If you’ve spent any time in the physician entrepreneur space, you’ve probably noticed something: there are a lot of doctors who start practices, work incredibly hard, and still never seem to break through. Then there are others who seem to hit their stride and just explode. After consulting with over 700 physicians on starting and scaling medical practices — and running my own multi-million dollar primary care practice — I can tell you the difference isn’t luck, and it’s usually not clinical skill either.