Another morning running late. There goes my lunch break. I can think of many reasons why this day is not going right: Check-in was too slow, a patient asked too many questions, the front desk added an emergency at the worst possible time, and that new equipment that would make everyone's life easier still hasn’t been approved in the budget. Pointing the finger at the problem of the day is easy, because of course it couldn't be me. I was feeling hungry and angry—outright hangry.
Embracing Ownership
A casual conversation in that hangry moment changed my work-life balance in a matter of minutes. It didn't seem like much at the time, but the awakening has impacted every day of my career since. I was whining in the tech area about missing lunch, again, when my senior partner looked at me and said, "Well, it's your fault." Excuse me? How dare he. The front desk added that patient. The techs were slow on the workup. None of this was on me. He just shrugged: "Yes, but this happens every day. You're the only one who can change that." He then just went back to charting, unbothered, while I was left stewing.
I stewed on it through my next patient. By the time I grabbed a quick snack, I'd cooled off enough to actually think it through. That’s when it landed: This wasn't about one [JF1] bad morning. This was about agency. I needed to look in the mirror instead of pointing out the window.
It's instinct to hide in the exam room, where it feels safe because we are equipped with the training to handle it. But hiding means you're not engaged, and you're not responsible for your day. You must decide what you want your day to look like, and then go make it happen: schedules, patient flow, staff culture, all of it. Your clinic is your bubble, and it's your reputation. Own it, work on it, and retire the excuse that "Medical school didn't teach me this" or “No attending ever quizzed me about patient schedules.” It doesn't matter. Reality hits hard. It's your job now.
Advocating in a Hospital or Private Equity Setting
This agency to shape your work life is not reserved for physician-owned practices. It is just as relevant if you are the 25th provider joining a group of doctors, a hospital, or a private equity (PE)-backed practice. Advocating for the way you work is personal. It is your hallway, your patients, and you are part of a team that can get this done. That is the why. What about the how?
Start by listening—to staff, to patients, to management, to colleagues, and most importantly, to yourself. Make a list and prioritize what to tackle first. Take the slow road, engaging your team on why changes are happening and how the changes will benefit patients. Over time, this shifts the work from “me” to “we.” That buy-in changes everything.
All change eventually comes down to a key decision maker. They decide if the schedule can change or if the budget allows for the equipment you need. First, decide why that decision would positively impact patient care. It could be to help education, efficiency, outcomes, or engaging technology for patient care.
Next, find out who makes this decision. In a private practice, it may be the managing physician. In a hospital setting, it could be your division manager or the provider who chairs your department. In PE, it is typically the regional director or the chief financial officer who builds the budget.
Here's where most of us get it wrong before we even start: Our instinct is to blame the hospital administration or PE management for every restriction that annoys us. It feels obvious. They added a rule, so they must be the problem.
I did this myself when I pushed to change how we set up a room in the OR to speed up turnover. I assumed it was a cost-cutting call from someone who'd never scrubbed in. It wasn't. The real issue was infection control and maintaining a clean room standard that satisfies both state inspectors and the hospital's own risk management team. I was so sure I was right that I went and pulled the actual code, fully expecting to find backup for my case. Instead, I found the opposite. Just because I'd been doing it a certain way for years doesn't mean it was ever correct. As it turns out, "We've always done it this way" is not a legal defense. What looked like management getting in my way was actually management keeping me out of a much bigger problem. I could have walked into that conversation assuming bad intent, arguing against a rule that had nothing to do with money and everything to do with liability.
The same thing happened when I was told to document more thoroughly on every cataract consult. My first reaction was that management just wanted more boxes checked to justify their own existence. Turns out, the real driver was compliance and audit risk. A single audit finding can cost a practice far more than the minutes I was losing per chart, and it can put the whole group's contracts on the line. Once I understood that, documentation stopped feeling like busywork and started feeling like insurance. Funny enough, I then sat on the board for our PE group, making me the one who had to hold other doctors accountable for their charting habits. On the call, I am careful to always lead with the “why” before providing supporting source documents and real audit cases. Turns out, it lands a lot better than "because compliance said so."
Building an Informed Case for Change
This is the trap: We assume the decision maker is standing between us and better patient care, when often they're standing between us and a regulatory or financial risk we never even see. Before you build your case, ask why the current rule exists in the first place. You may find that the obstacle you're trying to remove is quietly protecting something you didn't know needed protecting. Understanding the “why” builds mutual respect and empathy, but more importantly, it hands you the exact strategy you need to make your case for change.
Once you establish this, the next step is to learn the language of the decision maker. In private practice, the focus is efficiency and revenue. In a hospital setting, it relates to the established budget and department needs. In PE, it relates to EBITDA (earnings before interest, taxes, depreciation, and amortization) and capital expenditure allowance. Meet with the decision maker and ask what factors impact their decision for change. Get granular details and fully understand them, so when you do need to drive change, you can use their language and logic to present your “why.” No matter which language you learn, it always translates back to the same thing: impact on the bottom line. Speak in terms of the outcome they are accountable for, and you will have their attention.
For example, I wanted a new diagnostic test for cataract surgery. From my own research, I knew why I had to have it. I also knew the decision maker had to work within budget and meet revenue projections. My presentation focused on how this tool would provide better outcomes and allow me to better educate patients about the impact of astigmatism on vision after cataract surgery. That better understanding, I explained, should increase my femtosecond laser and toric conversion by 5% to 10% a year. It was October, so I asked to have it added to the following year's budget with the hope of purchasing it in January. Once I had the equipment, I met again a few months later to show reports of better outcomes and the revenue impact of that education. That success made my next ask easier. That experience taught me the real lesson: The ask was only half the battle. The other half was everything built before I ever walked in the door.
Agency isn't just about knowing what to fix; it's about building the kind of relationship where fixing things is easy. The most effective change method is to not show up only when you want something or when there is a problem. Instead, meet on a regular cadence, with an agenda, creating space for ordinary, low-stakes conversations alongside the necessary ones. By the time a hard conversation is required, the rapport already exists, and it becomes less about winning a point and more about the “why.”
Every conversation should return to one anchor—not what's best for you or even for staff, but what creates the best patient experience and outcome. Resist the urge to correct or complain in the moment unless it's truly urgent. It is best to save it for the agenda, where it can be raised and decided deliberately. Half of your list, and half of theirs, will resolve on its own simply by giving it time and space, rather than forcing it in the moment.
Relationships Are Foundational to Change
True agency actually lives in the discipline of showing up consistently before you need anything, not just in the big confrontation. This will build a real team culture and make work feel less like work. Avoid the pitfall of complaining about work and management in the hallways or randomly to your staff. This sets that same mood for the entire team, and they will spiral toward negativity. Instead, model positivity and earn the standing to ask for change when it truly matters. Dialogue built this way isn't a soft skill; it's the infrastructure that makes every future fix possible.
I tell my staff, almost daily, to expect fires. Not because I'm a pessimist, but because a practice with 0 fires is either lying or not addressing concerns. When small problems are just part of the job, nobody panics; they grab the extinguisher and move on.
The same goes for bigger changes. Educating your team to engage with change is essential, because nothing kills momentum faster than a staff that finds out about a new initiative the same day it launches. Recently, I added a novel premium lens for cataract surgery that demands significant time with the patient before and after the procedure to succeed. I could see the eye rolls coming before I even finished the sentence. It would have been easy for my team to hear, “Great, more work and yet another thing to explain to patients,” and quietly file it under things to resent. So instead of an email announcement or a 5-minute huddle, I gave them an actual presentation. I explained the technology, showed them how patients would benefit, and then did something that apparently still surprises people: I asked my staff how they thought we should roll it out. Turns out the people doing the work every day have better implementation ideas than the guy who read the journal article. We met weekly at first, sharing early patient wins, troubleshooting what wasn't working, and adjusting as we went. Nobody was handed a protocol and told to figure it out on their own at 4:45 PM on a Friday. Within a couple of months, the team stopped talking about the lens as "extra work" and started talking about it as "our outcomes." The shift from me to we is the whole game. Change built this way stops being something that happens to your staff and becomes something they helped build. If you skip the strategy and the intent, you're not managing change—you're just managing chaos within the clinic.
So the next time you're running late, missed lunch, and hunting for someone to blame such as check-in, front desk, or the budget, remember my senior partner's shrug. It's still your fault; however, that's the good news. The fires won't stop coming, but you get to decide whether you're the one stewing in the tech area or the one who already saw it coming. Change in your practice, whether it's your schedule, your team, or the decision maker who controls your budget, only happens when you decide to own it. Agency doesn't fix every bad morning. It just means you stop waiting for someone else to fix it for you.
“Cry without weeping, talk without speaking, scream without raising your voice.” —Bono, "Running to Stand Still," The Joshua Tree, 1987.
