A couple of years ago, I took genuine pride in doing everything. Finances, operations, marketing, and tech. If it had to get done, I was getting it done. There was something deeply satisfying about it, especially as someone who bootstrapped a practice from scratch. Every task I handled myself was a dollar saved, and every dollar saved felt like a small victory. I wore every hat as a badge of honor. 

That changed when I hired an office manager. 

Even after we made the decision to bring someone on, I fought it. I floated the idea of a super part-time role first before finally, reluctantly, conceding to a full-time position. My thinking has since done a complete 180. Where I used to ask “what else can I do?”, I now ask “who else can do this?” That might sound like getting lazy, but what it actually reflects is something more fundamental: a recognition that everyone has a ceiling on their skills. My practice now has three physicians, a nurse, and an office manager. As that team has grown, I’ve had to confront where I’m genuinely useful and where someone else is genuinely better. That confrontation is uncomfortable and necessary. 

There’s a term for what most founders operate as: the heroic founder. It’s the person who does everything, knows everything, and is the single point of failure for their entire organization. For a solo practice with no plans to grow, that model works fine. But the moment you start bringing on partners, staff, or additional clinicians, the heroic founder becomes a bottleneck.Over the last couple months, I’ve been actively working on what it means to be a better manager. Here are some takeaways. 

See the Person 

When you hire someone or bring on a partner, you give a title. But the person filling that title is more than the role. Over time, patterns emerge. For example you may notice that one person is exceptional at building relationships with patients but struggles with systematic follow-through. Another is meticulous with detail but freezes when asked to improvise. The initial instinct is to force people to improve their weaknesses  to “develop” them in the areas where they fall short. That impulse is mostly misguided. 

The better approach is to design work around where people are naturally strong and be honest about where they’re not. This doesn’t mean ignoring gaps that are core to someone’s role. But once someone is on your team, you learn more than the resume ever told you. Identifying those strengths correctly and routing the right work to the right person is one of the highest-leverage things you can do as a leader. Getting it wrong means your best people are grinding away at things they hate while the things they’re excellent at sit undone. 

Give Real Authority 

The defining habit of the heroic founder is “let me just handle it.” It’s faster in the moment, it’s familiar, and it avoids the discomfort of watching someone else do something differently than you would. But it slowly hollows out your team’s confidence and permanently keeps you in the weeds. 

What has worked better for me is the concept of authority lanes. Rather than assigning tasks, I’ve tried to assign protected domains of responsibility, areas where a partner or staff member has the authority to make most decisions. It’s still a work in progress. The discipline of redirecting questions to the appropriate authority lane, rather than just answering them myself, is building something more durable than any single decision I could make. It’s building a team that can function without me hovering. 

Say It Aloud 

This one feels soft until you realize how much it costs you not to do it. When you hand off authority and someone doesn’t handle it exactly the way you would have, the easiest response is to focus on the gap. What fell through the cracks. What could have been better. The problem is that approach quietly teaches your team that taking initiative leads to criticism, which teaches them to stop taking initiative, which puts everything back on you. 

The alternative isn’t blind cheerleading. It’s a deliberate practice of noticing what went right and saying so explicitly. Not because people need coddling, but because confidence compounds. A team member who feels trusted and capable will bring more energy and creativity to their work than one who feels monitored and corrected. Encouragement creates a feedback loop that, over time, actually produces the quality outcomes you were trying to micromanage your way to. 

Close the Loop 

Authority without accountability is just hope. If you’ve handed someone a lane and there’s no mechanism to track how things are going, you’ll eventually find yourself in a situation where things slipped and no one knows exactly when or why. That’s a systems problem, not a people problem. 

Building accountability doesn’t mean surveillance or distrust. It means creating regular check-ins, clear metrics, and an honest shared understanding of what success looks like. A lot of people who are newly empowered in leadership roles, staff and clinician partners alike, haven’t had much experience owning outcomes before. They may not have a natural system for tracking ongoing responsibilities or flagging when something needs escalation. Your job as the leader isn’t to do those things for them, but to build the scaffolding that makes it easier for them to do them for themselves. This is how you maintain oversight without needing to micromanage. 

Relationship First 

One lesson that surfaces repeatedly across management literature is how much the quality of your relationships determines the quality of your outcomes. Dale Carnegie figured this out almost a century ago. Andy Grove built Intel on it. The principle is simple but consistently underestimated: people work better, communicate more, and take more ownership when they feel genuinely seen and respected by the person leading them. 

For physicians especially, who trained in hierarchical environments and are used to either being the junior person following orders or the senior person giving them, the relational dimension of leadership can feel unfamiliar. But the DPC model already self-selects people who care deeply about relationships. The same instincts apply internally. Investing time in understanding your team members as people, their goals, what energizes them, what frustrates them, pays out enormously in trust when decisions get hard and stakes get high. 

Guard Your Time 

Andy Grove’s concept of managerial output reshaped how I think about my own calendar. Your output as a manager is more so what your team produces than what you personally produce. That reframing changes everything about how you should spend your time. Every hour you spend doing something a team member could own is an hour not spent on the things only you can do. Peter Drucker made a similar case for decades: the effective executive is ruthlessly selective about where their attention goes, because attention is the scarcest resource. 

For DPC physicians growing a practice, this means the question isn’t just “am I doing things right?” but “am I doing the right things?” If you’re still the one managing the EMR vendor relationship and ordering office supplies, your team probably has more capacity than you’re giving them credit for. And you probably have more leverage left untapped than you realize. 

Recommendations 

None of this came to me naturally. If you’re at the stage where you’re thinking about building a team or wondering why your existing team isn’t clicking, these books are worth your time. 

• How to Win Friends and Influence People by Dale Carnegie 
• Build by Tony Fadell  
• 10x Is Easier Than 2x by Dan Sullivan and Dr. Benjamin Hardy 
• Who Not How by Dan Sullivan and Dr. Benjamin Hardy 
• High Output Management by Andy Grove  
• The Effective Executive by Peter Drucker  

The shift from heroic founder to intentional manager is one of the harder transitions in building a 

DPC practice. It requires letting go of things you’re good at, trusting people before they’ve fully earned it, and measuring your success by outcomes you didn’t personally produce. It’s uncomfortable, ongoing, and completely worth it.