The Hidden Cost of Every Business Decision You Make

Every business decision has a cost.

When you say yes to one thing, you are saying no to something else. And when you say no, you may be choosing consequences you never intended.

In this episode of the EntreMD Podcast, Dr. Una breaks down how seemingly small decisions around visibility, team building, pricing, and investing in your own growth can have a major impact on your business, your income, your time, and your ability to serve.

You’ll learn how to evaluate both sides of a decision, recognize the expensive choices that may be holding your business back, and start making more profitable decisions as a physician entrepreneur.

If you want to build a business that gives you greater impact, financial freedom, and time freedom, this episode will help you think more strategically about the choices you make every day.

Tune in!

Additional Resources:

• Learn more about my 12-month program. 
• Interested in 1-on-1 coaching? Apply here.
• Grab a copy of the "The 7-Figure Physician CEO" book. 

When you are ready to work with us, here are three ways:

•  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

Additional Resources:

• Learn more about my 12-month program. 
• Interested in 1-on-1 coaching? Apply here.
• Grab a copy of the "The 7-Figure Physician CEO" book. 

When you are ready to work with us, here are three ways:

•  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 ...

Transcript

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SPEAKER_01 0:00

So embrace the challenge of building a profitable team, learn how to fire properly, learn how to fire properly, learn how to onboard properly, learn how to do onboard things, learn how to hold these feedings, and your people that have possible needs, learn how to help your people help to start and earth.

SPEAKER_00 0:21

Hi Doug! Welcome to the OnTraMD 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.

SPEAKER_01 0:40

Well, hello, my friend. Welcome back to another episode of the OnTraMD Podcast. Um, today we're going to talk about something that is going to be so profound. It will help you make better decisions. It will put you in a position where you'll be a lot more strategic as an entrepreneur. It will put you in a position where it will be very clear, very clear when you should say yes to what and when you should say no to what. Okay. Okay, now we're physicians. And so I want to put this in terms that you really are, you really get because our decisions, our destiny, um, our destination is at the mercy of our decisions. It is so wild. Like where I end up in life is based on the decisions I make. Where I end up as an entrepreneur is based on the things I say yes to, the things I say no to, the big ones, the little ones, all of that. And I'm gonna show you how to see this in a way you can never unsee it. So think about this. I have um recently been talking to a lot of people who are non-medical, um, who are in their 40s and 50s and 60s and have hypertension, right? They have hypertension. It's very intriguing to me that somebody will say to me, Oh, you know, my blood pressure typically runs about 165 over 95, sometimes 100, but I feel fine, so I don't take my medicine. Now, as I say that, it's probably like again, nails on a blockboard, like like that's probably what you're you're hearing. Well, to the person it means nothing. It's just like, but I feel okay. And because they don't understand what the numbers mean, because they don't understand what they're saying yes to by saying no to taking their medication, they just chill. They and they're okay and they're comfortable, and it seems like there's no problem. Meanwhile, there's a big problem, right? Because we're going like, oh my goodness, you could have a stroke, you could have this, all these kind of things can happen. Like, what's going on with your kidneys, what's going on with your heart, what's going on with your lungs, with blood pressure, like that. They're not thinking about any of that. They're totally chill. They're just like, Yeah, you know, um, yeah, I feel fine. Right? But you know this is a problem. Now, I want you to start seeing business decisions that way, where you'll stop being okay with the decisions that are a problem. Because the same way you see that for hypertension, that's the way I see it in business every single day. When people tell me about some decisions, they make it. I'm like, oh my goodness. But to them, they're like, I feel fine, and everything seems like it's fine. I'm like, no, it's most definitely not fine. Okay, so what I'm gonna do here is I'm I'm gonna give you three, maybe four examples. Um, and so you can see it, and then you're what I really would love for you to do is to start practicing, okay? Is to start practicing. Now, the big thing I want you to understand is whenever you say yes to something, you're saying no to something else. Whenever you say no to something, you're saying yes to something else. There are two sides to every decision you make. You have never seen a one-sided piece of paper, and there's no such thing as a one-sided decision. Every decision has a consequence. It's like cause and effect. Every decision has a consequence and they go together. It's a combo deal. They're like Siamese twins connected at the heart, lungs, and brain. They cannot be separated. Okay. So you have um, you have uh the decision, you have the consequence, you have the cause, you have the effect. No decision is just neutral. Okay, so let's let's look at a few examples here. Okay, and and why do I want you to know this? Because I want you to stop making expensive decisions, decisions that cost you so much. Okay. Okay, how did I learn? School of hard knocks. Why am I telling you? So you can skip the school of hard knocks. Number one, when someone says, I am, I am not, I don't, I'm too shy. You know, so I I don't really want to be visible. I don't, I don't want to build a referral base, okay? And and I, you know, I I started off as a socially awkward, super shy introvert, introvert. I understand being shy. I understand feeling like, oh, I can't put myself out there. I'm an introvert, I don't talk to people and all that. But by saying no to visibility, by saying no to building a referral base, I am deciding. So let me say as a private practice owner, I'm deciding that I want to have an unfilled schedule. I'm deciding as a coach that instead of having a hundred clients, I want to have two. So the question becomes are you that shy? Are you that shy that, okay, and let me give you an example, okay? Because you know, I like to play around with numbers, okay? Okay, let's say as a coach that you charge $10,000 a year. Okay. And if you were, if you decided, I may be shy, but this visibility is not gonna visibility itself. I need to go do what I need to do. Let's say I I decided that and I acquired 40 patients over the course of a year, okay? So 40 patient, 40 clients over the course of the year is $400,000. Yay, me. Okay. But let's say I was shy, so I didn't put myself out there, and so it's like, oh, I don't want my face on social media. Oh, oh, and I can't talk to referral. So it's oh no, I can't, I can't speak any fast. Oh, oh no, I'm too shy. Okay. I am saying no to the 400,000. And let's say, let's say I didn't do too badly. Instead of the 40, I got 20. So I got two, I got 200,000. I got half of the pay of the of the clients I could have gotten because I was too shy. And that's let's say that's year one. And then year two, right? My non-shy self could take us to a million. But this shy self does 200 all over again. I want you to think about it. Let's not even forget them. Let's forget them in the per for the purpose of this math. Let's say, you know, non-shy me could have done 400, but shy me, and not even non-shy me, shy me that's committed to success, right? In terms of impact, financial freedom, time freedom, that version of me makes 400,000. Then the version of me that's like, ooh, I'm too shy, makes 200,000. Over the course of a decade, over the course of a decade, I want you to hear me. That is $4 million versus $2 million. That is a difference of $2 million. That is a difference of $2 million. So my question is, are you like $2 million shy? Like, are you that shy? Right. And so it doesn't mean if you're shy, that's not a thing, but it means it's a thing to overcome. Because you want the business to work or you do not want it to work. And, you know, like let me be your evidence that this could be overcome. Because I would never be doing what I'm doing now, but I'm doing it because I'm committed. Like I've come to record podcast episodes and I'm like, I don't feel like it. What will people think about me if I say this? But it doesn't stop me. I feel it and I do it because I'm committed to impact helping you, to financial freedom, and to time freedom. I'm committed. I I would rather be uncomfortable and be visible so I can stay home and homeschool my four children than I am claiming I'm shy and not going out there. Do you guys see that? So when I say, uh, oh my goodness, like, uh-uh, I don't, I don't, I don't want to do that because I'm shy. I'm gonna work on that shy. Okay, so let's pretend. So we talked about it for a coach. Let's pretend this is a private practice owner, okay? And your schedule could be full, but your schedule is half full because you're shy. Okay, so you want it to you, you you would like to see 20 patients a day. You're only seeing 10 patients a day, 10 patients a day. Insurance company reimburses you $150 per visit, and you do this for 260 working days a year. That's $390,000, aka $400,000 left on the table because I'm shy. I am overcoming that shy in a heartbeat. Okay? Because over the course of the year, again, that's $4 million. In addition, this is not the whole revenue. This is in addition, being left on the table. No, I'm not that shy. Okay. So if you're shy, I want to invite you to decide this is a project and I'm gonna work on it. I'm gonna spend the next year, maybe, maybe 90 days. I'm gonna spend the next, the next 90 days practicing, practicing, showing up confidently. That is a skill. Practicing, owning the stage, practicing, dominating on social media, practicing, building a referral base. I'm gonna practice that stuff. I'm gonna, like 90 days, I'm gonna be so different. In a year, I would have gained mastery. Me and my shy self. Because I'm not saying yes to leaving 4 million on the table. I'm just not gonna do it. I'm not saying yes to, oh, I don't have time freedom because I couldn't afford the team that would give me the time freedom because I was so shy that I wouldn't go be visible. I'm not that shy. Okay, number two, second example. Um, and I see people do this all the time. Oh, you know, like working with people is so difficult. And I just don't, I don't want the household building team. Because if I build a team, then I have to lead all these people, I have to do with people, I have to do with their drama, and what happens to my profit margin? I'm not being able to pay myself well enough and all of these things. Like, I I'll just do it. So they could hire a doctor, they don't. They could hire another coach, they don't. They could hire a business manager, they don't, they could have an office manager, they don't. Don't hire anybody. Okay, they're doing everything by themselves, and everything is in layers for you. It may not, it may not be that you're doing everything. You may have a VA, you may have a front desk person, you may have a medical assistant, but you're at a stage in your business where you also have three doctors, you need an office manager. But you're like, yeah, I'm not doing that. Because how am I gonna find out what they're gonna do? Who's gonna lead them? I don't know if I can hold that kind of person accountable. Okay, well, I'm gonna show you the consequence of the decision. You can decide if you're gonna learn how to do that or not. Okay, so when I say I don't want the hassle of building a team, when I say no to a team, what am I saying yes to? All right, let's look at some things here, okay? I'm saying yes to doing $20 work, even though my hourly rate is $400. I'm deciding, you know what? I'm going to do this myself. Somebody I paid $20 an hour could do this, but I'm going to do this myself, which essentially means for every hour I work on those $20 tasks, I am costing my company $380 an hour. I'm a liability to the magnitude of $380 an hour in my own business because I won't learn how to lead a team, or I won't learn how to lead a team profitably. Do you guys see that? Like when we do it, we feel like, oh, well, I'm the one doing you're the whole CEO. You're the CEO of your company. Okay. So while you're busy there doing $20 hour tasks, you are like, it's like you paid somebody. I asked this in a question. I was teaching in the in the profitable private practice movement. We have sessions every Thursday. And I was teaching, I said, okay, so I told people to type all these things they're doing that they know they shouldn't be doing. And they typed all that. I said, okay, if you were paying a CEO $300,000 a year to be the CEO of your practice, this is specifically for private practice owners, and that person came up and told you they spent a day doing all these things you wrote here, what would you do? They're like, Oh, I'll fire the person. I'll maybe you need to fire your own self. Don't fire yourself. Okay, well, maybe you need to fire your own self. Because you're spending company dollars, company time doing things that a CEO has no business doing. Okay. So when I say yes, oh, I don't, so no, I don't want the household building team. What am I saying yes to? You are saying yes to building a business to which you are connected to, like a baby, a newborn baby is connected to the umbilical court. You can never be away from that business, never. That is your Siamese twin. You're never going to be away from that business. So even when you go on vacation, you have to check, you have to check in with the company, you have to check in with um, you know, the team that you have there that maybe somebody else should be leading. You have to be putting out fires, all this stuff. So you're on vacation, but you're not. And your kids, the whole time, when they've been with you at home, you come back at night and you're charting all this stuff. They're excited. We're going to Florida, we're going to you Jamaica, we're going to Hawaii. So finally, mommy can be away from work so that we can spend some time with mommy. And guess what? Mommy's computer comes out, mommy's phone comes out, mommy has this glazed look when they're talking to her, talking to her because mommy's not there, and mommy's not there because mommy said no to building a team, and because she said no to building a team, mommy has to be the business. Mommy is the business. Mommy is the business 24-7 for the rest of her life for as long as she has that business. Do you really hate building a team that badly? Like when you realize what you are saying yes to, maybe you build the team, maybe you learn how to build a profitable team. Okay. When I say no to building a team, what else am I saying yet yes to? I'm saying yes to the mental weight of being the only revenue generator. Meaning if it will be, it is up to me. I am when I think about payroll, oh, I have to generate payroll, I have to generate what we use for taxes, I have to have to generate what we used to pay for the supplies, I have to generate what we used to overcome overhead. I have to generate all this stuff. Well, if you had a team, somebody else generated with you. If you have a high capacity team, somebody else can generate this with you. When you say no to building a team, that's what you're saying yes to. I want to be the only revenue generator, I want to be the only person thinking about it. I want to be the only one responsible for everything. It is painful, it is hard, it is too much for one person. Okay. When I say no to building a team, what else am I saying yes to? I am saying yes to having a business I can never exit. Like when it is all set and done, after I've spent 15 years, blood, sweat, tears, all this stuff building this stuff, when I am done with it, it will be worth less. And I know that sounds harsh, but oh my goodness, if I sound harsh and I deliver you from this, you will say, Dr. I was harsh and you still give me a hug. Maybe even buy me a gift. Okay. You build a business you cannot exit from. When you're done, you just shut it down and you pay the cost of shutting a business down because it costs money to shut a business down. You'll not be able to reap any ROI. You'll not be able to reap anything from it. Why? Because you're the business. Nobody, like you're the business and you want to walk away, and then you guys want somebody to pay for what? What is the person going to pay for? The business is walking away. You. So embrace the challenge of building a profitable team. Learn how to hire properly, learn how to fire properly, learn how to onboard properly, learn how to do ongoing training, learn how to host these meetings and with your with your people that are profitable meetings. Learn how to help your people help you to serve and earn. These are all skills. My goodness, you learn how to do CPR, you learn how to do ACLS, PALs, all of these things. You know how to bring people back from the dead, aka running codes. You can learn this stuff. I didn't say figure it out. You can learn it. It's a skill, you can learn it. What you say no, this is what you're saying yes to, and that is a bad neighborhood. I highly recommend you don't go there. Okay. Number three. Number three. Oh, I you know what? I just want to help everybody. So I'm not gonna raise my prices, I'm not gonna charge appropriately for what I do. When you say no to charging appropriately, let me tell you what you're saying yes to. Okay, you are saying yes, you are saying yes to earning a little money, you're saying yes to potentially needing to work another job in your business. I see this all the time. You're saying, you know, you're saying yes to leaving ridiculous sums of money on the table. Okay, so let me use an example here. So let's say you run a DPC, and I'm not picking on DPC, I can use any kind of business. I just want to use all kinds of different businesses for this, okay? So let's say you run DPC and you're charging 70 bucks an hour. And really, you know, like two years ago, you were like, man, I should really be charging $120. You said it's two years ago, but still you're charging 70, 70 bucks. And I'm saying 70 bucks, I'm rounding up, it's 69, right? Okay, so you say that, oh, this is what you're gonna do, and you don't want the discomfort of raising your prices on what patients might say, and the drama of it, and all of that stuff. So you just decide to keep your prices the same. Okay. So let's say you have a panel of 300, 300 patients, okay? So 300 patients, and you are giving up $50 per patient per month. Okay, so $300 times $50 is $15,000. You're leaving on the table for work you already did. You already did the work. You already did work that was valuable enough that yes, you could have been charging $120. Okay? Okay, and I'm not saying $120 is a fee. I'm just using an example. Okay. And over the course of a year, that is $180,000. I want you to think about it. Like you legit said, yeah, no, I'm not going to do that. Instead of doing that, I will leave $180,000 on the table. Is that what you need? Because when you say no to raising your prices in this scenario described, that's what you're saying. Like, I could give myself a raise appropriately because I'm already doing the work. Like the value I'm giving already exceeds what I'm charging. I could give myself a raise for $180,000, but you know what? I just said eh. $200,000. Who wants that? I don't want that. Meanwhile, you're working a whole other job. You're working a whole other job so you can pay your bills, you can take care of your family, and you are making one decision that is costing you $180,000. Like you can legit quit the locums and be home with your family and get the rest that you deserve and enjoy taking care of your patients when you go see them. And your patients, who by the way, would pay the happily, they'll be okay. Everybody will be okay. But you decide no. No. I I I I want to I want to charge, I want to charge $180,000 less. I want to go work locum. Sometimes I'll need to travel. It is what it is. And I, you know, when uh when my kids come talk to me, I want to tell them I'm too tired because you know, mommy worked there and there. And when I go to work, I want to be irritated with my patients because I'm tired. It cannot be that uncomfortable to raise your prices. You can learn how to raise your prices ethically, professionally, and in a way that your conscience is clear.

unknown 20:07

Okay.

SPEAKER_01 20:08

Okay, so I don't want to raise my prices. What else am I saying yes to? When I say no to raising my prices, what else am I saying yes to? So I'm saying all these, but I want to give you two different scenarios. So you're a coach, you're charging $5,000 a year when you when you knew three years ago it should be $10,000. It means you can literally make one decision, keep the same number of patients, and double your business. And I'm not talking about charging inappropriately. Like you're already doing the work two years ago, you decided, yeah, I should be charging different from this. You are a private practice doc and you have a partner, it's both of you. And then you decided, because you you may say, oh, we're insurance, we don't pick the price. Yo, you do by what you code. Okay. So let's say you're your, I'm pulling out my calculator again. You and your partner, between both of you, you undercode, you undercode 10 99214s as 99213s every single day. Okay. So 10 times 260 working days between both of you, you do this 2,600 times a year. 2,600. Okay. The difference between the 99214 and the 99213 as far as reimbursement is about $35. So let's multiply this by 35. Both of you are just dumping $91,000 on the table. And it's literally pure profit because you already, you already paid the mortgage, you already paid the team, you already paid the utilities, you already paid for the HR. All that this is lovely green profit that could go right to the bottom line. But you're like, yeah, we don't want that. We don't want to charge a pro. We don't, we don't, we don't want to code properly. Uh-uh. We don't want to do that. Your no's can be expensive, your yeses can be expensive. Every time you say no, ask yourself, so what am I saying then saying yes to? Every time you say yes, then ask yourself, what am I then saying no to? You gotta learn to make decisions, like informed decisions. You gotta look at both sides. That's what we do, right? We tell the person this is the procedure, this is the potential complications, and all of these. So the patient can make an informed decision. But as entrepreneurs, we don't make informed decisions. We just pull something, you know, out of a hat and we're like, ooh, I'm gonna do that. No. Okay. You guys are getting Dr. Una too excited. All right, let me give you one more. Let me give you one more yes or no. Okay. When we say no to investing in ourselves to develop skills, right? Because this comes up all the time. This is my world, right? Once upon a time, I had the opportunity to say yes to gain mastery when it comes to speaking. Okay. And the program at the time was you guys have heard me tell this story so many times. It's 40, it was $43,000. And I almost said no to it. I'm so grateful I did. I almost said no to it. But eventually I was like, man, I've I've been here for three days at this event, and my mind is totally blown. And I've seen my, I've I see the world through a different lens now, and I see speaking as something I can master as a socially awkward, super shy, introvert or introvert. I was like, what is there to lose? I said yes to it, right? But by saying yes to it, I said yes to becoming a speaker. I said yes to using speaking to grow my practice. I said yes to finding myself in the world of evolution by mentorship. I said yes. So that one decision has made me millions and millions and millions of dollars. The frightening thing is I could have said no. And maybe till now, I'd not be speaking at all. And you know how I've grown my business? Speaking. Whether it's impact or time freedom or financial freedom, is through speaking. Okay. So what do we say no to? So I want to give you two examples. One is we've heard with this doctor on the podcast, Dr. Pram Tripathy. He has a beautiful episode. If you haven't listened to it, you want to go catch it. And he tells the story of you know, of being fired. Like he comes, he's a plastic facial plastic surgeon, he comes to work, he gets fired, right? And it would have been a disaster. You guys see this all the time. Except nine months earlier, he had said yes to something. He said yes to the entree MD business school, he joined the entree MD business school, he started learning, and I was so proud of him because even as an employed physician, if you will, he was learning and deploying all the skills. So we would talk about visibility, and he was already fairly visible, but he took it to a whole new level. We talked about monetizing your visibility. He was already doing that too level, he took it to a whole new level. We talk about building a team. He would leverage his team at his employee position and start leading them and start practicing, holding them accountable and showing them how to serve and earn. And all he was just doing the mostest. So on that day when they fired him, he was like, I gave myself, I don't remember what he said, whether it was a few hours or a few days. He gave himself the time he needed to, whatever. And boom, he found another location. He started seeing patients like temporarily, and then did this big, you know, got ready for his main launch. He launched, so I think this happened, if I remember correctly, like October. And then he launched his practice in January. And his first month, he did six figures in his first month. Why did that happen? Because he said yes. He said yes, and so he knew that he could pull it off. He knew he could build this, he knew what to do. That's what happens when you say yes. Okay. Um, Dr. Dr. Morius has shared her story, and Dr. Morris is so fun. She is um uh she's a OBGYN, and her main focus, I think, at this time, if I may say, is perimenopause, menopause, sexual health, all those kind of things, sexual medicine. And um, she oh, she is so amazing. She came to an event, and she had been in the entream business school when she first launched her practice and all of that stuff, but she was like, now it's time to grow again and all of that stuff. She came for an event, she's like, I think I need to do this. She comes back into entre MD business school. That yes created 41% growth in a year. Not in a year, in the second half of the year. She she came back in in the middle of the year, and she took seven weeks off, has brought her to a position where this year there's even more growth on top of that, and she's probably gonna take more time off. And she was working a locum job that she's been able to give up and all of that stuff. The yes meant no to not earning as much as I'm worth. She raised her prices, she did all kinds of stuff. That yes to the entrepreneurial business school meant no to charging inappropriately, it meant no to working a locum job, it meant no to not taking enough time off, you know, the amount of time I want to take off. It meant no to not sacrificing my family to build my business. Like it was no to so many things. You gotta understand, you've never seen a one-sided piece of paper. There's no such thing as a one-sided decision. When I say yes to something, what am I saying no to? When I say no to something, what am I saying yes? In my business as an entrepreneur, I need to look at both sides. Okay, and remember, business is an economic sport. So your decisions have three kinds of um um consequences. One would be impact, right? We talked about visibility. So when we say no to visibility, we're saying no to big impact, period, right? So impact is one, financial freedom is one. When we say no to visibility, we're saying we don't want certain dimensions of financial freedom. When we say no to visibility, we're saying we don't want certain dimensions of time freedom. Every business you decision you make has consequences in terms of impact, time freedom, financial freedom. So when you say yes, ask yourself, what am I saying no to? When I see when you say no, ask yourself what I'm saying yes to. But from today, understand that every decision has a cost. Some are expensive, some are profitable. The more profitable business, profitable decisions you make, the more you will profit in terms of impact, time freedom, and financial freedom. The more expensive decisions you make, the more expense you costs you will bear for impact, time freedom, and financial freedom from today. Make a commitment. I will make predominantly profitable decisions. And if you're making that decision, I want you to send me a DM on Instagram or Facebook, anywhere you are, and say, Dr. Una, I made the decision. I will make predominantly, my decisions will be predominantly positive, not predominantly expensive. We cannot afford to go through life, we cannot afford to go through business taking one expensive decision after the other. Too expensive. Okay. Okay. So if this was helpful for you, which I know it was, I want you to take this episode. I want you to share it with the doctors in your world. I want you to share it on social media, tag me, I'll come by to say thank you for it. But I want you to be the voice. I want you to help doctors understand this because if we understand this, we can thrive so much more as entrepreneurs. And as for you, I cannot wait to see. After you've put in the reps of building, of making profitable decisions, profitable decisions consistently for 90 days. I cannot wait to hear what your business and your life looks like. I am rooting for you, cannot wait to celebrate this with you. Go do this, go put in the reps, and I will see you, my friend, on the next episode of the Untrand B podcast,