Most physicians assume medical practices fail for obvious reasons: poor reimbursement, bad locations, declining insurance rates, staffing shortages, or market saturation. Those factors matter—but after consulting with hundreds of clinicians and building a multi-location practice myself, I can tell you something uncomfortable:
Most medical practices don’t fail because the owner didn’t work hard enough.
They fail because the owner’s ego quietly suffocated the business.
This is not an accusation. It’s an observation. And if you’re willing to confront it honestly, it may be the most liberating realization of your career.
Let’s start with a truth most doctors already understand.
If you made it through medical school, residency, fellowship—or even a doctoral program in another healthcare discipline—you already know how to work hard. You’ve endured long nights, delayed gratification, crushing exams, and constant evaluation. Work ethic is not your problem.
That’s why advice like “just work harder” is useless for physicians.
Hard work is the baseline. It gets you into medicine.
It does not automatically help you scale a business.
In fact, the very traits that make physicians excellent clinicians often make them terrible business owners—at least initially.
Medicine trains you to be decisive, authoritative, and confident. Patients expect certainty. When you cut someone open, prescribe medication, or manage a complex diagnosis, hesitation is dangerous.
So yes—you need an ego to practice medicine well.
But that same ego becomes toxic when you move into ownership.
Why?
Because business is not about certainty—it’s about systems, people, and outcomes. And ego interferes with all three.
Ego doesn’t always show up as arrogance. In fact, it’s usually disguised as responsibility, quality control, or “doing what’s best for patients.”
Here are the most common ego-driven behaviors I see:
In the beginning, this is true.
You have to build the first SOPs.
You have to hire, fire, answer complaints, manage billing disasters, and fix broken workflows. Everyone pays their dues.
But at some point, that mindset becomes the bottleneck.
If you still believe:
Only you can handle patient complaints
Only you can manage billing
Only you can approve every decision
Only you can hire effectively
You don’t have a business—you have a dependency.
That dependency will burn you out.
This is one of the most dangerous lies ego tells physicians.
Delegation does not mean abandonment.
It means training, empowerment, and accountability.
When you refuse to delegate:
Staff stop thinking critically
You become the approval bottleneck
Growth slows
Your stress skyrockets
Ironically, patient care often gets worse—not better.
Many physicians believe leadership means being involved in everything.
True leadership means:
Hiring people better than you
Letting them own outcomes
Judging performance by results—not by whether they did it “your way”
If you insist on approving every decision, you’re not leading—you’re micromanaging.
Here’s the mental shift that separates builders from strugglers:
Ego wants credit.
Business wants results.
Only one scales.
Medicine conditions you to value individual performance.
Business demands that you value collective output.
If your staff can achieve the same—or better—outcome with less friction, that is success. Even if they didn’t do it the way you would have.
When I consult with practices, I ask one simple question:
Is this a key person—or not?
If someone is:
Trusted
Competent
Aligned with your values
Then you must let them run with their strengths.
Marketing? Let them own it.
Front desk operations? Let them optimize it.
Billing negotiations? Let them handle it.
You still retain final authority, but you relinquish daily control.
That distinction is everything.
Another way ego kills practices is rigidity.
I see this constantly:
Therapists who refuse to supervise trainees—but complain about income
Physicians who refuse to work with midlevels—but can’t recruit doctors
Surgeons who insist on doing every follow-up—but feel trapped
In each case, the market is offering a solution—but ego blocks acceptance.
If you don’t like the available labor pool, you must change the model, not complain about reality.
That may mean:
Hiring midlevels with proper oversight
Moving to concierge or DPC
Charging more
Hiring support staff to offload low-value tasks
Refusing to adapt is not integrity—it’s stubbornness.
This question comes up constantly, and it deserves a direct answer:
No. Letting go is not cutting corners.
In fact, it often improves care.
Why?
Because burned-out physicians do not deliver excellent care.
When you:
Work out regularly
Spend time with your family
Stop doing low-value administrative work
You show up as a better doctor, leader, and human being.
Accessibility improves.
Continuity improves.
Systems improve.
That is not neglect—it’s sustainability.
Let me redefine confidence for you.
Confidence is not:
Doing everything yourself
Being the smartest person in the room
Protecting your territory
Real confidence is saying:
“I want people who are better than me at everything I’m not great at.”
That’s how real companies are built.
The best leaders I know actively try to become the dumbest person in the room—while still owning the vision.
Ego also shows up in how physicians chase validation.
Awards.
LinkedIn accolades.
“Fastest growing” lists.
Ask yourself honestly:
Does this bring patients through the door?
Does this improve operations?
Does this reduce friction?
If the answer is no, it’s noise.
Results compound quietly.
Ego seeks applause.
If your practice requires you to:
See patients full time and
Run the business full time
You don’t have one job. You have two.
That is unsustainable long-term unless:
You drastically increase your per-hour revenue, or
You build systems that don’t require you daily
Most burnout is not from clinical work—it’s from unscalable ownership.
When physicians truly let go, remarkable things happen:
Scalability increases
Staff take ownership
Better people join your team
Work-life balance improves
Patient access expands
The business grows without consuming you
Your role shifts from firefighter to architect.
That’s the goal.
If there’s one idea I want you to remember, it’s this:
Ego wants recognition.
Business wants outcomes.
Only one builds freedom.
Let go of the need to do everything.
Let go of the need to be right.
Let go of the need to be indispensable.
Build something that works without you—so it can work for you.
That’s how medical practices scale.
