The EntreMD Podcast

How to Solve Your Biggest Business Problems: Live Q&A With Dr. Una

• Dr. Una • Episode 518

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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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  •  The Profitable Private Practice Movement - If you want to build a thriving private practice that serves a lot of patients, while creating time and financial freedom for you, come join us here. 
  • EntreMD Business School Grow - This is our year-long program with a track record of producing physician entrepreneurs who are building 6, 7 and 7+ figure businesses. They do this while building their dream lives!
  • EntreMD Business School Scale - This is our high-level mastermind for physicians who have crossed the seven figure milestone and want to build their businesses to be well oiled machines that can run without them.

To get on a call with my team to determine your next best step, go here ...

SPEAKER_01

When things feel overwhelming, the place you want to start from is looking at what you're offering. Looking at how much time it's taking. And then looking at what would be a simpler way to do it. Why? Complexity constraints. Simplicity scales. You cannot scale a complex system. Hi Doc. Welcome to the OnCham D podcast, where it's all about helping amazing physicians just like you embrace entrepreneurship so you can have the freedom to live life 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 our priorities, like the priority of priorities, is to set the stage to make seven figures the new floor for physicians everywhere. And so that this puts us in a position where we understand how to thrive with all the challenges and everything going on. And so we are pretty clear that's a Herculean task, but we're also very clear that we're equipped for the task, right? And so that's what we've been doing in the entrepreneur business school. That's what we've been working on in PPPM, all of that stuff. And I figured, why don't we just come here and help doctors work through some things, create some big wins in their businesses and stuff. We had a number of people who had filled out the form that we had to ask questions, but this is what I will tell you. We're not going to answer everybody's question, right? It's just not possible to do that in the time frame that we have. However, when a question is asked, I'm not going to answer it for just the person. So I want you to approach this with a growth mindset. I want you to approach this with, I am going to get the nugget I need to move forward in my business. And that's the idea, right? We don't have to fix everything today. We can change our direction and start moving in the right direction with the most important thing. Okay. And that's how we keep ourselves from getting overwhelmed and all of those things. Okay. All right. Good stuff. Good stuff. All right. So, Nikita, do you want us to start with the questions that people had already filled out?

SPEAKER_00

Dr. Woodward said, in your experience, what has been the best way to combat no-shows? We have a huge population of Medicaid patients, so we can't charge them a fee for the inconvenience.

SPEAKER_01

This is a great question. My first business is my private practice, 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 have done. And I think the starting point of this, which is helpful for everyone, is realizing that every problem has a solution, right? Because what happens is I accept Medicaid. And so that means I just have to have an empty schedule because they know sure that's what they do. And so for us, we did two things. The first thing we did is we instituted a policy that if you missed three appointments, we will dismiss you from the practice. And we did that because I could have said, I don't want to take Medicaid, or I could limit, I could have limited Medicaid and all of that. But you know, I for me, and I'm not recommending this is just my thing. I figured I want them to have access 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 three times, we would dismiss you from the practice. And so that way you couldn't only be a repeat, repeat offender for so long. So that was the first thing that we did. The other thing we did is we calculated our no-show rate and we factor that into our schedule. So what that means is if I wanted to see 25 patients and I know between no shows and same-day appointments, I would need to start my day with 28 to end up with 25. Then I would schedule 28. And so when people no-show, I'm actually like, thank God, not now my schedule is empty. Do you see that? Now now the reaction to that changed because I'm like, okay, so we'll end at 25. I don't have to kill myself this patience. Yeah, some days I saw 32 or whatever needed to happen, but that's the thing. So the first is I put some consequences. I can't charge you, but I can do things. I have powers. And then the second is I factored in the no-shows and just increased the amount of people that I scheduled on uh I put on the schedule. Yeah, that's what we did. And then the third thing is this was more for the people who worked with me than me, is I sold them on the idea of flexibility. Because sometimes the doctor will say, Well, why are they 28 patients on my schedule? And I'm like, How many times have you actually seen 28 patients? You know what I mean? And some days they'll see 28 or they'll see 29. And so this is the way I put it. It's funny, but this is what I say. If I don't ask you for a refund on the day that you see 21 patients, you're not going to bother me the day you see 29. Right. So we have that flexibility, knowing that my job is to make sure that your average stays your average, but some days it will be more, some days it will be less. I can guarantee the average, but I cannot guarantee day to day because with the Medicaid practice, you just can't. Right. So those are the three things that we've used and it served us really well.

SPEAKER_00

We did have a question in the form, and this question says, How do I get started creating and building my brand? Which Dr. No, you always say every physician needs to build a brand. Every physician needs a brand.

SPEAKER_01

Okay, so that we can probably do an hour-long training on it. So we'll talk about how to start, not the whole thing. Everyone needs a brand. Your brand is in the simplest terms, think of it as your reputation, right? Especially online, your reputation. It doesn't matter how good you are in the mind of your patient. Like it matters, but it doesn't matter how good you are in the mind of your patients. It matters how good they think you are. If you get this, you get the rest of the stuff. It doesn't matter how good you are. It matters how good they think you are. So if you're a great physician, but they go on there and your reviews are 2.3 stars, in their minds, you are a 2.3 star physician. Even though you truthfully are a five-star physician, because you know, somebody was just mad you wanted them to pay a copay before they went in and they went and trashed you online. Right. And so we can't have accidental brands. We can't have cruise control brands. We are great, then we curate the perception of greatness in the minds of our patients. And someone may say, but it's not fair. I know I do good medicine. When they come, they'll see that. If they come, because if you have 2.3 stars, they're not coming. You see what I'm saying? This is you engineering the perception people have about you. Now, are we making up stuff? No. The greatness that's happening in the exam room needs to feature in other places where they can find because they're not going to come in the exam room to see it. Right. And so if I was to say where to start, 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 you think about it. Let's say you are in Dekula, Georgia, and you Google internal medicine doctors, Dacuula, Georgia. There is a chance your website won't come up, but your Google business profile will. Because Google is going to rank their stuff higher than your stuff. And so that's the case. You want to control what that says. That is like a website you have. Your Google Business profile is like a website you have. So you want to make sure you have reviews that are there. You want to control that. Now, is somebody gonna go leave you a one-star review? Yes. They leave one-star reviews for Disney, they leave one-star reviews for Apple, they leave one-star reviews for everybody. So if you get a one-star review, congratulations. You are now human. Okay. So, but then again, that's somebody going to do that. What of all the people who tell you the best thing size says sliced bread? Do you ask them to leave you reviews? Do you have a system for people leaving your reviews? These things matter. I would start there for your descriptions. You want to make sure they're SEO optimized. So for those of you who are in the profitable private practice movements, we got you a tool to do that. You want to make sure it's SEO optimized so that way Google becomes a true referral source for you. You can update the pictures, all of those things, but you want to pay attention to that. Okay. So that's one thing I'll tell you to do. The second thing I'll tell you to do is referrals, referrals, referrals. You want to build a great reputation amongst the people who can send you all the people. And so if you are an introvert like me or shy or a private person, that's awesome. And you're an entrepreneur. So you're going to build relationships, you're going to talk to people. And it's a skill. You can do it. You can learn to do it and you can do it. And so I would look to cultivate somewhere between meaningful relationships with someone between six to 12 people who can send me people. Those two things are things that can get you busy, get your name out there, get the no trust out there, right? Because I'm a pediatrician. And if I had six OBGYNs who preferentially referred to me, that's a lot. That's a lot. And it would matter. And when they refer, guess what they'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 the doctor said is true. Because look at what other people are saying over there. Right. So I would start from there. If you notice, I'd not say anything about logo. I'd not say anything about collars. I did not say anything about website and all of those things. All of those things are fantastic, but I wouldn't start from there. I would start from these two things because these are the things that are closest to the money.

SPEAKER_00

Okay, Dr. Ali says, what are the top three things you would tackle and open up a cash-based integrative medicine practice? So pretend you're starting all over and you're going to open up a cash-based integrative medicine practice, and you want to have a full panel before you start.

SPEAKER_01

Yeah, so if I were starting over and I was starting a cash based practice, I will start by looking for where my ideal people are. Now let me explain what I mean by ideal. The ideal patient is not somebody who needs what I do. And I'm gonna pause and I'm gonna let that sink. Your ideal patient is not the person who needs what you do, is the person who wants what you do and is willing to pay. A lot of times the people who need what you do, they don't want it and they will not pay for it. So who is the person who is somewhere sitting up at night saying, Oh my goodness, if I could just find somebody who did X, who is that person who has the pain, is aware of the pain, is ready for a solution, and is willing to pay for said solution. I will find out who they are where they are. It's a cash bay practice. Chances are these are people who already pay cash for other things, right? Sometimes I see people who have cash bay practices and they're trying to sell people who have insurance on not using insurance. I wouldn't do that. I wouldn't do that at all. There are people who pay for the convenience. There are people who pay for seeing one doctor rather than by being in a place with 10 doctors. They're people who will pay for that 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 of professionals, right? So I would take the time to figure out who that person is, where they're gathered. Okay, so the first is who that person is. Then the question is where are they gathered? And so for instance, if I'm a cash pay practice, well, which other cash pay practices will refer to me? A lot of times the people doing insurance will not refer to you. Now, there's scenarios where they will, right? Especially if there's a long wait time for what you do and all of those things, but a lot of times they don't understand the model. So they won't. Who are they already paying cash to? It may be other cash pay practices, it may be coaches, it may be health coaches. Do you know? I met a health coach that charges people$75,000 a year to work with them. Now that's somebody you want to know, because if people are paying$75,000, they'll pay you too. So who are they? Where are they gathered? And who serves these people in different ways? So I can go after that, right? And then the things I talked about building a brand, I would go all in on that. All in on that. Start collecting email addresses, sharing your journey of starting your practice, like almost like reality TV, not the drama, but just taking people on the journey that grows the no like and trust factor. So that's the way I that's the way I would do it. But the important thing is to find who is my person who will throw money at me. Like just take this, but make this problem go away. That's your ideal person.

SPEAKER_00

I think this one is kind of a piggyback on it. This is from Dr. Zink. Can you tell, talk about how to do things a bit different for cash-based practice versus insurance-based? My practice is private pay psychiatry. I've been working super hard doing all the visibility, networking, speaking, podcasts, Google Business Profile Optimization, et cetera, et cetera. And I would probably have a full schedule if I took insurance. I get a lot of increase from people who don't understand I don't take insurance. But I feel growth has been slow. So I'm wondering if there's a better strategy for cash practices. So I've guessed what you've said so far, Dr. Uno, right? Going back to who's their ideal patient.

SPEAKER_01

So one again is who is my ideal person, right? There, there's somebody who wants exactly what you do. The people who already tell you, Dr. Zink, that you're the best thing since slice bread, start studying them. Like, why do they say that? Are they professionals and their time is valuable to them or their privacy is valuable to them or what whatever? Like, start paying attention to them, your best clients, the people you love working with the most, the people who they're excited, they pay you without thinking about it, right? Who are they? And why are they saying that? Because they're more, there's more of them. It's important to know who they are. It's very different from the insurance 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 to talk to so that they can refer people to you. Again, the insurance people may be unsure about it. The other thing to do is it depends on where you are. Many places, the list to see a psychiatrist is 72,000 miles long. And so people cannot get in. So now you become desirable because you can get people in soon. So look for the doctors who could be insurance-based, but they're hurting because they can't find anybody to send their patients to. And you're like, I will happily see them. I can get them in in 48 hours or whatever your number is. These are my rates. So they can wait or they can pay. And in those circumstances, many people will pay, right? And so I will pay attention to that. Who are my ideal people? Who are my ideal referrals? And where can I solve a pain, even though I'm not accepting insurance? So if you have a long wait like many places, they will do that too. And not that you're going to convince people insurance or cash or whatever, because there's no convincing really. But when people call you and they say, Oh, I thought you took insurance, and you can say, No, we don't take insurance, so that you can have access to a psychiatrist, so we can get you in within 48 hours. So you can have this and so you can have that. And many of our patients, that's the why, even though they have insurance, they will come work with us. Do you see what I mean? So you want to, between you and your team, you want to have a way of responding. I will invite you to dig deeper, right? Like my ideal people, my ideal referrals, spread it wide, put more urgency, put more volume, right? And so, because in the process of doing that, it's almost like a boil that's come to head. You find the head, and it's weird, but we're doctors, you can handle it. But you find that, right? So keep going and keep optimizing. Even if it feels like it's the same thing. How can I do this better? How can I do this more strategic? Who am I missing? What angle can I try? What language can I try? That's the way we do it till we find the thing. I've been, I've run on TriMD for the last seven years. We'll be eight years in September. Like the things you're doing, I'm still doing. After all these years and after all this impact, after all this revenue, it's not something you grow out of. It's just something you get better and better at. And the better you get at it, the better the results will be. So you got it.

SPEAKER_00

This is a question from online. I am enrolling an average of eight new members per month in my concierge longevity practice. But I'm the bottleneck. I can't keep up with plan creation, team oversight, and marketing. What is the smartest next structural move to scale from$40,000 a month to$80,000 a month in the next eight to nine months without burning out? Is it hire a physician, a practice manager, or restructure my offer?

SPEAKER_01

As we grow our businesses, as we grow our practices, we will stumble on bottlenecks, roadblocks, and they will seem impossible. The good thing about growth is that you grow. The downside of growth is that you create brand new problems. Like the reward for solving problems is more problems. And so the better you get at, first of all, normalizing the problems and getting better at navigating 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 new patients a month, which is fantastic. Okay. But now it's bringing to her to a point where she's like, I can't keep up between the plan creation, the marketing, the team, managing the team. So what do I need to do? Okay. So let me walk you through how I would think about this. A lot of times for doctors, we love to over-deliver, which is a great thing. But a lot of times when we are in cash-based businesses, it also puts us in a position where we start off saying, okay, I'm going to offer these three things with my concierge package, but oh, it'd be nice if they get this other thing. Oh, oh my goodness, it'll be nice if they get this other thing. Oh, I'm going to add this other test. And before we know what is doing, where what is happening, we're doing five times the work that we set out to do. And so it doesn't matter if you get two patients or four patients, I'm overwhelmed. But of course, because it's just way too much work. Way too much work. And we don't factor in, okay, maybe I can use the team and leverage the team to do this part and all. So it's not too much work for me. And so when I see people, especially in a cash bay model, a lot of times the first place I'll look is how complex are the visits? How complex have we made them? How much extra stuff have we added to? How many extra steps did we add to them? Sometimes we feel, well, because I'm charging them this much, I must add all these features and all these benefits and all these bells and all these whistles. But a lot of times all those things still take us to the same place the simple stuff would have taken us to. Right? And so the question then becomes this person is paying me not for bells, not for whistles, not for features, not for benefits. They are paying me for an outcome. What is the simplest, cleanest, most elegant way to get them this outcome? A lot of times it's less complicated than what you're doing right now. And so when things feel overwhelming, the place you want to start from is looking at what you're offering, looking at how much time is taking it, and then looking at what would be a simpler way to do it. Why? Complexity constraints, simplicity scales. You cannot scale a complex system. You cannot. So if someone comes in, if I were coming into your business as a consultant and you're like, okay, over the next 18 months, we want to bring in scale, we want to do all of these things. The first thing I will look for is to gut out all complexity. Because if we don't remove that, you cannot scale. Do you know why you can have trees at scale? Because it's not complex. There's one tree, there's a reproductive system in the tree. So one tree makes another tree, that makes another tree, and then that makes another tree. Now imagine if every year they need to there needed to be the creation of brand new trees from scratch, 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 things to do, I'm thinking, what is the simplest way I can do this? How do I document it? How do I do it in such a way that I can train somebody else to do it and be done? Like I'm thinking that way from the beginning. Okay. And whether you're an insurance-based practice or any other kind of practice, simplicity, how can I make this simpler? How can I make this? This is the million-dollar question, like literal millions. Okay. So the first place I'll look is that how can we make it simpler? Then two is how can we delegate aspects of it? So we have a visit that takes two hours. Well, what portion of that do you need to be there for? What part of that could technology do? What part of that could a team member do? Right. And so it doesn't have to be all you. And in the beginning, it's easy to say it has to be all me. It doesn't have to be all you. So that you look in it, you're like, okay, what part can my team do? What part can technology do? What could pre-filled forms take care of? What could like these are the questions 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're paying me. No, they're paying your healthcare system, aka your practice. If you want to have a private practice that helps a lot of people while creating time freedom and financial freedom for yourself, you want to have a practice that is a system, not you. The idea is my business is getting them a result. It's not I am getting them a result. If that's the case, you can never retire, you can never go on vacation, you can never take time off. And whenever you're out of the business, it cannot make money. We were celebrating a doctor in the profitable private practice movement today who said, I am on my seventh week of maternity leave, and my practice is just there making a profit. It stayed profitable the entire time. So if she was the only one doing everything, that would never happen. But here she is, she has a baby. I was like, congrats on that. She took the time off, congrats on that. And her practice is not dying. Like it's still generating a profit, it's still changing while she's hanging out with her baby. So that's the second place. I didn't even talk about a hire. This is the team that she the doctor already has, right? So those are the two places I would look at first. And then if the team is optimized, the doctor's time is optimized, the visit is streamlined, then we can then talk about who do we need to hire to take this further. But the thing is, if you try to grow a chaotic system, everything falls apart. Let me backtrack on that because someone said, but my business is chaotic. Well, your business is and will always be a construction site, so there will be an element of chaos. But if you every time you want to 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 we call the assembly line, door to 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 that is, the happier the patients are. Then we can see the number of visits we need to see, and the doctors don't feel like they've been on a treadmill all day. Simplicity. Simplicity.

SPEAKER_00

Dr. Padma and Dr. Gentil's questions are very similar. So I'm kind of gonna read them together. They're both about time management as a physician entrepreneur. And I think a lot of people struggle with that, right? Dr. Padma's question is around she heard Dr. Una simplicity scales. Okay, I'm gonna simplify this stuff. I'm gonna do my marketing. I'm gonna do all this stuff. But then she spends the day putting out fires. And then Dr. Gento says, How do I balance all of it? Because I've got my practice, I have a side job that I'm working at for more income, and I have to 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? How do I?

SPEAKER_01

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, but it's a worthy walk, really worthy walk. Figuring out how to thrive in private practice has made it possible for me to have the financial freedom to pursue starting on-trame D. I hope you understand it's ridiculous, right? The on-traMD business schools. I was talking to Makita about this, started in June of 2020. Does anybody remember what was happening in June of 20, like in the middle of a pandemic where private practices were going out of business left, right, and center? So, and I didn't even realize it was in 2022. So I asked me, when did business school start? I said in June of 2020, like at the beginning of the pandemic. I thought about it, like, wow, that's crazy, right? But it gave me the freedom to pursue what I believe is my purpose, part a huge part of my purpose, why I'm here on the planet, and all of those things, and write the books and do the podcast and create the programs and all of those things, and to homeschool my kids because that's what I wanted to do. It's worth it, is the point I'm trying to make, but I'm not going to tell you it's easy because then I'll be lying to you. Okay. Okay. So let's start with, let's do Dr. Simone's first, and then we'll come to Dr. Podman. So, how do you balance working on the practice, the jobs, the time to plan, to strategize, and all of those things? I will tell you what I did, and I came into agreement with my husband about this. Okay. In the beginning, you have to realize that the dream costs what it costs. For me, when I started my private practice, it was insane. Like starting the on-trained business school in June of 2020 was crazy, but private practice was insane because I had a four-month-old and a two-year-old. And I didn't have any profitable private practice movement or on-train-d podcast or any of that stuff. I had no clue what I was doing. Okay. And at the same time we started the practice, my husband and I started a church. Okay. So that means I had four children. Okay. If you add everything together. And we applied for loans. I didn't go to medical school in the US. I went to the University of Nigeria. And I moved here after that to do my residency. I moved back. I was born here. But in those days, you didn't need to get a social security number when you were born. So here I came 26 years later. I was like, I need a social security number. Guess who gave me a social security number? Nobody. And so it took me forever to get that. So guess what? I had no credit history. I couldn't qualify for a loan for my private practice. I tried, nobody would give me money. And even the people who could have given me some money, they're like, you're asking for too 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 to self-fund the practice, which is fancy speak for. I did shifts at the local urgent care. I did that for two years, the first two years of my practice, self-funding. So that way we could take care of what we need to take care of for the family and take care of something it bills for the practice until we could do what it did. So the decision we had to make is we're going to self-fund this. And so because we're going to self-fund this and we have the practice, we have the two little children, we have the church and all this stuff, it's going to be interesting. We're still going to prioritize our families. So we still had our date night every Tuesday. We're still going to prioritize our children. So my husband was with them. Sometimes I'm with them and all that, but it is going to look different. We are going to need to do longer hours. We are going to need to do scary things, right? But the idea is because I know that and because I only want it to be for a time frame, I don't have time to play. Do you understand? I don't have time to say I'm not talking to referral sources. Uh uh, because every time I spend doing that, I'm not growing my practice. So I have to spend more time away from my family. I'm not saying I'm not gonna collect copays and I'm not gonna ask for reviews and all of that because I'm shy or because whatever. Because I don't have time. I have to put in the work so I can get out of this phase. There is a time season where it's gonna be interesting. But you decide it is what it is, I can make this interesting season last a year, or this interesting season can last seven years. It all depends on how I show up. So, Dr. Simone, you are doing what I did, it looks like, right? You have the practice, you have the job, working on the business, you have the time for family. What that means is you ain't got time to play. Okay. You the 20% activities that you need to do, you feel like when people are like, I'm too scared to do this, you just jump in and do it because it's either I do it now and then I have all the time I want in a year or in two years, 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'm at work, when it's time to see the patients, I see the patients. When it's time to do the business, I do the business. I collect all my co-pays, all my deductibles. If I need to raise prices, if it's cash pay, I'm raising the prices, I'm leveraging my team, I'm doing all the things because I don't have time. If you can put your head down and do it that way, then what that means is every month you have more and more time. Every month you have more and more time. So now I'm in a place where the practice can work without me. I've homeschooled my kids for years. I have the freedom to do four other businesses and all of that stuff. But it costs me in the beginning. You treat your time like every hour is worth a thousand dollars. The same way you will open your door and throw out a thousand dollars. You don't waste an hour. You invest the hour because you'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 you ain't got time. Okay, so if you're in PPPM, lean into that. Your EBS, lean into that. You have the Profitable Private Practice 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 of that so you can let go of the job, right? You can let go of the job, focus full time on your practice. You have more time for your family, right? Your children are younger now, and as they get older, you have more time with them. It would be fantastic, but you ain't got time to play. And then having said that, all the help you can get, take it all. Don't be afraid to ask for help. People ask you for help all the time, and you say yes. So now it's time for you to ask people for help. Ask people for help. Makita will tell you when I was pregnant with my baby, Makita stayed at stayed in my house, helped me walk with my kids, did all of that stuff. Ask for help. There's no award for doing it yourself, especially for the mommies. Hear me, mommies. There's no award. There children don't get like adults don't get together and say, Did your mommy get help? Oh shoot, what kind of mom is that? My mom did it all. Nobody, nobody remembers that. There's no award, nobody remembers it. Take all the help you can get. Dr. Padma asked a question. I start my day with motivation for marketing and all of those things. I feel I put out a lot of fires every day. Okay. Dr. Padma, there are a number of things that have helped me with this, okay? If you can schedule when you address the fires. Except it's a true fire burning down a building, right? So for instance, oh, this mom was upset. She needs a call back, blah, blah, blah, blah, blah, blah, blah. Great. I have my flex time scheduled for 3 p.m. I'll call her then. Oh, I need these five forms signed now today, blah, blah, blah, blah, blah. Awesome. Hold them all, bring them to my office at 3 p.m. My team knew that. Anything you want me to do, I will do it at 3 p.m. Except somebody's actually coding, don't get in my way. So that way the fires are contained. Do you see what I mean? And it doesn't feel like you're putting fire because that's the tyranny of the urgent. On the other side, Dr. Potna, if you adopt this, it will be a game changer for you, which is now when you put out the fire, you ask yourself the question, why did that fire happen? What is broken in my system? And not remember, we observe, we don't judge. So this is not I suck, my system is broken. No. What is broken in my system that made this fire possible? What do I need to do so this doesn't happen again? Do you see that? And what that will do is it'll put 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. Now you're having high-level fires, not lower level fires. Do you see what I mean? And so you can schedule the fires, but you want to get to the root of the fires and start putting those out. It will show you parts of your system you can work on. I'll give you an example. It's not quite a fire, but let me give you an example. In our pediatric practice, we had started, this is many years ago, we had started doing ear piercings and stuff like that. Then my phone would read off the hook all day, people asking questions about ear piercing. I'm like, this is insane. I told I went to my front desk person, I gave her a piece of paper, I said, write down all the questions they're asking. What am I doing? I'm a systems engineer. I'm like, what is going on here? Right? All the questions. Okay. And so she wrote all the questions, according to the answers, gave it to my website person. I said, create an FAQ for the ear piercing stuff, put it there. The phone calls went from a gazillion 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 the reason? They got lots of questions. And they found you, but they didn'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 making this possible? Simplify as much as possible. Padma, I like the way you said simplifies things. Dr. Ali, they ask for help. There is no award for doing it by yourself. In fact, we had a doctor, she joined the entream d business school. She doesn't have time, she's so strapped for time. We got talking and all that. And turns out all these people have been asking her to help her. No, I got it. I got it. I said, you will go to all of them and say, I got it not. Okay. I got it not. Do you know within two weeks she had 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 everybody who had been asking her, they had been offering to help her. There's no award for doing it yourself at all. Okay. So in all of our programs, you hear me talking nonstop about the 20%, how to identify them, how to identify when they change as you go higher in your business, how to have the mental fortitude to do that, like nonstop, because it's the price for freedom. If you live in the 80%, I mean you 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 needs what I do, but not everyone wants it. So my job is to look for the people who want it. 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 years and years and years. Let's go. Okay. Maximize what we have before starting something. Let's talk about this a little bit. Okay. There is something that I see, and I want to hug the people that say it. Like hug and say, okay, we're not gonna do that. I started private practice and I want to have multiple streams of income. So I want to start a side gig. Should I tell you the truth or should I pretend? Should I be politically correct? Or based on my decade and a half of experience. Should I tell you the truth? Don't do it. Multiple streams of income refers to streams, not trickles. When you start a private practice, that is your main gig, side gig, up gig, down gig, all the gig. It's the gig. Now, if you're self-funding, that's different, right? I told you my example, I self-funded. I'm so I'm not talking about not self-funding, but when things get hard, we get bored with our businesses. Don't do it. Because guess what you're gonna come up against when you get to that same point in your side gig, you're gonna get bored again. Then you're gonna find another side gig. I have seen people start 72,000 businesses. Of course, I'm exaggerating, but you get the point. Because every time they hit that roadblock, ooh, is tough. Oh, it looks like I need to do the same thing over and over again. Yeah, entrepreneurship is boring in 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 people who have hundreds of businesses, yes. But give the business the effort it will take to grow it, then build a team, free yourself of it somewhat, then go to the next one. That is how you can be a serial entrepreneur as opposed to building something that will fall apart. I cannot tell you how many times I've watched this. It breaks my heart every single time. Your private practice, you can self-fund it with the job with the side thing, but usually these people mean starting another business. If you have twins, you cannot say, I will feed them once. They're two people. You have to feed them twice, you have to change two sets of diapers, you have to pay for two cribs, you have to do twice the work. Well, most people pick up a second business and they want to do the same amount of work. It doesn't work. It doesn't work. And so if you want to have babies, many babies in the business world, be strategic about it. So you don't have to have pain and suffering. I've watched somebody who built a really successful practice violate this law and they're on the brink of losing everything. Why? It was not set up in a way to handle getting all like doing all these. Yeah. So don't do it. I said it, don't do it. Dr. Barbara, uh mindset change for me is that my business is always a construction site. It has always been, it will always be a construction site. And that's why in all of our programs, we push people to celebrate wins. Because most people are waiting for it to all be okay. That is not a thing, that is not a timeline, that is not a thing that will happen on this side of eternity. There will always be something wrong. And that's okay. How many of you have something that needs fixing in your practice? You've been working at it, you're diligent, you have all these wins, but something needs fixing. Like my hand is up. There'll always be something to fix. So if you wait to fix everything before you celebrate, you'll never celebrate. That will never happen. That will never happen.

SPEAKER_00

Dr. Benoit says I have a hybrid coaching and clinical practice. I'm currently seeing coaching clients one-on-one weekly for three months. For patients, it's a six-month commitment with monthly visits. I decided I would place everyone on a six-month commitment. But after working with the coaching clients, I think that monthly visits for six months is not enough time. Should I make it for one year?

SPEAKER_01

So this is the thing. And I'm guessing coaching would be around what you do, weight loss, and all the other things. Usually, coaching for six months is not enough, not because a coach is not a good coach, but because there are more results to be had. Right? There are more results to be had. Actually, it's really funny. We did a survey of the doctors in the entreamly business school, and some of them have been there since 2020. They never left. And consistently, their results are much higher than those that started in 2021. And the ones who started in 2021, their results are higher than those that started in 2022. Because let's say you built a practice and then you're like, oh yeah, okay, now you know, I know to do my code base, I know to do this, I know how to fill my schedule and all of those things. Well, how about managing your time? That is a whole area of mastery. And we're talking people who did million-dollar practices and took eight weeks off. So they had more revenue, more time off, and their happiness score, which there's a world happiness index, their happiness score was higher. But across the board, that was true for the people who've been there the longest. Like it was increasing as their length 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 a six-month commitment and they renew, you can do that. If you want to make it a one-year commitment off the back, you can do that as well. There's no right or wrong. Because I've had people, a coach, I was doing voice training and she had like four sessions 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 see potential everywhere. So when she was done with her spill, I was like, girlfriend, you're literally telling me to walk away. I'm willing to work with you for a year, but you're making the assumption that for four sessions, I'm done. And so literally, I could pay you 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, it's not about the number of sessions, it's about the outcome. We're getting them the outcome. They want more of an outcome. I have people work who've I've worked with in the entrepreneurial business school that came as employed physicians. And now they're running multi-million dollar practices. Right? We don't care about the sessions. And then what more do you want? Oh, I want to build a team so that I can exit this. Oh, I want to build this in such a way I can sell this. Oh, I want to build a whole healthcare system. I want to have 12 doctors working for me. Whatever. So as long as the outcome, there's still an outcome desire that I can deliver on, we don't need to end the arrangement. So absolutely, absolutely, but don't end it. And don't focus on the sessions, focus on the outcome. That's the whole point of the coaching. Yeah. Nobody pays for sessions, they pay for transformation.

SPEAKER_00

Dr. Gerald is asking about family practice 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-level or a good doc or a good yeah?

SPEAKER_01

Yeah, that's the whole production. But this is what I will tell you. The starting point is this you need to define what it is you want. How many of you needed to hire a role? You went to the internet, you're like job description of X or maybe Chat GPT now, and then it gave you a thing and you copied and pasted and you made it your own. We just take whatever we see and adapt it, right? You want to define what it is that you want. So, those of you in the profitable private practice movement, you created an ideal ideal job ad template, right? And we created that so you can create a job description that attracts who you want and repels who you do not want, right? Okay, so that's the starting point. Get clear on what you want. The reason why this is important is because of step two. Step two is then you put that ad everywhere. So you can put it on Indeed, you can put it on LinkedIn, you can put it on all your social media platforms, Facebook, Instagram, all of that stuff. You'll see a lot of our clients doing it. We're hiring. This is why you should work with us, blah, blah, blah. Okay. So you put it on there. You can send it to your email list. Hey, if you know any rock stars who are XYZ, all the physicians within your network, you tell them, I am looking. So when you don't have a properly done ideal job ad, then you attract a lot of people who are not a good fit for that. You want to have a really tight job ad. So that's number one. Then number two, you want to put that everywhere. The same way you would market for patients is the same way you market for a physician. So you put it everywhere. You tell everybody that you're looking. And then number three, which could be a one hour talk on its own, is you may not be able to find an affordable quote unquote doctor, but you should find a profitable one. Which means you run your numbers and every role should create their salary. The overhead associated with their role and a profit for the practice. If you didn't get anything out of what we did, anyway, you got a lot of things out of what we did today, but don't forget this. It must generate a profit for the practice, cover the overhead associated with the role, and cover the doctor's salary. So how many patients would they need 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 to happen? So you know what to do for this to be profitable for you. So when they ask you for a certain amount, you can stomach it with as long as they're seeing that volume because it will still be profitable to you. So a nice job ad, so it can filter, you put it everywhere, you interview all the things, and you define the metrics for profitability. Okay, so we want to hire people who will help us serve and earn, not people who will serve. This has been so much fun to do. I want to challenge you to take what 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 to do them. And if you're looking for support in doing that, you want the accountability, you want the community, you want to be around mentorship like this on a weekly basis. We have a number of ways of doing that. You can always book a call with the team. Akita will be the person. So you've met her. She's a physician ally, and actually I'm so honored that she's on our team. And so that's ontramd.com forward slash call. We're happy to talk to you to work you through which program would be the best one for you. But as you can see, we're all about supporting physicians and helping you guys win. 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 those of you who want that, at ontramd.com forward slash call, we have been able to support so many physicians and see them win in magnificent ways. Even the movement we celebrated. Highest revenue ever, greatest number of patients ever, greatest referral sources ever. Seven weeks of maturity leave, and my practice is still profitable doing its thing. And so we want that for physicians. We truly are on a mission to make seven figure businesses, dream business, dream life the norm 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 of autonomy and burnout and our practices not working and us being one trick ponies will all be historical facts. That's what we're here to know.

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