Stop Drifting: Why “I Just Want to Be Busier” Is Killing Your Practice

 

Hey everybody, welcome back. My name is Brad, and I help people start and scale medical practices. I also own and practice in a multi-million dollar practice myself. Today I want to talk about one of the most expensive mistakes I see doctors make, and one I made myself more than once: aimlessly drifting through your business and your life instead of moving through it with intention.

Let me get the core truth out of the way first, because everything else in this post hangs off of it. Practices and businesses do not drift toward excellence. And honestly, neither do people. You are never going to accidentally drift into getting in shape. You don’t wake up one day, having done nothing on purpose, and discover you’re lean and strong. You have to go at it with intention. You have to set a goal. You have to be deliberate about the thing you’re actually trying to hit. Businesses are exactly the same.

“I want to be busier” is not a goal

Whenever a doctor sits down to consult with me, my very first question is some version of: where do you want to be in three years? And you know what the number one answer is? “I want to be busier.” Everyone wants to be busier.

Here’s the problem. “I want to be busier” is like saying “I want more money” or “I want more muscles.” It sounds like a goal, but it isn’t one. Do you have a plan to get there? No. Are you going to execute on that plan? No, because there isn’t one. It’s not a strategy. It’s a wish.

Think about how a real company operates. Imagine if Google came out and said, “Hey everybody, I know the public invested an insane amount of money into us, and we’re worth nearly a trillion dollars. So here’s our strategy for the next year or two: we’re going to vibe it out. We’re going to see how things go. We’re hoping to make a little more money, we’ll keep you posted.” That would be absurd. Instead, Google puts out an actual report. This is where we plan to go over the next 12 and 24 months. This is where we plan to spend our capital expenditures. This is how we intend to grow and make more money. They have a roadmap.

And I’ll be honest with you: for a stretch, my own practice ran on the “vibe it out” plan. A lot of you are running your practice that way right now, and I say that with total respect. I am not here to beat you up over it, especially if you’re in your first year.

The first year is survival mode, and that’s okay

If you’re early, I need to say this clearly: the first year is insanely hard, and you’re not supposed to have it all figured out yet. In that first year or two you’re just trying to get your feet on the ground. You’re building a foundation. You’re trying to make payroll. You’re learning billing. You’re learning how to fight insurance companies. You’re hiring staff and then dealing with everything that comes with staff, up to and including what happens when two of your employees start sleeping together, or when someone starts stealing from you. You’re learning to keep patients happy as a business person, not just as a physician. You’re figuring out how to manage your phones. That’s survival mode, and survival mode is completely legitimate at that stage.

But here’s the key: survival mode is temporary. If you go into the military, boot camp is temporary. Almost everyone has to pay their dues at the start, and very few people are exempt from it unless they walked in the door having raised a ton of capital. The danger is when survival mode becomes your permanent operating system, because that is a horrible place to live long term, and you’ll never climb out of it.

So even in year one, your first “business plan” is really this: build your foundation through standard operating procedures. Anything that keeps you up at night, anything you have to do three or more times, turn it into a documented SOP. Every single month you should be sitting down and asking two questions: what am I going to automate, and what am I going to turn into a standard operating procedure? What can I do to make my life dramatically easier next month? If you’re not doing that, you’re setting yourself up for a world of hurt, because you’ll never build anything that runs without you.

Define what you’re actually building

Once you’re past pure survival, the real question comes back around, and it’s the one I care about most when I consult: where do you want this to go? What do you actually want to do with this business?

What I’m really trying to pull out of you is the shape of the thing. Do you want a micropractice? A DPC? Do you want to go concierge? Do you want to niche down hard on one thing, like sexual health, hormone replacement therapy, or being the best GI doc in your area doing advanced endoscopies? I genuinely don’t care which one you pick. What matters is that you define it. Because here’s the hard truth: you cannot optimize for everything at once. You have to prioritize.

And in business, prioritizing means deciding where your dollars go. You only have so much revenue and so much profit. Every $10,000 in profit is a real decision. It would usually be foolish to take that $10,000 and blow it on a single commercial at this stage. Now, are there exceptions? Absolutely. There’s the famous story of the shirt company, I think it was Twillory or one of those, that sponsored the Howard Stern show. They spent something like a million dollars, and it worked out immensely well for them. But they were selling a scalable consumer product, which is a completely different animal. I would not walk out today and drop a million bucks on one ad for my clinic, and neither should you. You start, you prioritize, and you sequence your spending on purpose.

Break the big goal into bite-sized chunks

The way I think about this is exactly how you’d counsel a patient. Someone comes in and says, “Doc, I want to lose weight.” Great, let’s start. But first, define it. Do you want to lose five pounds or a hundred pounds? Those are two totally different plans.

Business is the same. Say you come to me and say, “Brad, I want to be worth $100 million.” Hell yeah, good for you. That’s step one. But step two is where people freeze, because “$100 million” is like saying “I want to climb Everest.” You don’t just teleport to the summit. Step one might be that you haven’t been to the gym in a while, so let’s start there for a bit. Then let’s add some cardio, run half a mile, then a mile, then a mile and a half. It’s a stepwise approach. You’re not going from zero to a hundred million. You go from zero to a hundred thousand. Then a hundred thousand to a million. Then one million to five million. See where this is going? You break the mountain into chunks you can actually climb.

So instead of “I want more money for my practice,” you get specific. Okay, I want to maximize my top line. How? I want to make an extra $3 million. How am I going to do that? Maybe I improve operations and get more efficient. Maybe I have to terminate some people who aren’t helping. Maybe I hire more clinicians or more support staff to do more visits. Maybe I add remote patient monitoring or chronic care management. The point is that “more money” always resolves into a short list of concrete levers: I’m going to see more patients, bill more services, or hire more clinicians. Once you’ve defined it that clearly, the next question becomes easy. Which lever do I pull first? What’s the lowest-hanging fruit? Start there, then scale down the list from there.

The same logic applies when you’re stuck in fight-or-flight mode on some operational fire. For me, the worst was always the phones. My god, the phones. So many calls. It’s a beautiful problem to have, because it means people want you, but it is brutal. So I attacked it with intention. First I’d add virtual assistants. Then I’d build a phone tree. Then I’d add the “press one to hold your place in line and we’ll call you back” option. You just keep working the problem, deliberately, one improvement at a time.

My own expensive failure: the double-booking experiment

Let me share a real failure of mine, because I want you to see how easy it is to slip back into drift even when you think you’re being strategic.

My business partner and I recently sat down and asked, okay, what is our five-year goal? Where do we want to be in five years? We defined it. Then we asked how we were going to hit it. And that process surfaced a specific problem at one of our locations: the no-show rate was higher than we wanted.

For context, an established panel usually has a very low no-show rate. In my personal panel I get maybe one or two no-shows a week out of 90 to 100 patients, so I’m running a 1 to 2% no-show rate. But when you’re starting up, especially if you take Medicaid or you’re in an underserved area, your no-show rate can easily be 10, 20%, sometimes higher. So at this one location, the rate was elevated, and we decided to lean into it. Our plan: for patients who weren’t confirming, we’d double-book some of those slots.

So we designed it, and we tested it. And here’s where I failed. After the experiment ran for about 30 days, I never went back and closed the loop. I never created a metric to measure it, and I never made a decision to formally adopt it. What happened next is almost comical in how predictable it was. One day the doctor had a GI bug and said, understandably, “Please don’t double-book me today, I feel awful.” Boom. One exception. And that one exception spiraled. Suddenly we hadn’t double-booked in two months, and I was standing there going, what the hell happened?

I had done the hard part. I designed it, I tested it, I collected the data. But I never went back and asked: are we implementing this as a permanent, for-sure plan? And if so, I needed to write the standard operating procedure and move on. Instead I just sat there vaguely wanting them to be “busier.” And for a little while they were, but then the whole thing fell off the rails because I never created a hard-and-fast rule. Everyone treated it as an experiment, so it evaporated the moment it was inconvenient. That is 100% my failure, not theirs.

The lesson: create a one-day, a 30-day, and a 90-day objective, and then actually stick to it. Design, test, measure, decide, and codify. If you skip that last step, all your good work quietly unravels.

You can’t scale chaos

Here’s another thing I had to learn the hard way. Say you want to get to 10 locations, but right now you have one, and that one location is chaos. If you try to expand, all you’re going to do is spread the chaos to ten places. You have to fix the chaos in the one before you multiply it.

Now, it’ll never be 100% gone, no business is perfectly clean. But if you are the person personally doing everything, putting out every fire by hand, you cannot scale to 10 locations. It’s mathematically impossible. So your job is to systematize your way out of doing everything yourself. If you have chaos in one clinic and dreams of ten, working on the chaos is the growth work.

What I actually started doing

Over the past couple of months, I started writing my own forward-looking statements. I do a weekly, a monthly, and a quarterly. Now, I’ll be honest, the weekly one might fall off the rails because that’s a lot to maintain. But the real win is simply that I write it down. Ninety days from now, what are we going to accomplish?

And going through that exercise clarified everything. It led me to the realization of what we actually wanted: more revenue, more locations, more clinicians, a higher profit margin, strong patient satisfaction, and quality of care held steady. Once I laid all of that out plainly, the answer for how to implement it became obvious. The fog lifts the second you write the destination down.

So if you’re still in the foundation phase, apply this at your scale. This week, I’m going to nail down my colors, my theme, and my fonts, and get my branding guide done. Awesome, done. Next week, what’s the next brick? Same discipline, smaller bricks. It compounds.

Intention shows up everywhere

A few months ago I got a personal trainer, and it’s been transformative, mostly because it forced intention on me. When I used to go to the gym alone, I was aimless. “Yeah, I ran two miles today. Maybe I’ll do some arms. Maybe some core, I don’t know.” Now I show up with a plan and a purpose, and the difference in results is night and day. Those big, successful clinics and businesses did not become excellent by accident. They became intentional. They got obsessive about standardizing procedures, building trust, and making things scalable.

And this applies even if you don’t want to grow huge. If you want a micropractice, intention is how you train your patients and protect your time. Coming from a place of kindness, you can still set boundaries: “You cannot send me 40 portal messages a day, that’s not sustainable for either of us.” That’s an intentional design choice about the practice you want to run.

Here’s a mental trick that’s helped a lot of the people I work with: pretend you have an investor in your clinic, and you owe that investor a return, say $50,000 by the end of the year. Now you have to ask, how am I going to return $50,000 in equity to this person by year’s end? Suddenly there’s a sense of accountability. I’ve got to bring that money in. I don’t want to let them down. That imaginary investor turns a vague wish into a real number with a real deadline.

Light a fire under yourself

So here’s what I want you to do after reading this. Light a fire under your own butt. Pretend you’re the CEO of a publicly traded company. Go read one of those investor reports. Google says, “We’re going to build X data centers, hire Y engineers, spend Z on capex.” They lay out a roadmap for the future.

And notice: they also say, plainly, that things can change and things can go wrong. This is a plan, not a guarantee. Remember what Mike Tyson said. Everyone has a plan until they get punched in the face. Business absolutely will throw you curveballs and speed bumps. But the answer to that isn’t to abandon the plan, it’s to have one you can adjust. Because if you’re not intentional, you’re just me at the gym, wandering around going, “Eh, maybe I’ll do some arms today.” Your workout is going to suck, and your business outcome will be exactly as subpar and disappointing as that aimless workout.

There’s an old line about the ladder of success. If you’re not intentional about what success actually means to you, you can spend years climbing the ladder only to reach the top and discover it was leaning against the wrong wall the whole time. You climbed hard in the wrong direction. Or you slowly realize you’re no longer in control of your own destiny the way you used to be. I guarantee you that the more intentional you become, the happier you’ll be, and the happier your employees will be too. People love knowing where things are headed. Everyone wants guidance about the future.

Think about it: even the Fed telegraphs whether it’s going to raise interest rates, usually looking about 12 months out, because people and institutions crave a sense of what’s ahead. Your staff wants it. Your patients feel it. And if you ever need a loan, the banks absolutely want to see that you have a plan. Nobody, at any level, is comforted by “we’re just going to vibe it out.”

So define your destination, break it into bite-sized chunks, write it down, measure it, and codify what works. Stop drifting. Start building on purpose.

Thank you all so much for following along. I’ll see you on the next one.

 

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