Leadership lessons from academia for private practice

The New-Age landscape of private practice for chiropractors, physical therapists, clinical psychologists and other allied health professions can be characterized by a paradox of opportunity and challenges.

Demand for non-pharmacological care, functional rehabilitation and musculoskeletal expertise has never been higher. However, the operational stability of private clinics is increasingly under pressure from multiple converging factors. These pressures include the consolidation of various forms of care by large health systems, the increased administrative burden of insurance compliance, the strain of burnout and turnover and a different set of expectations from a younger patient base looking for convenience, clarity and connection.

The traditional sole-proprietor model, in which the charismatic doctor is at the center with support staff orbiting around them, has reliably sustained the profession in the past. But in today’s environment, that key-person model could become a liability. It bottlenecks decision-making, stifles innovation and isn’t in tune with emerging clinicians’ desire for mentorship, collaboration and purpose rather than a transactional employment role. Basically, a clinic built around a single person will struggle to inspire and retain the many individuals required for long-term success.

Private practitioners can navigate these pressures by drawing on a sector that has sustained itself for centuries: academia. While often criticized for its layers of bureaucratic process, paperwork and slowness to adapt, academic healthcare has quietly mastered something invaluable: resilient organizational leadership. When some of its core principles are distilled and applied to the agility of private practice, a more stable, innovative and talent-retaining healthcare business can result. Academia focuses on doing right by its students, and healthcare focuses on doing right by its patients. Despite operating in different domains, both need to rely on structure, ethical and moral decision-making, mentorship and evidence-based, data-driven practice to achieve those missions.

Why academia can offer the blueprint for sustainable private practice

Academic institutions thrive because they are designed to allow systems to overcome personalities, they use evidence over anecdotes and work to forge legacy over short-term convenience. They are built to outlast any one individual. This is a characteristic private practices need to establish as generational turnover accelerates.

Private clinics can integrate academic leadership frameworks, such as shared governance, a culture of inquiry and continuous improvement, formalized mentorship and coaching structures and data-driven quality assurance and decision-making. By implementing some of these frameworks, they transform from basic, owner-dependent entities into what the Institute of Medicine calls a Learning Health System. This is an organization that continuously adapts, grows and delivers high-quality outcomes. Shifting to this kind of organizational structure is not theoretical. It is absolutely practical and directly addresses challenges, such as associate turnover, clinical stagnation, patient retention issues and operational inefficiencies.

Pressures experienced in today’s private practices

Even amid high demand, the private practice sector is dealing with unprecedented volatility that includes administrative overload, changing workforce dynamics, employee retention challenges and bottlenecks in decision-making.

Administrative overload is taking time away from what clinicians do best: being clinicians. Documentation requirements, insurance verification and billing complexities increasingly consume clinical time. Many practitioners describe their roles as “data entry specialists who occasionally treat humans.” This is not sustainable, nor does it inspire younger clinicians to remain in this sector for the long term. Older practitioners are retiring, and younger clinicians bring different perspectives and motivations. Younger-generation providers value professional development, mentorship, clarity of expectations, belonging, purpose and structured growth pathways. They don’t want to take on administrative duties; they want to be subject-matter experts, i.e., the clinicians. These elements are abundant in academic environments but often absent in private clinics, where departments and compartmentalized expertise are designed so that the right people do the right tasks.

Hiring and retention continue to become challenges

Across small healthcare businesses, many report difficulty filling open positions. Burnout, limited internal advancement opportunities and unclear role expectations exacerbate the problem. The hard truth is a clinic that cannot retain staff cannot scale. This phenomenon may lead to the clinic struggling to survive. Academia uses consistency and transparency in its roles, hiring and advancement. Handbooks rule the land and drive recruitment and retention. When the outlook is clear from the beginning, a staff member or associate is more likely to embark on that path and stay committed.

Bottleneck leadership slows everything down

In many private practices, the doctor makes every decision while the staff executes tasks. This structure leads to disengagement, lack of ownership and limited innovation. If the doctor is unavailable or absent, decisions are withheld. This decision-making process is the opposite of the adaptive culture needed in modern healthcare. Patients who have to wait will navigate to the quick, clear and decisive answers that can be found in larger health systems or membership-based organizations that use app interfaces. Academia gives authority and autonomy to those who know what to do. Doctors can benefit from being told “here is what we did” rather being asked “what do you want to do?” In this shift, the doctor can focus on what they do best: Treat patients.

What private practice can learn from academia and apply immediately

 Distribute leadership to decrease decision-making bottlenecks

Academic programs rely heavily on distributed leadership through committees, coordinators and subject-matter expertise. This load-sharing of the decision-making process allows the leader to give their vision and delegate the outcomes. When doing that, the committee or domain experts get to work on operationalizing that vision. In private practice, distributed leadership roles could look like:

• A clinic operations director who manages the office workflows and teams, historically known as the office manager.
• An assessment and data lead who monitors documentation compliance, sometimes known as quality assurance.
• A patient experience coordinator who focuses on outcomes and satisfaction, sometimes seen as the front office staff.
• A clinical mentor who advises and trains associates, sometimes a senior physician or clinician.

These examples create ownership of processes, place accountability on decision-making and allow the clinic to continue operating even when the owner is out for a week on vacation.

Create a culture of inquiry and improvement

Universities thrive on questions: Why do we do it this way? What does the data tell us? How can we improve? While regulatory bodies such as accreditors can be a driver for this inquiry process, accreditors seek insight into the process, not just the answers. Clinicians can adopt the inquiry mindset here, especially when the decision-making process is truly distributed. The owner is now trying to determine why things are being done the way they are and how things can be improved. In private practice, this could be:

• A continuous quality improvement committee tasked with looking into processes and understanding the why.
• Evidence-based case discussions during monthly clinical meetings. This is extremely helpful in development, as new associates bring forth emerging evidence.
• Staff leading a process redesign. They were hired as experts; they know how to manage processes.
• Consistent review of clinic metrics presented by the assessment and data lead (patient visit data, referral sources, cancellations, outcomes).

A learning culture keeps the clinic agile and keeps clinicians intellectually alive. Innovation lives in the minds of those who are navigating the day-to-day. A culture of inquiry yields ideas that drive innovation and improvement.

Implement formal mentorship and coaching pathways

Academic programs excel in mentorship because they expect it, structure it and assess it. Structured growth leads to better outcomes. Lifelong learning is part of the process for clinicians, both by design for continued licensure and by the nature of how healthcare evolves. In an academic culture, new faculty must be developed to ensure student outcomes are met. In private practice, the same holds for new physicians. Younger providers crave purpose, development and the desire to impact. In private practice:

• Pair new associates with experienced clinicians.
• Employ structured observation and feedback cycles. Feedback is the key to improvement and growth.
• Develop growth paths aligned with mastery rather than seniority. The number of years of experience is an aging benchmark that no longer demonstrates mastery or proficiency.
• Know that learning requires time and planning. Provide protected time for teaching, feedback and reflection.
• Think about tenure, an academic concept that drives excellence. It not only protects the associate but leads them to meaningful and impactful contributions.

Adopt data-driven quality assurance

Consider data as a seat at the table. Academic health centers take data seriously and so should private practices. Build dashboards that present clinical outcomes and patient-reported measures, billing accuracy and collections, scheduling efficiency, patient satisfaction and provider performance metrics. Set benchmarks for each of these elements and find ways to track these outcomes. Data removes guesswork and makes business improvement a team effort.

Build institutional memory, not dependence on one person

Academic institutions survive changes because systems hold the knowledge. Standard operating procedures, training manuals, checklists, handbooks, documented workflows and committees will create institutional memory for a private practice. This will ensure consistency and protect the business from disruption during staff turnover or uncertain times.

A future where private clinics become learning health systems

Academic institutions have endured because they embrace change as a scholarly duty. Private practices will endure when they embrace change as a leadership strategy. When clinics model themselves after academia by prioritizing mentorship, structure, inquiry, shared leadership and data, they become resilient, profitable, innovative and clinically excellent. The future of private practice does not belong to the star clinician who “does it all.” It belongs to teams that learn, adapt and thrive together.

Final thoughts: How do you start?

You don’t need a faculty senate to begin working toward excellence. You need the willingness to lead your clinic like a teaching institution, where everyone grows, the systems support the mission and the patients benefit from a team committed to continuous improvement.

Ferrahs Abdelbaset, DC, is assistant vice president for academic affairs and associate professor at Ponce Health Sciences University. For more information or consultation, visit ferrahs.com.