for physicians.
This whole talk of loss ofautonomy and burnout and our
(46:26):
practices not working and usbeing one trick ponies will all
be historical facts.
That's what we're here to know.
When things feel overwhelming, the place you want
(00:02):
to start from is looking at whatyou're offering.
Looking at how much time it'staking.
And then looking at what wouldbe a simpler way to do it.
Why?
Complexity constraints.
Simplicity scales.
You cannot scale a complexsystem.
Hi Doc.
Welcome to the OnCham D podcast,where it's all about helping
(00:23):
amazing physicians just like youembrace entrepreneurship so you
can have the freedom to livelife and practice medicine on
your terms.
I'm your host, Dr.
Imna.
Hi, everyone.
Welcome to this Q ⁇ A session.
Super pumped we can do this.
As we got into 2026, one of ourpriorities, like the priority of
(00:47):
priorities, is to set the stageto make seven figures the new
floor for physicians everywhere.
And so that this puts us in aposition where we understand how
to thrive with all thechallenges and everything going
on.
And so we are pretty clearthat's a Herculean task, but
we're also very clear that we'reequipped for the task, right?
And so that's what we've beendoing in the entrepreneur
(01:09):
business school.
That's what we've been workingon in PPPM, all of that stuff.
And I figured, why don't we justcome here and help doctors work
through some things, create somebig wins in their businesses and
stuff.
We had a number of people whohad filled out the form that we
had to ask questions, but thisis what I will tell you.
We're not going to answereverybody's question, right?
It's just not possible to dothat in the time frame that we
(01:30):
have.
However, when a question isasked, I'm not going to answer
it for just the person.
So I want you to approach thiswith a growth mindset.
I want you to approach thiswith, I am going to get the
nugget I need to move forward inmy business.
And that's the idea, right?
We don't have to fix everythingtoday.
We can change our direction andstart moving in the right
(01:52):
direction with the mostimportant thing.
Okay.
And that's how we keep ourselvesfrom getting overwhelmed and all
of those things.
Okay.
All right.
Good stuff.
Good stuff.
All right.
So, Nikita, do you want us tostart with the questions that
people had already filled out?
SPEAKER_00 (02:03):
Dr.
Woodward said, in yourexperience, what has been the
best way to combat no-shows?
We have a huge population ofMedicaid patients, so we can't
charge them a fee for theinconvenience.
SPEAKER_01 (02:14):
This is a great question.
My first business is my privatepractice, which we've had for
about 15 years at this point.
We run between 60 and 70%Medicaid and it's
insurance-based practice.
So I feel your pain.
Okay, so this is what we havedone.
And I think the starting pointof this, which is helpful for
everyone, is realizing thatevery problem has a solution,
(02:35):
right?
Because what happens is I acceptMedicaid.
And so that means I just have tohave an empty schedule because
they know sure that's what theydo.
And so for us, we did twothings.
The first thing we did is weinstituted a policy that if you
missed three appointments, wewill dismiss you from the
practice.
And we did that because I couldhave said, I don't want to take
(02:58):
Medicaid, or I could limit, Icould have limited Medicaid and
all of that.
But you know, I for me, and I'mnot recommending this is just my
thing.
I figured I want them to haveaccess to great quality care.
And I will do that.
But if I'm going to do that,then you're going to respect my
schedule.
And so if you no-show threetimes, we would dismiss you from
the practice.
And so that way you couldn'tonly be a repeat, repeat
(03:18):
offender for so long.
So that was the first thing thatwe did.
The other thing we did is wecalculated our no-show rate and
we factor that into ourschedule.
So what that means is if Iwanted to see 25 patients and I
know between no shows andsame-day appointments, I would
need to start my day with 28 toend up with 25.
(03:39):
Then I would schedule 28.
And so when people no-show, I'mactually like, thank God, not
now my schedule is empty.
Do you see that?
Now now the reaction to thatchanged because I'm like, okay,
so we'll end at 25.
I don't have to kill myself thispatience.
Yeah, some days I saw 32 orwhatever needed to happen, but
that's the thing.
So the first is I put someconsequences.
I can't charge you, but I can dothings.
(04:00):
I have powers.
And then the second is Ifactored in the no-shows and
just increased the amount ofpeople that I scheduled on uh I
put on the schedule.
Yeah, that's what we did.
And then the third thing is thiswas more for the people who
worked with me than me, is Isold them on the idea of
flexibility.
Because sometimes the doctorwill say, Well, why are they 28
patients on my schedule?
(04:20):
And I'm like, How many timeshave you actually seen 28
patients?
You know what I mean?
And some days they'll see 28 orthey'll see 29.
And so this is the way I put it.
It's funny, but this is what Isay.
If I don't ask you for a refundon the day that you see 21
patients, you're not going tobother me the day you see 29.
Right.
So we have that flexibility,knowing that my job is to make
(04:41):
sure that your average staysyour average, but some days it
will be more, some days it willbe less.
I can guarantee the average, butI cannot guarantee day to day
because with the Medicaidpractice, you just can't.
Right.
So those are the three thingsthat we've used and it served us
really well.
SPEAKER_00 (04:55):
We did have a question in the form, and this
question says, How do I getstarted creating and building my
brand?
Which Dr.
No, you always say everyphysician needs to build a
brand.
Every physician needs a brand.
SPEAKER_01 (05:06):
Okay, so that we can probably do an hour-long
training on it.
So we'll talk about how tostart, not the whole thing.
Everyone needs a brand.
Your brand is in the simplestterms, think of it as your
reputation, right?
Especially online, yourreputation.
It doesn't matter how good youare in the mind of your patient.
Like it matters, but it doesn'tmatter how good you are in the
(05:28):
mind of your patients.
It matters how good they thinkyou are.
If you get this, you get therest of the stuff.
It doesn't matter how good youare.
It matters how good they thinkyou are.
So if you're a great physician,but they go on there and your
reviews are 2.3 stars, in theirminds, you are a 2.3 star
physician.
Even though you truthfully are afive-star physician, because you
(05:49):
know, somebody was just mad youwanted them to pay a copay
before they went in and theywent and trashed you online.
Right.
And so we can't have accidentalbrands.
We can't have cruise controlbrands.
We are great, then we curate theperception of greatness in the
minds of our patients.
And someone may say, but it'snot fair.
(06:11):
I know I do good medicine.
When they come, they'll seethat.
If they come, because if youhave 2.3 stars, they're not
coming.
You see what I'm saying?
This is you engineering theperception people have about
you.
Now, are we making up stuff?
No.
The greatness that's happeningin the exam room needs to
feature in other places wherethey can find because they're
not going to come in the examroom to see it.
(06:32):
Right.
And so if I was to say where tostart, especially if you're
trying to ramp up your practice,the first place would be your
Google business profile.
That would be a place to start.
And this is a funny thing if youthink about it.
Let's say you are in Dekula,Georgia, and you Google internal
medicine doctors, Dacuula,Georgia.
There is a chance your websitewon't come up, but your Google
(06:55):
business profile will.
Because Google is going to ranktheir stuff higher than your
stuff.
And so that's the case.
You want to control what thatsays.
That is like a website you have.
Your Google Business profile islike a website you have.
So you want to make sure youhave reviews that are there.
You want to control that.
Now, is somebody gonna go leaveyou a one-star review?
(07:16):
Yes.
They leave one-star reviews forDisney, they leave one-star
reviews for Apple, they leaveone-star reviews for everybody.
So if you get a one-star review,congratulations.
You are now human.
Okay.
So, but then again, that'ssomebody going to do that.
What of all the people who tellyou the best thing size says
sliced bread?
Do you ask them to leave youreviews?
Do you have a system for peopleleaving your reviews?
(07:37):
These things matter.
I would start there for yourdescriptions.
You want to make sure they'reSEO optimized.
So for those of you who are inthe profitable private practice
movements, we got you a tool todo that.
You want to make sure it's SEOoptimized so that way Google
becomes a true referral sourcefor you.
You can update the pictures, allof those things, but you want to
pay attention to that.
(07:58):
Okay.
So that's one thing I'll tellyou to do.
The second thing I'll tell youto do is referrals, referrals,
referrals.
You want to build a greatreputation amongst the people
who can send you all the people.
And so if you are an introvertlike me or shy or a private
person, that's awesome.
And you're an entrepreneur.
(08:18):
So you're going to buildrelationships, you're going to
talk to people.
And it's a skill.
You can do it.
You can learn to do it and youcan do it.
And so I would look to cultivatesomewhere between meaningful
relationships with someonebetween six to 12 people who can
send me people.
Those two things are things thatcan get you busy, get your name
out there, get the no trust outthere, right?
(08:40):
Because I'm a pediatrician.
And if I had six OBGYNs whopreferentially referred to me,
that's a lot.
That's a lot.
And it would matter.
And when they refer, guess whatthey're going to do?
They're going to go Google you.
And so when they Google you,they meet your optimized
business profile.
And they're like, oh, what thedoctor said is true.
Because look at what otherpeople are saying over there.
Right.
(09:00):
So I would start from there.
If you notice, I'd not sayanything about logo.
I'd not say anything aboutcollars.
I did not say anything aboutwebsite and all of those things.
All of those things arefantastic, but I wouldn't start
from there.
I would start from these twothings because these are the
things that are closest to themoney.
SPEAKER_00 (09:14):
Okay, Dr.
Ali says, what are the top threethings you would tackle and open
up a cash-based integrativemedicine practice?
So pretend you're starting allover and you're going to open up
a cash-based integrativemedicine practice, and you want
to have a full panel before youstart.
SPEAKER_01 (09:29):
Yeah, so if I were starting over and I was starting
a cash based practice, I willstart by looking for where my
ideal people are.
Now let me explain what I meanby ideal.
The ideal patient is notsomebody who needs what I do.
And I'm gonna pause and I'mgonna let that sink.
Your ideal patient is not theperson who needs what you do, is
(09:52):
the person who wants what you doand is willing to pay.
A lot of times the people whoneed what you do, they don't
want it and they will not payfor it.
So who is the person who issomewhere sitting up at night
saying, Oh my goodness, if Icould just find somebody who did
X, who is that person who hasthe pain, is aware of the pain,
(10:17):
is ready for a solution, and iswilling to pay for said
solution.
I will find out who they arewhere they are.
It's a cash bay practice.
Chances are these are people whoalready pay cash for other
things, right?
Sometimes I see people who havecash bay practices and they're
(10:38):
trying to sell people who haveinsurance on not using
insurance.
I wouldn't do that.
I wouldn't do that at all.
There are people who pay for theconvenience.
There are people who pay forseeing one doctor rather than by
being in a place with 10doctors.
They're people who will pay forthat right now.
Some of them are professionals,they're too busy to do things
other ways.
And guess what?
We are all connected to tons ofprofessionals, right?
(11:02):
So I would take the time tofigure out who that person is,
where they're gathered.
Okay, so the first is who thatperson is.
Then the question is where arethey gathered?
And so for instance, if I'm acash pay practice, well, which
other cash pay practices willrefer to me?
A lot of times the people doinginsurance will not refer to you.
Now, there's scenarios wherethey will, right?
Especially if there's a longwait time for what you do and
(11:22):
all of those things, but a lotof times they don't understand
the model.
So they won't.
Who are they already paying cashto?
It may be other cash paypractices, it may be coaches, it
may be health coaches.
Do you know?
I met a health coach thatcharges people$75,000 a year to
work with them.
Now that's somebody you want toknow, because if people are
paying$75,000, they'll pay youtoo.
(11:43):
So who are they?
Where are they gathered?
And who serves these people indifferent ways?
So I can go after that, right?
And then the things I talkedabout building a brand, I would
go all in on that.
All in on that.
Start collecting emailaddresses, sharing your journey
of starting your practice, likealmost like reality TV, not the
(12:05):
drama, but just taking people onthe journey that grows the no
like and trust factor.
So that's the way I that's theway I would do it.
But the important thing is tofind who is my person who will
throw money at me.
Like just take this, but makethis problem go away.
That's your ideal person.
SPEAKER_00 (12:20):
I think this one is kind of a piggyback on it.
This is from Dr.
Zink.
Can you tell, talk about how todo things a bit different for
cash-based practice versusinsurance-based?
My practice is private paypsychiatry.
I've been working super harddoing all the visibility,
networking, speaking, podcasts,Google Business Profile
Optimization, et cetera, etcetera.
And I would probably have a fullschedule if I took insurance.
(12:42):
I get a lot of increase frompeople who don't understand I
don't take insurance.
But I feel growth has been slow.
So I'm wondering if there's abetter strategy for cash
practices.
So I've guessed what you've saidso far, Dr.
Uno, right?
Going back to who's their idealpatient.
SPEAKER_01 (12:56):
So one again is who is my ideal person, right?
There, there's somebody whowants exactly what you do.
The people who already tell you,Dr.
Zink, that you're the best thingsince slice bread, start
studying them.
Like, why do they say that?
Are they professionals and theirtime is valuable to them or
their privacy is valuable tothem or what whatever?
Like, start paying attention tothem, your best clients, the
(13:18):
people you love working with themost, the people who they're
excited, they pay you withoutthinking about it, right?
Who are they?
And why are they saying that?
Because they're more, there'smore of them.
It's important to know who theyare.
It's very different from theinsurance model.
Now, when it comes to referrals,it's the same thing.
Where are the DPCs?
Where are the DSCs?
These are the people you want totalk to so that they can refer
(13:38):
people to you.
Again, the insurance people maybe unsure about it.
The other thing to do is itdepends on where you are.
Many places, the list to see apsychiatrist is 72,000 miles
long.
And so people cannot get in.
So now you become desirablebecause you can get people in
soon.
So look for the doctors whocould be insurance-based, but
they're hurting because theycan't find anybody to send their
(14:01):
patients to.
And you're like, I will happilysee them.
I can get them in in 48 hours orwhatever your number is.
These are my rates.
So they can wait or they canpay.
And in those circumstances, manypeople will pay, right?
And so I will pay attention tothat.
Who are my ideal people?
Who are my ideal referrals?
And where can I solve a pain,even though I'm not accepting
(14:21):
insurance?
So if you have a long wait likemany places, they will do that
too.
And not that you're going toconvince people insurance or
cash or whatever, becausethere's no convincing really.
But when people call you andthey say, Oh, I thought you took
insurance, and you can say, No,we don't take insurance, so that
(14:42):
you can have access to apsychiatrist, so we can get you
in within 48 hours.
So you can have this and so youcan have that.
And many of our patients, that'sthe why, even though they have
insurance, they will come workwith us.
Do you see what I mean?
So you want to, between you andyour team, you want to have a
way of responding.
I will invite you to dig deeper,right?
(15:03):
Like my ideal people, my idealreferrals, spread it wide, put
more urgency, put more volume,right?
And so, because in the processof doing that, it's almost like
a boil that's come to head.
You find the head, and it'sweird, but we're doctors, you
can handle it.
But you find that, right?
So keep going and keepoptimizing.
(15:24):
Even if it feels like it's thesame thing.
How can I do this better?
How can I do this morestrategic?
Who am I missing?
What angle can I try?
What language can I try?
That's the way we do it till wefind the thing.
I've been, I've run on TriMD forthe last seven years.
We'll be eight years inSeptember.
Like the things you're doing,I'm still doing.
After all these years and afterall this impact, after all this
(15:45):
revenue, it's not something yougrow out of.
It's just something you getbetter and better at.
And the better you get at it,the better the results will be.
So you got it.
SPEAKER_00 (15:53):
This is a question from online.
I am enrolling an average ofeight new members per month in
my concierge longevity practice.
But I'm the bottleneck.
I can't keep up with plancreation, team oversight, and
marketing.
What is the smartest nextstructural move to scale from
$40,000 a month to$80,000 amonth in the next eight to nine
(16:17):
months without burning out?
Is it hire a physician, apractice manager, or restructure
my offer?
SPEAKER_01 (16:24):
As we grow our businesses, as we grow our
practices, we will stumble onbottlenecks, roadblocks, and
they will seem impossible.
The good thing about growth isthat you grow.
The downside of growth is thatyou create brand new problems.
Like the reward for solvingproblems is more problems.
And so the better you get at,first of all, normalizing the
(16:47):
problems and getting better atnavigating the problems makes
your life so much better, right?
So that's the way that works.
So now if we look at this doc,she has a concierge practice and
now she's getting eight newpatients a month, which is
fantastic.
Okay.
But now it's bringing to her toa point where she's like, I
can't keep up between the plancreation, the marketing, the
(17:09):
team, managing the team.
So what do I need to do?
Okay.
So let me walk you through how Iwould think about this.
A lot of times for doctors, welove to over-deliver, which is a
great thing.
But a lot of times when we arein cash-based businesses, it
also puts us in a position wherewe start off saying, okay, I'm
(17:33):
going to offer these threethings with my concierge
package, but oh, it'd be nice ifthey get this other thing.
Oh, oh my goodness, it'll benice if they get this other
thing.
Oh, I'm going to add this othertest.
And before we know what isdoing, where what is happening,
we're doing five times the workthat we set out to do.
And so it doesn't matter if youget two patients or four
patients, I'm overwhelmed.
But of course, because it's justway too much work.
(17:54):
Way too much work.
And we don't factor in, okay,maybe I can use the team and
leverage the team to do thispart and all.
So it's not too much work forme.
And so when I see people,especially in a cash bay model,
a lot of times the first placeI'll look is how complex are the
visits?
How complex have we made them?
How much extra stuff have weadded to?
(18:15):
How many extra steps did we addto them?
Sometimes we feel, well, becauseI'm charging them this much, I
must add all these features andall these benefits and all these
bells and all these whistles.
But a lot of times all thosethings still take us to the same
place the simple stuff wouldhave taken us to.
Right?
And so the question then becomesthis person is paying me not for
(18:36):
bells, not for whistles, not forfeatures, not for benefits.
They are paying me for anoutcome.
What is the simplest, cleanest,most elegant way to get them
this outcome?
A lot of times it's lesscomplicated than what you're
doing right now.
And so when things feeloverwhelming, the place you want
to start from is looking at whatyou're offering, looking at how
(18:58):
much time is taking it, and thenlooking at what would be a
simpler way to do it.
Why?
Complexity constraints,simplicity scales.
You cannot scale a complexsystem.
You cannot.
So if someone comes in, if Iwere coming into your business
as a consultant and you're like,okay, over the next 18 months,
(19:18):
we want to bring in scale, wewant to do all of these things.
The first thing I will look foris to gut out all complexity.
Because if we don't remove that,you cannot scale.
Do you know why you can havetrees at scale?
Because it's not complex.
There's one tree, there's areproductive system in the tree.
So one tree makes another tree,that makes another tree, and
(19:40):
then that makes another tree.
Now imagine if every year theyneed to there needed to be the
creation of brand new trees fromscratch, out of nothing.
Right?
How many trees would we have?
Not many.
It's important.
Whatever your business is.
Like now, when I have new thingsto do, I'm thinking, what is the
(20:03):
simplest way I can do this?
How do I document it?
How do I do it in such a waythat I can train somebody else
to do it and be done?
Like I'm thinking that way fromthe beginning.
Okay.
And whether you're aninsurance-based practice or any
other kind of practice,simplicity, how can I make this
simpler?
How can I make this?
This is the million-dollarquestion, like literal millions.
Okay.
(20:23):
So the first place I'll look isthat how can we make it simpler?
Then two is how can we delegateaspects of it?
So we have a visit that takestwo hours.
Well, what portion of that doyou need to be there for?
What part of that couldtechnology do?
What part of that could a teammember do?
Right.
And so it doesn't have to be allyou.
And in the beginning, it's easyto say it has to be all me.
(20:44):
It doesn't have to be all you.
So that you look in it, you'relike, okay, what part can my
team do?
What part can technology do?
What could pre-filled forms takecare of?
What could like these are thequestions you're asking?
So maybe it's a two-hour visit,but it ends up being 30 minutes
of your time.
And you might say, but they'repaying me.
No, they're paying yourhealthcare system, aka your
(21:05):
practice.
If you want to have a privatepractice that helps a lot of
people while creating timefreedom and financial freedom
for yourself, you want to have apractice that is a system, not
you.
The idea is my business isgetting them a result.
It's not I am getting them aresult.
If that's the case, you cannever retire, you can never go
(21:26):
on vacation, you can never taketime off.
And whenever you're out of thebusiness, it cannot make money.
We were celebrating a doctor inthe profitable private practice
movement today who said, I am onmy seventh week of maternity
leave, and my practice is justthere making a profit.
It stayed profitable the entiretime.
So if she was the only one doingeverything, that would never
(21:47):
happen.
But here she is, she has a baby.
I was like, congrats on that.
She took the time off, congratson that.
And her practice is not dying.
Like it's still generating aprofit, it's still changing
while she's hanging out with herbaby.
So that's the second place.
I didn't even talk about a hire.
This is the team that she thedoctor already has, right?
So those are the two places Iwould look at first.
(22:10):
And then if the team isoptimized, the doctor's time is
optimized, the visit isstreamlined, then we can then
talk about who do we need tohire to take this further.
But the thing is, if you try togrow a chaotic system,
everything falls apart.
Let me backtrack on that becausesomeone said, but my business is
chaotic.
Well, your business is and willalways be a construction site,
(22:31):
so there will be an element ofchaos.
But if you every time you wantto make a big leap, you have to
stop and simplify, then leap,simplify, then leap.
That's the way that works.
And that is a good approach,whether you feel like you're the
bottleneck or not, right?
Is like, how do I simplify this?
In my practice, we have what wecall the assembly line, door to
(22:52):
door.
Somebody walks through the door,take care of them, do all the
things, they walk out the door.
We call that the assembly line.
So they come in, check-in,roomed, vitals, doctor, doctor,
postdoc, checkout, right?
We have a whole thing.
And so we're constantly going,where's the bottleneck?
Where's the roadblock?
Where can we simplify?
Why?
Because the more efficient thatis, the happier the patients
(23:14):
are.
Then we can see the number ofvisits we need to see, and the
doctors don't feel like they'vebeen on a treadmill all day.
Simplicity.
Simplicity.
SPEAKER_00 (23:22):
Dr.
Padma and Dr.
Gentil's questions are verysimilar.
So I'm kind of gonna read themtogether.
They're both about timemanagement as a physician
entrepreneur.
And I think a lot of peoplestruggle with that, right?
Dr.
Padma's question is around sheheard Dr.
Una simplicity scales.
Okay, I'm gonna simplify thisstuff.
I'm gonna do my marketing.
(23:43):
I'm gonna do all this stuff.
But then she spends the dayputting out fires.
And then Dr.
Gento says, How do I balance allof it?
Because I've got my practice, Ihave a side job that I'm working
at for more income, and I haveto try and strategize to make
this practice work.
And I have my family.
So how do you do it all, Dr.
Una?
How do you do it all?
(24:04):
How do I?
SPEAKER_01 (24:05):
First of all, hugs, private practice is no joke, but
we can win.
We can win.
But it's not a walk in the park,especially in the beginning.
It's not a walk in the park, butit's a worthy walk, really
worthy walk.
Figuring out how to thrive inprivate practice has made it
possible for me to have thefinancial freedom to pursue
starting on-trame D.
I hope you understand it'sridiculous, right?
(24:25):
The on-traMD business schools.
I was talking to Makita aboutthis, started in June of 2020.
Does anybody remember what washappening in June of 20, like in
the middle of a pandemic whereprivate practices were going out
of business left, right, andcenter?
So, and I didn't even realize itwas in 2022.
So I asked me, when did businessschool start?
I said in June of 2020, like atthe beginning of the pandemic.
(24:46):
I thought about it, like, wow,that's crazy, right?
But it gave me the freedom topursue what I believe is my
purpose, part a huge part of mypurpose, why I'm here on the
planet, and all of those things,and write the books and do the
podcast and create the programsand all of those things, and to
homeschool my kids becausethat's what I wanted to do.
It's worth it, is the point I'mtrying to make, but I'm not
going to tell you it's easybecause then I'll be lying to
(25:06):
you.
Okay.
Okay.
So let's start with, let's doDr.
Simone's first, and then we'llcome to Dr.
Podman.
So, how do you balance workingon the practice, the jobs, the
time to plan, to strategize, andall of those things?
I will tell you what I did, andI came into agreement with my
husband about this.
Okay.
In the beginning, you have torealize that the dream costs
(25:29):
what it costs.
For me, when I started myprivate practice, it was insane.
Like starting the on-trainedbusiness school in June of 2020
was crazy, but private practicewas insane because I had a
four-month-old and atwo-year-old.
And I didn't have any profitableprivate practice movement or
(25:50):
on-train-d podcast or any ofthat stuff.
I had no clue what I was doing.
Okay.
And at the same time we startedthe practice, my husband and I
started a church.
Okay.
So that means I had fourchildren.
Okay.
If you add everything together.
And we applied for loans.
I didn't go to medical school inthe US.
I went to the University ofNigeria.
And I moved here after that todo my residency.
(26:11):
I moved back.
I was born here.
But in those days, you didn'tneed to get a social security
number when you were born.
So here I came 26 years later.
I was like, I need a socialsecurity number.
Guess who gave me a socialsecurity number?
Nobody.
And so it took me forever to getthat.
So guess what?
I had no credit history.
I couldn't qualify for a loanfor my private practice.
(26:31):
I tried, nobody would give memoney.
And even the people who couldhave given me some money,
they're like, you're asking fortoo little.
Like we only do from$200,000.
And I'm like,$200,000?
That's like a house.
I'm not doing that.
And so we made the decision toself-fund the practice, which is
fancy speak for.
I did shifts at the local urgentcare.
I did that for two years, thefirst two years of my practice,
(26:53):
self-funding.
So that way we could take careof what we need to take care of
for the family and take care ofsomething it bills for the
practice until we could do whatit did.
So the decision we had to makeis we're going to self-fund
this.
And so because we're going toself-fund this and we have the
practice, we have the two littlechildren, we have the church and
all this stuff, it's going to beinteresting.
(27:15):
We're still going to prioritizeour families.
So we still had our date nightevery Tuesday.
We're still going to prioritizeour children.
So my husband was with them.
Sometimes I'm with them and allthat, but it is going to look
different.
We are going to need to dolonger hours.
We are going to need to do scarythings, right?
But the idea is because I knowthat and because I only want it
(27:37):
to be for a time frame, I don'thave time to play.
Do you understand?
I don't have time to say I'm nottalking to referral sources.
Uh uh, because every time Ispend doing that, I'm not
growing my practice.
So I have to spend more timeaway from my family.
I'm not saying I'm not gonnacollect copays and I'm not gonna
ask for reviews and all of thatbecause I'm shy or because
(27:59):
whatever.
Because I don't have time.
I have to put in the work so Ican get out of this phase.
There is a time season whereit's gonna be interesting.
But you decide it is what it is,I can make this interesting
season last a year, or thisinteresting season can last
seven years.
It all depends on how I show up.
(28:22):
So, Dr.
Simone, you are doing what Idid, it looks like, right?
You have the practice, you havethe job, working on the
business, you have the time forfamily.
What that means is you ain't gottime to play.
Okay.
You the 20% activities that youneed to do, you feel like when
people are like, I'm too scaredto do this, you just jump in and
do it because it's either I doit now and then I have all the
(28:43):
time I want in a year or in twoyears, or I wait seven years and
I'm not waiting seven years.
Okay, so you don't have time,you don't have time to play.
So what that means is when I'mat work, when it's time to see
the patients, I see thepatients.
When it's time to do thebusiness, I do the business.
I collect all my co-pays, all mydeductibles.
If I need to raise prices, ifit's cash pay, I'm raising the
(29:04):
prices, I'm leveraging my team,I'm doing all the things because
I don't have time.
If you can put your head downand do it that way, then what
that means is every month youhave more and more time.
Every month you have more andmore time.
So now I'm in a place where thepractice can work without me.
I've homeschooled my kids foryears.
I have the freedom to do fourother businesses and all of that
(29:27):
stuff.
But it costs me in thebeginning.
You treat your time like everyhour is worth a thousand
dollars.
The same way you will open yourdoor and throw out a thousand
dollars.
You don't waste an hour.
You invest the hour becauseyou're like, I need to get out
of this stuff, right?
Yeah.
The things you need to learn,learn them quickly.
Learn them quickly because youain't got time.
(29:49):
Okay, so if you're in PPPM, leaninto that.
Your EBS, lean into that.
You have the Profitable PrivatePractice Praybook, read it.
Read a chapter, do the chapter,read the chapter, do the because
you don't have time.
You need to pull yourself out ofthat so you can let go of the
job, right?
You can let go of the job, focusfull time on your practice.
You have more time for yourfamily, right?
Your children are younger now,and as they get older, you have
(30:11):
more time with them.
It would be fantastic, but youain't got time to play.
And then having said that, allthe help you can get, take it
all.
Don't be afraid to ask for help.
People ask you for help all thetime, and you say yes.
So now it's time for you to askpeople for help.
Ask people for help.
Makita will tell you when I waspregnant with my baby, Makita
stayed at stayed in my house,helped me walk with my kids, did
(30:33):
all of that stuff.
Ask for help.
There's no award for doing ityourself, especially for the
mommies.
Hear me, mommies.
There's no award.
There children don't get likeadults don't get together and
say, Did your mommy get help?
Oh shoot, what kind of mom isthat?
My mom did it all.
Nobody, nobody remembers that.
There's no award, nobodyremembers it.
Take all the help you can get.
Dr.
Padma asked a question.
(30:53):
I start my day with motivationfor marketing and all of those
things.
I feel I put out a lot of firesevery day.
Okay.
Dr.
Padma, there are a number ofthings that have helped me with
this, okay?
If you can schedule when youaddress the fires.
Except it's a true fire burningdown a building, right?
So for instance, oh, this momwas upset.
(31:15):
She needs a call back, blah,blah, blah, blah, blah, blah,
blah.
Great.
I have my flex time scheduledfor 3 p.m.
I'll call her then.
Oh, I need these five formssigned now today, blah, blah,
blah, blah, blah.
Awesome.
Hold them all, bring them to myoffice at 3 p.m.
My team knew that.
Anything you want me to do, Iwill do it at 3 p.m.
Except somebody's actuallycoding, don't get in my way.
(31:36):
So that way the fires arecontained.
Do you see what I mean?
And it doesn't feel like you'reputting fire because that's the
tyranny of the urgent.
On the other side, Dr.
Potna, if you adopt this, itwill be a game changer for you,
which is now when you put outthe fire, you ask yourself the
question, why did that firehappen?
What is broken in my system?
(31:57):
And not remember, we observe, wedon't judge.
So this is not I suck, my systemis broken.
No.
What is broken in my system thatmade this fire possible?
What do I need to do so thisdoesn't happen again?
Do you see that?
And what that will do is it'llput you in a position where in
your journey as an entrepreneur,you just get less and less
fires, or you get bigger fires,meaning you've graduated.
(32:19):
Now you're having high-levelfires, not lower level fires.
Do you see what I mean?
And so you can schedule thefires, but you want to get to
the root of the fires and startputting those out.
It will show you parts of yoursystem you can work on.
I'll give you an example.
It's not quite a fire, but letme give you an example.
In our pediatric practice, wehad started, this is many years
ago, we had started doing earpiercings and stuff like that.
(32:42):
Then my phone would read off thehook all day, people asking
questions about ear piercing.
I'm like, this is insane.
I told I went to my front deskperson, I gave her a piece of
paper, I said, write down allthe questions they're asking.
What am I doing?
I'm a systems engineer.
I'm like, what is going on here?
(33:02):
Right?
All the questions.
Okay.
And so she wrote all thequestions, according to the
answers, gave it to my websiteperson.
I said, create an FAQ for theear piercing stuff, put it
there.
The phone calls went from agazillion to one a week.
Do you see what I'm saying?
So when you see that, it's like,oh, these people don't stuff.
No, you're like, but what is thereason?
(33:22):
They got lots of questions.
And they found you, but theydidn't find the answer.
So they're gonna call you.
I don't want them calling me.
You want to do ear piercing?
Schedule your appointment.
We'll see when you get here.
Right?
So that's the idea.
When fires happen, you stop.
Like, you know, what is makingthis possible?
Simplify as much as possible.
Padma, I like the way you saidsimplifies things.
(33:44):
Dr.
Ali, they ask for help.
There is no award for doing itby yourself.
In fact, we had a doctor, shejoined the entream d business
school.
She doesn't have time, she's sostrapped for time.
We got talking and all that.
And turns out all these peoplehave been asking her to help
her.
No, I got it.
I got it.
I said, you will go to all ofthem and say, I got it not.
Okay.
I got it not.
(34:04):
Do you know within two weeks shehad bought back 10 hours of her
time?
10.
Like one, two, three, four,five, six, seven, eight, nine,
ten.
Ten.
Just by saying yes to everybodywho had been asking her, they
had been offering to help her.
There's no award for doing ityourself at all.
Okay.
So in all of our programs, youhear me talking nonstop about
(34:25):
the 20%, how to identify them,how to identify when they change
as you go higher in yourbusiness, how to have the mental
fortitude to do that, likenonstop, because it's the price
for freedom.
If you live in the 80%, I meanyou just have a ton of stuff to
do and little to show for it.
That's just the way it is.
I think every physician needswhat I do, but not everyone
wants it.
So my job is to look for thepeople who want it.
(34:47):
And I'm like, you want it?
Hey, hi, let's do it, man.
I've been practicing for you.
I've been doing this for yearsand years and years.
Let's go.
Okay.
Maximize what we have beforestarting something.
Let's talk about this a littlebit.
Okay.
There is something that I see,and I want to hug the people
that say it.
Like hug and say, okay, we'renot gonna do that.
I started private practice and Iwant to have multiple streams of
(35:08):
income.
So I want to start a side gig.
Should I tell you the truth orshould I pretend?
Should I be politically correct?
Or based on my decade and a halfof experience.
Should I tell you the truth?
Don't do it.
Multiple streams of incomerefers to streams, not trickles.
When you start a privatepractice, that is your main gig,
(35:31):
side gig, up gig, down gig, allthe gig.
It's the gig.
Now, if you're self-funding,that's different, right?
I told you my example, Iself-funded.
I'm so I'm not talking about notself-funding, but when things
get hard, we get bored with ourbusinesses.
Don't do it.
(35:52):
Because guess what you're gonnacome up against when you get to
that same point in your sidegig, you're gonna get bored
again.
Then you're gonna find anotherside gig.
I have seen people start 72,000businesses.
Of course, I'm exaggerating, butyou get the point.
Because every time they hit thatroadblock, ooh, is tough.
Oh, it looks like I need to dothe same thing over and over
again.
(36:12):
Yeah, entrepreneurship is boringin the most exciting way.
If you cannot stand to be bored,it will be tough to thrive as an
entrepreneur.
Can you have 72 businesses?
I mean, come on, we see peoplewho have hundreds of businesses,
yes.
But give the business the effortit will take to grow it, then
(36:32):
build a team, free yourself ofit somewhat, then go to the next
one.
That is how you can be a serialentrepreneur as opposed to
building something that willfall apart.
I cannot tell you how many timesI've watched this.
It breaks my heart every singletime.
Your private practice, you canself-fund it with the job with
the side thing, but usuallythese people mean starting
(36:52):
another business.
If you have twins, you cannotsay, I will feed them once.
They're two people.
You have to feed them twice, youhave to change two sets of
diapers, you have to pay for twocribs, you have to do twice the
work.
Well, most people pick up asecond business and they want to
do the same amount of work.
It doesn't work.
(37:13):
It doesn't work.
And so if you want to havebabies, many babies in the
business world, be strategicabout it.
So you don't have to have painand suffering.
I've watched somebody who builta really successful practice
violate this law and they're onthe brink of losing everything.
Why?
It was not set up in a way tohandle getting all like doing
(37:37):
all these.
Yeah.
So don't do it.
I said it, don't do it.
Dr.
Barbara, uh mindset change forme is that my business is always
a construction site.
It has always been, it willalways be a construction site.
And that's why in all of ourprograms, we push people to
celebrate wins.
(37:57):
Because most people are waitingfor it to all be okay.
That is not a thing, that is nota timeline, that is not a thing
that will happen on this side ofeternity.
There will always be somethingwrong.
And that's okay.
How many of you have somethingthat needs fixing in your
practice?
You've been working at it,you're diligent, you have all
these wins, but something needsfixing.
(38:18):
Like my hand is up.
There'll always be something tofix.
So if you wait to fix everythingbefore you celebrate, you'll
never celebrate.
That will never happen.
That will never happen.
SPEAKER_00 (38:26):
Dr.
Benoit says I have a hybridcoaching and clinical practice.
I'm currently seeing coachingclients one-on-one weekly for
three months.
For patients, it's a six-monthcommitment with monthly visits.
I decided I would place everyoneon a six-month commitment.
But after working with thecoaching clients, I think that
monthly visits for six months isnot enough time.
(38:47):
Should I make it for one year?
SPEAKER_01 (38:50):
So this is the thing.
And I'm guessing coaching wouldbe around what you do, weight
loss, and all the other things.
Usually, coaching for six monthsis not enough, not because a
coach is not a good coach, butbecause there are more results
to be had.
Right?
There are more results to behad.
(39:10):
Actually, it's really funny.
We did a survey of the doctorsin the entreamly business
school, and some of them havebeen there since 2020.
They never left.
And consistently, their resultsare much higher than those that
started in 2021.
And the ones who started in2021, their results are higher
(39:32):
than those that started in 2022.
Because let's say you built apractice and then you're like,
oh yeah, okay, now you know, Iknow to do my code base, I know
to do this, I know how to fillmy schedule and all of those
things.
Well, how about managing yourtime?
That is a whole area of mastery.
And we're talking people who didmillion-dollar practices and
took eight weeks off.
So they had more revenue, moretime off, and their happiness
(39:54):
score, which there's a worldhappiness index, their happiness
score was higher.
But across the board, that wastrue for the people who've been
there the longest.
Like it was increasing as theirlength of time was increasing.
So there's always more to do.
So could you make it a year?
Absolutely.
But you can choose how to do it.
There is no right or wrong.
If you want to do it as asix-month commitment and they
(40:15):
renew, you can do that.
If you want to make it aone-year commitment off the
back, you can do that as well.
There's no right or wrong.
Because I've had people, acoach, I was doing voice
training and she had like foursessions or something like that.
After that, she was like, okay,so it's really nice working with
you at all of that stuff.
I can't help myself.
I love people and I seepotential everywhere.
So when she was done with herspill, I was like, girlfriend,
(40:37):
you're literally telling me towalk away.
I'm willing to work with you fora year, but you're making the
assumption that for foursessions, I'm done.
And so literally, I could payyou X amount of dollars, and you
told the dollars to go away.
And I'm sure after this, you go,pray, Lord, I need more clients.
Like, how shall these things be?
So when you're coaching people,it's not about the timeline,
(40:57):
it's not about the number ofsessions, it's about the
outcome.
We're getting them the outcome.
They want more of an outcome.
I have people work who've I'veworked with in the
entrepreneurial business schoolthat came as employed
physicians.
And now they're runningmulti-million dollar practices.
Right?
We don't care about thesessions.
(41:18):
And then what more do you want?
Oh, I want to build a team sothat I can exit this.
Oh, I want to build this in sucha way I can sell this.
Oh, I want to build a wholehealthcare system.
I want to have 12 doctorsworking for me.
Whatever.
So as long as the outcome,there's still an outcome desire
that I can deliver on, we don'tneed to end the arrangement.
So absolutely, absolutely, butdon't end it.
(41:40):
And don't focus on the sessions,focus on the outcome.
That's the whole point of thecoaching.
Yeah.
Nobody pays for sessions, theypay for transformation.
SPEAKER_00 (41:51):
Dr.
Gerald is asking about familypractice MD or PA in I think
that's Prince George County,Maryland, for an affordable
price in an affordable way.
I guess that's all about hiring.
How do you find a good mid-levelor a good doc or a good yeah?
SPEAKER_01 (42:07):
Yeah, that's the whole production.
But this is what I will tellyou.
The starting point is this youneed to define what it is you
want.
How many of you needed to hire arole?
You went to the internet, you'relike job description of X or
maybe Chat GPT now, and then itgave you a thing and you copied
and pasted and you made it yourown.
(42:28):
We just take whatever we see andadapt it, right?
You want to define what it isthat you want.
So, those of you in theprofitable private practice
movement, you created an idealideal job ad template, right?
And we created that so you cancreate a job description that
attracts who you want and repelswho you do not want, right?
Okay, so that's the startingpoint.
(42:50):
Get clear on what you want.
The reason why this is importantis because of step two.
Step two is then you put that adeverywhere.
So you can put it on Indeed, youcan put it on LinkedIn, you can
put it on all your social mediaplatforms, Facebook, Instagram,
all of that stuff.
You'll see a lot of our clientsdoing it.
We're hiring.
This is why you should work withus, blah, blah, blah.
Okay.
(43:10):
So you put it on there.
You can send it to your emaillist.
Hey, if you know any rock starswho are XYZ, all the physicians
within your network, you tellthem, I am looking.
So when you don't have aproperly done ideal job ad, then
you attract a lot of people whoare not a good fit for that.
You want to have a really tightjob ad.
So that's number one.
Then number two, you want to putthat everywhere.
(43:32):
The same way you would marketfor patients is the same way you
market for a physician.
So you put it everywhere.
You tell everybody that you'relooking.
And then number three, whichcould be a one hour talk on its
own, is you may not be able tofind an affordable quote unquote
doctor, but you should find aprofitable one.
(43:52):
Which means you run your numbersand every role should create
their salary.
The overhead associated withtheir role and a profit for the
practice.
If you didn't get anything outof what we did, anyway, you got
a lot of things out of what wedid today, but don't forget
this.
It must generate a profit forthe practice, cover the overhead
(44:15):
associated with the role, andcover the doctor's salary.
So how many patients would theyneed to see, for instance, for
that to happen?
Okay.
If you're cash pay, how many,what does the panel side need to
be, size need to be for that tohappen?
So you know what to do for thisto be profitable for you.
So when they ask you for acertain amount, you can stomach
it with as long as they'reseeing that volume because it
(44:38):
will still be profitable to you.
So a nice job ad, so it canfilter, you put it everywhere,
you interview all the things,and you define the metrics for
profitability.
Okay, so we want to hire peoplewho will help us serve and earn,
not people who will serve.
This has been so much fun to do.
(45:00):
I want to challenge you to takewhat you got.
The things you've learned,they're really good, but they
create results when you do them.
And so I want to invite you todo them.
And if you're looking forsupport in doing that, you want
the accountability, you want thecommunity, you want to be around
mentorship like this on a weeklybasis.
(45:22):
We have a number of ways ofdoing that.
You can always book a call withthe team.
Akita will be the person.
So you've met her.
She's a physician ally, andactually I'm so honored that
she's on our team.
And so that's ontramd.comforward slash call.
We're happy to talk to you towork you through which program
would be the best one for you.
But as you can see, we're allabout supporting physicians and
helping you guys win.
(45:43):
Okay.
Okay, so leave us a review.
Give me some jewelry.
Okay.
Give me some jewelry.
My birthday was on Saturday.
Give me some jewelry.
And then, yes, again, for thoseof you who want that, at
ontramd.com forward slash call,we have been able to support so
many physicians and see them winin magnificent ways.
Even the movement we celebrated.
Highest revenue ever, greatestnumber of patients ever,
(46:05):
greatest referral sources ever.
Seven weeks of maturity leave,and my practice is still
profitable doing its thing.
And so we want that forphysicians.
We truly are on a mission tomake seven figure businesses,
dream business, dream life thenorm for physicians.
If you look on my vision board,that's what you'll see there.
Right?
That is the norm for physicians.
This whole talk of loss ofautonomy and burnout and our
(46:26):
practices not working and usbeing one trick ponies will all
be historical facts.
That's what we're here to know.
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