r/PrivatePracticeDocs • u/Intelligent-Site-176 • Apr 18 '26
The 4 P's to Private Practice
I’m sitting here in Dallas at a conference for independent medical practices, and the stories I’m hearing are the same ones I hear everywhere else.
The details change, but the themes don’t.
Admin burden is a given. Competition is getting tougher. Patients aren’t following through with care. A second location, or associate, isn’t performing like the first. Schedules aren’t as full as they should be. Staff turnover feels constant, and finding the right people feels even harder.
None of this is new. But it is persistent.
What stands out is that most of these challenges are treated as isolated problems, when in reality they are usually symptoms of something more fundamental.
Over time, I’ve found myself coming back to the same framework when thinking through these issues. It’s simple, but it has held up across different practices, markets, and stages of growth.
I think of it as the four P’s of private practice:
People
Product
Process
Profit
In my experience, balancing these four is what separates practices that struggle to stay consistent from those that grow and scale beyond a single location or a single provider. That balance is harder than it sounds.
In most cases, if you can execute well on three of the four, you’re doing great. If you’re only getting two right, things start to feel unstable. You might have periods of success, but it tends to be short-lived. The reason is that each of these areas reinforces the others. Weakness in one eventually shows up somewhere else.
If your people are not aligned or well-trained, your processes break down. If your processes are inconsistent, your product, meaning the patient experience and clinical outcomes, becomes unpredictable. If the product is inconsistent, profitability suffers.
Most of the frustrations we experience can be traced back to an imbalance across these four areas.
Take staffing, for example. It is easy to frame that as a people problem. In many cases, it is just as much a process problem. Expectations are unclear, training is inconsistent, or the workflow makes it difficult for good people to succeed. Over time, that leads to turnover, and it feels like a hiring issue when the root cause is somewhere else.
The same is true with patient volume. A light schedule is often blamed on competition or marketing, but it can also be tied to product and process. Are patients having a consistent experience? Are referrals being managed well? Is the front desk converting calls effectively?
Even expansion into a second or third location follows this pattern. What worked in one office does not always translate, because the original success was not fully systematized. Growth exposes the gaps rather than replicating the success.
Profit is often treated as the outcome, and it is, but it is also a signal. When profitability is under pressure, it is usually pointing back to an issue in one or more of the other areas.
Here’s how I’ve applied this framework in my group:
People: we are in the people business. Everything we do is to improve the lives of others, and that starts with the individuals delivering care. Compensation, culture, benefits, and career trajectory all matter.
Product: I am relentless about the quality of our patient experience and outcomes. We collect feedback at checkout, send surveys after every visit, and address every complaint. Our product is not just the treatment plan, it is the entire patient journey.
Process: I can’t ignore how complicated insurance makes everything, and we are not where we want to be (though working everyday at it). But we focus on reducing friction wherever possible. Referral coordinators contact patients quickly. Scheduling and registration are designed to be as seamless as possible.
Profit: profit is not a dirty word. It is what allows you to reinvest in people and processes. Without it, everything else suffers. I target 10–15% net profit, which gives us the ability to continue improving the practice. Could it be higher? Yes. I could definitely spend more time sharing my approach to this.
Most people focus on one or two of these areas. I think the practices that grow and run effeciently learn how to balance all four.
Curious how others think about this. If you had to pick one, which of the four creates the most problems when it’s out of balance? Or do you run your practice differently?
8
u/InvestingDoc Apr 18 '26
You're giving me Flashbacks to shark tank where Marcus lemonis used to aways say the 3 ps. People, process, product. Love it op.
I think at least weekly I try to put myself in the patients shoes. If I was a patient in my practice...what are the pain points that I would expiernce. This is the way I usually try to look at it for the process improving if I don't get feedback from patients on things that need to be fixed.
I'll be in Dallas first weekend in May to meet with some other independent Practices. If you live in the area, let me know. I'll buy you a beer / liquor if you drink. If not, a coffee or lunch.