What got you here won’t get you there

Every practice owner has an origin story. Maybe you started seeing patients out of a single room and built your way up to a full team. Maybe you took over a struggling practice and turned it around through sheer will and long hours. Whatever the story, it has a hero in it and the hero is you. That story matters. It's also the thing most likely to quietly undermine you five or ten years down the track, because the instincts, habits and decisions that built your practice are not automatically the same ones that will grow it, protect it, or take it where it needs to go next.

There's a particular trap that catches successful people more often than failing ones, because failure tends to force a rethink while success quietly reinforces whatever you were already doing. If working eighteen hour days got you through the early years, it's tempting to keep working eighteen hour days indefinitely, even once the practice actually needs you to step back and build systems rather than personally carry everything. If being hands on with every clinical and operational decision built trust with your first patients and staff, it's tempting to keep being hands on with every decision long after the practice has grown past the point where that's sustainable or even helpful. The leadership behaviours that built your practice were the right behaviours for that stage. They are not automatically the right behaviours for this stage, and confusing the two is one of the most common reasons growth stalls, not because the owner stopped working hard, but because they kept doing the version of hard work that used to be effective and stopped noticing it had quietly become the ceiling.

There's an old idea, sharpened more recently by Ryan Holiday's writing on stoicism, that the obstacle in front of you isn't blocking the path, it is the path. Whatever is currently frustrating you about your practice, whether it's a staff member who isn't performing, a system that keeps breaking down, or a decision you've been avoiding, is rarely a distraction from the real work of leadership. It usually is the real work of leadership. It's easy to treat obstacles as interruptions to the plan, something to get through quickly so you can get back to the important stuff, but the obstacle you keep avoiding is almost always pointing directly at the leadership growth you actually need next. The staff member who isn't performing is forcing you to confront whether you can have a hard conversation. The system that keeps breaking is forcing you to confront whether you've actually built proper structure or just patched things together as you went. The decision you've been avoiding is forcing you to confront whether you're leading from clarity or from comfort. Treating the obstacle as the way through, rather than as an inconvenience standing between you and the real work, changes how you approach almost every difficult moment in running a practice. It stops being something happening to you and starts being the thing actually building you.

Here's the uncomfortable one. Are you still the right person for this job, at this stage, doing it the way you're currently doing it? Not whether you built something good, because you clearly did, and not whether you care, because nobody questions that. The question is narrower and harder, whether the specific things you are doing day to day, and the way you are leading right now, are actually what this practice needs at its current size, complexity and stage of growth, or whether you are leading it the way you led it three years ago because that's familiar and that's what worked then. This isn't a question you answer once, it's one worth returning to regularly, because the practice keeps changing and so does what it needs from you. The owner who is still personally approving every small decision three years after hiring a practice manager isn't being thorough, they're holding the practice back at exactly the point it should be able to run without them in every detail. The owner who built the practice on being the most senior clinician in the room may eventually need to become the person who builds other senior clinicians, which is a genuinely different skill and sometimes an uncomfortable shift in identity.

If a staff member's performance had plateaued, or if their skills clearly hadn't kept pace with what the role had grown into, you'd address it. You'd have the conversation, you'd look at what development was needed, and you wouldn't let loyalty to how things used to be stop you from being honest about how things are now. Leaders rarely extend themselves the same scrutiny, because nobody is reviewing your performance the way you review everyone else's, and that makes it your responsibility to do it yourself, regularly and honestly, rather than waiting for a crisis to force the question. The practices that keep growing well tend to be led by people who ask this question of themselves before it becomes obvious to everyone else that the answer has changed.

What got you here was real, and it deserves credit. But it was never a guarantee for where you're going next, and the leaders who keep building are the ones willing to keep asking, honestly and often, whether they're still the right person for the job they're currently doing, not just the one they started with.