The E-Myth Physician

1. The E-Myth: Most Medical Practices Are Just Jobs

Most medical practices today are failing—not necessarily going out of business (though many are doing that every day) but failing to fulfill the potential the Doctor envisioned in those halcyon days of medical school.

The Technician Trap. Many doctors, driven by an "entrepreneurial seizure," start their own practices believing their medical skills alone will guarantee success. However, they quickly find themselves trapped in a job, working long hours and struggling to keep up. They become technicians working in their business, rather than entrepreneurs working on it.

Beyond Medical Skills. The problem isn't a lack of medical expertise, but a lack of business acumen. Knowing how to perform a procedure doesn't equate to knowing how to build and run a successful medical practice. Doctors need to understand the fundamentals of business, including finance, management, and marketing, to truly thrive.

The E-Myth Solution. The E-Myth philosophy challenges doctors to shift their perspective from technician to entrepreneur. This involves creating a business that can operate independently of the doctor, allowing them to focus on strategic growth and long-term vision, rather than day-to-day tasks. The goal is to build a practice that fulfills its potential and provides the doctor with both financial rewards and personal fulfillment.

2. Strategic Thinking: Work On Your Practice, Not Just In It

According to the E-Myth, the key to transforming your practice—and your life—is to grasp the profound difference between going to work on your practice (Systems Thinker) and going to work in your practice (Tactical Thinker).

Two Mindsets. There's a critical distinction between working in your practice as a technician and working on your practice as an entrepreneur. The technician is focused on the daily tasks of providing medical care, while the entrepreneur is focused on building a sustainable and scalable business.

Strategic vs. Tactical. Strategic thinking involves looking at the big picture, identifying opportunities for growth, and creating systems to improve efficiency and profitability. Tactical thinking, on the other hand, is about addressing immediate needs and solving day-to-day problems. Doctors need to balance both, but prioritize strategic thinking to build a thriving practice.

The Entrepreneurial Role. The entrepreneur is the visionary, the manager is the organizer, and the technician is the doer. A successful medical practice needs all three roles to be fulfilled. The doctor must learn to delegate technical tasks and focus on strategic initiatives, such as marketing, financial planning, and team development.

3. Money Matters: Income, Profit, Flow, and Equity

Failure to distinguish how the four factors of money play themselves out in your practice is a surefire recipe for disaster.

Four Factors of Money. Understanding the four key factors of money – Income, Profit, Flow, and Equity – is crucial for financial success. Income is what the doctor earns as an employee, Profit is what's left after expenses, Flow is the movement of money in and out of the practice, and Equity is the value of the practice as an asset.

Income vs. Equity. Many doctors focus solely on income, neglecting the importance of building equity. Equity is the financial value of the practice, which can be realized upon sale. Building equity requires creating a business that is system-dependent, not doctor-dependent, making it more attractive to potential buyers.

The McDonald's Model. The story of Ray Kroc and McDonald's illustrates the power of building a system-dependent business. Kroc focused on creating a consistent and replicable process, which allowed him to scale the business and build immense equity. Doctors can apply this same principle by creating standardized systems for patient care, administration, and marketing.

4. Planning Triangle: Business, Practice, and Completion Plans

The Business Plan determines who you are (the business), the Practice Plan determines what you do (the specific focus of your practice), and the Completion Plan determines how you do it (the fulfillment process).

Three Interrelated Plans. Effective planning involves creating three interconnected plans: the Business Plan, the Practice Plan, and the Completion Plan. The Business Plan defines the overall vision and purpose of the medical enterprise. The Practice Plan outlines the specific services offered and how they will be delivered. The Completion Plan details the step-by-step processes for fulfilling patient expectations.

Strategic and Tactical Questions. The planning process should be guided by both strategic and tactical questions. Strategic questions shape the vision and destiny of the business, while tactical questions turn that vision into reality. For example, a strategic question might be, "Who are we trying to serve?" A tactical question might be, "How do we schedule appointments efficiently?"

The Importance of Systems. The Completion Plan is essentially an operations manual, providing detailed instructions for every task performed in the practice. This ensures consistency and quality, regardless of who is performing the task. By creating a well-defined Completion Plan, doctors can build a system-dependent business that can operate independently of their direct involvement.

5. Management: Systems Over People

Instead of managing people, management is really all about managing a process, a step-by-step way of doing things, which, combined with other processes, becomes a system.

Process-Driven Management. Traditional management focuses on managing people, but the E-Myth approach emphasizes managing systems. Instead of trying to control individual employees, focus on creating well-defined processes that guide their behavior and ensure consistent results.

The Management System. A Management System is the method by which every manager innovates, quantifies, orchestrates, and monitors the systems through which your practice produces the results you expect. It's about creating a framework for continuous improvement and ensuring that the practice operates efficiently and effectively.

Transferable Systems. When a business is dependent on who manages, it's in serious jeopardy. How you manage (a system) can be taught, whereas who manages can’t be taught. A well-designed Management System is transferable, meaning that anyone can be trained to use it and achieve the desired results. This creates stability and scalability, allowing the practice to grow without being limited by the skills or availability of individual employees.

6. People Power: Systems-Dependent, Not People-Dependent

People allow you to be everywhere you want to be simultaneously, without actually having to be there physically!

People as Leverage. People are a doctor's greatest asset, but only if they are properly trained and managed. Without people, a doctor owns a job, not a practice. The key is to create a system that allows people to replicate the doctor's skills and expertise, effectively multiplying their impact.

The Sinatra Analogy. Just as Frank Sinatra's records allowed him to reach millions of people without being physically present, a well-designed medical practice can allow a doctor to serve more patients and generate more income without working longer hours. This requires creating a "recording" of the doctor's unique talents and replicating it through trained staff and standardized systems.

The People Law. The People Law states that without a specific system for doing business; without a specific system for recruiting, hiring, and training your people to use that system; and without a specific system for managing and improving your systems, your practice will always be a crapshoot. Without a system, people are more often a liability than an asset.

7. The Patient Promise: On Time, Every Time

The rule of business growth says that every business, like every child, is destined to grow! Needs to grow. Is determined to grow.

Patient Satisfaction. Keeping patients happy is essential for a thriving practice. The key is to keep your promise and make sure your patient knows you kept your promise every step of the way. This involves understanding what patients really want, communicating effectively, and addressing any dissatisfaction promptly and professionally.

The Client Fulfillment System. The Client Fulfillment System is the step-by-step process by which you do the task you’ve contracted to do and deliver what you’ve promised—on time, every time. It's about creating a consistent and reliable experience for every patient, every time.

Dealing with Dissatisfaction. When a patient is dissatisfied, it's important to listen, understand, apologize, and offer a solution. Even if the patient's complaint seems unreasonable, it's often possible to find a compromise that satisfies their needs and preserves the relationship. The goal is to turn every dissatisfied patient into a loyal advocate for the practice.

8. Growth and Change: Embrace Evolution

It is not the strongest of the species that survive, nor the most intelligent, but the one that proves itself most responsive to change.

Growth is Inevitable. Every business, like every child, is destined to grow. Resisting growth is like trying to hold back the tide. The key is to embrace change and adapt to the evolving needs of the market and the practice.

Expansion vs. Contraction. Change can be viewed as a movement between expansion and contraction. Expansion is associated with openness, awareness, and growth, while contraction is associated with fear, resistance, and stagnation. The goal is to cultivate an attitude of openness and embrace change as an opportunity for growth.

The Big Change. If all this is going to mean anything to the life of your practice, you have to know when you’re going to leave it. At what point in your practice’s rise from where it is now to where it can ultimately grow are you going to sell it? Because if you don’t have a clear picture of when you want out, your practice is the master of your destiny, not the reverse.

9. Time is Life: Manage Your Being, Not Just Your Doing

Until you deal with Time with a capital T, you’ll worry about time with a small t until you have no Time—or life—left.

Time as a Finite Resource. Time is not just a commodity to be managed, but a finite resource that represents your life. Every second that passes is a second that you can never get back. The key is to use your time intentionally and purposefully, aligning your actions with your values and goals.

Being vs. Doing. Instead of focusing solely on what you do, consider who you want to be. This involves making a life choice, not just a work choice. By aligning your actions with your desired identity, you can create a more fulfilling and meaningful life.

The Big Question. To fully grasp Time with a capital T, you have to ask the Big Question: How do I wish to spend the rest of my Time? By answering this question, you can gain clarity about your priorities and make conscious choices about how to allocate your most valuable resource.

Last updated: March 3, 2025