Like most of us, I was never taught to manage or lead a clinical practice.
There was little time in our educational curriculum for these matters. But like it or not, we were thrust into the business world with no knowledge of how this game was played. Kind of a “sink or swim” phenomenon without the aid of water wings.
And so, we floundered; overwhelmed by the task of starting a business and clinical practice simultaneously.
What were we to do?
Well, if you were like me, you likely called some respected colleagues for advice and guidance. “Here, take this form” or “Do this” I was told.
Yes, some of their well-intended advice was helpful, but there was no continuity to this piecemeal advice.
What I needed was a master plan; something that brought all the parts together into a cohesive vision. I needed tools that would help me run a business. Tools that could make up for my deficiencies and lack of business knowledge.
After much consideration, I decided that what I needed was a practice consultant.
Someone who could help me develop and manage business systems. And this is what I got, a full-blown experience in developing and managing business systems. In fairness, this was a valuable experience. I have a great amount of respect for practice consultants and what they do.
The problem, at least from my perspective, is that management, and particularly “systems management”, will only take us so far. The consultant left me with the impression that by managing these systems I was fulfilling my leadership role.
I now know, after forty-one years of clinical practice, that nothing could be further from the truth.
When my practice was new, I had time to manage the systems and my staff was small enough that I could manage them as well. But as the practice and staff grew, my time was spent in clinical pursuits, with decreased time for systems management.
Yet, I foolishly held the idea that only I could manage the business systems. The thought of training my staff to manage business systems was not on my radar.
The result of my obvious blind spot was predictable, and I see this happening to many of our colleagues as well. I found myself being pulled in multiple directions.
The demands of managing systems while providing clinical care became overwhelming. Furthermore, the increased demands of the practice conflicted with my need to be present as a father and husband.
Quite simply, my work/life balance was out of my control, and this imbalance became increasingly acute as my practice continued to grow.
Even worse, I was beginning to experience staff issues in the form of conflict and staff turnover. Unfortunately, I was already stretched too thin and had little energy left to deal effectively with these issues. The stress was becoming intolerable. I was on the verge of acute burnout.
Need I go on? I wonder if my story is resonating with you.
This is a rhetorical question. I already know the answer.
I see my story being played out in the lives of my colleagues on a regular basis. Fortunately for me, I was able to extricate myself from this vicious downhill spiral. Through the help of business coaches, I understood that I had hit the wall.
I realized that my limited management skills had taken me to this point but that they could take me no further. I saw for the first time that I had been trying to substitute management for leadership. I now know this to be a losing proposition.
Let me give you an example. Many consultants leave us with the false impression that by managing systems we are actually leading our practices. So, when we fail, like I did, by substituting management for leadership, we reach a natural conclusion that we failed as leaders which engrain the thought that “I can’t lead”.
In fact, nothing could be further from the truth.
Everyone can lead. It is just a matter of finding the right leadership voice; one that fits your unique style.
History is full of images of iconic leaders who are imprinted in our minds. Most of them are bigger than life figures, but there are untold others that we never hear about. Leaders that quietly, and in their own unique way, changed the trajectory of their own lives as well as the lives of those they led.
Practice management has much to do with the inner game.
It is much more than a collection of systems and techniques. Understanding the relationship between management and leadership is critical as we move forward into the future. Warren Bennis, a leadership guru, author, and professor emeritus at USC puts it all in perspective when he states that “Organizations that are over-managed and under-led are more likely to fail”.
As you read this… I want you to reflect on your practice and where it stands. Where your personal life stands.
Are you managing your systems or leading your practice? If you want to achieve peak performance, you will need to focus on your leadership and develop a leadership voice that fits your style, your practice and your life!
If you want help doing this, please reach out and book a complimentary strategy session with me or Dr. Mac. We are here to help professionals like you find that unique voice and style so you can achieve the business and life you envisioned when you started your practice.
Best Regards,
Dr. Joel
There are still a few spots left in our next cohort of the Leader to Leader Group Coaching program Learn more about this program, and if interested fill out the application form to get started.

Dr. Joel Small and Dr. Edwin McDonald, the founders of Line of Sight Coaching, are dental practitioners, authors, speakers and Business Leadership Coaches who work with healthcare professionals to help them build more successful practices so they can live the balanced life they seek.
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