In his early days as a pilot, my husband, Jimmy, decided to fly from Idaho Falls to Oshkosh, Wisconsin. With fuel stops and bathroom breaks, the trip would take his small plane about 10 hours. Heading east from Idaho Falls, Jimmy had to navigate over the Rocky Mountains. After that, the terrain flattened. When he reached Sioux Falls, Jimmy realized that, while he had been adjusting his course along the way, he had failed to consider making altitude adjustments. He was still flying as if there were mountains below him. This sudden realization required him to adjust his landing approach.
Any pilot will tell you that flying requires constant tweaks and adjustments. To them, headings, altitude, and wind are just data points — information that helps them adjust along the way. Turbulence, changes in air pressure, and storms will throw them off course.
Purchasing an existing practice is a lot like piloting a plane. Now that the deal is done, you’re in charge. You’ve gained clients, equipment, and a team. You may have also inherited some challenges, like outdated pricing, vendor relationships shaped by the previous owner, negative reviews, or a practice management system you don’t like. Good or bad, everything in the practice is now yours to manage.
You’re stepping into the cockpit of a plane in midflight. The previous pilot flew a specific route at a specific altitude with specific habits. Frequent passengers are used to a particular turbulence pattern, a certain announcement style, and a familiar in-flight experience. And now you — the new pilot — have your own ideas about how this flight should go. Due to turbulence, pressure changes, and wind shear, the aircraft is constantly pushed off course. A good pilot doesn’t panic. A good pilot reads the instruments, makes small corrections, and stays focused on the destination.
Your first year of ownership may feel like constant turbulence. Staff will test you. Clients will compare you to your predecessor. Existing systems and policies might frustrate you. Cash flow will be tighter than you projected. Most likely, these challenges are not emergencies; they are data points telling you to make small corrections and stay deliberate. Keep flying.
The One-Change Rule
Many new owners bring a great vision and a long list of changes, and they want to implement those changes now. All of them. New PIMS. New payroll system. New scheduling philosophy. New associate. New equipment. New brand. New culture. All of it, simultaneously, in year one.
But that’s not a good plan. Each big change causes turbulence for your team. Most people can handle one change at a time. If you pile on several at once, your best employees may start looking for new jobs, clients notice instability, revenue can dip, and you’ll feel overwhelmed, managing chaos instead of building the success you envisioned.
Instead, make one big change at a time.
But where should you begin? Start with what bleeds. Not every change is equal. Make a list and prioritize. Think about each change’s impact, and be honest about which problems are costing you right now and which problems simply annoy you.
Focus on:
- Your team’s stability: Your team is your foundation. If you have staffing gaps, toxic dynamics, or pay issues causing resentment, fix these before changing anything else. A stable team can handle change; an unstable team can’t.
- Revenue and compliance: If the fee schedule hasn’t been updated in four years, you’re losing money every day you wait. The same goes for billing gaps, insurance problems, or compliance risks. These add up. Fix them as soon as possible. They’re less disruptive than operational changes and can often be addressed quietly.
- Systems and workflows: A new PIMS might be needed, but it will cause disruption. It’s easier to switch when your team trusts you and your revenue is strong. Don’t overhaul the system before earning your team’s confidence.
- Brand, culture, and vision: These matter enormously in the long run. But they are also the changes that take the longest to stick. Forcing them too early often backfires. Culture shifts are embraced when people feel safe and see consistent behavior from leadership over time — not because you announced a new set of values in month two.
Allow each major change 60 to 90 days to settle before adding another. Despite how it feels, this isn’t slow; it’s how lasting change happens. For some practices, it takes an entire year for the team to embrace a new PIMS.
As in aviation, regardless of the challenges you face en route, the destination stays the same. In practice ownership, the timing of adjustments and how quickly you make corrections is what separates owners who build something great from those who burn out their teams trying to reach their goals.
Plan for Survivors and Departures
When you buy a practice, some people will leave. Clients who came to see Dr. So-and-So will follow Dr. So-and-So. Long-tenured team members may decide they don’t want to learn a new way of doing things. Some staff turnover and client attrition in the first year is completely normal.
On the other hand, some people will become your biggest supporters. Staff who were frustrated before may thrive under your leadership. Long-term clients who care about the practice will give you a real chance. Vendors with past issues may welcome the fresh start.
The survivors are real. The departures are real. Plan for both, and you won’t be blindsided by either.
Buying an existing practice, if done well, can be one of the best ways to become an owner. You realize immediate cash flow, and you get an established client base, a trained team, and a proven location and track record. These are some of the real benefits that a startup can’t offer right away. But you’ll only see these advantages if you approach ownership with open eyes. Once you’re the pilot, fly your plane with patience. The corrections will be manageable. The turbulence will pass, and you’ll arrive at your destination.