A Start My Practice Guide
5 mistakes that cost a cash practice its first year
And what each one actually costs — from someone who's made every one of them.
Stephen Smith · Founder, Start My Practice · startmypractice.net
There's an old idea I build everything around: figure out where you're going to fail, and stay away from that place. Most advice about opening a practice is a checklist of what to do. This is the opposite — the handful of mistakes that quietly cost new cash practices their first year.
I've opened five practices across Washington, Idaho, and Wyoming over more than forty years in healthcare. I've made every mistake on this list myself. That's why I can tell you what they cost — not in theory, in rent checks and lost months. Read it once. It'll save you more than the few minutes it takes.
Avoid the wrong turns and you don't need to be brilliant — you just need to keep moving in the right direction.
The Five
1
Signing the wrong location
What It Looks Like
You find a space that's affordable, available, and "good enough." You sign before you've really studied who walks and drives past it, whether they pay cash, whether they can park, whether they'll ever find you.
What It Costs
This is the one you can't undo. A weak location doesn't fail loudly — it just underperforms, month after month, while you pay rent on a multi-year lease you can't break. It's the most expensive decision most owners make, and they usually make it fastest.
The Fix
Treat the lease like the largest financial commitment it is. Study the traffic, the demographics, the visibility, and the exit terms before you sign anything. If you're not sure, that uncertainty is information — listen to it.
2
Pricing from fear instead of value
What It Looks Like
You set prices low to "get people in the door," afraid cash patients will balk. So you discount, bundle, and undercharge from day one.
What It Costs
Underpricing starves the practice of the cash it needs to survive its first year — and it signals low value to exactly the patients who pay cash for quality. You work harder for less, and you train your market to expect it. Raising prices later is far harder than setting them right the first time.
The Fix
Price what the work is worth and what the practice needs to be stable. Cash patients aren't shopping the way you fear — they're choosing confidence. Set prices you can defend and sustain.
3
No fast path to cashflow
What It Looks Like
You build the practice you dream about before there's revenue to pay for it — the full service menu, the ideal patient, the long-visit model — and wait for it to fill.
What It Costs
Time you don't have. Every month before cashflow is a month you fund out of savings and nerve. Practices rarely die from bad care; they die from running out of runway before the revenue shows up.
The Fix
Stand up a fast, repeatable, cash-generating visit type from day one — the quick visits that pay the bills while the rest of the practice grows. Where credentialing actually pays off, like L&I and select fee-for-service exams, use it deliberately to shorten the road to cash. Cashflow first. Then build the practice you want.
4
Betting everything on one revenue line
What It Looks Like
One service, one product line, or one referral source carries the whole practice. It's working, so you lean on it harder.
What It Costs
Concentration feels like focus — until the thing you depend on dips. A rule changes, a referral dries up, a product falls out of favor, and suddenly the whole practice is exposed with no cushion under it.
The Fix
Diversify revenue early, while you still have room to. A few visit types, a membership, sensible retail, a partnership or two. You don't need many legs on the stool — you need more than one.
5
Growing before you're stable
What It Looks Like
The practice is finally moving, so you add staff, space, services, and marketing spend to push it faster.
What It Costs
Instability scales too. Growth layered on a shaky base multiplies the problems instead of outrunning them — now you're paying more people to operate a system that wasn't running cleanly yet.
The Fix
Stability before growth, every time. Get the core engine running clean — predictable cashflow, defined visits, calm operations — and then add load. Growth is a reward for stability, not a substitute for it.
The pattern underneath all five
Notice what these have in common: none of them are about clinical skill. They're business decisions, made early, under pressure, usually alone — which is exactly why they're avoidable, and exactly why coaching pays for itself. The value isn't a checklist of what to do. It's having someone who has already paid for these mistakes standing next to you so you don't repeat them. That's speed, and that's avoided cost — the two things that actually save you a year.
Start with a free discovery call.
If you're opening or reshaping a practice, tell me what you're building. I'll tell you the fastest honest path to get there — and whether coaching is part of it. No cost, no pitch.
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Start My Practice provides business coaching for launching and operating independent practices. This guide is general business education — not medical, legal, financial, or tax advice.