For Growth-minded, independent, specialist physician-owners.
Stress-Testing Growth Decisions Before They Cost You Six Figures
Decision-Making Series, Part 5 of 7
DECISION-MAKING
5/31/20261 min read
Most growth plans look great in the optimistic version.
* The associate ramps quickly and is the smartest young physician EVER.
* The new location fills up with lovely, high reimbursing, grateful patients.
* Systems somehow install themselves. They are a work of art.
* Everyone follows your protocols. They are the smartest, most dedicated, brilliant and happy staff to ever grace an office.
And the birds sing. The sun is out. The sky is blue. It's truly magical, isn't it?
Reality, of course, is less cooperative.
Why Optimism Is Dangerous
Once owners lean toward a plan, they protect it. Defend it. Risks feel manageable. Assumptions harden into “facts”. Red flags become “temporary issues.” It is their baby.
Hope becomes the strategy because people (all people) must be “right”.
The foundational problem is that humans natively are compelled to be “right”. It’s an evolutionary fundamental. “Right” equals survival. “Wrong” equals being eaten by that saber-toothed tiger. So, people must be “’right’ to survive”. Hence, once a decision is made, it must be defended.
That’s how “hope” becomes a strategy. Once a decision is made, one must be “right”, and protect that decision.
The “Pre-Failure” Exercise
Here’s how owners can get around that primal protective instinct. It’s a simple but powerful technique:
Imagine it’s 12 months from now. The decision you’re considering has already been made. And it failed.
Revenue didn’t grow. Stress went up. Margins suffered.
Now ask: "Why did it fail?"
Practice owners who do this exercise uncover issues they would never list under “cons”:
* The associate was clinically solid but culturally wrong
* The owner became a bottleneck instead of a leader
* Staff capacity broke before provider capacity did
* Fixed costs rose faster than collections
Why This Works
By assuming failure, you bypass defensiveness and surface actual risks early, when they’re fixable. This gives you a chance to re-think things and plan ahead to mitigate actual potential failure.
Hope is not a strategy. Neither is “we’ll figure it out.” Do this exercise so you actually will be “right”.