What the work actually looks like.
A hot seat is what it sounds like. An owner brings the thing they are stuck on and we work it, out loud, until it is clearer than when we started. These are a few of those, written up. I have changed names and identifying details. The situations are real.
If one of them sounds like your week, that is the kind of thing we would work on together.
A decision
She wanted to know whether to close the clinic. I didn’t think she was ready to answer that yet.
She was working something close to 90 hours a week and finishing documentation late into the evening. Things at home had reached the point where her husband told her plainly that it had to change: fix the business, or close it and take a job. She had been going back and forth for months.
What I told her
Right now exhaustion is narrowing the choices you can even see. That isn’t a character flaw, it’s arithmetic. Before you decide whether to close, we need to get you enough room to make that decision as a rested person. The decision will still be there in three months. You won’t be the same person making it.
So we stopped debating whether to close and started looking for the fastest ways to take work off her. A virtual assistant for the administrative crush. A PTA to absorb clinical hours. Anything that got her under 60 hours a week and gave her back two evenings.
A behaviour
The clinic felt like it was imploding, so she went back to treating patients.
She had come through a stretch that went badly in every direction at once. A therapist she relied on left. The billing was a mess and collections were down. The clinic lost money. She answered it by picking up a nearly full treatment caseload to cover the schedule and hold down payroll. Her clinical numbers looked excellent. She was busy all day.
What she realised
The more treatment hours I do, the worse the business does.
What I told her
Treating gives you the satisfaction of finishing work you already know how to do well. That is exactly why it pulls at you right now. It also keeps you away from the work that only the owner can do. The billing. The staffing. The decisions underneath the losses.
The clinic doesn’t need another productive therapist. It needs its owner.
The economics
Sixteen patients a day, documenting until midnight, and the money still wasn’t there.
The schedule was full. He skipped lunch, had no time to run the business, and spent his evenings catching up on notes. From the outside the clinic looked successful, because every available slot was filled. The problem was what those slots were worth. His time was averaging somewhere between $5 and $25 an hour for the work he was doing. He had started his practice because he cared about people, so he kept taking every patient who walked in, whatever their plan paid.
What he called it
A mouse in a wheel. Running constantly and never moving forward.
What I told him
Not all money is good money. Your schedule isn’t just failing to pay you, it’s spending the one thing you can’t make more of. Those contracts don’t just underpay you. They use up the hours you’d need to build something that can care for more patients, not fewer.
You aren’t short on demand. You’re short on capacity, and you’re spending it on work that can’t support the clinic.
What changed: he ended his worst contracts, moved some services out of network, added cash-based options, and started checking coverage before scheduling. The schedule got lighter. The income held steady. The midnight documentation stopped.
The next step is a conversation.
If one of these sounded like your situation, set up a call with me. We’ll talk about what’s going on in your business, whether we’re a fit, and what working together would look like.
It’s a conversation. It could be a no for either of us. That’s fine.