Tea Nguyen, DPM (00:53.836)

Most physicians think the hard part about direct care is opting out of insurance. In actuality, the hard part is you, who you have to become to make this happen. This episode is going to talk about some uncomfortable truths that building your own practice is one of the most powerful personal development journeys you will ever have to take, whether you signed up for it or not. Let's get real about how unresolved patterns from your personal history

will silently run your business decisions until you've named them, claimed them, and start healing them. If a patient has ever said, I can't afford this, and you immediately started to slash your prices in your brain before they even finished their sentence, let's talk about this. Nobody told us that leaving insurance would hand us front row seats to every fear, every wound, and every limiting belief.

We've ever carried about money, self-worth and belonging. Business ownership does not create these patterns, it reveals them. And the longer you ignore them, the more it's going to run your practice. It's going to make your business decisions for you before you even realize it. What scarcity mindset looks like in a direct care practice is the following. You price your services based on what you think people can afford, not on the value you deliver. You undercut your

prices before anyone even asks you for a discount. You create this invisible sliding scale, but you never push it back up to where it needs to be to be a profitable practice. You compare your prices to the cheapest option in town instead of the best option in town, or you simply feel guilty charging more than what insurance reimburses us. Where does this scarcity come from? The not enough feeling comes from.

It may have come from growing up without financial security or you were trained in a system where your worth was determined by your productivity. These are production models, RVU models, reimbursement code dependent. I'm sure you can dig around in your own experiences and find patterns and instances where you were never truly valued no matter how hard you worked, no matter how hard you tried. Here's the practical implication of lowering your prices to attract patients.

Tea Nguyen, DPM (03:18.946)

You might be thinking that it is kind to discount for somebody, but what's really happening is when you discount or lower your prices, you are confirming the belief that you do not deserve more. Under-price services attract price-sensitive people who will leave you when somebody else charges less, so now you're fighting for the bottom of the barrel. You cannot build a sustainable practice on scarcity pricing. Price-sensitive patients can go where they have more resources. Private practices aren't one of them. Remember, if you're wanting to have a profitable private practice, it requires intention. Once you have financial sustainability, then you can decide if you wanna build in charity work, just like what the flight attendants say, to put on your own oxygen mask first before helping your neighbor. I've caught myself doing this in the past, raising my prices, but having some legacy patients who have been with me for over seven years, where they went from paying zero dollars because I took insurance at the time, to now they're paying $2,100. And yes, a few of them would gripe and say, well, I don't have to be here. I didn't have to pay this in the past. And I would just say the same, I also don't have to be here. And so we would just kind of laugh and it was great. It was a relationship.

And then you can see that they get it and they say, okay, I get it now. And sometimes some patients you might have the luxury of bantering back and forth in a lighthearted kind of way, which is a lot of my patients. So I'm grateful for that. And then you charge their credit card. So I don't really take a lot of things that seriously anymore. This is just a business decision. And as a person, as the CEO of my practice, I have to make those really hard decisions. And I have to detach myself from what I think it means about me and reframe it as to this is what the business needs. 

So I'm the CEO, not a people pleaser. In some instances, if you're loosening boundaries to win over the patient, to earn their trust, their business, boundary erosion could look like this. You're extending appointment times because you feel guilty just shortening it or ending it too soon.

Tea Nguyen, DPM (05:37.27)

or you're answering phone calls and texts or email messages, patient portal messages after work hours because you're afraid that they'll have a negative feeling about you, that they will leave or they leave a nasty online review. So you're doing things outside of your normal work hours that's interfering with your personal life. Or you find yourself trying to accommodate payment plans that maybe don't really work for your practice but you want to keep the patient's business and so you kind of bend the rules a little bit. Or you're agreeing to work with the patient and then you're functioning outside of your area of expertise because you need the revenue. What's the underlying wound to this?

 It's people-pleasing. It is a survival strategy a lot of us developed as a way to stay safe, as a way to not disappoint people who matter to us. Maybe you learned that this is how you earned love or approval and now that conditioning shows up in your business. Every time you loosen your boundary to keep a patient, you're teaching that patient and yourself that your boundaries are negotiable. And then you begin to resent the patients because you were so flexible, now you can't hold them up anymore. You've accommodated them. But if you would never let a patient dictate your treatment plan, your diagnosis.

Why do you let them dictate your schedule or your scope in your policies? Having healthy boundaries in your business, in your direct care practice is the most professional thing that you can do for you, for your patients, and for your bottom line. And it does take practice to implement them, to say no when it doesn't feel right, and to let them know where you stand. Now let's say you've done a wonderful consultation with a patient. You laid out the care plan, you have a working diagnosis, you believe in it.

and then you tell them the price. And then the patient says, I need to think about it, or worse, they say, okay, that sounds good, they walk away and you never hear from them again. And then suddenly you create this inner dialogue that feels like a rejection. It feels like they rejected you as a doctor, that you as a doctor, you're not good enough for them. So you're associating your worth as a physician with a no to your offer.

Tea Nguyen, DPM (07:59.606)

If you find that when a patient says no to your treatment plan and you feel that way, that could be an abandonment issue. And how it shows up in your business is that you over explain or you over justify your prices or you're talking more than you should. Maybe you don't take breaths and you're just rambling off a bunch of stuff, a bunch of tech specs that they'll get at that price point. Or you follow up excessively after the patient has disappeared. 

You're chasing that close, you're wanting them to see you for what you're worth, you're wanting to feel valued. Or you take those notes personally and you spend hours replaying that conversation in your mind, ruminating over this, making it about yourself. Or you change your offer, you add more stuff, you lower your prices before they even ask, just so that the discomfort is blunted. Because that space after you give them your price is uncomfortable. Staying silent is uncomfortable.

Or worse, you avoid that discomfort by never presenting what you offer. By never showing them the premium services that you do have because you don't want to face another rejection. You've had enough. Where does abandonment wounds come from? It could have been an early experience of feeling left behind, of having that emotional imprint of pain somewhere. It could have been emotionally, physically, relationship wise. So you have then learned that love and acceptance were not guaranteed, that it was limited, and maybe develop some hypervigilance around rejection cues. But let's snap you back into reality. When a patient says no, it's not you they are abandoning. A no could mean not right now, or I don't understand the value. So this is a communication skill. Don't tether your worth to their response. Your job is to present the value clearly and guide them.

Their no is not about your worth. It never was. They have their own situation going on, but help them understand by being clear and not over explaining. So the doctor who can't sit in that discomfort of when the patient says no will chase the patient, which undermines your authority, or you stop offering your stuff altogether because it feels uncomfortable.

Tea Nguyen, DPM (10:26.112)

Either way, it'll be really hard to grow your practice until you deal with it. Some of the other wounds that may show up at your work or in your business are things like imposter syndrome or not feeling like you're good enough. Listen, you've got more credentials than most people you know, but maybe you hesitate to call yourself an expert or you deflect compliments. So imposter syndrome is the feeling or the belief that you felt you were never quite enough, no matter how much training you had, no matter how many certifications you received or earned or number of conferences you've attended and you're just waiting to be found out that you're some kind of a fraud. 

Another wound that can show up, perfectionism. This is where you have a difficult time delegating because you want control from A to Z, from everything that you do or you hire your staff to do something and it wasn't good enough, they maybe did 80%, but you want 100%. And so you redo their work or you overstep your work, you invalidate their effort. So now you're breaking the structure of your team because now they can't be trusted to do things right. And this is not about them not meeting your very high standard. It's about you that you only feel safe if you did it yourself, if you had control in all of the variables and scaling your practice becomes difficult if not impossible if you continue to function this way. 

And here's the big one, unworthiness around money. Physicians are high income earners, but discussing money has always been taboo for us professionally and personally. And this affects those who grew up without money or in cultures where we just don't talk about it. So there's a deep shame around charging appropriately or charging really well for this level of expertise or you do charge it and then you have guilt around it. So you have a hard time celebrating your wins or you're celebrating it quietly when you have a really good financial month. It's as if being too proud of your income will jinx it or it makes you look greedy or something else. This is a wound that you have to be able to spot and deal with. So here's how your business is showing you the wounds that are running the show. If you're always discounting, don't punish yourself into shame.

Tea Nguyen, DPM (12:48.822)

It happens. So instead, build one, two, or three options so that the patient can choose with you. So what I'll do is I'll present my package to a patient and I say, well, we can do nothing, which is not a great option, or we can do this very expensive thing, but there's a mid-level package that they can choose. So when you price compare, you price anchor your stuff to other stuff that's available, it does make the decision process a lot easier for the patient.

And that way you're not accidentally discounting people because you were in a hyper-vigilant mode and you just wanted to appease the patient and avoid that discomfort of silence after you give your price. Let it be uncomfortable. You did your job. So now allow them the autonomy to choose with those viable options right in front of them. If you are finding yourself exhausted and resentful of your patients, it could be a people pleasing mechanism or you have loose boundaries.

So you want to ask yourself, where did your energy leak today or this week? And how could it be prevented? Maybe you need to screen your calls better. Maybe you need to improve your communication and expectations. Once you start identifying what recurring pattern shows up, then you can deal with it and create new protocols around it. Now, if a patient says no, they're asking for a refund or they're giving you a negative review, and all of that lives rent free in your mind longer than it should, it might be that abandonment issue and you're feeding it by seeking for more validation just to feel good enough. You are already good enough and I dare to say it, you're excellent. You're a specialist who has gone above and beyond than the average person. You are not average, my friend. 

Our brain will always hyper-focus on the small negative thing that happened overriding all of the great things that you already accomplished. So don't let that sneaky, negative Nancy in your brain override all of the good that you've already done. Now, if you cannot delegate tasks, low-level tasks that you as a physician don't need to be doing, this could be a perfectionism or control mechanism. Loosen the death grips from time to time. And you'll see when you empower your staff to do their stuff at good enough,

Tea Nguyen, DPM (15:13.506)

that nobody died, that there wasn't a grave consequence in hiring somebody to do a task that they're pretty good at, even if it's not perfect, these things are trainable and you can empower your team better if you loosen those death grips. And the last point here is if you feel guilty earning a lot of money, then you need to look at your money story or cultural conditioning and understand where it comes from and realize money is just a tool.

It's not good, it's not bad. It is there for you to use to buy things, to invest in your business, to have nice things in your home. It is a tool to get you stuff. And when doctors have money, we can do a lot of great things with it too. Just like if money is in the wrong hands, bad things can happen as well. It is a totally neutral player. It is a tool that is neither good nor bad. It's whatever you decide it to be.

So here's some practical steps that you can take right now. You can choose to work with a coach or a therapist or a mentor who understands the business issues and the emotional patterns that show up. They're not isolated. People like to compartmentalize that that's just business or that's just a personal thing. They marry each other. If you don't deal with your personal stuff, it shows up in your business and vice versa. You also want to start noticing your body in moments that feel uncomfortable.

If your palms are getting sweaty after you give a price point, allow it to be sweaty. Yes, you're uncomfortable and that's okay. Hold space. Let it be weird. Let it be uncomfortable, but stay silent. Name the situation. Is this an abandonment issue? Is it people pleasing? Is it lack of boundaries? Recognize it and then stop it. It's kind of like weeds in the garden. If you don't recognize it, you can't stop it. But once you start noticing the growth, you pull it out, right? Here's the bigger picture.

Your business will only grow as big as your capacity to handle it. Every uncomfortable moment is an invitation for you to become a leader that your practice needs and evolve into the person that can handle it. Your practice will only grow as far as you're willing to grow yourself. The business stuff is learnable, but this stuff that we're talking about here, that's the real work. And I know you are so ready for it.

Tea Nguyen, DPM (17:38.604)

If you found this episode insightful, please share it with the physician you know who is building their practice and are feeling stuck. I'm so grateful that you joined me here today. I will catch you next week. Take care.