Most private practices wait too long to build their next leader. Here's how to develop leadership from within before you ever need it. Read more.
Most practice owners only start thinking about succession when they are burned out, ready to sell, or already walking out the door. By that point, the conversation is too late.
Succession is not an exit strategy. It is an organizational health strategy, and it should start on day one.
I had a conversation with Amy Lafko on the Private Practice Survival Guide podcast that reframed this completely. If you are a practice owner who has ever said, "I can't step back because my name is on the door," this one is for you.
Here is the pattern Amy sees constantly: a practice owner builds something successful, looks around for someone to eventually carry it, and then picks the best clinician in the room.
Best clinician does not mean best leader. Those are different skill sets, and treating them as interchangeable is where practices stall.
A physical therapist who is exceptional at patient outcomes is not automatically equipped to manage performance conversations, hold staff accountable, or make sound decisions under financial pressure. That gap is not a character flaw. It is a training gap, and it is the owner's responsibility to close it.
Amy made a point that stopped me mid-conversation. When a patient comes in, you assess them. You identify the gap between where they are and where they need to be. You build a plan. You measure progress. You adjust.
Why are we not doing the exact same thing with our emerging leaders?
Soft skills, which is an underselling term for things like conflict resolution, delegation authority, financial literacy, and communication under pressure, are trainable. They follow the same gap analysis model you use in the clinic every day. The only reason we treat them differently is a stubborn cultural assumption that leadership is something people either have or they do not.
That assumption is costing practices their future.
Amy described something I see play out in practices constantly. A manager gets promoted, they want to do the job well, and then they discover they do not actually know what authority they have.
Can they hire? Can they terminate? Can they write someone up without escalating to the owner first? Most of them do not know. And when they bring an issue forward and the owner is the only one who can decide, the manager learns quickly that their title is decorative.
That is a systems failure, not a people failure. According to Leadership research from Inc., unclear authority structures are one of the most consistent contributors to middle-management burnout and turnover. Practice owners who want to develop the next generation of leaders have to hand over real lanes, not just job titles.
Amy introduced a framework I think every practice should adopt: the career rock wall instead of the career ladder.
A career ladder assumes everyone wants to climb straight up to management. A rock wall says: where do you want to go, what skills do you want to build, and let's find the path that fits you. The movement is lateral, diagonal, and upward, based on the individual.
Practically, this looks like:
One of Amy's clients created an "AI Ambassador" role, no pay bump, just ownership and visibility, and it became the first visible rung of a development path for a high-potential team member. That is creative leadership infrastructure, and it costs almost nothing.
Brandon closed the episode with a framework I keep coming back to. People stay, grow, and lead when three things are present: connection, progress, and choice.
They need to feel connected to the people and mission around them. They need to see visible movement in their own development. And they need agency, the sense that they are choosing this path, not being assigned to it.
When those three elements are missing, you get the unfulfilled manager who feels like a babysitter. When they are present, you get someone who is actively building their own resume because a mentor asked them what they added to it this month.
That question, what did you do to add to your resume this month, is one of the most powerful development tools I have heard described. It signals investment. It communicates that growth is expected, not optional. And it keeps the individual's trajectory in their own hands.
Succession should not begin when someone announces they are leaving. It should be so embedded in your culture that when someone steps away, the next leader is already operating at 70 percent of the role.
That means building org charts that account for where the practice is going, not just where it is. It means identifying high-potential team members before they ask to be identified. It means giving people authority that matches their title, and then coaching them through the moments when they are not sure how to use it.
For practices that want support building those people systems from the ground up, our Fractional HR Support is designed to function as the HR infrastructure you need without requiring a full-time hire. We build the frameworks, the accountability structures, and the development pathways so your leadership bench grows with your practice.
And if you are also looking at where your practice stands financially before you start scaling people costs, our Medical Billing services give you the revenue clarity to make those investment decisions with confidence.
For practice owners who want to work through these questions with peers who are at the same growth stage, the Growth Code Conference brings that conversation into a room built for it.
Succession is not what you do when you are ready to leave. It is what you do every day so the practice can grow beyond any one person, including you.
If you are ready to start building that foundation, let's see if we're the right fit.
