The High-Performance Practice Series Intro: Profits & Freedom

The High-Performance Practice Series Intro: Profits & Freedom

Building A High-Performance Business Beyond The Clinic Floor

A quick heads up for all the private practice owners who are reading. If you've been tuning in to the show for a while, you know that it took me at least ten years of grinding in my own clinics before I finally figured out how to scale and sell my 4 practices for 7 figures and about 3 times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit, systems, and my role as the owner.

That's exactly what we're going to be working on together with you at the High Performance Practice Conference this fall in San Antonio, Texas. From October 15th through 17th, 2026, Adam Robin and I are hosting a 3-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable and best of all, don't depend on them 24/7.

We'll dig into simple profit and KPI frameworks, real leadership and culture work, and practical systems you can take home and plug in with your team. If you're doing roughly 6 to 7 low figures a year and want your clinic to feel more like a real business and less like a job/cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them, too. Let's get into this episode.

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Escaping The Reactive Cycle Of Day-To-Day Operations

Welcome to the show. I’m with my partner, Adam Robin. How are you doing?

Do you want the truth, or do you want to lie?

We're always about the truth and clarity.

I am working on businesses. I'm in the season where I'm doing the deep work.

It's not fun, is what you're saying.

Not fun, but usually, that's where all the success lives. It’s in the boring, dull work. I've got some heavy lifting that I'm doing, but other than that, I’m grateful.

Welcome to the first of a multi-episode series that we're doing. We did this sometime ago with the Private Practice Playbook. We did a series of nine episodes, if I'm not mistaken, going through all the different departments of an organization. In this series, our focus is on the high-performance practice, which falls in line with the theme of our conference in October 2026. If you're reading this, our next conference is in October 2026 in San Antonio.

The theme is The High-Performance Practice: How to Generate Profits, Purpose, and Freedom. You can go to PPOClubEvents.com to register. We'll have more speakers, more access, more everything. We’ll have more people and more sponsors at this conference than we've ever had before. If you've been to them in the past, this is going to be even better. If you haven't been before, you're going to be overwhelmed because everyone who went before had an amazing time and got a ton of value out of it.

We'll even have breakout sessions for your leadership teams. We're going to do a few breakout sessions specific to our pediatrics and speech therapy teams that come. You want to be part of that. We’ll also have specific breakouts for being better owners, being better leaders, you name it. We're looking to provide a ton of great value this time, more than we've provided in the past, so check out PPOClubEvents.com.

That falls in line with this series. We're to do about 8 to 10 episodes of the High-Performance Practice Series with the idea being that I tend to come from a little bit more of a system and metrics/financial strength, whereas your strength is a little bit more the people, accountability, delegation, developing teams, that kind of thing. You are a little bit more people-centric. That's a strength of ours that we can come together and talk about these things like this. That's where we're coming at it from in our particular roles regarding this show and the series. Before I get into that, is there anything you want to add to the things I've shared thus far?

First of all, the conference is going to be incredible. I wanted to piggyback off of that. We've got a big challenge ahead of us. If you want to be a practice owner and win in this climate, you've got to be good. You've got to be equipped with some skills, some strategies, some knowledge, some awareness, and perspectives. It's not until you elevate yourself to that level because that's the only thing that's going to drive your business forward. Make sure you're pouring into yourself. Come to the conference and bring your team. That's number one.

As far as this series goes, I think it’s cool because it serves two main purposes for me. Number one, we get to get clear on all of the values that we're going to deliver at the conference through this series. We get to have a standing meeting to discuss how we are going to add value. Number two, come to the conference. They can get a taste of what they might be able to experience through this as well. I'm excited for that, too.

When we're talking about this episode, it's going to be based on your experience and mine. Whereas when you come to the conference, you're going to network with the speakers who are there, who come from their perspective and talk about how they've implemented it in their practices. You can sit shoulder-to-shoulder with other owners who are going through it at the same time and learn from them, which is one of the strengths of going to the conferences. It is the networking that you do. I learned so much more from the speakers and going to dinner and lunch with other owners in my same space than I did from the speakers. It’s a huge networking opportunity. I can't say enough about that.

To kick it off in the first episode, we want to talk about what freedom looks like as a private practice owner. I'm going to let you kick this off because you've talked to so many owners, hundreds maybe, over the past couple of years, from all different levels of ownership. You’ve talked to different people on different paths in the journey. Some at the beginning, some in the middle, and some towards the end.

You can speak to how practice owners are hurting out there, but also what some of them are experiencing, good and bad. We want to talk a little bit about freedom. Lay the groundwork for why we are doing this and what we are hoping to achieve by taking owners through this series of episodes and the ideal outcome at the end of it. Can you speak to that a little bit?

Breaking Free From The Trapped Clinician Mindset

The question was what I've been seeing. When I think about freedom, I think the opposite, which is being trapped, or caged, or having boundaries on your options, or being disempowered. I don't know what the opposite of power is. Is that the right word? Disempowered? Unempowered? Something like that?

Maybe.

From every decision that you can possibly imagine of how owners are spending their time, like, “I have to spend my time like this. I have to do this. I have to treat patients. I have to show up at this time. I have to open my clinic at this time.” It goes to how many patients they treat. They’re like, “I have to see these patients. The doctor is making me see these patients. The patients only want to see me.”

It’s all me.

They’re like, “I'm stuck with this reimbursement, this type of fee schedule. I'm stuck at this revenue per visit. I can't do this.” It's a lot of that limitation mindset. Not necessarily the mindset, but the perception of being trapped. It’s the catalyst that creates burnout. It’s the lack of options and feeling like the work that you're doing is not adding value or not moving you in the direction of your true purpose or true calling from a financial perspective and a time perspective all the way down to, “I can't show up for my family or for the people that I care most about the way that I want to because of the limitations that I'm carrying from my business.”

I see it from all angles, all across the country. Every state has different challenges, depending on where you are in the US. Every discipline, whether you're a PT, OT, speech therapist, or mental health practitioner, has different challenges. It's ultimately that idea of how we break free from that, to where we can start operating from a place of choice and a place of design.

It’s not from a place of limitation, but from a place of possibility, which is hopefully not from a place of, “I believe it,” or manifestation, but from a place of facts. It’s from actual numbers, objectives, systems, and structure, as Nathan is going to be able to speak to, so that people can have a blueprint to creating more of that freedom in their lives.

When you say the opposite of freedom, caged is a good word. I think of feeling overwhelmed. Their business consumes them seven days a week. It drains them of energy that could be going towards their family and friends. They are out of control. When I mean out of control, they don't have control over the business. The business is telling them what to do. Thus, they're being reactive to whatever comes across their email or whatever the employees say that day. Instead of being in control of, “This is what I'm doing today, and this is why I'm doing it. I'm expecting this kind of response or this kind of product from the work that I do today.” They lack that kind of control.

Regaining Control Over Stressed Clinical Systems

What we see is that as people go through this progression, they've gone through our program, and they've learned what they need to do and how to organize their business, that word comes to me first off. They gain control. They tend to organize the chaos in their favor so that they can control it. These people look like people we've talked about in the past.

They’re overwhelmed because they don't know where to focus their priorities. They judge their business based on a couple of key metrics instead of knowing how to dig deeper. They are not holding their team accountable to the values of the organization, so their culture is not what they would want it to be. They have team members that they suffer with instead of teammates that they'd love working with.

These people, unfortunately, have built a business that they don't enjoy being in, and that is very exhausting. You brought up burnout. I see it. You've heard plenty of owners who have probably used that phrase specifically. The idea behind this episode is to give you a little bit of a glimpse as to what you can do to get off that path and then to a path where control, influence, and purpose are in line with what you want.

I want to share something quick. To not be too doom and gloom, I did take a few minutes prior to this episode and try to define what that feeling of being trapped manifests as a practice owner. I want to share what I wrote down. I wrote down some bullet points. The first thing I wrote down was weight. It feels like you're carrying a physical and emotional weight that slows you down and doesn't allow you to be yourself.

I wrote down feeling rushed, feeling like you have these waves and rushes of anxiety and panic sporadically throughout the day. It could even creep up on you at night or outside of work. I wrote down, feeling like a failure, feeling like you're not capable. Somehow, the challenges of your business are some type of representation of who you are as a person. That's a hard emotional challenge to deal with. I wrote feeling stuck, feeling blocked, feeling angry, and feeling frustrated. There are all these cuts and all these regulations that are keeping us down.

The last thing I wrote was no self-care. One of the major signs that the business is consuming you is that you have no morning routine, you have no self-care, there's no breathing time on your calendar, and there's no connection time with the people that you care about. The workhorse of the company starts to get sick and tired. Those are the things that I wrote down. At least that's what I've experienced in the past when I was in bad seasons in the business.

Prioritizing Your Future Goals Over Urgent Distractions

One way to get the most out of these episodes is that we're going to have a worksheet that's downloadable. You can download a worksheet specific to each topic to give you a little bit of guidance, help you organize your thoughts, and, most importantly, put together at least an action item to help you move forward. I'm sure you'll come away with 3 or 4. You and I both know that as you put pen to paper, those thoughts become more concrete. You can also, based on those thoughts, then develop an action plan.

The worksheet is meant to help you organize those thoughts, make them more concrete, and then develop that plan so you can put this into practice. It’s not just while you're driving where you’re like, “That's a good thought. That's a good idea. I like that idea. I'll have to remember that.” Lo and behold, we usually don't. Nothing happens. If you're not taking the opportunity to build action items off of these episodes, then you're consuming them to take time. Hopefully, it becomes more than that and becomes super valuable for you.

This being the series intro, I don't know if there's a whole lot to share in terms of deeply detailed, implementable actions other than to start thinking about what you truly want to get out of your business. What is the ideal scene? Where do you want to be? What does that look like? If you want to make it a little bit more concrete, if you will, where do you want it to be at the end of 2026, whenever you consume this episode? It’s a little bit past the middle of the year. Where do you want to be at the end of 2026? Where do you want to be at the end of 2027, or whatever year you're in? What does that look like?

When you have that end in mind, you can then work backwards from that. Hopefully, what you're looking at are steps towards more control, more freedom, more joy, and more purpose in your company. Adam, based on the number of conversations that you've had with owners in different phases, where do you think most people need to start as they're looking to attain more freedom in their company and clinic? Where would you recommend they start?

How Designing Clear Boundaries Protects Your Schedule

You nailed it. Where do you want to go? Stephen Covey says to begin with the end in mind. It's not intuitive. Typically, the way that we're wired is when we enter into a difficult situation, like growing a business. That is very hard to do. It's extremely hard to do. There are going to be a lot of threats and urgent problems that are going to be pinging at you all day long. Guess what? Our brain is good at identifying threats. We get distracted by urgent things.

Before we realize it, because it's not our natural instinct, we get off course. We're over here, buried in this admin stuff that doesn't even align with the vision that we have for the company. Growing your business, in a lot of ways, is about learning how to break that habit of getting trapped by the reactive, urgent brain and being more grounded and clearer on exactly where you want to go. It is choosing to sacrifice what the seemingly urgent things are for the more important thing more consistently, which is going to help you move the needle. It all starts with getting clear on where you want to go.

I've got this idea. I've done a little bit of thinking around what it looks like and what it feels like to be in places of freedom, which is not where you're going to be all the time because your business is going to have peaks and valleys. Ideally, we can be there more often. That will create more abundance for you and for the people that you love.

Number one, when you're able to get to a place where you start your day every day, serving your family and yourself first. How many times have you started the day where there are emails, fires, urgent things, and bad ideas? You jump straight into the freaking urgent thing, and you go down this cascade of putting out fires and dodging bullets all day long.

That is not from a place of design. That's from a place of you being pulled into issues and problems that you probably shouldn't be. How cool is it to be able to get up and be like, “Before I jump into the fight, what if I had a second to drink a glass of water and be present with the people that I care most about? Take care of yourself. That's number one.

The second symptom that I see is that we get to truly align with our purpose, which is about serving other people. It is when we can wake up from a place of like, “I'm going to try to find ways to serve at the highest level.” As a result, assuming the systems are in place, the money will take care of itself, versus a scarcity mindset.

Which is like, “I've got to figure out how to protect the money. Whatever I have left over, I'll figure out how to serve people on the side.” That's a good sign that you're feeling trapped. Freedom looks like caring for yourself, caring for your family, and serving at the highest capacity that you possibly can. That's where, ultimately, we want to help practice owners get to.

When I talk about being clear on what you want, it is getting down into the granular. Maybe you've asked this of other owners before. If you did, people stutter, stop, and aren't clear as to what they want until you start goading them a little bit or giving them a little spur. It’s like, “How much money do you want to make? What does your time look like? What are you doing on your ideal day? Who are you working with on a regular basis? Where are you working? What does that look like?”

“Where do you want to spend all your time if you had that time to do so in the clinic? Do you want to be treating? Do you not want to be treating? Do you want to work from home, a remote space, or the office? Would you rather be coaching providers?” They could become better providers. It is getting clear as to not only what your business looks like, which I'm glad you brought up, but what your day looks like. Where are you spending your time? The work that you should be working on is getting to that point so that you can spend your time where you get the most joy and fulfillment.

Measuring Profit Margin And Time To Evaluate True Freedom

When we ask people to get clear on what it is that they want, get detailed. Get granular. Break it down. Where are you spending your hours? How many days a week? Do you have Fridays off? Do you have Mondays off? Do you jam-pack your Tuesday, Wednesday, and Thursday so you can take it easy on Monday? Do it however you want to do it, but get down and granularize what you want out of the business so that you know if you're on target with all this stuff. Otherwise, you're floating in the wind. You’re like, “Whatever happens, happens. If I have some money at the end, cool.” That's no way to live.

That's what we're talking about when we're talking about being intentional. We're using a lot of synonyms for the word control, but taking control of your business, taking control of your life, and taking control of your schedule so that you're intentional with your time and energies. Especially regarding you, individually, the family around you, and then with your team and your organization.

When you think about freedom, there are two components, which are freedom of time and some type of financial freedom as well. You need both in there. Maybe they're synonyms, I don't know, but it goes back to the original question. Where do you start? In my opinion, you get clear on what you want. Before you start moving forward, you've got to create a routine or a system of personal management of your time, attention, and routines, such that you're redefining where you spend your time and energy. In my opinion, I feel like that's the most important thing to get right before you start talking about marketing, sales, recruiting, or all of those things. It has to be designed. Being the intentional designer and creating control around that will ultimately lead you to freedom.

Hopefully, this doesn't catch you off guard, but if I were to ask you, what is one metric that you could consider where that would determine if someone is in control or has freedom in their organization? I'll let you go either direction, but can you think of it? Can you put a number to it? Can you put a statistic to it?

It's probably something that I don't measure. I don’t know. That's a good brainstorming question. It's hard to be free as a practice owner without enough money. It's impossible to be free without enough time.

The statistics that I thought of were both in line with those things.

I can't think of a statistic that captures both, but if I had to summarize it, it would be something like profit margin in your business and how much time you're spending with your kids. Do you have dedicated blocks of time for your kids? Are you doing date night with your spouse? Are you keeping those first things first, or whatever those first principles are for you? Are they truly occupying the amount of bandwidth and energy that you want, or are they getting the scraps? Are they getting the leftovers?

Are they getting the leftovers of me?

Correct. We've all been there. We all find ourselves there at times. We are constantly having a battle to try to make sure that we're keeping that in line. That's ultimately where most people want to be.

I love that. I thought the same thing financially. What does it come down to other than profit margin? If that profit margin is slim, you and I both know the feelings that you're feeling, or when it goes negative. You can feel it. It's almost like profit margin is an emotion.

There's a survival energy that kicks in whenever it gets tight. It's hard to relax.

On the other side, when it comes to time, I love that you brought up family time. That could also be hobby time for things that you love.

Whatever bubbles up for you.

When you're starting from the very beginning and starting to take control of your business, the thing that came to my mind was the time spent working on the business. The more time that you have to spend on the business tells me where you are in your journey as an owner towards freedom. At least that was my experience. It was probably the same for you.

Initially, while working on the business, I got the scraps. At lunch, after work, or on weekends, that's when I worked on the business. If someone canceled, I’d be like, “Now I can cut some checks and maybe look at a report,” or something like that. When I finally took control of my schedule and set aside blocks of time to work on the business, that put me on the path to freedom.

As I set aside more chunks of time to work on the business, learn how to work on the business, improve myself as an owner and a leader, read the books, listen to the podcasts, and went to the conferences, the more time I spent on those things, working on the business, my freedom fell in line with that.

It was a result of it. It was the product.

They were parallel lines on the graph. One followed closely behind the other, but as I put more time into the business, my freedom started following suit.

What I heard you say there, which is important for people who are reading, is that freedom didn't come until you prioritized the thing that wasn't easy to prioritize. I don't know if that's the right thing to say.

I had to say no to something.

Freedom is the product of becoming good at delayed gratification. You have to be okay with saying no to whatever thing that you think is important that isn't like, “Somebody emailed me. I got to respond right now,” or, “A doctor sent a referral and said I have to treat them today.” At some point, you have to draw lines around that, which is hard to do.

For a long time, that's going to feel like a critical component for the survival of our business, but also in direct contradiction to that freedom that we're trying to create. You have to say no to the short-term satisfaction of, “I'm going to keep that thing whole for the long-term game.” It’s the same thing with your family. There's never going to be a, “I have an extra five hours today to go bring my kids to the park.” It has to be designed. There have to be boundaries set around that, which comes back to the time management piece. It's a choice. I like how you said that.

If we were to give some people some takeaways from this episode, two things come to mind right away. Number one is to get clear on what you want from your company. Number two, dedicate specific time towards achieving that goal. Those are two huge takeaways for me. Will you add anything else to that? Did I miss anything there? Get clear on your profit margin?

It's not always about knowing exactly what you need to do during those times, but there are a few things, like working on your business, running your numbers, and working on the marketing plan.

Organize your systems.

Improve your systems. It's about honoring that time, maintaining the integrity of that time, ruthlessly pursuing that freedom during that time, and not being distracted by the thing. What I’m trying to say is make sure you make a list of the things that belong in that time block and not, “I'll figure it out whenever I get there.” Make a list, design it, and stick to the list.

Take control again.

Don't rely on your brain, especially during the fight. Predetermine what you're going to do so you can systemize your focus.

There are two things right away that don't belong in that time block, and those are documentation and paying bills.

Answering emails. Don't do that.

Those don't count.

It could also be answering the phone.

Maybe it's, “What am I going to do to market this week? What am I going to do to recruit the next provider this week? How much time am I spending on social media or working my network to find that next provider? What do I need to do to improve my onboarding processes? How do I hold people accountable? How do we improve our billing and our charges, maximizing encodes?” There are many ways you can go, but think of some of the most high-level things where there's a pain or where you can see yourself as being the obstacle to growth in your organization. How can you start working on that?

That's right.

This is a good way to kick it off. In our next episode, we're going to be talking about schedules. We're going to talk about how to optimize schedule efficiency and utilization in the company. We're going to go through this over the next 8 to 10 episodes and start knocking out different aspects of the organization so you can become a more highly efficient, high-performing practice.

Don’t forget. Check out the conference. Go to PPOClubEvents.com to register for the conference on October 15th through 17th, 2026, in San Antonio. There are going to be good times. I don't know how else to sign off other than we'll see you again over the next few episodes and get more down into the weeds. Does that sound good?

That sounds good. We'll see you then.

Important Links

• Private Practice Owners Club - Events
• Private Practice Owners Club on Apple Podcasts
• Private Practice Owners Club Podcast & Coaching on YouTube