Before Scaled Comes Shared
The first step towards healthcare business profitability
Clinic owners dream of scale. But in owner-operated healthcare businesses, where founders are also responsible for billable hours and clinical work, there is an important stage that comes before scaling is even possible.
Sharing.
The owner or founder of a business has different pressures, responsibilities and ultimately drive compared to the other contractors or employees that work within the business ecosystem. Owners will pick up shifts, market more, and get awfully creative when revenue is required to balance the books, which, in health care practices, translates to the owner also being the busiest clinician, with the most recognizable authority in the business community, and the most diversified income. This “carrying” phase precedes sharing, and often builds pressure and resilience in one of the practices or arms of the business (the owner’s).
In the early years of clinic or business ownership, this phase is likely necessary, but living in the carrying phase beyond 3 years highlights gaps in the practice model and the “sharing” required well before scaling.
Carrying → Sharing → Scaling
Every owner-operated healthcare business begins by carrying. The founder generates the majority of the revenue, solves the problems, builds the reputation, fills the schedule, and absorbs the financial risk.
The next stage is sharing. Revenue generation, accountability, leadership, reputation, and the financial demands of the business become distributed across the team. The business begins to function as an ecosystem rather than an extension of the owner's capacity.
Only then is the business truly ready for scaling. Growth is no longer constrained by the founder's personal capacity because the people, systems, and financial model can support expansion.
Founders dream of jumping directly from carrying to scaling. In reality, sharing is the bridge between the two.
The shift from carrying to sharing requires the following transition points
The owner takes home the same % of their income as their associates do, or is paid an appropriate hourly rate plus an owner’s salary. This may not be a “CEO” level salary at this phase, but the owner does require a profit or salary beyond their own patient visits to successfully move into the shared stage.
Each practice within the clinic needs to carry the financial weight of the resources it consumes. A simple starting point is dividing major overhead expenses (rent, payroll, technology, reception and utilities) across practitioners based on their use of those resources. Some professions naturally require more support than others. If one practice consistently consumes more resources than it contributes, the owner inevitably absorbs the difference through their own work output.
The clinic or business needs a marketing system that goes beyond the owner's reputation. The name of the clinic and the reputation of the clinic or business as a whole need to mean something beyond the owner’s name.
Employees need to have revenue-generating KPIs. This could include KPIs that track billable hours in the owner’s work column, but ideally, the KPIs are connected to overall business revenue. If employees are only responsible for tasks, not outcomes, the owner remains the controller of all revenue-generating activities and doesn’t share ownership of the outcomes of any work activities.
The sharing stage is exactly what it sounds like. The subcontractors and employees in a business ecosystem need to be connected to revenue-generating activities that extend beyond the owner’s own work product, and subcontracts need to carry the weight of the demand they put on business resources. The business overhead needs to be shared before the business can be scaled.
Ironically, founders often delay the transition to the shared stage themselves. By directing new patients into their own schedule, accepting every speaking opportunity personally, or holding onto leadership responsibilities that others could grow into, they unintentionally reinforce the carrying model they are trying to escape. Each of these steps requires trust and patience, and for founders who grip to the day-to-day cash flow as their sole responsibility, the transition to a shared model is a leadership stretch that often requires coaching, financial modelling and sometimes price adjustments.
Scaling shouldn’t feel like we’re asking one person to work harder. Scaling comes after building a business where success is distributed and shared. Before a clinic can grow sustainably, its people, systems and financial model must all share in creating that growth. When the owner is no longer the only person carrying the weight of the business, they've created the conditions for something much more valuable than their own work column and start to build the conditions for scale and resilience.
If you're still carrying more than you're sharing, don't ask how to scale next. Ask what needs to be shared first. The answer to that question is often the foundation of your next stage of growth.
Every clinic owner wants to know how to scale. The better question is whether your business has learned to share.