It's not unusual for a practice owner to arrive at a one-hour coaching session with five or six different things they want to work through. Compensation, hiring, marketing, billing, financial performance, team management. The list can get pretty long. I understand why. They're paying for my time, they have a lot on their minds, and they want to make the most of the hour. But I sometimes have to remind them that talking about six problems isn't the same as solving one. And that's an important distinction.
Getting to the heart of the problem takes some work.
Let's say a practice owner comes to me because their clinicians aren't maintaining full caseloads. We could spend fifteen minutes discussing marketing strategies and ways to generate more referrals. I could offer a handful of recommendations, and they'd leave with some things to try. But what if marketing isn't the problem?
What if the practice is already generating plenty of inquiries, but the intake process is losing prospective clients before they ever get scheduled? What if clinicians have availability, but their scheduling preferences make it difficult to accommodate the people who are calling? What if the compensation model is unintentionally discouraging the productivity the owner wants to see? I've encountered variations of all of these issues.
Without understanding how the practice actually operates, I'd be offering solutions to a problem we haven't properly identified. That doesn't strike me as a particularly good use of anyone's time or money.
There's a difference between advice and operational change.
I offer individual coaching sessions because sometimes a practice owner needs an experienced person to help them think through a decision, evaluate their options, or get unstuck. An hour can be enormously useful for that. But there are limits to what we can reasonably accomplish in an hour, particularly when we're dealing with issues that have developed over months or years.
If your compensation structure needs to be redesigned, we need to understand your financials, employment arrangements, productivity expectations, and business goals. If your management team isn't functioning well, we need to look at roles, responsibilities, communication, and accountability. If your practice is growing but you're working more hours than ever, we need to understand which responsibilities are still sitting with you and why. These aren't problems that lend themselves to a quick answer.
Sometimes the work calls for a focused project. Sometimes it makes sense to meet regularly and work through challenges as they arise. And sometimes a practice has reached a point where it needs ongoing operational leadership, not just occasional advice. Part of my responsibility is helping owners understand which kind of support will actually serve them.
Practice owners already know something about this.
There's a certain irony here. Therapists understand better than most that meaningful change takes time. They don't expect their clients to resolve years of challenges in a single session. But when they're sitting in the business owner's chair, they sometimes expect exactly that of themselves. And just like in therapy, insight is valuable, but insight alone doesn't produce change.
We can identify that a practice owner is holding on to too many responsibilities. We can talk about delegation, organizational structure, and developing managers. But then comes the harder part. Deciding what to delegate. Determining who should own it. Establishing expectations. Training people. Following up. Resisting the urge to take everything back when someone doesn't do it exactly the way you would. That's where the real work happens. And it's rarely accomplished in a single conversation.
I want our time together to be useful.
I'm not particularly interested in sending someone away with fifteen recommendations simply because we managed to discuss fifteen topics. I'd rather help them understand the two or three things that matter most, make an informed decision, and have a realistic plan for what happens next. Sometimes that means we cover less ground than they originally hoped. Sometimes it means I ask more questions than they expected. And sometimes it means I tell them that the issue they're worried about isn't the one I'd recommend addressing first.
That's part of what they're hiring me to do. My work isn't about giving practice owners more things to think about. Most already have plenty of those. It's about helping them make sense of what's happening in their businesses, identify what needs attention, and build the structures and habits that will support the next stage of growth.
I don't measure the success of a coaching session by how many topics we cover. I measure it by whether we've identified what matters, made progress toward a solution, and established a realistic next step. Sometimes that takes one conversation. Sometimes it takes months of work. Healing doesn't happen overnight. Neither does success. And in both cases, doing the right work matters more than trying to do it all at once.