Why Practice Growth Isn't a Straight Line (And What To Do When It Cycles Back) - A Special SNACK Episode, EP 271
Every practice owner has been there: you push through a brutal season, finally catch your breath, and assume the hard part is behind you. Then a new stage of practice growth arrives — a bigger team, a second location, a jump in patient volume — and suddenly you're back in the messy middle, wondering what you did wrong. In this SNACK episode of The Thriving Practice Podcast, Operations Manager Miranda Dorta turns the tables on Tracy Cherpeski to unpack why growth isn't a straight line, and what that means for healthcare practice owners trying to build a sustainable practice without burning out.
This conversation builds on Tracy's solo episode, “The Alchemy of Change” (EP260), where she introduced a three-stage framework for understanding why the hardest seasons of practice ownership real growth in progress, not failure. Here, Miranda pushes Tracy further: how do you tell the difference between cycling back through a hard season and actually losing ground? Why does every new chapter of practice growth seem to restart the whole process? And what does it look like to make peace with a cycle that may never fully end?
Tracy answers with real client stories — including a solo practice that grew into a two-location group with a full clinical and admin team — plus a personal story about getting knocked around by ocean waves that turned into an unexpectedly useful metaphor for resistance versus surrender. If you're a healthcare practice owner in the middle of a hard season and wondering if you're doing something wrong, this episode is your reminder: you're not failing, you're cycling.
Key Takeaways
Growth is not a straight line. The two-steps-forward-one-step-back pattern practice owners experience isn't a sign of doing it wrong — it's the normal shape of the “messy middle.”
Repeating patterns are information, not regression. When a hard season resurfaces, the useful question is “what am I learning right now?” rather than treating it as a step backward.
New growth exposes old gaps. Adding a bigger team, a new location, or more patient volume will reveal any process, structure, or expectation that wasn't fully built out the first time.
Structure beats “we're all adults here.” Clear expectations and documented processes matter more as a practice scales — informal culture that worked with a small team often breaks down with a bigger one.
Expecting the cycle reduces its impact. Practice owners who anticipate that hard seasons will recur are less likely to be thrown off guard by the next one, even if they can't predict exactly what it will look like.
Q&A
Why does growth in a healthcare practice rarely feel like a straight line?
Tracy explains that practice owners are often sold an unrealistic picture of success as a clean, linear climb. In reality, growth looks more like a tangled ball of yarn: two steps forward, one step back, with a “messy middle” that can feel brutal and endless while it's happening — much like the transition phase of childbirth, or the itch of a wound that's almost, but not quite, finished healing.
What's the difference between cycling back through a hard season and actually losing ground?
According to Tracy, cycling back usually means there's unfinished business — a pattern repeating because there's still something to learn from it. The useful move is to ask, “what am I learning right now?” instead of treating a dip as failure. A single hard moment isn't a regression; a sustained downward trend in the numbers is the real signal to address.
Why does hiring a bigger team or opening a new location restart the hard parts of practice ownership?
Any unhandled issue or undocumented process gets magnified by growth. Tracy shares the story of a solo neuropsych practice that grew over 20 years into a two-location group with 10–11 doctors, techs, and admin staff — where the informal “we're all adults here” culture that worked at a small scale stopped working entirely. The fix wasn't a full overhaul, just a pause to identify what structure and expectations were actually needed.
How can practice owners make peace with cycles that may never fully end?
Tracy points to the pace of change in healthcare — regulatory shifts and fast-moving technology — as a reason to expect ongoing cycles rather than resist them. Her framework: acknowledge the reality, ask “now what?”, and build the systems, people, and support that let the practice adjust without a full pivot every time.
Episode Highlights
Why “success is a straight line” is a myth, and what practice growth actually looks like on the ground
The messy middle as a transition, and the childbirth metaphor Tracy uses to describe it
How to tell if you're cycling back through old patterns versus actually regressing
A real client story: growing from a solo neuropsych practice to a two-location, 20+-person team
The ocean-wave metaphor: what resisting change costs versus what surrender makes possible
Why healthcare's pace of regulatory and technological change means the cycle may never fully stop
How to prepare for the next cycle without bracing against it
Memorable Quotes
"Whatever you expand in your practice will also expand your problems." — Tracy Cherpeski
"We're all adults here is good, but that's not actual guidance." — Tracy Cherpeski
"If you resist, it's going to hurt. It actually hurts." — Tracy Cherpeski
"It's kind of like it is what it is. Now what?" — Tracy Cherpeski
"What am I learning right now?" — Tracy Cherpeski
Growth won't ever hand you a permanently smooth season — but knowing that the messy middle can resurface doesn't have to knock you off balance. If you're in the middle of a hard season right now, remember Tracy's reframe: it's not regression, it's information. To go deeper on the three-stage framework behind this conversation, listen to EP260, The Alchemy of Change. And if you're ready to build a practice that can handle its own growth, visit practicesuccess.co.
Episode Referenced
The Alchemy of Change: What Burnout Is Really Telling You About Your Practice, EP 260
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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