You have probably known for a while. A team member is not quite working out, and you keep telling yourself it will improve, the timing is off, or replacing someone will take more than you have to give. Meanwhile the rest of the team adjusts, patients pick up on it, and you carry the weight alone.
In this SNACK episode of the Thriving Practice Podcast, Miranda Dorta turns the mic around and interviews Tracy Cherpeski with questions she has not heard before. Together they talk about how to tell a people problem from a process problem, what it costs a practice when an owner waits, and how to have the conversation with clarity and care. If you are searching for practice leadership guidance on handling a team member who is not the right fit, this is a strong place to start.
Tracy draws on her years of coaching independent healthcare practice owners, plus her own corporate experience, to show why the first look belongs on your leadership, and why the conversation you keep avoiding is often a relief for everyone involved.
Key Takeaways
Most owners wait because they feel overwhelmed or do not want to be the "bad guy." Both reactions are human, and both keep a problem alive longer than it needs to be.
Look at your own leadership first. Unspoken expectations, undocumented processes, and workflows that changed without an update can look like a people problem.
Delay has a real cost. Morale, patient experience, productivity, time, and energy all pay for the conversation that does not happen.
Fit can change. A practice can outgrow a team member, or a team member can outgrow the practice, and a role that worked at startup may not work at growth.
Be honest in the conversation. Name the tension, set a time to talk, and never tell someone their job is safe if you do not believe it.
Q&A
Why do practice owners wait so long to address a team member who is not working out?
Tracy says it usually comes down to two things: feeling overwhelmed by the thought of losing momentum and training someone new, and not wanting to be the "bad guy." Either way, waiting tends to make the situation heavier.
How do I know if it is a people problem or a process problem?
Slow down and look at yourself first. Ask whether an expectation was never made clear, whether a documented process exists, and whether a workflow changed without anyone adjusting the role. If those are addressed and it still does not feel right, you may be facing a fit issue.
What does it cost a practice when the owner avoids the conversation?
Morale comes first. Other team members pick up the slack, patients sense that something is off, and the work slows down. Tracy also points to lost time, productivity, and energy, none of which you get back.
What should I say to open a hard conversation with a team member?
Tracy offers a script: "Hey, I'm noticing some tension. I don't know if it's yours or mine. I'd like to take a little time to think about this, and then we can come back and have a conversation." If you do not expect the person to stay, be honest that the conversation will be uncomfortable instead of telling them their job is safe.
Episode Highlights
Why owners wait months to act, and what that waiting feels like from the inside
The forensic look at leadership, communication, documentation, and workflow changes before you look at the person
Why "we're a family here" can backfire on a team
What delay costs: morale, patient experience, productivity, time, and energy
A client story: a startup practice, a role the first hire outgrew, and the decision matrix that replaced daily interruptions
Why a weekly meeting with the physician can replace daily check-ins
Why to review your operations manuals before the conversation, and why employee protections in your state matter
Tracy's script for opening a hard conversation, and when not to use it
The turnaround talk: addressing a behavior before it becomes a habit
Memorable Quotes
"Your practice can outgrow somebody, or they can outgrow your practice." Tracy Cherpeski
"A practice is a living entity. Things can change over time, and maybe there's a process that hasn't caught up." Tracy Cherpeski
"Energy isn't something we can get back." Tracy Cherpeski
"If you are pretty sure that it's not going to work with that person, don't tell them their job is safe." Tracy Cherpeski
"Those difficult conversations are the ones that forge great relationships." Tracy Cherpeski
The conversation you have been putting off is rarely as bad as the story you tell yourself about it. Check your own leadership, tighten the documentation, and then have the talk sooner rather than later. Most people already sense that something has shifted, and clarity is a kindness to them and to you. If you would like a thinking partner as you prepare, explore the Thriving Practice Community at thrivingpracticecommunity.com or learn more about working with Tracy at PracticeSuccess.co. Thank you for listening, and thank you for the care you bring to your team.
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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