“I Take What I Get” — And Other Costly Myths About Your Payer Contracts Featuring Brett Spark, EP 267
Most private practice owners have a feeling they're not being paid what they're owed by insurance payers — but very few can prove it. In this episode, Tracy Cherpeski talks with Brett Spark of Aroris Health about why payer underpayment is so common, and why visibility into your payer contracts might be the most overlooked lever for practice profitability.
Most private practice owners have a feeling that they're not being paid what they're owed by insurance payers — but very few can prove it. In this episode of The Thriving Practice Podcast, Tracy Cherpeski talks with Brett Spark of Aroris Health about why payer underpayment is so common, why almost no practice has its own contracts organized, and how visibility into the payer relationship can directly impact the profitability of a medical practice.
Brett's path is a unique one: he spent the first half of his career climbing the ladder inside a large regional health system before being recruited into a private practice CEO role. That shift exposed him to just how differently independent practices operate — with more autonomy, more speed, and far less red tape, but also far less infrastructure for managing complex payer relationships. Aroris Health grew out of that gap, evolving from a peer negotiation service into a software platform that digitizes contracts and tracks every claim against what a practice is contractually owed.
For practice owners thinking about time management for healthcare practice owners, running a profitable medical practice, or building private practice without burnout, this conversation reframes payer contract management from an overwhelming back-burner task into one of the highest-leverage things a practice owner can do.
Key Takeaways
Most practices don't have their own contracts organized. Brett notes that in six years of business, Aroris Health has yet to have a client who could produce all of their payer contracts, amendments, and fee schedules in one place.
Underpayment is rarely simple fraud — it's often complexity and drift. Rate changes, coding complexity, and contract amendments create frequent opportunities for errors to creep in undetected, sometimes for years.
Visibility, not just negotiation, is the real lever. Many practices assume their only option is to renegotiate rates, but Aroris Health often finds that practices are simply being paid incorrectly relative to their existing contract — a fixable error, not a negotiation.
Independent practices preserve choice in the healthcare ecosystem. Brett argues that empowering private practices to stay independent — rather than being absorbed by health systems or private equity — protects patient access to a different, often more personal, care model.
Doing something is better than doing nothing. Brett's parting advice: practice owners have a fiduciary responsibility to understand what they signed, whether they tackle it internally or bring in outside support.
Q&A
Why are independent practices losing money on payer contracts without realizing it?
According to Brett, most practices have never had full visibility into their own contracts — many can't even produce a complete copy of what they originally signed, let alone every amendment since. Without that visibility, it's nearly impossible to know whether a payer is reimbursing according to the terms that were actually agreed upon.
Is payer underpayment usually intentional?
Brett is careful not to assume bad intent across the board. He points to the sheer complexity of coding, modifiers, site-of-service rules, and contract terms that change year over year as a major driver of errors — alongside cases where payers simply aren't held accountable for catching their own mistakes.
How much revenue can be recovered once a practice gets visibility into its contracts?
Brett shares that Aroris Health has uncovered cases where a practice was paid the wrong rate for an entire year, resulting in six-figure and even million-dollar corrections — revenue that would have otherwise been permanently lost.
What's the first step a practice owner should take if they suspect they're being underpaid?
Brett's advice is to start by simply gathering the actual contracts, amendments, and fee schedules — something most practices have never done. From there, even a basic comparison between what's billed and what's paid can reveal discrepancies worth pursuing.
Episode Highlights
Brett's path from a large regional health system to private practice CEO — and what it taught him about autonomy and speed
Why Aroris Health evolved from a peer negotiation service into a payer-contract software platform
The six-year track record: no client has ever shown up with a complete, organized contract file
How the software digitizes contracts and flags discrepancies between contracted rates and actual claims paid
The Netflix subscription analogy: how reimbursement rates quietly shift without practices noticing
Why timely filing windows for correcting payer errors vary contract by contract
The case for preserving independent, private practice as a vital part of the healthcare ecosystem
Brett's parting advice: doing something is better than doing nothing
Memorable Quotes
“Don't buy into the narrative that has existed of, I just signed the contract, I take what I get.” — Brett Spark
“Visibility will lead to revenue opportunities.” — Brett Spark
“Doing something is better than doing nothing.” — Brett Spark
“I think to be successful, the practices that we're seeing really growing and evolving are taking a more focused approach: I need to essentially start right, to end right.” — Brett Spark
“Our mission is to preserve the spirit of medicine.” — Brett Spark
Brett Spark's conversation with Tracy is a reminder that the most overlooked opportunity in a private practice's finances might not be a new patient acquisition strategy or a pricing change — it might be the contract that's already been signed and never fully read. For practice owners who've ever had the nagging feeling that they're not being paid what they're owed, this episode offers a concrete, fiduciary-minded path forward: get visibility first, then decide what to do with it. Share this episode with a colleague who manages the business side of their practice and visit ArorisHealth.com to learn more about Brett's work. Explore ThrivingPracticeCommunity for additional resources to help you build a practice that truly thrives.
Guest Bio:
Brett Spark has spent his career inside the business of healthcare — first climbing the ranks of a large regional health system, then taking the leap into private practice as a CEO. That shift changed everything. Seeing firsthand how payer contracts shape both financial performance and patient care, Brett co-founded Aroris Health to give independent practices the clarity and tools they need to navigate those relationships with confidence. Today, Aroris combines negotiation expertise with a purpose-built software platform that helps practices understand exactly what they're owed — and actually get it.
Find Brett:
Website: ArorisHealth.com
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Still Doing It Yourself? What That's Really Costing Your Practice, EP 266
Are you the one still writing every patient email, every social post, every practice announcement? In this solo episode, Tracy Cherpeski asks the question most practice owners don't want to answer: is that actually your job?
Are you still writing your own patient emails? Still drafting every social post, every newsletter, every practice announcement — and quietly wondering why it still lands on your plate? If that question landed uncomfortably, you're in the right place. In this solo episode of The Thriving Practice Podcast, Tracy Cherpeski names one of the most overlooked bottlenecks in independent practice ownership: not a staffing gap, not a capacity problem, but a standards problem — one that founders build carefully, one "I'll just do it myself" at a time.
This episode isn't about delegation as a time-management tactic. It's about recognizing the moment when the habits that made your practice work in year one start quietly capping its growth in year three. If you've ever felt the exhaustion of being the bottleneck, the guilt of resenting a team you haven't actually handed work to, or the quiet dread of watching something go out that doesn't sound quite like you — Tracy's talking directly to you.
For independent practice owners navigating burnout prevention, sustainable growth, and what it actually looks like to lead a team instead of just absorbing all the work personally, this episode is a must-listen.
Key Takeaways
It's a standards problem, not a capacity problem. Most practice owners aren't behind because they don't have enough help — they're behind because their standards are so specific to them that nothing can leave their hands. That's a bottleneck you built.
"For now" has a shelf life. There's a legitimate season where you really are the only one who can do it. The problem is when that season quietly becomes permanent — and no alarm goes off to tell you it did.
The guilt loop is real — and it's not a character flaw. Resentment toward a team you haven't actually handed things to, followed by guilt about the resentment — that loop exhausts founders faster than the task itself. Recognizing it is the first step.
Letting go doesn't mean lowering your standards. It means trusting that your standards can be taught, absorbed, and carried by other hands — even if the first few attempts don't quite land.
You make room for things you can't build. One client's team started coordinating across locations on their own — not because she engineered it, but because she finally stepped aside long enough for it to happen.
Q&A
Why do high-achieving practice owners become the bottleneck in their own businesses?
It's rarely about lacking help — it's about standards so specific to the founder that nothing can leave their hands until it sounds, looks, and feels exactly right. Without ever deciding to be the bottleneck, they build one, one "I'll just do it myself, it's faster" at a time.
How do I know if it's still the right season for me to be doing this work myself?
Ask yourself: is "I'm the only one who can do this right" still a temporary truth about your team's skill level — or has it become a permanent story about who you are in this business? If there's no plan attached to "for now," it may have already become permanent.
What does delegation actually cost when you delay it?
Tracy's client was losing on three fronts simultaneously: potential leads (inconsistency loses browsers before they book), returning patients (sporadic communication makes even loyal patients forget you), and team growth (if you're still holding everything, you're blocking the exact doors you built for your team to walk through).
What does the transition actually look like — does it go smoothly?
Usually not at first, and that's the point. The adjustment period — where things don't sound quite like you yet — is exactly when most founders grab the task back. The ones who don't grab it back are the ones whose teams eventually start solving problems the founder didn't even know existed.
Episode Highlights
The cold open question that reframes what your job actually is
Why this is a standards problem, not a staffing problem
A real client story: two locations, one human bottleneck, three hidden costs
Sitting with the discomfort — what it actually feels like at the tipping point
The guilt loop: resentment, then shame for the resentment
The root-bound plant metaphor: what happens when your business runs out of room to grow
"For now" — since when, and until when?
A three-question gut-check to see where you actually stand
Why the bottleneck is yours to dismantle — and why that's actually good news
The TPC founding member invitation
Memorable Quotes
"You're not behind because your standards are too low. You're behind because your standards are so specific to you that nothing can leave your hands until it sounds like you, looks like you, feels like you." — Tracy Cherpeski
"The season never ended. She was still doing all of it long after 'I'm the only one who can do this well' had quietly turned into 'I am the only one who does this, period.'" — Tracy Cherpeski
"That loop — resentment, then guilt, then shame for the resentment — will exhaust you faster than the actual task ever could." — Tracy Cherpeski
"She didn't build that. She made room for it." — Tracy Cherpeski
"The bottleneck you're frustrated by? You built it carefully, with good intentions, one 'I'll just do it myself' at a time. Which means you're also the only one who can take it apart." — Tracy Cherpeski
The task you're still holding — the one you keep telling yourself is temporary — may be the single thing standing between where your practice is now and where it could go. Tracy's not asking you to lower the bar. She's asking you to trust that the bar can be handed to someone else. If this episode hit close to home, share it with a colleague who's carrying the same weight. And if you're ready to do this work alongside a community of practice owners who get it, visit ThrivingPracticeCommunity.com to learn about TPC founding membership.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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“I Don’t Want to Burden Them”: The Real Reason Practice Owners Go It Alone – A Special SNACK Episode, EP 265
Private practice ownership comes with a particular kind of loneliness that no one warns you about. In this SNACK episode, Miranda Dorta turns the mic around and interviews Tracy Cherpeski about what isolation actually costs practice owners, and why so many high-achieving providers resist the very support that could help.
Private practice ownership comes with a particular kind of loneliness that rarely gets named out loud. You’re surrounded by patients, staff, maybe a partner or two, and still making most of the big decisions on your own. In this SNACK episode, Miranda Dorta turns the mic around on Tracy Cherpeski to talk about what that isolation actually costs practice owners, and why so many high-achieving providers resist the very thing that could help.
Tracy gets candid about a pattern she sees constantly in her work with practice owners: people who don’t even recognize their own isolation until someone else names it first. It’s not that they lack support at home, she explains. It’s that they don’t want to burden the people who do support them. That single distinction reframes a lot of what looks like self-sufficiency as something closer to quiet overload.
The conversation also digs into why generic networking and professional communities often fall flat, what actually shifts in a practice owner’s body language and decision-making once they let their guard down with true peers, and why “I don’t have time” is often less about the calendar and more about what busyness lets people avoid.
Key Takeaways
Isolation often hides behind competence. Many practice owners don’t identify their own situation as lonely until someone else reflects it back to them; it just feels like “I’m the only one who makes these decisions.”
It’s not a lack of support, it’s reluctance to burden others. Spouses and partners often do understand, but practice owners hold back because those people already carry their own full plates.
Peer-specific community works differently than general networking. Being understood by someone in a nearly identical professional situation creates a kind of recognition that coaching or consulting alone can’t replicate.
Letting your guard down changes more than you’d expect. Tracy describes visible shifts in body language, like relaxed shoulders and a sense of relief, the moment practice owners feel safe enough to be honest with peers.
Busyness can be a convenient shield. Being “too busy” sometimes functions as a socially acceptable way to avoid harder internal work, including the work of delegation and letting go of control.
Q&A
Why don’t practice owners talk about how isolating ownership can feel?
Many don’t recognize it as isolation in the first place. It often surfaces only after trust has been established, sometimes when one person in a group setting names the feeling first and others realize they share it.
Isn’t this just about not having support at home?
Not usually. Tracy points out that the issue is rarely a lack of understanding from spouses or partners. It’s that practice owners don’t want to add to a partner’s already full plate by bringing them into every decision.
What makes peer community different from typical networking?
According to Tracy, the difference is being instantly understood by someone in a very similar role. A coach or consultant can offer expertise, but a fellow practice owner offers recognition: someone who has lived the same kind of decision fatigue and knows exactly what it costs.
Is “I’m too busy” a real barrier or an excuse?
Both, in different ways. Tracy says time constraints are real, but busyness can also become a badge of honor that conveniently excuses people from doing harder internal work, like learning to delegate or examining why they’re holding onto control.
Episode Highlights
How isolation shows up for practice owners who appear successful from the outside
The difference between “not supported” and “not wanting to burden someone”
Why peer-specific community beats general professional networking
The visible, physical shift Tracy has witnessed when practice owners let their guard down
Busyness as a badge of honor, and what it often conceals
The risk of losing control as practices grow and owners start delegating
What the smallest first step toward real professional community actually looks like
Memorable Quotes
“It’s usually not that they’re not supported at home, it’s that they don’t want to burden people.” — Tracy Cherpeski
“The richness of instantly being heard, seen, and understood, and then seeing yourself reflected in another person who’s in a very similar situation to yours. That is gold.” — Tracy Cherpeski
“How conditioned are we all to be like, busyness is my badge of honor. And also it keeps me from having to commit to crap I don’t want to do.” — Tracy Cherpeski
“Some safety revealed itself and they felt like they could let their guard down, and literally everything changes.” — Tracy Cherpeski
“It’s a really, really powerful decision to decide not to do something as well. You can always leave.” — Tracy Cherpeski
If you’ve ever felt like the only one carrying the weight of every decision in your practice, this episode is a reminder that the feeling is common, and that it doesn’t have to stay that way. Sometimes the smallest first step is simply being open to checking out what a real professional community could look like for you. Visit thrivingpracticecommunity.com to learn more, or head to practicesuccess.co to schedule a consultation with Tracy.
Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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Whoever Answers the Phone Wins: The Hidden Cost of Missed Calls Featuring Erika Sanchez, EP 264
Five missed phone calls could be costing your practice $5,000 to $10,000 a month — and most practice owners have no idea it's happening. In this episode, Tracy Cherpeski talks with Erika Sanchez, CEO of Healthcare Call Center, about the hidden gap between marketing spend and practice growth.
Five missed phone calls. That's all it takes to quietly drain $5,000 to $10,000 a month from a healthcare practice — and most practice owners have no idea it's happening. In this episode of The Thriving Practice Podcast, Tracy Cherpeski talks with Erika Sanchez, CEO of Healthcare Call Center, about the hidden gap between marketing spend and practice growth: the front desk.
Erika's team is built almost entirely of stay-at-home moms working from home across the country, and they've helped healthcare practices triple their lead-to-new-patient conversion. For independent practice owners trying to run a profitable medical practice without burning out their front office staff, this conversation gets at a problem that rarely gets named directly: clinicians are excellent at healing, but most were never trained to run a business, let alone manage the speed-to-lead demands of modern healthcare marketing.
Whether you're a practice owner wondering why your ad spend isn't converting, a clinician feeling stretched between patient care and operations, or someone exploring time management for healthcare practice owners, this episode offers a clear, practical look at where the money is actually being lost — and how to fix it.
Key Takeaways
Missed calls are missed relationships, not just missed dollars. Erika reframes the cost of a missed call from a sterile number into what it actually represents: a prospective patient who needed care and didn't get a response.
Nearly half of new patient interest happens after hours. Roughly 46 percent of inquiries come in outside business hours, which means a practice that only answers 9-to-5 is missing a huge share of potential patients.
Speed to lead is everything. Prospective patients who don't get a response within about five minutes are roughly four times more likely to go to a competitor instead.
Front desk and lead follow-up are two different jobs. Asking one person to handle in-office patients and respond to new leads in real time sets both the role and the practice up to fail.
A simple three-question framework builds trust fast. Asking what's going on, how long it's been an issue, and whether the patient has seen another provider can build real trust in under two minutes.
Q&A
Why are independent practices losing money even when their marketing is working?
Most practice owners are clinicians first, not business operators, and the disconnect usually shows up at the front desk. Leads come in from marketing campaigns, but if no one follows up quickly — especially after hours or on weekends — those leads go to a competitor who answers first.
How much revenue can a missed call actually cost a practice?
Erika shares that with an average patient value of a few thousand dollars, missing just a handful of calls over a single weekend can leave $5,000 to $10,000 on the table — money the practice already spent to generate through advertising.
Why don't patients want to talk to an AI bot when scheduling healthcare appointments?
Even as practices lean on automation for administrative tasks, patients consistently want a human on the other end of a healthcare conversation, particularly for sensitive topics. Erika notes that trust, more than efficiency, is what determines whether a caller becomes a patient.
What makes stay-at-home moms particularly effective at this kind of work?
Erika has built her team almost entirely of stay-at-home moms because, in her experience, empathy and the ability to multitask are qualities she can't easily teach — but the technical and process side of the job, she can. The flexible schedule also lets her offer meaningful part-time work to women who want it.
Episode Highlights
Erika's path from healthcare marketing into building a call center built for medical practices
Why front desk staff and lead follow-up are fundamentally different jobs
The real dollar cost of a missed call, explained in plain terms for non-business-minded clinicians
Why nearly half of new patient inquiries come in after standard office hours
The "speed to lead" principle and why five minutes matters so much
Why patients still want a human, not a bot, when it comes to healthcare
The simple three-question framework that builds trust in under two minutes
How Erika trains her team using an AI role-play bot so new hires practice on simulated patients, not real ones
Erika's advice for overwhelmed practice owners: find people you trust and build real partnerships
Memorable Quotes
"Whoever answers the phone wins." — Erika Sanchez
"It's a speed-to-lead game. If you don't answer a text or call within five minutes, they are 400% more likely to go elsewhere." — Erika Sanchez
"I will not treat patients and you will not do marketing. Everyone just stay in their lane and do what they're really good at." — Erika Sanchez
"It's really important when you're spending money on marketing, you're missing so many opportunities that you're already paying for." — Erika Sanchez
"Find the people that you trust, find the people that you want to partner with, and we can grow together." — Erika Sanchez
Erika Sanchez makes the case that the biggest leak in a healthcare practice's growth often isn't the marketing — it's what happens, or doesn't happen, after the phone rings. For practice owners who've felt the frustration of paying for leads that go nowhere, this episode offers a clear, actionable place to start looking. If this conversation helped you see your front desk differently, share it with a colleague who's wondered why their ad spend isn't converting into new patients.
Guest Bio:
Erika Sanchez spent over a decade in restaurant marketing before a move into healthcare marketing introduced her to a problem she couldn't shake: practices were generating leads they weren't equipped to convert. That insight eventually led her to Healthcare Call Center, where she's now CEO and has built a team of stay-at-home moms who consistently out-schedule what most practices manage in-house. Outside of work, Erika homeschools her three daughters and recently celebrated 16 years of marriage.
Find Erika:
Website: HealthcareCallCenter.com
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Is Your Practice a Sellable Asset? Luisa Alberto on Cash Flow, Sustainability, and Building to Exit, EP 263
What does it really take to run a profitable, sustainable healthcare practice — and why does the financial side feel so impossibly hard? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Luisa Alberto, CEO of People First Finance, People First Foundations, and Kindredly, for a conversation that is equal parts practical and genuinely energizing.
What does it really take to run a profitable, sustainable healthcare practice — and why does the financial side feel so impossibly hard? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Luisa Alberto, CEO of People First Finance, People First Foundations, and Kindredly, for a conversation that is equal parts practical and genuinely energizing.
Luisa didn't grow up as a "money person." She was an art kid who studied philosophy, built and closed a brick-and-mortar business, and raised her daughter as a single mom in San Francisco. Through necessity and determination, she mastered personal and business finance — and built three companies around helping self-employed professionals do the same. Her perspective is especially valuable for healthcare practice owners who are excellent clinicians, often capable leaders, and genuinely overwhelmed by the business side of what they have built.
If you've ever wondered where all the money went, why your practice feels profitable on paper but tight in practice, or how to even know what you don't know when it comes to finances — this episode is for you.
Key Takeaways
Financial clarity is a leadership tool. Understanding your numbers isn't just an accounting task — it's what lets you make confident, strategic decisions for your practice.
There's an emotional cost to doing it alone. The mental load of unresolved financial questions can wake you up at 3am and quietly erode your focus and wellbeing.
Know the difference between a bookkeeper, a CPA, and a CFO. Each plays a distinct role. Understanding who does what helps you build the right team and ask better questions.
Your practice is a sellable asset. Building with sustainability and profitability in mind sets you up to exit on your terms — and potentially change your family's financial trajectory.
You can outsource the task — not the thinking. Staying engaged with your finances, even at a baseline level, protects your business and your relationship with the professionals serving you.
Q&A
What does financial clarity actually mean for a practice owner?
Luisa defines it as understanding how money flows through your business — revenue in, expenses out, net profit — and knowing what portion needs to be set aside for tax, how to pay yourself correctly based on your entity structure, and what your cash position looks like several months out. The goal isn't to become a finance expert. It's to be informed enough to ask the right questions.
What's the real cost of managing your own finances without support?
Beyond compliance risk and potential tax errors, Luisa highlights the emotional cost: carrying a heavy mental load of open financial questions leads to the kind of sleepless nights and low-grade dread that compound over time. She calls this "burnout brain" — a state where you're making survival decisions rather than strategic ones.
What's the difference between a bookkeeper, a CPA, and a CFO?
Bookkeeping accurately records all money flowing through your accounts. A CPA handles compliance and tax filing. A CFO manages cash flow strategically — forecasting revenue, planning for seasonal dips, identifying your runway, and helping you build toward long-term profitability. Many practice owners conflate these roles and end up either under-served or paying for expertise they aren't fully using.
How should practice owners think about building something they can eventually sell?
Luisa encourages owners to think about their practice as a sellable asset from day one. A practice that runs profitably, has sound systems in place, and doesn't collapse when the owner steps back for a few weeks is a practice with real market value. That kind of exit can represent generational wealth — a motivator that makes the work of building sustainable systems feel genuinely worth it.
Episode Highlights
Luisa's origin story: from philosophy student and art kid to business finance expert — by way of a bankruptcy and single motherhood in San Francisco
Why business owners feel isolated — and why niche professional communities are helping to change that
The physician's version of "now what?": the moment after the doors open and the overwhelm sets in
"I'm not a money person": why that belief can cost you your practice
The cash flow forecasting skill that keeps Luisa running profitably every year — and how to build it yourself
Why financial clarity is a leadership skill, not a personality trait
Burnout brain vs. growth mindset: two very different places to make decisions from
What a CFO should actually be doing for your practice
Building a practice that can run without you for three weeks — and why that matters for your long-term exit
Parting advice: keep going
Memorable Quotes
"If you're just like, 'I'm not a money person' — having your own business is going to be very, very difficult for you." — Luisa Alberto
"What a CFO should be doing is helping you make strategic decisions that protect your cash and increase your profitability over time." — Luisa Alberto
"You're making decisions from burnout brain. The opposite is making decisions from a place of growth mindset — knowing you're on the right path." — Luisa Alberto
"Can you take real time off? Can you step away for a few weeks and nothing breaks? That's another marker." — Luisa Alberto
"A large portion of owning a business is making sure that you have enough money. If you don't have those things on lock — you don't have a business. You have a very expensive hobby." — Luisa Alberto
Luisa is proof that financial clarity isn't a personality trait — it's a learnable skill that changes everything. For practice owners who want to enjoy the autonomy they signed up for, build something sustainable, and eventually exit on their own terms, this episode is a roadmap. Connect with Luisa at luisakalberto.com or find her on LinkedIn, and explore the Self Employment Built to Last email series while you're there. And if you're ready to bring more strategic support into your practice, visit practicesuccess.co to learn how the Thriving Practice Community can help you build a practice that truly thrives.
Guest Bio:
Luisa Alberto didn't set out to become a finance expert — she became one out of necessity. After running her own brick-and-mortar business, becoming a single mother, and facing a landlord threatening to evict her from her apartment in one of the most expensive cities in the country, Luisa realized that loving her business wasn't enough; she needed to master her own financial literacy to protect her family's future. That experience became the foundation for People First Finance, People First Foundations, and Kindredly — three ventures she now leads to help self-employed business owners (with a particular soft spot for women) achieve the financial clarity and independence that real freedom requires.
Find Luisa:
Websites: PeopleFirstFinance.com LuisaKAlberto.com
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The One-Lever Method: Tracy Cherpeski on Course Correcting Your Practice Without Chaos – A Special SNACK Episode, EP 262
Does your practice still reflect why you started it? In this SNACK episode of The Thriving Practice Podcast, host Tracy Cherpeski joins co-host Miranda Dorta to unpack what Tracy calls "practice identity drift" — the subtle, gradual process by which a once-intentional practice loses its center. If you're a healthcare practice owner who's checked all the boxes but still feels like something is off, this episode is for you.
Does your practice still reflect why you started it? In this SNACK episode of The Thriving Practice Podcast, host Tracy Cherpeski joins co-host Miranda Dorta to unpack what Tracy calls "practice identity drift" — the subtle, gradual process by which a once-intentional practice loses its center. If you're a healthcare practice owner who's checked all the boxes but still feels like something is off, this episode is for you.
Practice identity drift rarely announces itself. The practice may be profitable and running smoothly on paper, but the owner feels disconnected, bored, or quietly resentful without knowing why. Tracy draws a direct parallel to burnout progression: the drift often starts with outside forces — the relentless pace of change in a heavily regulated industry — before compounding through overcommitment, reactive decision-making, and a gradual erosion of the things that made the work meaningful.
Whether you've been in reactive mode for years or just sense that your practice has drifted from what you originally envisioned, this conversation offers a practical framework for finding your way back — without overcorrecting.
Key Takeaways
Drift is subtle — until it isn't. A practice can look successful from the outside while the owner feels disconnected, bored, or resentful. Recognizing the drift is the first step.
Overcommitment compounds the problem. Physicians rarely have bandwidth to spare — and when yes becomes the default answer, drift accelerates.
Slowing down is the starting point. Tracy's first coaching sessions focus on deep intentional reflection before any action is taken — typically a 90-minute session that helps owners get outside their regular thinking.
Pull one lever at a time. Course correction works best when changes are made incrementally, observed over roughly eight weeks, and adjusted before the next change — not all at once.
Clinical thinking has business applications. The methodical diagnostic approach physicians use with patients is directly transferable to identifying what's not working in a practice.
Q&A
What is practice identity drift, and how does it happen?
Practice identity drift is the gradual process by which a practice owner's original vision becomes obscured by external demands, overcommitment, and reactive patterns. Tracy describes it as similar to burnout progression — subtle at first, often invisible from the inside — driven largely by the speed of change in healthcare and the compounding pressure to stay on top of compliance, patient needs, and clinical obligations.
How can a practice owner course correct without making things worse?
The biggest risk in course correction is overcorrecting — making too many changes at once and losing the ability to assess what's actually working. Tracy recommends pulling one lever at a time, observing for approximately eight weeks, and then making the next adjustment. The exception is a practice that needs a complete overhaul, in which case a more intensive engagement makes sense.
How does Tracy help practice owners figure out what they actually want?
Tracy's onboarding process starts with a 90-minute deep-dive coaching call structured around pointed questions designed to move clients through a progression of clarity. She warns clients in advance: the first four to six weeks will feel slow and uncomfortable. But that discomfort is where the insights live — and clients regularly surprise themselves with what they articulate out loud for the first time.
How do I know if my practice has drifted?
Tracy offers a simple three-part diagnostic: ask yourself whether the challenge you're facing is a people problem, a process problem, or something external. That distinction alone helps practice owners prioritize what to address first and where to focus their energy.
Episode Highlights
What practice identity drift looks like — and why it's so hard to see from the inside
The role of healthcare's pace of change in pulling practice owners away from their original vision
Why overcommitment isn't just about saying yes too much — it's a cascade of displaced priorities
The "patient as customer" tension and when adapting to patient needs starts working against the practice owner
Tracy's onboarding process: slowing down as a strategic move, not a delay
What a client's first F-bomb in a coaching session revealed about the power of the process
Why course correction beats pivot — and the Friends reference that explains the difference
The one-lever-at-a-time method: how practice owners can test changes without chaos
When clinical diagnostic thinking is exactly the right tool for business problem-solving
The three-question self-assessment: people, process, or external?
Memorable Quotes
"The drift is usually pretty subtle until it's not. It might still be humming along — on paper, on the surface, externally successful — but something feels off." — Tracy Cherpeski
"That first call is 90 minutes. We take a long deep dive. And it's amazing what happens. You get outside of your regular thinking, especially when someone is taking you through a progression to get to where you want to be." — Tracy Cherpeski
"Not overcorrecting. That's the hardest part of course correction." — Tracy Cherpeski
"Just because you can doesn't mean you should." — Tracy Cherpeski
"Is it people? Is it process? Or is it something external? Chunk it down — that helps you figure out what's next." — Tracy Cherpeski
Practice identity drift doesn't happen overnight — and course correction doesn't have to either. Tracy's message in this episode is both practical and reassuring: you don't need to blow things up to find your way back. You need to slow down, get honest about what's not working, and make deliberate, measured changes one step at a time. If this episode resonated with you, visit practicesuccess.co to schedule a consultation with Tracy, or explore the community at thrivingpracticecommunity.com.
Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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Market Yourself, Not Your Practice: Ginger Allen on Personal Branding for Physician Growth, EP 261
What if the most powerful marketing tool a physician has isn't a website or an ad campaign — it's themselves? In this episode, Tracy Cherpeski sits down with Ginger Allen, founder of Your Medical Liaison and president of the Florida Medical Association Alliance, to talk about what actually works when growing a functional medicine practice or any independent healthcare practice.
If you've ever wondered why a beautifully designed website and a $50,000 piece of equipment still aren't bringing new patients through the door, Ginger Allen has some thoughts on that. In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Ginger — founder of Your Medical Liaison (YML) and a 12-year veteran of medical marketing — to talk about what actually works when it comes to growing a functional medicine practice or any independent healthcare practice.
Ginger's take is direct: the old model of marketing a practice is over. The physicians who are building sustainable, burnout-resistant practices right now are the ones marketing themselves as people — not their clinics, not their credentials, not their equipment. For independent practice owners trying to cut through the noise and attract patients who are the right fit, this conversation is both validating and actionable.
Whether you're a physician making the move from a hospital system to private practice, a functional or integrative medicine provider trying to grow your patient base, or simply a practice owner who's tired of throwing money at marketing that isn't working, Ginger offers a perspective shaped by years of working alongside physicians on the front lines of building something they actually love.
Key Takeaways
People connect with people, not logos — and the physicians gaining traction are the ones leaning into authentic, visible personal brands. Personal branding has replaced practice branding.
Ginger has seen too many providers invest in high-cost machines before they have a patient base to support them. The marketing has to come first. Patients must come before equipment.
Most doctors didn't go into medicine to create content or manage ad campaigns. Removing that burden is one of the most direct ways to protect their longevity. Getting marketing off a physician's plate is burnout prevention.
Functional and integrative medicine practices can't rely on insurance referral pipelines. They need intentional patient acquisition strategies built around visibility and trust. The self-pay model requires a different marketing strategy.
Across her interviews and client relationships, Ginger has noticed a consistent theme: providers who make the shift to root-cause, relationship-centered care report far higher levels of professional satisfaction. Functional medicine physicians are genuinely happier.
Q&A
Why do functional medicine practices need a different marketing approach than traditional medical practices?
Because the business model is fundamentally different. Most functional and integrative medicine practices are cash-pay or membership-based, which means they can't rely on insurance networks or hospital system referrals to keep the schedule full. They have to actively build visibility, earn trust, and attract the right patients — which looks far more like running a small business than hanging a shingle and waiting.
What's the biggest marketing mistake physicians make when starting or growing a functional medicine practice?
Investing in expensive equipment before building a patient base. Machine reps will tell you the equipment sells itself — Ginger says that's simply not true. You have to have the patients first. People will buy whatever their doctor recommends, but the machine won't bring the patients in on its own.
What does personal branding actually look like for a physician who's not naturally comfortable on camera?
Ginger's approach: batch it. Once a month, she guides clients through a one-hour recording session on Streamyard, prompting them with questions so they're in the flow of talking about what they love — their work, their patients, their approach. They're not creating content, they're having a conversation. That content then gets repurposed across channels, and the physician barely has to think about it.
How does strong marketing support help prevent physician burnout?
When physicians are carrying the full weight of running a business — clinical work, operations, and marketing — something eventually breaks. Ginger's philosophy is to take marketing entirely off their plate so they can stay in their zone of genius: caring for patients. That reduction in cognitive and administrative overload is a real factor in helping physicians stay sustainable over the long term.
Episode Highlights
How Your Medical Liaison grew from field marketing to a full-service boutique agency over 12 years
The two-division model: field marketing for specialists, digital marketing for functional and integrative medicine providers
Why Ginger niched into functional and integrative medicine — and what she's observed about physician happiness in that world
The machine rep problem: how predatory sales practices push new practice owners into serious overhead before they're ready
What Ginger's intern's marketing professors told her about the future of brand strategy — and why it matters for healthcare
Why millennials and younger patients respond to genuine content, not polished productions
The autonomy factor: why physicians consistently cite independence as the primary reason they go into private practice
Ginger's own wellness practices — nature, sunlight, grounding — and how they align with what her functional medicine clients prescribe
Memorable Quotes
"People like to work with people, not companies. We are no longer marketing the business. We are marketing you." — Ginger Allen
"You have to have the patients first. Machines will not bring business in." — Ginger Allen
"I don't want my physicians burning out. I want you to get that monkey off your back, because it is not what you went to school for." — Ginger Allen
"The freedom to be autonomous far outweighs the stress of running a business." — Ginger Allen
"Market you. That's what I'd like to leave them with." — Ginger Allen
Ginger Allen brings something rare to the medical marketing world: she genuinely cares whether her physicians thrive. And the through-line in everything she shared — from personal branding to equipment purchasing to patient-first strategy — is that building a healthy practice starts with building a sustainable one. If you're a practice owner who's ready to stop doing it all yourself and start showing up as the face of your own brand, this episode gives you both the rationale and the roadmap. Visit ymlteam.com to learn more about Ginger's work, and explore thrivingpracticecommunity.com for resources to help you build a practice that truly thrives.
Guest Bio:
Ginger Allen is a seasoned marketing professional with 25+ years of experience in sales, customer service, and consulting. As the Chief Joy Officer and owner of Your Medical Liaison, she leads a full-service medical marketing agency specializing in both digital and field marketing, helping functional and integrative medicine practices maximize ROI while reclaiming their time.
She is passionate about creating meaningful connections through strategic marketing and supports small medical practices with personalized consulting for startups and reorganizations.
Ginger currently serves as President of the Florida Medical Association Alliance and is an active member of several national organizations supporting physicians and women business owners. She is also the host of The Functional and Integrative Medicine Podcast for Providers and a co-author of the best-selling book Everyday Women’s Guide to Doing What You Love.
Find Ginger:
Website: YMLteam.com
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The Alchemy of Change: What Burnout Is Really Telling You About Your Practice
Every practice owner has a moment when they do the math — and quietly wonder whether they'd be better off just becoming a barista. If you've been there, this episode is for you.
Every practice owner has a moment — usually somewhere around 3:00 AM — when they do the math. What if I just left? What would it actually cost me to walk away from all of this and do something anonymous and uncomplicated? If you've ever found yourself Googling bartending salaries in the Caribbean at midnight, you're in the right place.
In this solo episode, Tracy Cherpeski explores what she calls the Alchemy of Change — a framework for understanding why the hardest seasons in your practice aren't evidence of failure, but of transformation in progress. Drawing on the medieval concept of alchemy and the surprising etymology of the word "quicksilver," Tracy reframes burnout, disillusionment, and identity confusion not as warning signs, but as necessary stages in a sequence that every growing practice owner moves through.
This episode is for the healthcare practice owner who's questioning the call, feeling the weight of responsibility, and wondering whether they'll ever feel like themselves again in their own practice. Spoiler: you will. And this is what that process actually looks like.
Key Takeaways
The 3 AM barista fantasy isn't weakness — The 3 AM barista fantasy isn't weakness — it's data.
Burnout and disillusionment are not failures. They're named, predictable stages in a larger transformation process.
You can't force the third stage. Like a physician creating conditions for the body to heal, your job is to create the right environment — not to manufacture the outcome.
The gold is already in you. The work is revealing what's there, not adding something new.
The most important thing a guide does is prevent you from quitting during disillusion and calling it a conclusion.
Q&A
What is the Alchemy of Change, and why does it apply to practice owners?
Alchemy was the medieval precursor to chemistry — the attempt to transform base metals into gold. Tracy uses this as a metaphor for what practice owners experience during periods of burnout and growth: a process with distinct, predictable stages that ultimately reveals something more valuable than what existed before. The gold was always in the base material. The alchemist's job was to create the conditions for it to emerge.
What are the three stages, and how do I know which one I'm in?
Calcination is the burning — the season when what used to work stops working and the structures you built start to crack. Dissolution is the messier middle stage, where old identities soften and certainty gives way to confusion. This is where most people want to quit. Coagulation is the solidification of something genuinely new: a practice that fits the person you've become, not the person you were when you started. Tracy is clear that these stages aren't always linear — you can cycle through them as your practice grows.
How do I move through this faster?
You don't. Tracy is direct on this point: you cannot force the transformation any more than a physician can force the body to heal. What you can do is create the right conditions — the right team, systems, relationship with your time, and the right thinking partner to help you see what you can't see when you're too close to it.
What does a coach or thinking partner actually do in this process?
Tracy distinguishes clearly between a guide and an alchemist. The guide doesn't transform you — that's your work. A skilled thinking partner recognizes where you are in the process even when you can't see it, asks the questions nobody else is asking, reflects back what's underneath what you're saying, and holds the container steady during dissolution. And critically, they don't let you quit during the hardest stage and call it a conclusion.
Episode Highlights
The late-night math: why practice owners fantasize about becoming baristas — and what it actually means
Tracy's meditation that led to the word "quicksilver" — and the Old English root that stopped her cold
Alchemy as a metaphor: why the goal was never to create gold from nothing
The three stages — calcination, dissolution, coagulation — and how to locate yourself in the sequence
Why you can't skip dissolution, no matter how many people try
The physician parallel: creating conditions vs. forcing outcomes
Growing tomatoes: why your practice transformation works the same way
What the other side actually looks like — and why it doesn't look like perfection
Memorable Quotes
"Nobody talks about this. Your colleagues look fine. Your staff needs you to be fine. Your patients need you to be fine. So you close the laptop and go to bed and don't tell anyone you just Googled bartending salaries at 5-star resorts in the Caribbean." — Tracy Cherpeski
"Quicksilver. The only metal that moves at room temperature, that you cannot hold still, that skitters and merges and refuses to be fixed. In the alchemical tradition: a spirit captured in matter, waiting to be released." — Tracy Cherpeski
"This is not failure. This is the material doing exactly what it must do before something new can form. You cannot skip this stage. Believe me, people try. I have tried." — Tracy Cherpeski
"I'm not the alchemist. You are. I'm just the one who knows what the process looks like from the outside, and who will not let you quit during disillusion and call it a conclusion." — Tracy Cherpeski
"Your feelings are data, and that data informs everything, including your business decisions." — Tracy Cherpeski (quoting a graduated client)
The alchemy of change isn't a metaphor for suffering through hard times — it's a framework for understanding why hard times are productive. If this episode landed somewhere real for you, share it with the colleague who's been a little quiet lately. The one who might be in dissolution right now and doesn't know what to call it. Find Tracy at practicesuccess.co, and explore the Thriving Practice Community at thrivingpracticecommunity.com.
From Pajama Charting to Month-Long Vacations: Practice Management Software That Actually Understands Healthcare Featuring Damien Adler, EP 259
Running a healthcare practice was supposed to mean doing the work you trained for. But somewhere between the scheduling, the invoicing, the charting, and the follow-ups, it started meaning something else entirely. In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Damien Adler — co-founder of Zanda Health and a practicing psychologist — to talk about how the right practice management software can give independent practice owners their time, their energy, and honestly, their lives back.
Running a healthcare practice was supposed to mean doing the work you trained for. But somewhere between the scheduling, the invoicing, the charting, and the follow-ups, it started meaning something else entirely. In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Damien Adler — co-founder of Zanda Health and a practicing psychologist — to talk about how the right practice management software can give independent practice owners their time, their energy, and honestly, their lives back.
Damien and his wife built their psychology practice from the ground up, scaled it over 14 years, and eventually sold it — all while taking month-long vacations to Europe. The secret? The system ran the practice. That insight is what eventually became Zanda Health, a practice management platform designed to reduce administrative burden, automate the friction out of patient journeys, and make it genuinely enjoyable to run a private practice.
Whether you're a solo practitioner drowning in pajama charting, a growing group practice trying to attract and retain the best clinicians, or a practice owner who can't remember the last time you left work at work — this conversation is full of practical, been-there wisdom from someone who actually lived it.
Key Takeaways
Administrative burden isn't just an inconvenience — it's a burnout accelerator. Practice owners who don't build systems to handle scheduling, invoicing, and documentation end up working evenings and weekends by default.
The system should run the practice. When the right automations are in place, practitioners can step away, take real vacations, and come back to a practice that didn't implode.
Patient experience is shaped more by the surrounding environment than the clinical care itself. Simple, thoughtful touches — pre-visit directions, beverage preferences, fresh flowers — have an outsized impact on satisfaction and retention.
AI in healthcare doesn't have to be scary. Zanda Health's approach — compliance-first, secure, encrypted, practitioner-controlled — is a model for how AI tools can save hours of documentation time without compromising patient privacy.
Start small. You don't have to overhaul everything at once. One automation, one friction point fixed, makes a difference — and those changes compound.
Q&A
What are the top administrative tasks draining private practice owners?
According to Damien, the big three are scheduling and appointment management (making sure patients actually show up), invoicing and financial flow, and documentation — notes, letters, and referral communication. These are where the hours go, and where automation has the most immediate impact.
How much time do practice owners spend on admin tasks?
Tracy's research with practice owners shows that most are spending 30–35% of their time on administrative work — while the ones who really have it dialed in are closer to 10%. That gap is the opportunity.
How does Zanda Health handle AI safely in a healthcare context?
Before writing a single line of AI code, Zanda brought in their data protection and security officers to build a compliance and ethics framework first. Their AI features — session transcription, automated charting, patient insights — run in a separate, encrypted environment. The AI company has no visibility into patient data. Everything stays in Zanda.
Can a small or solo practice actually benefit from practice management software?
Absolutely — and the earlier, the better. As Damien notes, administrative complexity doesn't grow linearly with practice size. Even solo practitioners benefit from automation that handles appointment reminders, waitlist management, and financial follow-up, freeing them to focus on patient care without the after-hours catch-up.
Episode Highlights
Damien's origin story: from psychologist in private practice to co-founder of a global practice management platform
Why admin burden doesn't just grow — it compounds — as a practice scales
The simple pre-visit automation that gets patients to appointments on time and in a better headspace
Why patients rate their experience based on surroundings, not clinical care — and what that means for practice owners
The hospitality mindset: fresh flowers, beverage preferences, and what a bowl of mints has to do with patient retention
How Zanda's AI transcription and charting works — and the compliance-first process that built it
Why practitioners who can't take a real vacation have accidentally created the worst job they've ever had
Damien's one piece of parting advice: start small, let it accumulate
Memorable Quotes
"The system ran the practice. And we were able to sort of step back a lot from the clinical work over time — take vacations — and the practice would operate." — Damien Adler
"Either paperwork and admin will eat you, or you can eat the admin. You just make sure you come out ahead." — Damien Adler
"A well-run practice means you've got the right people doing the right things." — Damien Adler
"The more you can outsource those parts of your brain activity into a system, the more your brain goes: the system's got it. I don't need to think about it." — Damien Adler
Damien Adler built what a lot of practice owners wish existed: a tool that actually understands the practitioner experience, because it was built by one. If this episode made you think differently about how your practice runs — or doesn't run without you — that's exactly the inflection point worth paying attention to. Explore Zanda Health at Zandahealth.com/thrivingpracticepod, and grab their free e-book, The 9 Secrets of Successful Health Practices, linked in the show notes. And when you're ready to go deeper on building a practice that works for you, visit thrivingpracticecommunity.com.
Guest Bio:
Damien Adler is a registered psychologist, practice owner, and co-founder of Zanda, an all-in-one practice management platform used by thousands of health practices across Australia, the UK, Ireland, New Zealand, Canada, the US, and beyond. He spent 15 years building and running Mind Life Clinic, a large private psychology practice in Central Victoria — so he knows firsthand how administrative complexity can quietly compete with a clinician's original purpose.
That experience led him and his brother Paul to co-found Zanda (formerly Power Diary), now one of the most widely used practice management systems in the Allied Health space. Damien brings both the clinician's perspective and the operator's eye to conversations about sustainable practice-building, smart systems, and using technology in ways that actually serve practitioners and their clients.
Resource Mentioned: “The 9 Secrets of Successful Health Practices” http://zandahealth.com/ThrivingPracticePod
Find Damien:
Website: ZandaHealth.com
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The Grip Problem: What White-Knuckling Your Practice Is Really Costing You – A Special Snack Episode, EP 258
Learn how the grip of control in healthcare practice ownership quietly drains profit, stunts team growth, and leads to burnout—and how to release it.
Do you ever feel like you're white-knuckling your way through practice ownership — doing everything yourself, holding every thread, trusting no one quite as much as you trust yourself? If so, this SNACK episode is for you. In this candid, unscripted conversation, Miranda Dorta turns the mic on Tracy Cherpeski to explore one of the most persistent and costly patterns she sees in healthcare practice owners: the grip.
This isn't about delegation tactics or time management systems. It's about something deeper — the way high-achieving clinicians can quietly keep their practices (and their teams) from reaching full potential by holding on too tightly. Tracy draws on over 15 years of coaching experience, and her own personal reckoning with surrender, to unpack why this pattern is so common, why it's so hard to see in yourself, and what actually shifts when you finally let go.
If you're a practice owner who wants sustainable growth without burnout, this conversation will give you both the language and the permission to loosen your grip.
Key Takeaways
The grip has a real financial cost. White-knuckling your practice doesn't just wear you out — it quietly costs you in opportunity, profit, and team performance.
Clinician training creates the pattern. The stoicism that serves you in clinical settings can become a liability on the business side when it shows up as "if you want something done right, do it yourself."
Fear — not lack of ambition — keeps practices small. There's nothing wrong with choosing a simple practice model, but growth goals require honest clarity about what you're actually willing to do to get there.
Surrender is active, not passive. Tracy reframes surrender as the recognition that you are neither powerful enough to make something happen nor to make it not happen — and that this truth actually frees you.
What moves first is often a surprise. When practice owners release the grip, the first shifts tend to be financial — or their teams start noticing they seem lighter, calmer, more present.
Q&A
What does "the grip" actually look like in a healthcare practice? Tracy describes it as a pattern of slowed decision-making, inadvertently blocking team members from excelling, carrying the full weight of the business on your shoulders, and the persistent sense that everything depends on you. It often shows up as overwork, overwhelm, and significant opportunity cost — even when the practice owner is genuinely trying to do right by their team and patients.
Why is white-knuckling so hard for clinicians to recognize in themselves? Because it disguises itself as responsibility. Clinical training reinforces stoicism — staying unflappable for patients and staff is a real skill. But that same "never let them see you stressed" conditioning can carry over into the business side of practice ownership in ways that quietly stifle growth. High-achieving clinicians are particularly vulnerable because competence and control can look identical from the inside.
How does Tracy define surrender in the context of practice ownership? She defines it not as giving up, but as accepting a fundamental truth: "I am neither powerful enough to make someone else do something, nor am I powerful enough to make someone else not do something." What you do have some power over is your reaction, your response, and the decisions you make in the moment. That reframing creates breathing room — for you and for your business.
What should practice owners expect when they start letting go? Tracy says the first shifts are sometimes financial — things start moving that were stuck. Other times it's the team that notices first: "You look different. You seem more calm." And there's a ripple effect: when Tracy became more regulated and less attached to outcomes, her clients became more decisive and empowered in their own practices. Regulation, it turns out, is contagious.
Episode Highlights
What the grip actually looks like day-to-day — and how practice owners miss it in themselves
Why clinical training's greatest asset (stoicism) can become a liability in business
The difference between intentionally keeping a practice small and keeping it small out of fear — and how to tell which one is happening
Tracy's reframe of surrender: removing "war mentality" and what it actually feels like in the body
Her personal experience of learning what surrender truly means — not from a coaching framework, but from life
The baby bumblebee principle: why living things (including businesses) need breathing room
The unexpected places where freedom shows up first: money, team feedback, personal calm
How Tracy's own letting go created a ripple effect of confidence and empowerment in her clients
Memorable Quotes
"The hardest thing for nurturing people in helping professions is actually letting go." — Tracy Cherpeski
"I am neither powerful enough to make someone else do something, nor am I powerful enough to make someone else not do something. And so that's actually surrender." — Tracy Cherpeski
"Sometimes the willingness and the desire aren't talking to each other yet." — Tracy Cherpeski
"We can treat the business like a living entity. It needs breathing room, just like anything else does." — Tracy Cherpeski
"Me being bent around the axle about how they implement something that I've suggested to them does not show that I have confidence that they're going to take it and apply it in the way that's going to be best for their practice, their team, and their community." — Tracy Cherpeski
The grip is one of the most common — and most costly — patterns in healthcare practice ownership. And the good news is that releasing it doesn't require a complete overhaul of your systems or your identity. It starts with clarity, honesty about what you actually want, and a willingness to see control for what it really is. If this conversation resonated, share it with a colleague who might need the permission to breathe. And if you're ready to go deeper, visit practicesuccess.co to learn about working with Tracy, or explore thrivingpracticecommunity.com for tools and community designed to help your practice — and you — truly thrive.
Is your practice growth-ready? See Where Your Practice Stands: Take our Practice Growth Readiness Assessment
Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
Connect With Us:
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Stop Giving Away Your Energy: Phil Johnson on the Real ROI of Emotional Intelligence, EP 257
What if the biggest gap in your healthcare practice isn't clinical—it's emotional? In this episode, Tracy Cherpeski sits down with returning guest Phil Johnson, founder of the Master Business Leadership program, for a direct and data-driven conversation about emotional intelligence and why most high-achieving healthcare professionals have barely scratched the surface of developing it.
What if the thing holding back your healthcare practice has nothing to do with your clinical skills, your workflows, or even your team—but with your emotional intelligence? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with returning guest Phil Johnson, founder of the Master Business Leadership program, to go deep on the one competency most high-achieving healthcare professionals are leaving almost entirely undeveloped.
Phil's work reaches executives and organizations across 18 countries, and he's been on this path for over 57 years. His perspective on EQ is anything but soft. He's direct: most people who talk about emotional intelligence have done nothing to actually develop it. And in a field like healthcare—where smart, driven, intellectually rewarded professionals are the norm—that gap is especially wide, and especially costly.
Whether you're a solo practitioner navigating burnout, a group practice owner struggling with team engagement, or a healthcare leader wondering why all the right systems still aren't producing the results you want, this episode gets to the root of the problem—and offers a real path forward.
Key Takeaways
EQ development is experiential, not intellectual. Reading the books and watching the videos does nothing. The development requires emotional labor—and most people haven't done it.
High IQ and low EQ often go hand in hand. For healthcare professionals trained to rely on intellect, this is a critical and costly blind spot.
There are three primary sources of resistance to change: biological (the amygdala and cortisol response), sociological (the people around us resist our growth too), and educational (our systems never taught us emotional labor).
The ROI of EQ development is concrete. Phil shares results including a $55M revenue increase and $500K cost reduction for a single company in one year.
Developing EQ requires either pain or passion—and for most high-achievers, it's discomfort that finally moves them to act. As Phil puts it: if it doesn't hurt enough, you'll come back when it does.
Q&A
What is emotional intelligence, really—and why does it matter for healthcare practice owners?
Emotional intelligence is the ability to respond to challenges rather than react out of fear, and it's developed through experience, not intellectual study. For healthcare practice owners, Phil's data shows it directly affects revenue, employee engagement, and patient relationships. His work with one company produced a revenue increase of over $55 million and cost reductions exceeding $500,000 in a single year.
Why do high-achieving healthcare professionals often struggle with emotional intelligence?
Healthcare professionals are trained and rewarded throughout their careers for intellectual ability. Phil describes it plainly: when all you have is a hammer, everything looks like a nail. As a general pattern, people with high IQs tend to have low EQs—not because of personal failing, but because the educational and professional systems they came through never developed that muscle. For most high-performers in healthcare, EQ is the thing that's actually holding them back.
What does it actually take to develop emotional intelligence—is there a process?
Phil describes two foundational practices: learning to stop giving away your energy, and developing authentic listening. When how we feel about ourselves is based on how others feel about us, we unconsciously give away energy—and then have to steal it from others to compensate. That dynamic drives drama, conflict, and disengagement at every level. As we build the habits that lower our walls and stop that energy drain, trust deepens, consciousness rises, and results improve—with less effort.
How does EQ development apply to burnout prevention in healthcare?
When we're in a chronic state of amygdala activation—fight, flight, or freeze—our bodies are in survival mode, and our executive function is offline. That physiological state is at the root of much of the burnout epidemic in healthcare. As EQ develops, the amygdala response calms, and leaders are able to engage from a more grounded and present place. At the team level, higher EQ creates environments where people feel safe—reducing the drama, disengagement, and turnover that exhaust practices and their owners.
Episode Highlights
Why EQ is "over-talked and under-understood"—and what actually distinguishes intellectual knowledge from genuine development
The neuroscience of resistance: the amygdala, cortisol, and the prefrontal cortex shutdown that puts us on autopilot
The three primary sources of resistance to change: biological, sociological, and educational
Why we're only conscious about 3–5% of the time—and what a 1% increase in consciousness could change in your practice
The authentic listening habit: why not taking anything personally is a practice, not just a principle
Apple's hiring strategy and why it centers entirely on emotional intelligence
Gallup's data: 21% global employee engagement and what's really behind those numbers in healthcare organizations
The UC Berkeley study comparing IQ and EQ—and the 400% finding
Why AI will have an equivalent IQ of over 1,000 within a few years—and why that makes EQ development more urgent, not less
Children's consciousness vs. adult consciousness: what we lose as we grow older, and how EQ development brings it back
Memorable Quotes
"The development of emotional intelligence is an experiential process. It is not an intellectual process—and it's incredibly difficult." — Phil Johnson
"People with high IQs tend to have low EQs. The thing that's holding them back isn't their intellect. It's their lack of emotional intelligence." — Phil Johnson
"The development of our emotional intelligence is the ultimate competitive advantage." — Phil Johnson
"It is the hardest work you will ever do. And the ROI is massively greater." — Phil Johnson
"If how we feel about ourselves is based on how somebody else feels about us, we're unconsciously giving away our energy." — Phil Johnson
Phil Johnson has been on this path for 57 years, and his message hasn't gotten softer—it's gotten more urgent. If today's episode left you with a sense that something's been missing, that you've been talking about EQ without actually doing much about it, Phil would say that feeling is the doorway. You can connect with him directly by booking time on his Zoom calendar (link in show notes).
And if you're ready to explore what this kind of development could look like alongside a community of like-minded practice owners, visit thrivingpracticecommunity.com to learn more about the Thriving Practice Community.
Guest Bio:
Phil Johnson, MBL
Phil Johnson, Founder & CEO Master of Business Leadership Academy. During 2025 Master of Business Leadership Academy clients generated more than $55M in documented revenue growth, delivered $500K+ in cost savings, and increased leadership retention and performance across global organizations. MBL has partnered with C-level executives, founders, and investors operating under relentless pressure to accelerate revenue, retain top talent, deepen strategic relationships, and sustain high performance without sacrificing their health or personal lives.
The Master of Business Leadership Academy has alumni in the United States, Canada, England, Italy, Japan, Germany, Bosnia, South Africa, Australia, Middle East, Saudi Arabia, India, Nepal, Poland, Slovakia, Greece, Zambia and Kenya.
Find Phil:
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Keep the Main Thing the Main Thing: Dr. Peter Kevorkian on Purpose-Driven Practice and Burnout Prevention, EP 256
What does it look like when a healthcare practice owner stays connected to their purpose for over four decades — and then pours everything they've learned into shaping the next generation? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Dr. Peter Kevorkian, President of Life Chiropractic College West and a chiropractor who spent 42 years in private practice, to talk about the one thing that sustainable, burnout-proof practice ownership comes down to: keeping the main thing the main thing.
What does it look like when a healthcare practice owner stays connected to their purpose for over four decades — and then pours everything they've learned into shaping the next generation? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Dr. Peter Kevorkian, President of Life Chiropractic College West and a chiropractor who spent 42 years in private practice, to talk about the one thing that sustainable, burnout-proof practice ownership comes down to: keeping the main thing the main thing.
Dr. Peter has spent his career as a quiet voice of conscience for healthcare practitioners — reminding them that they entered this work to serve people, not to be consumed by coding, compliance, and insurance bureaucracy. His perspective on building a profitable, values-aligned private practice without losing yourself in the process is something every practice owner navigating the tension between business and calling needs to hear.
Whether you're rethinking your care model, considering dropping insurance panels, or simply trying to remember why you started, this conversation offers both grounding and a practical path forward.
Key Takeaways
Purpose is the antidote to burnout. When your actions and words fall out of alignment with your values, it creates a slow erosion — Dr. Peter calls it being "rotted from the inside out." Reconnecting to your why isn't soft advice; it's a survival strategy.
The business of healthcare can crowd out the heart of it. Coding, compliance, billing, and HR pull practitioners away from the patient relationship that drove them into the field. Naming this pattern is the first step to resisting it.
Patient empowerment is good medicine and good business. Dr. Peter built a practice where over 90% of patients were self-pay, not by being inaccessible, but by making care affordable and helping people understand why investing in their own health was worth it.
You can operate outside the system ethically and profitably. He never turned a patient away who truly wanted care — instead he created an "angel plan" that tied reduced fees to community service, keeping care accessible without sacrificing sustainability.
Everyone wants to feel heard. Dr. Peter's final wisdom is disarmingly simple: every human being — patient, employee, student — wants to feel heard, significant, and loved. Leading from that understanding changes everything.
Q&A
Why do so many healthcare practice owners burn out?
Dr. Peter points to the gap between why practitioners enter the field and what the business of healthcare actually demands from them. Most people go into healthcare driven by a desire to serve and help people thrive — but once they're in practice, they get pulled into coding, compliance, billing, HR, and all the operational machinery that comes with running a business. When the daily work stops reflecting your values and your purpose, the disconnection compounds over time. As Dr. Peter puts it, doing and saying things that aren't aligned to who you are and what your life purpose is — that rots people away from the inside.
How did Dr. Peter build a profitable practice outside the insurance system?
More than 90% of Dr. Peter's patients over the course of his 42-year practice were self-pay. He made care affordable, structured his fees to reflect what people could realistically manage, and was transparent about why. For patients who genuinely couldn't afford his rates, he created what he called an "angel plan" — a sliding scale arrangement where the remaining balance was offset by a commitment to community service. His view: money is just energy, and there are many forms of exchange. This approach let him run a thriving, values-aligned practice while never turning anyone away who truly wanted care.
What does patient empowerment actually look like in practice?
Dr. Peter describes a fundamental shift in how he thought about his role: not as the authority who tells patients what to do, but as a guide who helps them make informed decisions about their own bodies. He pushed back on the idea of the patient who packages up their body and hands it to the doctor to fix. Instead, his job was to give people information, ask what they wanted, and meet them where they were — even if that meant finding exercises they actually enjoyed rather than prescribing a routine they'd never stick to. The result, as Tracy confirms from her own experience with a collaborative provider, is dramatically higher compliance and a far more durable patient relationship.
What role does creativity play in healthcare leadership?
Dr. Peter draws an unexpected parallel between Walt Disney's imagineers and the kind of leadership healthcare needs. What inspired him about Disney wasn't the brand — it was the commitment to letting human creativity operate outside the constraints of convention, looking at problems from different angles and building experiences no algorithm could anticipate. He believes that's the one human capacity that will never be replicated by AI, and it's precisely what practice owners need to solve the complex, human problems they face every day.
Episode Highlights
Dr. Peter's 42-year private practice journey and what led him to leave it for academia
Why he describes himself as a "voice of conscience" for chiropractors throughout his career
The critical difference between a caregiver and a businessperson — and what happens when they collide
Why Dr. Peter believes third-party payers have fundamentally distorted the healthcare system
The "angel plan": how he made care accessible without undermining his business
Why patient compliance goes up when patients feel genuinely heard and empowered
Disney's imagineers as a model for creative leadership in healthcare
His simple, profound final message: everyone wants to feel heard, significant, and loved
Memorable Quotes
"Sometimes we lose healthcare in the business of healthcare."
— Dr. Peter Kevorkian
"When your actions and your words aren't aligned to your values and principles, that rots people away from the inside."
— Dr. Peter Kevorkian
"You can live outside the system and do it honestly, ethically, and in a compassionate way."
— Dr. Peter Kevorkian
"More than anything else, everyone wants to feel heard. They want to feel significant. And more than anything else, they want to be loved."
— Dr. Peter Kevorkian
"The system is really a sick care system. We give people benefits for having a condition — and virtually nothing to empower their body to become healthier and stronger."
— Dr. Peter Kevorkian
Dr. Peter Kevorkian has spent over four decades reminding healthcare practitioners of something that's easy to forget in the weeds of running a practice: you are here to serve people, and everything else is in service of that. If the business of healthcare has started to crowd out the heart of it for you, this episode is a good place to start finding your way back. Visit lifewest.edu to learn more about Dr. Peter's work and Life Chiropractic College West, and explore thrivingpracticecommunity.com for resources to help you build a practice that sustains you as much as it serves your patients.
Guest Bio:
Dr. Peter Kevorkian is the 4th President of Life West Chiropractic College and a chiropractor with over 40 years of practice, teaching, and global leadership experience. Known for his philosophy of Give. Do. Love. Serve., he has mentored thousands of practitioners, served on the boards of the ICPA and Sherman College, and spent decades helping families — and the practitioners who serve them — live with greater purpose, clarity, and joy.
Find Dr. Kevorkian:
Website: Lifewest.edu
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What Med School Never Taught You About Running a Practice—And How to Close the Gap – A Special Snack Episode, EP 255
Medical school taught you how to care for patients. It didn't teach you how to run a practice. In this SNACK episode, Miranda Dorta interviews host Tracy Cherpeski about the business knowledge gap that's quietly costing independent practice owners—and what you can do about it whether or not you have a business degree.
Most healthcare practice owners spent years—sometimes decades—in training to become excellent clinicians. But here's the gap no curriculum covers: how to actually run a practice as a business. In this SNACK episode of The Thriving Practice Podcast, Miranda Dorta flips the mic on host Tracy Cherpeski to explore what the absence of formal business training really costs independent practice owners—and what to do about it, with or without an MBA.
Tracy, who holds an MBA herself, makes a point that may surprise you: formal business education isn't a prerequisite for practice ownership success. What matters more is the willingness to shift perspectives—to stop examining your practice through a clinical lens and start examining it through a leadership one. That shift, she argues, is where the real work begins.
Whether you're a solo provider who's been winging the business side, a practice owner stuck in operational overwhelm, or a clinician curious about what sustainable leadership actually looks like, this episode offers grounded, practical insight you can act on immediately.
Key Takeaways
Business knowledge matters more than a business credential. A business degree isn't required to run a successful practice. Tracy explains why formal credentials matter less than most practice owners think—and what actually moves the needle.
The clinician hat and the CEO hat are not interchangeable. Clinicians are trained to be linear, proof-driven, and evidence-based. Those are clinical strengths—but they can work against decisive business leadership.
Delegation is not abdication. Handing off tasks and responsibilities is a sign of strong leadership, not lost control.
Business leadership requires a different relationship with uncertainty. Unlike clinical decision-making, running a practice requires trusting the process once due diligence is done. That capacity for informed leaps of faith is a skill that has to be developed intentionally.
Pause before you accelerate. When you feel behind on the business side, the most effective first step isn't moving faster—it's getting clear on what actually needs attention.
Q&A
What's the most critical business skill that healthcare practice owners are missing?
It's not strategy—it's perspective. Many practice owners approach business decisions the same way they approach clinical problems: seeking linear proof, extensive data, and certainty before acting. In business, that approach can create decision paralysis. The shift is learning when the data is sufficient and taking a forward-moving step even without perfect certainty.
Do practice owners really need an MBA to run a successful practice?
No—and Tracy (who has one) says so directly. For most private practice owners, formal credentials aren't necessary. More impactful options include finding a mentor who's succeeding on the business side, taking a targeted interest in one area of business at a time, or working with a consultant or coach who brings deep practical experience.
What does the clinician-to-practice-leader shift actually look like?
Tracy describes more ease—not necessarily easy, but more of it. Decision-making becomes faster. Delegation becomes almost automatic. The friction between clinical identity and business identity softens. The joy factor increases, and stress symptoms start to decrease. It's a significant shift—and she says it's genuinely remarkable to witness.
Episode Highlights
Why more physicians are pursuing MBAs—and what it signals about the state of practice ownership
The difference between business education in large integrated systems versus independent private practice
Why business is business regardless of industry—and why that's actually good news
How the data-driven clinical mindset can slow down business decisions
"Delegation is not abdication": breaking down one of the most important mindset shifts for practice owners
What the clinician-to-practice-leader shift actually looks and feels like in real life
The most practical first step for practice owners who feel behind on the business side
Memorable Quotes
"Delegation is not abdication." — Tracy Cherpeski
"Business is business is business regardless of the industry. A package of business is a package of business, period, full stop." — Tracy Cherpeski
"Take off the clinician's hat, put it on its shelf, buff it, shine it, make it pretty—and then put on your CEO hat and look at business as a business person." — Tracy Cherpeski
"Don't accelerate on something. Pause. Get a lay of the land." — Tracy Cherpeski
"There's a tremendous amount of trusting the process once you put something in motion and taking informed, data-backed leaps of faith. And that's a big challenge for medical practice business owners." — Tracy Cherpeski
The business of running a practice is learnable—and you don't have to go back to school to learn it. Tracy's first recommendation isn't a course or a credential: it's a pause. Get honest about what's creating the most friction, get it out of your head and onto paper, and address it one step at a time. When you're ready for more support, visit practicesuccess.co and thrivingpracticecommunity.com to explore resources built specifically for practice owners who are serious about building something sustainable.
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Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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The Diagnostic Eye: Reading Your Practice's Recurring Problems, EP 254
There's something in your practice that keeps coming back. You handle it, move on — and there it is again. In this solo episode of The Thriving Practice Podcast, Tracy Cherpeski reframes every recurring problem in your practice: those problems aren't malfunctions. They're messages.
There's a problem in your practice that keeps coming back. Maybe it's a recurring staff conflict, a billing breakdown, or an operational gap you've already fixed at least twice. You handle it, move on — and there it is again. If you've ever stood in front of that moment and wondered what you're missing, this episode is for you.
In this solo episode of The Thriving Practice Podcast, Tracy Cherpeski introduces a mindset shift that reframes every recurring problem in your practice: what if those problems aren't malfunctions? What if they're messages? Drawing on her background in regenerative gardening and her work coaching independent healthcare practice owners, Tracy makes the case that the diagnostic intelligence you use inside the exam room belongs in the business side of your practice — and most practice owners have simply never been invited to bring it there.
This is part two of a two-part mindset series. Part one — Episode 247, From the Weeds to the Horizon — introduced the altitude shift: learning to zoom out from day-to-day operations and see your practice from a wider view. Today's episode is about what you do once you're up there. What you see — and how to read it. Whether you're dealing with persistent team friction, chronic operational breakdowns, or the kind of exhaustion that rest doesn't seem to fix, this framework gives you a starting place that's different from anything you've tried before.
Key Takeaways
Recurring problems aren't evidence of failure — they're data. Your practice communicates through patterns, and learning to read them is a leadership skill.
The diagnostic intelligence you use in patient care translates directly to practice management. Most practice owners haven't been invited to bring it out of the exam room.
Three categories of practice problems — operational friction, team dynamics, and persistent personal depletion — each signal something different and require different responses.
The Two-Week Data Log is a simple tool that shifts you from reactive problem-solver to pattern-reader, often revealing more in two weeks than months of individual fixes.
Altitude (zooming out) combined with a diagnostic eye equals leadership. Without both, you're either drowning in problems or avoiding them.
Q&A
Why do the same problems keep showing up in my practice?
Most recurring practice problems are symptoms of something structural — a missing system, a role that's outgrown its design, or a care model misaligned with how you're wired to work. Tracy uses a regenerative gardening metaphor: weeds keep returning because the soil condition that called them forth hasn't changed. Fixing the surface problem without reading what's underneath means they'll keep coming back. Your practice isn't broken — it's communicating.
How do I apply my clinical skills to running my practice?
Tracy walks through four questions drawn directly from clinical history-taking that you can apply to any recurring business problem: How long has this been happening? When does it get worse? What have you already tried? What else is showing up alongside it? These aren't new skills for clinicians. You use them every day in the exam room. This episode is the invitation to bring them with you when you walk out.
What is the Two-Week Data Log?
It's a simple practice: for two weeks, when a problem surfaces, log it — thirty seconds, a note on your phone or a running document. Just what happened, when, and anything you notice. No analysis, no immediate fixes. At the end of two weeks, look for clusters. What kept showing up? What's it grouped around? Tracy calls it a soil test — you're reading the land before you pull a single weed, so you can respond to what's actually there rather than what you assumed was there.
Is this episode related to Tracy's earlier solo episode?
Yes — this is part two of a two-part mindset series. Part one (Episode 247) focused on the altitude shift: getting perspective on your practice by zooming out from the weeds. This episode completes the arc by giving you something to do once you've zoomed out — a diagnostic lens for reading the patterns you can now see. Tracy recommends listening to both, though either stands on its own.
Episode Highlights
Part two of the two-part mindset series — completing the arc from altitude shift (EP247) to diagnostic action
The clinical parallel: how skilled diagnosticians treat recurring symptoms versus how most practice owners handle recurring business problems
The regenerative gardening metaphor: how weeds signal soil conditions, and what your practice "weeds" are actually pointing to
Three categories of recurring practice problems (operational friction, team friction, personal depletion) and what each signals
The four diagnostician's questions — applied to practice management, not the exam room
The Two-Week Data Log: a low-effort, high-value tool for moving from reactive to diagnostic
The integration of altitude and diagnosis — and why both are necessary for real leadership
Tracy's invitation to the June TPC cohort for peer-supported practice diagnostics
Memorable Quotes
"Your recurring problems are not malfunctions. They are data points." — Tracy Cherpeski
"The diagnostic brain doesn't stop being useful at the exam room door. You just haven't been invited to bring it with you." — Tracy Cherpeski
"A weed is not the problem. The weed is the message." — Tracy Cherpeski
"Zoomed out with a diagnostic eye? That is leadership." — Tracy Cherpeski
"The next time something comes back — instead of reaching for it immediately, pause. Kneel down. Look at it. And ask: what are you telling me?" — Tracy Cherpeski
The next time something comes back — a problem you've handled, a friction point you've already addressed — try something different before you reach for the fix. Pause. Look at it. Ask what it's telling you about what's happening underneath. That small shift, Tracy says, is where real practice leadership begins. If this episode resonated, share it with a colleague who's deep in their own weeds and needs permission to look at them differently. And if you're ready to do this kind of thinking alongside peers who understand what it means to run an independent practice, Tracy's June TPC cohort is open now. Visit ThrivingPracticeCommunity.com to learn more and schedule a call.
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Resources Mentioned:
Episode 247: From the Weeds to the Horizon: The Altitude Shift That Sharpens Every Decision and Protects You From Burnout
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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You May Be the Bottleneck: What a Telehealth Entrepreneur Wants Every Practice Owner to Know Featuring Paulina Riedler, EP 253
What does it cost when a skilled provider spends their afternoon doing compliance paperwork instead of treating patients? In this episode, Tracy Cherpeski sits down with Paulina Riedler — founder of SpaKinect and a registered nurse turned entrepreneur — to talk about telehealth compliance, practice efficiency, and the real cost of being the bottleneck in your own medical spa or aesthetic practice.
What does it cost when a highly skilled provider spends their afternoon doing paperwork instead of treating patients? For a lot of aesthetic practices, that question has a very specific answer — and it's higher than they think. In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Paulina Riedler, founder of SpaKinect, to talk about telehealth compliance, operational efficiency, and what it really means to stop being the bottleneck in your own medical spa or aesthetic practice.
Paulina is a registered nurse who co-founded SpaKinect 14 years ago after spotting a gap in the aesthetics industry: nurses were performing Botox injections without proper physician oversight, not because they were careless, but because the existing system made compliance impractical and expensive. Her solution was a telehealth-based good faith exam model that connects patients with nurse practitioners before aesthetic treatments — protecting providers, protecting patients, and freeing up the practice to run more efficiently.
What started in California now serves over 40 states with 42 employees. But the business growth story isn't the most important thing Paulina has to share. It's what she's learned about how healthcare practice owners think — and how they need to think differently — when it comes to time, infrastructure, and building something that can thrive without them.
Key Takeaways
When providers handle every task that touches their name — exams, consults, approvals — they create a single point of failure that slows down the whole practice and limits growth. You may be the bottleneck you can't see.
Good faith exams are often treated as a cost of doing business. Flip the script: outsourcing them frees up nurse injectors who generate $500–$1,000 per hour for the practice. Compliance has a business case.
Practices that have clear workflows and SOPs in place get far more out of operational support services than those still figuring out their processes on the fly. Build the infrastructure before the growth.
Writing down every task and how long it takes for one week is one of the most clarifying exercises a practice owner can do. Most of what shows up can be done by someone else. Do a time audit — really.
Whether or not you ever plan to sell, building a practice that doesn't depend entirely on you is the smartest thing you can do for your future, your team, and the patients you serve. Always be deal ready.
Q&A
What is a good faith exam, and why does it matter for med spas?
A good faith exam is essentially a health history evaluation for patients receiving aesthetic treatments like Botox or fillers. It must be performed by a licensed prescribing provider — typically a physician, nurse practitioner, or PA — before treatment begins. Many aesthetic practices have RNs who are highly skilled injectors but cannot legally prescribe, which creates a compliance problem. SpaKinect solves this by connecting patients with telehealth NPs who conduct the exam and issue a treatment plan, allowing the RN to legally carry out the procedure.
How does outsourcing good faith exams actually improve a practice's bottom line?
The math is straightforward once you see it. A nurse injector generates between $500 and $1,000 per hour in revenue for a practice. Every 10-minute good faith exam that pulls them away from a treatment room is lost revenue. Multiply that across a day, and the cost of not outsourcing becomes significant. The same logic applies to physicians or NPs who are the sole person responsible for exams — their highest and best use is almost certainly not doing compliance consults all day.
What does it mean to 'always be deal ready'?
Paulina uses this phrase to mean that your practice should always be in a position where it could be transitioned, sold, or handed off — even if that's never the plan. That means documented SOPs, clear workflows, a team that can function without you, and financials that tell a coherent story. It's the same logic as estate planning: you don't do it because you expect to need it tomorrow. You do it because life happens, and being prepared is always better than scrambling when it does.
How do compliance gaps in aesthetics get created in the first place?
Partly because aesthetics has grown so fast that regulation hasn't kept up. Partly because many people — including some physicians — didn't initially think of Botox as medicine. And partly because the system made compliance genuinely difficult and expensive, which led some providers to work around it. Paulina now runs a nonprofit advocacy organization focused on educating state legislators about telehealth and aesthetics regulation, fighting bills that would create new barriers to compliant care rather than addressing the real problems.
Episode Highlights
How a California Medical Board crackdown on RN-led Botox practices revealed a market gap
The telehealth pivot: how SpaKinect adapted an existing platform for aesthetic compliance
What happens when a plastic surgeon becomes the single point of failure for their own aesthetics team
The "I'll squeeze it in" culture in healthcare — and the hidden costs it carries
Why thinking like a CEO feels unnatural to clinicians, and how to make the shift
Paulina's time audit recommendation: one week, write it all down
A real story about succession planning (and the physician who had none)
The Texas med spa patient death that sparked a lobbying battle over telehealth
Tracy's shoutout to Miranda for systematizing her role before going on maternity leave
Memorable Quotes
"Our mission statement is to protect providers and patients through aesthetic telehealth." — Paulina Riedler
"Everyone sort of thinks about this as a compliance checkbox and a cost of doing business. But we don't talk about it as a revenue generator if they flip the script." — Paulina Riedler
"If you really audit your time — write down what you're doing, how much time you're spending on it — you'll be shocked at how much of that you go, I really didn't need to do that at all." — Paulina Riedler
"Just always be deal ready. You don't have to be planning for that, but you want a contingency plan." — Paulina Riedler
"Think about where you might be a bottleneck. Where do things wait on you, on your approval, on your time. Audit that, and figure out where you can free some of that up." — Paulina Riedler
Paulina Riedler built a company by asking a simple question: why is this so hard, and how do we make it easier? That same question applies to every practice owner who's tired of being the last stop for every approval, every consult, every decision. If this conversation gave you something to think about, share it with a colleague who's running hard and hasn't looked up lately.
Visit thrivingpracticecommunity.com to explore resources that help you build a practice that runs — and thrives — without burning you out in the process.
Guest Bio:
Paulina Riedler, RN, is the CEO and co-founder of Spakinect, an innovative telehealth company providing compliance support to 4,000 medical spas across the United States. Riedler grew Spakinect from a San Diego, California, startup with 3 employees in 2012 to the seven-figure, national enterprise it is today. She brings to her clients more than a decade of experience developing and implementing clinical operations protocols as well as training medical providers.
As a medical compliance expert who has impacted legislation on the state level within the Med Spa industry, Riedler has appeared on prestigious industry podcasts including Legal 123s with ByrdAdatto and Spa Marketing Made Easy. She also founded the National Med Spa Society, a nonprofit organization aimed at advocating for and educating the public on patient rights within the aesthetics industry. A married mother of two, she lives in Durham, North Carolina.
Find Paulina:
Website: SpaKinect.com
Instagram: @Spakinect
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The Ick Factor: Why Practice Owners Avoid Fee Conversations — And What It's Costing Them – A Special Snack Episode, EP 252
If you've ever looked at your fee schedule and felt a knot in your stomach, you're not alone. Fee setting is one of the most avoided conversations in private practice — and it's not about not caring. It's about the discomfort that runs deep in helping professions, where talking about money can feel like it conflicts with the commitment to care.
If you've ever looked at your fee schedule and felt a knot in your stomach, you're in very good company. Fee setting is one of the most avoided conversations in private practice — not because practice owners don't care about the financial health of their business, but because the whole topic can feel loaded. In healthcare, there's often a deeply held belief that focusing on money is somehow at odds with the commitment to patient care. It isn't. And in this episode of The Thriving Practice Podcast, Tracy Cherpeski and Miranda Dorta make that case clearly.
This SNACK episode is a focused, practical conversation about the financial foundation every independent practice needs — and the mindset shifts that make it possible to build one. Tracy draws on her experience working with practice owners across medicine, dentistry, therapy, chiropractic, and more to explore what's really going on when practice owners underprice their services, avoid raising fees, or struggle to make sense of why profitable practices still feel broke.
Whether you're a solo practitioner trying to figure out your break-even number, a growing practice owner considering whether to stay on insurance panels, or someone who just knows it's time to take a real look at the financial side of the business, this episode is a solid starting point. No accounting degree required.
Key Takeaways
Helping professions carry a money mindset burden. The discomfort around pricing in healthcare is real — and it's rooted in professional identity. The Hippocratic oath commitment to service is a strength, but when it creates an aversion to financial conversations, it can quietly undermine the sustainability of the practice.
Know your numbers, especially cash flow. Profitability and cash flow are not the same thing. A practice can be technically profitable and still have no money available. Knowing your burn rate — what it costs just to keep the doors open — is the baseline for every financial decision.
The undercharging-burnout connection is direct. Undercharging isn't just a revenue problem — it's a burnout risk. Financial stress affects how you show up in the exam room, how you treat your team, and how long you can sustain the work you've built.
Fear, not math, is what stops most fee increases. Raising fees is harder psychologically than mathematically. The fear of being perceived as money-driven or of upsetting patients often has more influence than the actual market reality.
Insurance decisions should be strategic, not inherited. There is no single right answer on insurance versus out-of-pocket — but there is a right answer for your practice, your population, and your goals. That decision deserves a clear-eyed look, not a default.
Q&A
Why do so many practice owners avoid looking at their fee structure?
The resistance is usually emotional before it's practical. In healthcare and other helping professions, there's a strong cultural narrative that equates financial focus with compromising your commitment to care. That shows up as avoidance — not looking at the numbers, delaying fee reviews, or simply charging what colleagues charge without asking whether it works. Tracy describes it plainly: money in a care context carries an ick factor that's worth naming and working through.
What's the relationship between undercharging and burnout?
It's more direct than most practice owners realize. When fees don't cover true costs — or don't leave room for the unexpected — financial stress becomes a constant undercurrent. That stress affects your clinical presence, your team culture, and your capacity to serve patients well over time. As Tracy puts it: if you want to truly show up as the best provider you can be, you have to be financially sound. One reinforces the other.
How do you figure out what to charge?
Start with the end in mind. What are your goals — for revenue, for growth, for the life the practice is supposed to support? From there, work backward: what's your burn rate (the cost of keeping the doors open)? What level of revenue gets you to break-even, and then to a cushion that gives you real stability? Tracy recommends having at least a few months of total expenses available at any given time — not as a luxury, but as a basic operational buffer.
When is it time to look at the insurance-versus-out-of-pocket question?
Honestly, it's always worth revisiting. Some practices do well staying on certain panels — particularly payers known for fair reimbursement and low administrative burden. Others find that hybrid models (some insurance, some direct-pay) give them more flexibility. And others go fully cash-based, which Tracy notes requires intentional systems, strong patient communication, and a commitment to a hospitality-level experience. The point isn't to pick the trendy model — it's to pick the model that fits your population, your values, and your financial goals.
Episode Highlights
Why money conversations feel loaded in healthcare — and why that matters for practice sustainability
The numbers every practice owner should know: revenues, profitability, burn rate, and cash flow
How to set fees by starting with goals and working backward
The undercharging-burnout connection and why financial stress affects clinical quality
What stops practice owners from raising fees — and why the obstacle is usually psychological
Insurance panels, direct care models, and hybrid approaches: how to think through the tradeoffs
The one number you can pull up right now that tells you something real about where your practice stands
Memorable Quotes
"If you want to be of service, to truly show up and be the best clinician you can be, you have got to be financially sound." — Tracy Cherpeski
"Take off the clinical hat. Put on the CEO hat." — Tracy Cherpeski
"Knowledge is power. Making a wise decision about how your fee schedules are set up is a big piece of the puzzle." — Tracy Cherpeski
"If you paint yourself into a corner, you're going to have to make a mess getting out." — Tracy Cherpeski
"It is an exchange of energy. You are providing something people are seeking out, and it needs to be paid for." — Tracy Cherpeski
Fee setting isn't just an accounting exercise — it's one of the most direct expressions of how you value your work, your team, and the practice you've built. Tracy's message here is practical and clear: get clear on your numbers, make a plan, and stop letting financial stress quietly erode the thing you worked so hard to create. If this episode prompted some honest reflection, share it with a colleague who could use the same nudge. And when you're ready to take a real look at the financial side of your practice, visit thrivingpracticecommunity.com to explore what's available to help you move forward.
To learn about CFO services or schedule a Strategic Finance Consultation: Inquire here
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Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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If You Don’t Ask, You Don’t Know: A GP’s Case for Making Menopause Care a Practice Priority Featuring Dr. Danielle Hunte, EP 251
What if the physician best positioned to help women through perimenopause is the one they’re already seeing — their GP? In this episode, Tracy sits down with Dr. Danielle Hunte, a general practitioner from Barbados and founder of Midlife Meridian, to explore exactly that.
What if the physician best positioned to help women through perimenopause and menopause is the one they’re already seeing — their GP? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Dr. Danielle Hunte, a general practitioner in Barbados with nearly 30 years in medicine and the founder of Midlife Meridian, a growing platform dedicated to closing the gap in menopause care and education for both patients and providers.
Danielle didn’t set out to become a menopause specialist. She set out to be a GP — and stayed one for two decades. But when she went through perimenopause herself and found that even her own medical training hadn’t fully prepared her for the experience, something shifted. She saw the gap: women running businesses, leading teams, raising families, and silently struggling because no one had given them a full picture of what midlife hormonal change could actually look like. And she saw her own profession’s role in that silence.
For practice owners navigating what it means to truly serve patients — not just treat conditions — this episode is essential listening. Danielle brings both the clinical perspective and the business perspective, and the conversation covers everything from screening tools and digital product development to LinkedIn strategy and burnout prevention for the physician-entrepreneur.
Key Takeaways
GPs are uniquely positioned to manage perimenopause and menopause. Because menopause is not limited to one system — it can affect nearly every tissue in the body — primary care physicians are better suited than most specialists to put the whole picture together.
If you don’t ask, you don’t know. Danielle developed a simple screening form patients fill out in the waiting room. It’s revealed a whole cohort of women with symptoms who simply weren’t saying anything.
The infrastructure gap is what’s holding GPs back. It’s not just lack of awareness — it’s lack of practical tools: reference materials, patient education resources, prescribing guides. That’s exactly the gap Midlife Meridian is built to fill.
Service-first content is the most effective marketing. Danielle started writing LinkedIn articles purely to educate — and women started reaching out asking to book appointments. No campaigns. No funnels. Just genuinely useful information.
Sustainable practice growth means knowing what you’re giving up. Whether you’re adding a new clinical service or a new revenue stream, time isn’t renewable. Getting clear on what you’re stepping back from is what makes adding something new actually work.
Q&A
Why are GPs better suited for menopause care than gynecologists or specialists?
Because menopause is a full-body event. It’s not a gynecological problem — it’s what Danielle calls neuroendocrine upheaval that can affect almost every tissue in the body. Specialists manage one system. GPs manage everything. They’re the first line — the ones sorting through all the symptoms and putting the puzzle pieces together. They just need the education and infrastructure to do it intentionally.
How can a GP add menopause care to their practice without a massive learning curve?
Start with awareness, then build the infrastructure. The Menopause Society and International Menopause Society both offer accessible, on-demand education. Then ask: do I have a screening tool? Do I have patient education materials? Do I know what’s available and what isn’t in my market? Danielle’s Midlife Meridian is developing “practice-in-a-box” digital products specifically designed to give GPs the tools they need to implement without starting from scratch.
What does sustainable practice growth look like when you’re already stretched thin?
It looks like clarity and subtraction. Danielle brought in another physician to see GP patients while she’s focused on menopause care. She protected her Thursday “off” day even when things got chaotic. And she got honest about the pace she could sustain. As she put it: “I can’t work at this pace for the next 20 years.” That honesty is what drives the move toward more scalable, lower-overhead revenue streams — like the digital products she’s building.
How can physicians use LinkedIn without it feeling like marketing?
Stop thinking of it as marketing and start thinking of it as service. Danielle didn’t write her LinkedIn articles to get patients — she wrote them because women in leadership deserved accurate, readable information about what was happening to their bodies. The appointment requests followed. When your content genuinely helps people, the business results take care of themselves.
Episode Highlights
Danielle’s origin story: a personal perimenopause experience that revealed a gap in her own clinical knowledge
Why menopause care belongs in primary care, not just specialty practices
The screening tool she developed — and the cohort of symptomatic patients it uncovered who never said a word
Building a “practice-in-a-box”: reference materials, prescribing guides, and patient education resources for other GPs
LinkedIn as service-first content strategy — and why it’s outperformed any deliberate marketing effort
The challenge of operating a private practice, owning the building, and managing tenants — all at once
Creativity as burnout prevention: jewelry-making, acrylic painting, and what the right brain needs after a day of science
The business case for adding menopause care: your captive audience is already there
Delegation, boundaries, and the art of protecting your off day
Memorable Quotes
"GPs are uniquely positioned to manage perimenopause and menopause because it’s not just a gynecological problem. It’s neuroendocrine upheaval that affects almost every tissue in your body."
— Dr. Danielle Hunte
"If you don’t ask, you don’t know."
— Dr. Danielle Hunte
"You already have a captive audience. Women are probably the biggest demographic in your clinic. A lot of them are going to be midlife women — and you’re probably missing revenue if you’re not doing it."
— Dr. Danielle Hunte
"Time is not renewable. So if you’re adding something, what are you giving up?"
— Dr. Danielle Hunte
"Success is just the ability to keep going. In spite of what life is throwing at you, to just keep going."
— Dr. Danielle Hunte
Dr. Danielle Hunte is proof that the best practice innovations often come from lived experience — from a physician who felt the gap herself and decided to close it. Whether you’re a GP considering menopause care, a practice owner looking for a smarter model, or someone trying to build something sustainable without burning out, this episode offers both the permission and the playbook. Connect with Danielle on LinkedIn or visit midlifemeridian.com to learn more about her work. And if you’re ready to build a practice that thrives on your terms, explore the community and resources at ThrivingPracticeCommunity.com.
Guest Bio:
Dr. Danielle Hunte is a General Practitioner in Barbados who spent nearly 30 years treating everything from emergency cases to chronic disease management before realizing the most underserved population in her practice wasn't the elderly or the acutely ill - it was midlife women navigating perimenopause.
Now completing her Menopause Society certification and building a platform to educate both patients and clinicians, Dr. Hunte is bridging the gap between emerging menopause science and practical primary care - particularly for doctors in small practices and resource-limited settings. Through her LinkedIn newsletter "Midlife for Women Who Lead" and her clinical work at Maxwell Medical Clinic, she's proving that evidence-based menopause care doesn't require specialty training or expensive protocols - just awareness, empathy, and willingness to learn. Connect with her on LinkedIn where she shares practical approaches to midlife women's health
Find Dr. Hunte:
Website: Maxwell-Clinic
Instagram: MaxwellMedClinic
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18 Years in the Insurance System, Then She Built Something Better: Dr. Samantha Mekrut on DPC and Women’s Midlife Health, EP 250
After more than 18 years in insurance-based healthcare, Dr. Samantha Mekrut made a decision a lot of physicians dream about: she left to build something better. The result is Meristem Family Medicine — a direct primary care practice in Medfield, Massachusetts, where patients pay a flat monthly membership fee, appointments run 30 to 60 minutes, and the administrative machinery of insurance billing is nowhere to be found.
What does it actually take to build a healthcare practice that serves patients well, keeps overhead low, and doesn’t burn you out in the process? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Dr. Samantha Mekrut — a family physician with more than 18 years in insurance-based healthcare who left the system to found Meristem Family Medicine, a direct primary care practice in Medfield, Massachusetts. For anyone who’s wondered what running an independent practice on your own terms really looks like, this conversation delivers.
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Dr. Mekrut’s approach centers on something the conventional model rarely allows for: time. As a direct primary care provider, she works on a flat monthly membership model — no surprise billing, no insurance middlemen, no ten-minute appointments. Her patients get 30- to 60-minute visits, same-day messaging access, and a physician who actually knows their story. It’s a model gaining serious attention among practice owners who are exhausted by the administrative weight the insurance system demands.
Beyond the business model, Dr. Mekrut has built a specialty that’s both timely and deeply needed: menopause care for women in midlife. With decades of research being revisited and a whole generation of women in their 40s and 50s looking for providers who take their symptoms seriously, she’s filling a gap that the conventional system has largely leftopen.
Key Takeaways
Direct primary care and concierge medicine are not the same. Direct primary care and concierge medicine are not the same. DPC includes all visit services in the monthly membership fee with no additional charges or insurance billing — making it far more affordable than most patients expect.
Eliminating insurance billing overhead is what makes affordable DPC possible. Eliminating insurance billing overhead is what makes affordable DPC possible. The average physician requires 1.7 administrative billers to manage insurance reimbursements — a cost that DPC removes entirely.
Autonomy is the real draw for providers. Autonomy is the real draw for providers. Without insurance companies dictating how care is delivered, Dr. Mekrut can offer services — like annual nutrition analyses — that genuinely benefit patients but wouldn’t be reimbursed in a conventional model.
Women in midlife have been underserved by the conventional medical system, often for decades. Women in midlife have been underserved by the conventional medical system, often for decades. Perimenopause and menopause are not disease states — Dr. Mekrut argues they belong in primary care and prevention, not specialist-only territory.
Community presence is authentic marketing. Community presence is authentic marketing. Library talks, midlife book clubs, and patient education with no strings attached build the kind of trust that no ad spend can replicate.
Q&A
What’s the real difference between direct primary care and concierge medicine?
Both use a membership model, but direct primary care includes all visit services in the monthly fee with no additional charges and no insurance billing. Concierge practices typically still bill insurance and charge copays on top of the membership fee. That distinction is what allows DPC to be accessible at a price point that surprises most people who assume it’s only for wealthy patients.
Can a direct primary care practice actually be financially sustainable?
Yes — and the key is overhead. Dr. Mekrut points out that the average physician requires 1.7 administrative billers just to manage insurance reimbursements. DPC removes that cost entirely. Combined with a streamlined EHR system and a direct scheduling link (no receptionist needed), the model can be lean enough to offer genuinely affordable monthly fees while still building a viable practice.
How does direct primary care handle lab work?
Services performed on-site — strep tests, urinalysis, and the like — are typically covered within the membership fee. For external labs, patients can use their existing insurance or take advantage of a cash pricing arrangement, which Dr. Mekrut describes as significantly less expensive than paying through insurance for those without coverage. It’s one more way the model reduces the financial guesswork patients dread.
Why should menopause care live in primary care rather than with specialists?
Because menopause isn’t an illness — it’s a natural transition that affects half the population, and it belongs in the prevention realm of primary care. Dr. Mekrut makes the case that having a primary care physician who can address menopause alongside general health concerns gives women more integrated, continuous care. She also points to two decades of under-prescribing hormone therapy based on a misreading of the Women’s Health Initiative study — and why a closer look at the data tells a very different story about safety and benefit.
Episode Highlights
The meaning behind “Meristem” — and why a biology background shaped how Dr. Mekrut thinks about growth and healing
How direct primary care differs from concierge medicine, and why the distinction matters for both patients and providers
What a typical Tuesday looks like: two to four patients, unhurried appointments, and no insurance billing in sight
The 1.7 billers statistic — and how DPC eliminates that overhead entirely
Why Dr. Mekrut says she doesn’t need an insurance company telling her how to practice medicine after 18 years of experience
How the Women’s Health Initiative study shaped two decades of under-prescribing hormone therapy — and what newer data actually shows
Dr. Mekrut’s work in Nicaragua training community health workers, and how that experience shaped her view of community-based care
How library talks and midlife book clubs build genuine patient trust — without selling anything
What comes next for Meristem: hiring intentionally and growing a team without losing the culture she’s built
Memorable Quotes
“It just takes the guesswork out of coming in to see your doctor. If you’re sick, you just come in — you don’t have to worry.” — Dr. Samantha Mekrut
“I really don’t need an insurance company to tell me how to practice medicine.” — Dr. Samantha Mekrut
“Menopause is not an illness. We really want to keep it in that prevention realm of primary care.” — Dr. Samantha Mekrut
“If someone doesn’t know about my practice, they can’t benefit from it.” — Dr. Samantha Mekrut
“Decoupling primary care from insurance — that’s my way of voting with my feet.” — Dr. Samantha Mekrut
Dr. Samantha Mekrut built her practice around a simple but powerful idea: that good medicine shouldn’t require financial guesswork, rushed appointments, or a system that prioritizes billing over patients. For practice owners wrestling with burnout, overhead, or the tension between doing right by patients and running a sustainable business, this episode is a reminder that a different model is not only possible — it’s already working. Learn more about Meristem Family Medicine at [url— please verify], find menopause provider directories through The Menopause Society at menopause.org, and explore thrivingpracticecommunity.com for resources to help you build a practice that truly thrives.
Guest Bio:
Dr. Sam Mekrut is a board-certified family physician, Menopause Society Certified Practitioner (MSCP), and the founder of Meristem Family Medicine, a direct primary care practice in Massachusetts. She has spent nearly two decades in community and women’s health, including leadership roles as Medical Director at the Edward M. Kennedy Community Health Center in Framingham and previously with Optum Student Health Services. Her work has centered on expanding equitable access to care, developing high-functioning clinical teams; and advancing maternal–child health, obstetrics, and gynecologic care, alongside teaching and mentoring medical students, residents, and advanced practice providers.
Today, Dr. Mekrut focuses on innovative, relationship-based care through the DPC model, with a particular emphasis on evidence-based primary care, menopause care, and midlife women’s health. She is passionate about empowering patients, supporting a healthier and more sustainable healthcare ecosystem, and promoting more joy and fulfillment in clinical practice
Find Dr. Mekrut:
Website: MeristemFamilyMedicine.com
Instagram: @meristemdpc
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The Real Burnout Prevention Framework for Independent Practice Owners – A Special Snack Episode, EP 249
Burnout is one of the most talked-about topics in healthcare — and still one of the most misunderstood. In this SNACK episode, Miranda Dorta turns the mic around and puts Tracy in the hot seat for an unscripted conversation about what burnout prevention actually requires. Not the surface-level version. The real one.
Everyone in healthcare is talking about burnout. Fewer people are actually doing something to stop it before it starts. In this SNACK episode of The Thriving Practice Podcast, Miranda Dorta flips the script — putting Tracy Cherpeski in the interview chair for an unscripted conversation about what burnout prevention genuinely requires for independent practice owners. If you've been waiting for someone to go beyond the self-care checklist, this is that conversation.
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Tracy has delivered this content as CME-accredited programming in California, and she brings that same research-grounded depth here. The question she's really answering: what does it actually take to build a practice that's sustainable — not just one that survives until the next crisis?
Whether you're a physician, dentist, chiropractor, therapist, or any other independent practice owner feeling the weight of wearing too many hats, this episode offers a framework that's both honest about the structural challenges of the healthcare system and practical about what you can do right now.
Key Takeaways
Burnout prevention starts earlier than you think. Most providers picture burnout at its most extreme — late-stage crisis. Real prevention means understanding how it starts, often back at the beginning of a career, with the habits and patterns that look like dedication.
Practice ownership compounds burnout risk in unique ways. The data on burnout rates has largely been collected through large integrated systems — it rarely captures the experience of the practice owner carrying both full-time clinical and full-time business responsibilities simultaneously.
Prevention is a structural decision, not just a personal one. Building systems for compliance, decision-making, and delegation relieves pressure at the business level — which is often where the burnout actually originates for practice owners, not on the clinical side.
Skipping delegation is one of the most expensive shortcuts. The 'I'll just do it myself' habit keeps goalposts moving indefinitely. Understanding what to delegate, when, and to whom — or to what system — is essential prevention work that most practice owners delay too long.
Regulation is where you start. One micro-habit — like five intentional breaths before you walk in the door at home — can help regulate your nervous system, slow your brain down, and make you more resilient to the pressures that fuel burnout.
Q&A
What does real burnout prevention look like for a practice owner?
It starts with naming reality: the healthcare system is structurally extractive, and that's not going to change overnight. From there, prevention means building your business model to relieve pressure — compliance systems that are built in, not bolted on; decision frameworks that eliminate paralysis; and a clear understanding of the role of delegation. It's about having little pressure valves all over your operation, not white-knuckling it until you can't anymore.
Why don't the standard burnout stats capture what practice owners experience?
Most burnout data has been gathered by and through large integrated health systems — that's who the AMA's clients are, and that's where research funding tends to go. Independent practice owners carrying dual roles (clinician and CEO) often fall outside that data, which means their risk factors are underestimated and underserved by conventional burnout frameworks.
Where do most practice owners skip the prevention work?
Delegation. The 'I can do it myself' reasoning is understandable, but it keeps moving the goalposts with no end in sight. And that open-ended, no-finish-line dynamic is one of the clearest recipes for burnout. Tracy notes it's not just about knowing what to delegate — it's understanding to whom or to what system, and making the time to train for it.
Episode Highlights
Why 'self-care, better boundaries, time management' is the incomplete version of burnout prevention
How burnout starts at the beginning of a career — not at the breaking point
What the data misses about independent practice owners and burnout risk
The structural healthcare system challenges practice owners need to name before they can address
Why burnout for practice owners often originates on the business side, not the clinical side
The delegation problem: where prevention work gets skipped most often
Tracy's immediate, grounded advice if you're already in the thick of it
A preview of The Prevention Paradigm masterclass — what it covers and why it's different
Memorable Quotes
"When we hear burnout prevention, we think of the little platitudes — self-care, better boundaries, time management. And yes, and. But that's the misconception of where prevention is actually meant to be." — Tracy Cherpeski
"Prevention is really about understanding how it starts. Going all the way back to the beginning of one's career — the model physician saying yes, working late, doing all the things. That's actually where it begins." — Tracy Cherpeski
"The current structure of the healthcare system is highly extractive. We have to name it. We have to look at it. We have to make a decision not to allow it to victimize." — Tracy Cherpeski
"The goalposts continue to move with no end in sight — and that is a recipe for burnout." — Tracy Cherpeski
"We're not throwing glitter bombs at you and telling you to get a bubble bath. We're going to give you really practical information you can take and implement immediately." — Tracy Cherpeski
Burnout prevention isn't a personality trait or a personal discipline problem — it's a design challenge. And Tracy Cherpeski's work is about helping independent practice owners build the systems, structures, and awareness to get ahead of it before it becomes a crisis. If this conversation resonated, the next step is The Prevention Paradigm masterclass on April 28th — the link is in the show notes. And whenever you're ready to talk about what this looks like for your practice specifically, Tracy is available at thrivingpracticecommunity.com.
Sign up for the Prevention Paradigm Masterclass.
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Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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Fork in the River: Leadership, Loneliness, and What Healthcare Can Learn from the Rise and Fall of Company Towns Featuring Lisa Prior, EP 248
What if your practice is one of the last true neighborhoods your patients have access to? In this episode, Tracy Cherpeski sits down with Lisa Prior — leadership and change consultant and author of the forthcoming Rubber Avenue: When Work Was the First Neighborhood — for a conversation that reframes where practitioner burnout really comes from.
What does the collapse of American company towns have to do with physician burnout? More than you might expect. In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Lisa Prior — leadership and change consultant, and author of the forthcoming Rubber Avenue: When Work Was the First Neighborhood — for a conversation that reframes the emotional burden healthcare practitioners carry in a genuinely new way. If you've ever felt like patients are bringing you more than a chief complaint, this one is for you.
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Lisa grew up in Naugatuck, Connecticut, the world's first rubber town, and has spent decades in leadership and organizational change work before turning to a book project 15 years in the making. The thesis is this: work was once the organizing principle of community — the shared employer, the shared school, the shared neighborhood. As those structures have eroded through deindustrialization, institutional decline, and the atomization of work, frontline healthcare practitioners have quietly absorbed the emotional weight that used to be distributed across entire communities. Your practice, Lisa argues, may be one of the last true neighborhoods many patients have access to.
For independent practice owners wrestling with burnout prevention, sustainable care models, and how to lead a team under pressure, this conversation offers both a framework for understanding the moment we're in and genuine encouragement for why the work you do is worth sustaining.
Key Takeaways
Your practice may be the last neighborhood your patients have. As community institutions have declined — civic organizations, religious communities, stable local employers — healthcare practitioners have absorbed an increasing share of patients' emotional and social needs, alongside their medical ones.
The loneliness epidemic is landing in your exam room. The surgeon general declared loneliness a public health crisis, and Lisa connects that directly to the rising emotional load on frontline practitioners. Understanding this context doesn't solve the problem, but it does reframe it.
Intentionality is the antidote to disconnection. Whether building relationships online or in person, Lisa argues that meaningful connection doesn't happen by accident. It requires initiative, structure, and deliberate investment — from both individuals and institutions.
Leadership is a choice — every time. Lisa's father-in-law proved this when he showed up in bankruptcy court to fight for 750 retirees' medical benefits. For practice owners under pressure, the reminder that showing up is always a decision is both clarifying and energizing.
We are at a fork in the river. The old social contract between businesses and the communities they serve is gone. A new one is being shaped right now, and how business leaders — including practice owners — show up in this moment matters.
Q&A
Why are healthcare practitioners carrying such a heavy emotional load?
Lisa connects practitioner burnout to a structural shift in American life: as neighborhoods have eroded through deindustrialization, the decline of religious institutions, remote work, and social fragmentation, healthcare providers have become one of the few remaining consistent human touchpoints. Practitioners are absorbing emotional weight that used to be distributed across entire communities — and often without any acknowledgment that this is what's happening.
What does 'work as the first neighborhood' mean for a healthcare practice owner?
Lisa's central thesis is that work has historically been where community forms — shared schools, shared employers, shared physical spaces. For independent practice owners, the office itself functions as a kind of neighborhood. You may be the only person who physically sees and touches a patient in a given week. That's not just a clinical role. It's a community role, and recognizing it as such can reframe both the burden and the meaning of the work.
How can practice owners protect themselves from burnout in this environment?
Lisa encourages practice owners to take care of themselves — not as a soft recommendation, but as a professional responsibility. She also suggests reframing the emotional load: it isn't a sign that something is wrong with your practice. It reflects the fact that your work is playing a genuinely important role during a difficult historical moment. Building intentional connection — within your team, with your patient community, and in your own life — is part of the long-term answer.
Episode Highlights
Lisa's personal connection to the book: her father-in-law's fight to protect retiree medical benefits for 750 people
The three braids of Rubber Avenue: economic history, the life of a Connecticut company town, and family story across generations
The 'Hollywood model' of work — how project-based, atomized employment has replaced stable community-building employment
Why healthcare practitioners may be the only person who physically touches a patient in a given week
The MIT proximity study: why sitting more than 50 feet apart measurably erodes connection, even in the same building
What the mayor of Naugatuck is doing to reframe his town's identity after deindustrialization
Leadership is a choice — and what that means for practice owners who are overwhelmed and wondering if it matters
How to build intentional online connection: Lisa's writing partnership with a woman she met coaching young women in India
Memorable Quotes
"For frontline practitioners, you're probably the only consistent part of some of your patients' neighborhoods." — Lisa Prior
"Leadership is a choice. And it takes courage to show up, especially when there are more questions than answers." — Lisa Prior
"We spend about a third of our total life — 90,000 hours — working. And for at least some of your practitioners, that number feels low." — Lisa Prior
"Work will always be the first neighborhood as long as humans have to work." — Lisa Prior
"The question I keep coming back to is: what's the line between building on the work people have given to a business, and extracting from it?" — Lisa Prior
Lisa Prior's work is a reminder that the challenges healthcare practice owners face don't exist in a vacuum — they're connected to much larger shifts in how Americans work, live, and find community. If this conversation helped you see your practice in a new light, share it with a colleague who's been carrying that weight without quite having the words for it. You can connect with Lisa at lisa@priorconsulting.com or find her on LinkedIn, and stay tuned for updates on Rubber Avenue as it makes its way into the world. For resources on building a practice that goes the distance, visit thrivingpracticecommunity.com.
Guest Bio:
Lisa Prior, Leadership & Change Consultant | Author
Lisa Prior is a leadership and culture consultant with 30 years of experience guiding leaders from Fortune 500 companies to early-stage Life Sciences Firms. She has coached physicians and healthcare leaders, consulted mid-size healthcare systems, and served as a research coach on a study of front-line physician burnout. Her work sits at the intersection of leadership, culture, and organizational change—helping executives and their teams align around vision, take charge of their time and energy, and lead with confidence. Lisa’s insights have been featured in the Wall Street Journal, The Economist, and Forbes, and her book Career Advice You Won’t Get f rom Your Boss serves as a resource for organizations navigating talent development.
Lisa holds a Master’s in Organizational Development from Boston University and held a research appointment at the Harvard Kennedy School of Government. She has served as an executive coach at MIT Sloan School of Management and Harvard Business School, and is affiliated with the Institute of Coaching at McLean/Harvard Medical School. She is Past Chair of The Boston Club, New England ’s largest network of women leaders, and serves on the Governor-appointed Massachusetts Economic Assistance Coordinating Council. Lisa is currently writing Rubber Avenue: When Work Was the First Neighborhood, a narrative nonfiction book investigating the rise and fall of the social contract between American businesses, workers, and communities.
Find Lisa:
Email: Lisa@PriorConsulting.com
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