6 Top Reasons Why Your Membership Medicine Practice Is Seeing Slow Growth

“You’re not interested in growing, if you’re not interested in learning.” ~J.H., Author

By Concierge Medicine Today, Editor

Over the past 18-months, we have spoken with some membership medicine practice owner-Physicians (eg. DocPreneurs!) who were observing that nothing seems to have changed in their medical practice, despite COVID, increased tele-health offerings and their best efforts to make things happen.

Unfortunately, when we dig a little deeper into their time management, leadership style, staffing and operations, we found that they continue to do a lot of the same things that have gotten them little to no positive results.

1. You’re still exhausted.

Sure the billing model changed, but you didn’t.

The second most common phrase we hear membership medicine physicians say on a regular basis is how tired they are. We’ll tell you the first most common phrase in a minute but we need to address the elephant in the room, burnout.

Is it possible to be a Concierge Doctor and get burned out?

  • Yes.

Is it possible to be a Direct Primary Care (DPC) Doctor and get burned out?

  • Yes.

If you don’t believe me, that’s fine. However, I know few Doctors who would actually try to argue this point. And, those few in number that would, usually share an evangelistic narrative that feeling this way (eg. fatigue, worried, exhausted, joy is depleting, etc.) is a badge of honor every Physician should be proud of.

Fortunately if you’re a regular reader of our publications, listener to our DocPreneur Leadership Podcast or attendee of our many events over the years, you know that we are FOR DOCTORS. As an advocate FOR DOCTORS for nearly two decades, we don’t have the luxury to see one healthcare delivery model as superior or better than another. We strive to provide objective education about all models, then let you decide. Moreover, we see our role as objective and that you are far too important in our communities to feel as if you are just as tired now as you were before. We are strong believers in all of the Membership Medicine delivery models but never, ever, should the practice of medicine leave you weaker, sidelined and ineffectual … even if you are practicing within a Concierge Medicine, DPC or other subscription-based healthcare delivery model.

So, whether it’s exhausted from the fatigue of COVID, frustrated with practice operations or administrative tasks, too much empathy that boundaries between family and work are now blurred, more often than not, yes, there are Physician’s today practicing within a membership medicine (eg. Concierge Medicine; DPC; Telehealth Subscription; Etc.) whom are tired, fatigued, exhausted and more than likely, haven’t changed anything about their schedule or daily working routine and habits.

The phrase “Everywhere you go, there you are” comes to mind. Or, like we often hear in our culture “Three marriages later and what do they all have in common? You!”

But, the voices inside your head and mine lie to us and say things like ‘No one can do it as well as you.’ Or, they’ll say things like ‘If you don’t do it, no one else will.’ Or, our personal favorite ‘No one cares as much about it as you do.’

As a result, Physicians already practicing within a wonderfully subscription-based healthcare delivery model now find themselves wearing the same hats, complaining about the same things and refusing to trust their team or even build a great one that can help them go from good to great and grow their practice in the first place.

You see when Physicians convince themselves that nothing runs without you, eventually you can get to the place where nothing runs—because even you don’t anymore. Then your burnout picture is complete.

One Physician we interviewed on The DocPreneur Leadership Podcast recently shared a personal story about her struggle with seeing a psychologist. More specifically, the psychologists diagnosis, her personal observations and even more personal solutions were difficult to swallow for the M.D. being treated as a Patient for once.

“It was really difficult for me to accept the Psychologists advice due to my own bias, fatigue, background, education and training,” she says. “Eventually, months later I overcame those feelings and it’s been helpful to see things about myself that I always knew we’re there but I just couldn’t move past.”

Things always seem more obvious and predictable after they have already happened, right? In psychology, this is what is referred to as the hindsight bias, and it can have a major impact on not only your beliefs but also on your behaviors.1

One potential problem with this way of thinking is that it can lead to overconfidence. If we mistakenly believe that we have exceptional foresight or intuition, we might become too confident and more likely to take unnecessary risks.

Fast forward to today, you might be experiencing a low-grade or maybe even severe burnout in your career, your station in life or maybe even in your personal life. It’s important to note that there are levels of burnout that every Physician may experience and it goes without saying that everyone is experiencing it but it arises differently or at a different times in each of our journeys.

Living as though you have unlimited energy is a great way to deplete all your remaining energy, even if you’re currently working as a Concierge Doctor or in a Direct Primary Care practice.

2. You have no idea where to go

This is the number one most common observation spoken by Physicians which we have observed for almost two decades in talking to and learning from subscription-based, private practice medical programs.

The fact of the matter is you will never get to where your medical practice (which by the way is in every sense of the word a business, whether you label it that or call it a practice or not), you will never get to where your medical practice to where it should be or could be if you have no idea where you want to take it. For this reason, Physicians must see beyond the exam room. They must look to the future and forecast what their community will look like and how your place in it should be and could be in the years ahead.

Author and communicator Andy Stanley in his book, Visioneering: God’s Blueprint for Developing and Maintaining Personal Vision, writes “Vision always precedes preparation. Initially, your vision will exceed your competency.”

Rarely, if ever, have these words been said from an exam room by a Physician: “I have a new vision for growing the practice!”

In summary, look at your business (yes, I said business) every six months or so and evaluate it. Maybe your spouse helps you run it. Maybe the two of you need an organizational retreat where you work on the business, not in it. This mindset will provide ample time for you and your team to Stop, Start and Repeat certain things. It may also change your current direction so you don’t find yourself circling back to old habits and months or even years later frustrated with your growth and feeling like your taking one step forward and two steps back.

3. You Let Other People Decide How You’ll Spend Your Time

Time Management is every Physician’s daily battle. It seems like no matter how hard you try this is a wrestling match you just cannot win.

You’ve tried Apps. You’ve tried calendars and built-in schedulers but nothing seems to work.

So, you throw up your hands and assign it to someone in the office.

‘Here … you deal with it … but don’t over schedule me.’

According to author, speaker and former attorney, Carey Nieuwhof, “Another way to burnout quickly is to let other people decide how to spend your time. This is largely accomplished by spending your entire day reacting to everything that comes your way— emails, texts, knocks at the door, and random requests.”

Sound familiar?

One of the most important (but usually never urgent) tasks of a great Physician is eventually replacing yourself.

That might sound odd but the goal isn’t to remove you from your post. The goal is so that you have margin to focus your time on the things and people that matter most.

Carey adds “When you fail to focus your time on the things and people that matter most, the most important relationships and tasks always get neglected. Which further raises your anxiety level and creates an ever-growing sense of never being done.”

Another leadership and business author we recommend Physicians lean into their books is Jeff Henderson, author of Know What You Are For. He writes in his book … You replace yourself by developing others not replicating yourself.

Therefore, your strategy should be to do things. First, if you don’t decide ahead of time how to spend your time, other people will decide for you. Second, your daily strategy should be to recruit amazing people and have them around you at all times. Then, get out of their way.

Try it. Then, send me an email at editor@conciergemedicinetoday.com and let us know what your story is. Maybe we’ll even publish it or ask you to come on our DocPreneur Leadership Podcast and share your story with your peers!

4. You have a hard time delegating

Doesn’t everybody?

I know I do. And, one of the reasons it can be so difficult to release responsibility from our shoulders is because we fail to train others and tell ourselves in our minds ‘I can just do it quicker and it won’t take that much time.’

We have these little conversations in our mind every day, don’t we?

In fact, we’re so good at it that we’ve talked ourselves into every bad decision we’ve every made?! Right?!

Your peers have echoed the same sentiment. That is, it is difficult, if not impossible, to move your medical practice forward and grow when you are still in the middle of all of the daily exams, paperwork and practice operations.

You’ve gotten to the point today where you have hired people to help you, right? But, do they feel completely empowered to help you in your areas or weakness? Are you creating a culture that they can speak freely to you or make recommendations to you without you dismissing the idea as a bad idea … because it wasn’t yours?

The fact is, the less time you spend in your practice, the more time you will be able to plan the direction your practice should go. Get out of your staff members way and let them help you create more margin so you can spend more time to grow your practice. Ultimately, your patients will notice and be glad that you did.

5. You realize you can’t sacrifice the practice for one person.

This is a hard one. It’s difficult because it involves the emotions, the salary and maybe even the years of friendship you’ve put into someone.

However, one of the most common reasons Concierge Medicine, private practice and Direct Primary Care (DPC) physicians over time have stated that their patient panel isn’t growing is because of staff.

Staff interactions speak volumes about your leadership and to every single Patient that walks in your door(s), your care. The fact is if a member of your team or staff is dismissive, busy, unfriendly or not interested in the Patient, that Patient takes that negative emotion and encounter with them into the exam room. They carry that emotion and think ‘the Doctor is going to be this way too …’

The fact is you could be the most charismatic and charming Physician with all of the accolades and best reviews in your State, but the wrong hire or the wrong person on your staff or team can eclipse all of the hard work you’ve done over the years and anchor your practice from the sea of growth that can take you years to recover from.

Great Doctors, not simply good Doctors, never have to demand loyalty from their Patients or their Team. Your Staff, your Patients, they want a great Doctor. You can’t afford for your staff to anchor your medical practice. You’ll eventually lose Patients, team members and burnout from exhaustion, lack of confidence in them and fatigue. You may not realize it as a DocPreneur, but as the Physician-CEO of the practice today, you are responsible for the care and treatment of your Patients but also the emotional and professionalism your staff provides each day.

Your staff are on display because you put them there. When was the last time you reviewed their real job description?

6. Stop Being The CEO (Chief Officer of Everything)

In the book, EntreLeadership, the author contends that If you really want to burnout deeply, convince yourself that you have to be the CEO—Chief Officer of Everything (e.g., Hat Tip to EntreLeadership for that term).

Another Physician recently said “I’ve curiously discovered that everybody’s not a reader.”

We had a good laugh about that observation he made.

Let’s Sum It All Up

In closing, it’s easy to complain about how things are falling apart or how you’re not growing as fast as you’d like. Yet if you look back, you realize you haven’t made any investments in yourself. Things in your life don’t suddenly become better overnight or within a year with the wave of a magic wand or fairy dust just because you changed your business model from a fee-for-service to subscription-based healthcare delivery practice. There are psychological changes and soft-skills that need to be developed and continually reinforced, maybe even remind us once in a while.

Do yourself a favor and take the time and money to start investing in yourself.

I don’t know who said it but I think it was in the book At Your Best, where the author write … You get 24 equal hours in a day, but not all hours feel equal or produce equally.


1. Pezzo M. Hindsight bias: A primer for motivational researchers. Social and Personality Psychology Compass. 2011;5(9):665-678. doi:10.1111/j.1751-9004.2011.00381.x