Podcast Summary:

Private Practice Startup Podcast – Episode 163: “When to Grow, Hold or Pump the Breaks!”

• Hosts: Dr. Kate Campbell & Katie Lemieux
• Guest: Casey Compton, LMFT, systems/processes expert and multi-location group practice owner
• Date: November 23, 2019

Overview of Main Theme

This episode centers on the crucial decisions private practice owners face about scaling their businesses: when to grow, when to maintain ("hold"), and when to "pump the brakes" to prevent burnout or missteps. Guest Casey Compton draws from her experience growing a large, multi-specialty group practice in rural Kentucky. She shares insights on building infrastructure, spotting market opportunities, implementing vital systems, and nurturing one's team—all while staying true to personal meaning and vision.

Key Discussion Points and Insights

Casey's Origin Story and Practice Growth Journey

[03:08–07:07]

• Casey never set out specifically to build a massive practice:

  “I just knew whatever I did, I wanted it to be very controlled and very structured and just… natural feeling. So it wasn’t really like I set out and said, ‘Hey, I want to have a hundred employees’ or anything like that. It just kind of… happened so naturally.”
  – Casey [03:08]

• Early hurdles—lack of clinical confidence, high-risk pregnancy, almost no income, leading to group practice model for residual income:

  “When I got back and had her ... I was like, I have to have residual income. I cannot do this again. And so that’s when I really started looking into group practice ... from there it just kind of grew.”
  – Casey [05:21]

• Timeline: Official group practice launched October 2015; practice built up over four years with 80+ employees at time of recording.

When to Grow

[11:42–13:57]

• Grow if:

  • You have strong systems/infrastructure reducing your own involvement:

    “When you have those systems in place that are not pulling you into the business all the time… that’s a good indicator that you might be ready to grow.”
    – Casey [11:42]

  • A clear market need/opportunity exists (“First-mover” advantage helps)
  • You’ve created something unique for your area/population
  • You have the funds/financial stability for hiring or expansion

• Example: Casey’s practice addressed a gap by working with the local medical community for referrals and assessments, being the only provider in her region serving commercial insurance patients.

  “There was no practice working with [the physicians]. … We could help you better serve your patients by providing these assessments and then giving you the results.”
  – Casey [14:01]

Systems and the Power of Dashboards

[15:22–19:20]

• Advocates for 4–5 core systems in any group practice, with a strong emphasis on accountability measured by a "dashboard."
• Dashboard = Google Sheet (or similar) tracking crucial KPIs:
  • Calls received
  • Referrals (and conversions)
  • Appointments scheduled
  • Billing: claims sent, denials worked

“Everything on this screen is going to tell you basically when to grow, when to hold, and when to pump the brakes. … That dashboard in our practice has helped me find major problems before they could have really taken a bad, bad, bad toll on my practice.”
– Casey [16:36]

• Example: If referral numbers drop or insurance denials aren't worked, the system alerts you to intervene.

  “If they’ve not worked denials in 10 days, guess what? You’re getting ready to have a cash flow problem.”
  – Casey [17:45]

When to Hold

[20:19–22:50]

• When not sure about your desired future direction:

  “If you don’t know where you’re going, any road will get you there. … Everything we do is intentional. And I think if you don’t know where you’re going, then you need to hold and figure that out.”
  – Casey [20:41]

• When needing to build up revenue or financial safety

• When you haven’t identified clear business patterns or trends (e.g., revenue, hiring); these are key to predicting and planning for future growth.

When to Pump the Brakes

[22:53–24:12]

• If you feel burnt out, overwhelmed, or have your hand in every aspect, it’s time to stop and fix foundational issues:

  “Pump the brakes when you feel like you are losing your mind.… If you feel overwhelmed or stressed out, you have a system problem. … You need to pump the brakes and go back … and see what you can fix.”
  – Casey [22:53]

Building the Right Team

[25:46–27:34]

• Casey runs her practice with a strengths-based approach; every admin has a narrowly defined task they excel at.

  “Everybody in our practice does the thing that they are their superpower at. … I would rather manage the people than manage the individual tasks.”
  – Casey [26:44, 27:34]

• She was inspired and validated by Mike Michalowicz's similar approach.

Final Takeaways & Encouragement

[28:31–29:09]

• Your business does not have to follow a cookie-cutter model:

  “Business doesn’t have to follow a model. … It should be a reflection of your personality and there’s no right or wrong.”
  – Casey [28:31]

Notable Quotes & Memorable Moments

• On systems:
  [16:36] “Everything on this screen is going to tell you basically when to grow, when to hold, and when to pump the brakes.”
• On pumping the brakes:
  [22:53] "Pump the brakes when you feel like you are losing your mind."
• On business design:
  [28:31] "Business doesn’t have to follow a model. … It should be a reflection of your personality and there’s no right or wrong.”

Timestamps for Important Segments

• 03:08 – Casey’s unplanned journey to group practice
• 05:21 – Turning point: high-risk pregnancy, need for residual income
• 11:42 – Indicators for when to grow
• 14:01 – Finding a unique market need (medical community, commercial insurance)
• 16:31 – How a “dashboard” works
• 20:41 – When to “hold” business development and why
• 22:53 – Signs it’s time to “pump the brakes”
• 26:44 – Strengths-based team structure
• 28:31 – Parting advice: make business reflect you, not the mold

Episode Tone and Style

Conversational, candid, and inspiring—Casey is honest about her mistakes and growth, sharing both systems expertise and personal anecdotes. Kate and Katie encourage deep reflection on business purpose, emphasizing intentionality, clarity, and creative flexibility.

Bottom Line:
Whether you're just starting out, at a plateau, or feeling swamped, this episode provides actionable insights on reading your practice’s signals—using data, self-awareness, and strategy—to decide when to expand, hold steady, or pause and tune up your systems, all in a way that stays true to your unique goals and values.