I had a fascinating conversation with Dr. Dan Neissany, a former physical therapist turned practice optimization consultant, that reframed how I think about the challenges facing private practice clinicians today.

What emerged wasn’t the typical “doctors are bad at business” narrative we hear so often, but something far more nuanced and actionable.

The Rules Changed Mid-Game

It’s not that physicians can’t run businesses. It’s that someone went around back and changed all the rules after they started.

The system that once worked- where you could see a reasonable number of patients and keep the lights on- has been systematically undermined.

Reimbursements are declining, denials are increasing and the result is physicians having to see 20%+ more patients just to make the same income they made before.

Which creates, essentially, a “burnout” trap. A doctor seeing 52 patients in one day with 10 surgical cases the next day might technically be capable of handling that load, but as Dan asked:

“Do you want to do it? And how long can you do it for?”

The real issue isn’t capability- it’s sustainability.

When your passion for medicine starts to fade because you’re drowning in volume, what then? By the time most physicians realize they need help, it’s often too late.

What Actually Needs Measuring

Here’s where the conversation got really practical. Most private practices are flying blind when it comes to basic metrics that could dramatically improve their operations.

Dan highlighted several key areas:

Daily Metrics:

* Cancellation and no-show rates (many practices don’t calculate this)

* Schedule fill rates

* Patient flow efficiency

Weekly/Monthly Metrics:

* First-pass claim acceptance rates

* Denial reasons and patterns

* Patient retention rates

* Revenue per visit

The shocking reality? Many established practices have been around for 10-15 years but have only a handful of online reviews. They have no social media presence. They’re essentially invisible to potential patients making decisions in 2025.

The Missing Infrastructure

What struck me most was Dan’s point about getting outside help.

Unlike other business leaders who surround themselves with experts in different areas, many physicians feel they need to master everything themselves.

“You take the CEO of any company, they’re not expected to be the expert at web design and cybersecurity… The skill set that they need is the ability to listen to the people who are experts at those things and then make the best decisions.”

Clinicians are smart and well educated. They have these executive functioning skills. What they often lack is knowing there’s a framework of trusted experts they can build around their practice – and using them.

The Opportunity Hidden in the Crisis

Rather than just complaining about everything wrong with the system, Dan advocates for a different approach:

Instead of focusing on everything that’s going wrong… let’s look at the opportunity here.

But it isn’t about accepting a broken system- it’s about building resilience while working toward systemic change.

The practices that thrive are those that:

* Build systems early rather than waiting until they’re overwhelmed

* Use data to identify revenue leakage they didn’t know existed

* Create authentic connections with patients through modern channels

* Develop leadership teams that can handle business operations while physicians focus on patient care

The Social Media Blind Spot

One of the biggest missed opportunities Dan identified is social media presence. Not silly dancing videos, but authentic content that shows the personality and culture of the practice.

When patients are choosing between five similar practices with similar reviews, the one with an active, authentic social media presence often wins. It’s free marketing that builds trust before patients even walk through the door.

The Bottom Line

The narrative that “doctors are bad at business” is not only wrong- it’s harmful. Physicians are dealing with a system that’s been deliberately stacked against private practice success. The solution isn’t to become MBAs; it’s to build the right support systems and focus on what actually moves the needle.

As Dan said:

Healthcare is still business. If you’re not making money, nobody’s staying open… It’s like you don’t want to treat it as business but newsflash if you’re not making money you’re closing down or you’re going to be forced to sell.

The physicians who will thrive are those who acknowledge this reality while staying true to their mission of excellent patient care. They’re not selling out- they’re building sustainable practices that can weather whatever changes come next.

This conversation reminded me that the best solutions often come from stepping outside our industry silos and learning from unexpected places.

Sometimes the insights we need are hiding in plain sight- we just need the right lens to see them.

Want to connect with Dan Neissany?

* Podcast: “All Things LOCS” (Leadership, Operations, Culture & Strategies)

* Website: tbpstrategies.com

Until next week,

Tiffany

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