The CEO Shift: Building a Profitable and Sustainable Practice with Dr. Adam Robin

Jan 10

Most private practice owners don’t wake up one day and decide, “I’d like to become a CEO now.”

It happens the way most things happen in practice ownership. Slowly at first, then all at once.

Your schedule fills. You’re treating. You’re documenting. You’re answering messages, fixing small problems, smoothing over cancellations, juggling staff needs, and trying to keep marketing going when you can. From the outside, it looks like a thriving practice. From the inside, it can feel like you’re one unexpected week away from everything getting wobbly.

That’s what this conversation with Dr. Adam Robin is about. Adam is a physical therapist, owner of three private practices, and part of the Private Practice Owners Club. He’s also built a coaching company and a virtual assistant staffing agency, which gives him a front-row seat to what actually makes a practice run and what quietly drains it.

We talked about money, KPIs, and outsourcing, but the real thread running through all of it is this: the practice can’t stay healthy if the owner never shifts into the CEO seat.

The part no one tells you about private practice ownership

Early in the episode, Adam and I land on something I think most clinicians feel but don’t always say out loud. Entrepreneurship is a personal transformation journey. It forces you to look at your patterns, your relationship with discomfort, and the stories you’ve been carrying around money, boundaries, leadership, and self-worth.

I’ve seen this in my own business. In the early days, tiny things could take me out. A misunderstanding. A client who wasn’t happy. Someone is doing something similar to what we were doing. I’d spiral for days. Now, it’s different. Not because those situations never happen, but because I’ve learned not to hand my power away so easily.

That shift doesn’t come from learning a new marketing tactic. It comes from becoming the kind of owner who can stay grounded, make decisions, and keep moving.

A finance-first mentality (and why it feels so hard at first)

One of the clearest ideas Adam shared is what he calls a “finance-first mentality.”

Most of us start with a patient-first mentality, which makes sense. We got into this work to help people. For many clinicians, money can feel uncomfortable, even conflicting. You want to serve, support, and make care accessible. But you also need the practice to pay you, pay your team, cover rent, and stay alive.

Adam explained it in a way that stuck with me: profitability doesn’t happen by accident. It has to be demanded and intentionally captured.

A lot of owners work hard all month and then keep whatever happens to be left in the account. If there’s nothing left, they tell themselves they just need to work harder. The problem is, that approach turns you into the leftover. It trains you to accept whatever scraps remain after everyone else’s needs are met.

Finance-first flips the order.

Instead of spending first and hoping there’s profit later, you decide up front what the business can spend. Adam gave a simple example: if every dollar that comes into the practice only allows you to spend 80 cents, you have to run the business within that budget. That’s what creates room for profit.

And yes, it requires boundaries.

It requires saying no when it would be easier to say yes. It requires charging cancellation fees instead of letting fear drive the decision. It requires sticking to budgets even when someone’s disappointed.

That’s the CEO shift. It’s not just knowing what you “should” do. It’s building the conviction to do it.

Boundaries are financial, not just personal

As we talked, it became obvious that money and boundaries are tied together.

It’s easy to set aside profit on paper. It’s harder to protect it in real life.

A team member asks for something that isn’t in the budget. A patient no-shows and you don’t enforce the fee because you’re worried about a bad review. A staff member is underproductive, but you avoid the conversation because it feels uncomfortable. Little by little, that 20 cents you meant to protect starts to disappear.

Adam put it plainly: the business doesn’t care about feelings. One plus one is still two. If the numbers don’t work, the practice can’t stay healthy.

At some point, the owner has to decide, “I deserve to run a profitable practice. And I’m not going to sacrifice the financial health of the company.”

That decision changes everything.

The KPI that tells you if you’re actually safe

When we got into KPIs, Adam made it simple in the best way.

The best KPIs are the ones that help you make decisions. Anything else is noise.

His favorite metric is break-even, and the reason I love this is because it gives you clarity fast.

Here’s the concept:

Know your average revenue per visit.
Know your total monthly expenses (including paying yourself and running the whole company).
Divide expenses by revenue per visit.
That tells you how many visits you need to cover the month.

Then you can take it further. Add 10% or 20% to your expenses and run the same calculation. Now you know how many visits you need to hit to create a real margin.

Adam said it should be highlighted and circled because if you’re under that number, you’re going broke. It’s blunt, but it’s true. And once you know that number, it becomes something your whole team can rally around. Front desk, clinicians, the owner. Everyone understands the target.

It also helps you spot patterns. If you know you always dip in December or certain seasons, you can plan instead of panicking.

The new patient roller coaster (and why it happens)

We also talked about something a lot of owners experience: the cycle of being “full” and then suddenly not being full.

When things are good, it’s tempting to stop marketing. You get comfortable. You stop nurturing referral relationships. You stop showing up consistently. Then a few discharges happen or cancellations spike, and suddenly you’re scrambling.

Adam called out the deeper issue behind that cycle: it’s hard for owners to step out of treatment to work on the business.

There are practical reasons for that, but there’s also identity. If you’ve always been the clinician, it can feel risky to stop treating. It’s familiar, it’s what you’re good at, and it’s a direct revenue driver.

But the CEO work is what stabilizes the practice.

Marketing. Relationships. Systems. Financial tracking. Decision-making. The things that don’t always feel urgent until they’re urgent.

And like Adam said, you have to get comfortable being uncomfortable. You’ll stink at the CEO skills at first. Then you’ll stink less. Then you’ll start getting better. That’s how it goes.

Outsourcing as a way to protect the “golden goose”

This is where our conversation about virtual assistants fits perfectly.

Adam said something that made me laugh and also made me pause. The owner is the golden goose. You’re the person with the vision, relationships, leadership, and high-income skills. Nobody else can make the business work the way you can.

But when you’re overloaded, the golden goose gets “sick.” You’re exhausted, reactive, and stuck doing low-energy tasks that drain your attention.

So the question becomes: how do you free up the most important person in the business to do the most important work?

That’s what a VA can do when it’s set up well.

We talked about the learning curve because I’ve lived it. My VA, Frenzy, has been with us since late 2021 or early 2022, and she’s incredible. But when I first started hiring help, I didn’t have clear SOPs. I didn’t even fully know what I wanted someone to take over. That’s a common experience.

Adam’s process is structured in a way that helps owners avoid that awkward “staring at each other” phase:

Do a time audit and write down everything you do.
Split it into high-energy tasks (the work that fills you up) and low-energy tasks (the work you’d love to never do again).
Turn that low-energy list into the VA’s job description.
Build a two-week training program with clear outcomes.
Have the VA build SOPs for your tasks, and create a KPI dashboard so you can track the work.

He also shared practical supports around HIPAA, password protection software, VPNs, and healthcare training for VAs.

Another key point: commitment matters. Adam’s agency places VAs at a minimum of 20 hours a week because anything less tends to turn into side-gig energy. And honestly, I agree. If you’ve got a practice, you can find 20 hours worth of work to offload.

“Those who adapt will survive”

Toward the end, Adam shared something he heard that stuck with him: those who adapt will survive.

Since Adam opened his practice in 2019, he’s seen reimbursements drop significantly. Practices are being forced to look for efficiencies, whether that’s in billing, verification, front desk systems, or how they allocate labor.

The practices that stay rigid will feel the squeeze hardest. The practices that stay intentional, track the right numbers, protect profitability, and build operational capacity will have more options.

And that’s really what the CEO shift is. It’s not becoming cold or corporate. It’s becoming clear. It’s deciding your practice deserves to be financially healthy so it can keep serving people without draining the owner into the ground.

If you want to start making the shift

Adam recommended two books that are a solid place to begin if you’re working on your money mindset and financial structure:

Profit First by Mike Michalowicz
Rich Dad Poor Dad by Robert Kiyosaki and Sharon Lechter

And if you take nothing else from this episode, take this: your business will reflect the decisions you make, not how hard you work.

Hard work can build momentum, but it won’t build stability on its own.

When you start tracking what matters, holding boundaries, and delegating what drains you, you stop running your practice like a clinician who happens to own a business. You start running it like a CEO.

And that’s when it becomes profitable and sustainable.