Why Some Business Owners Love Their Companies—and Others Don't

I've met an unsettling number of business owners who have built companies they now hate.

Me? I love my business. I look forward to going in every day. Sometimes I even sneak away on weekends to work on things (shhh, don't tell my wife). All jokes aside, She is the most supportive person of my business.

I suggest you find a partner that does the same. That will also make a massive difference.

So, what makes the difference? Why do some people end up loving the companies they built while others end up resenting theirs?

Here's the kicker: people who hate their businesses usually built the wrong ones. They followed someone else's blueprint without asking themselves what they really wanted.

The Two Paths for Physical Therapy Clinics

As a physical therapy clinic owner, you're at a crossroads. You have two choices:

1. Stay small and create a high-performance boutique clinic.

2. Scale up to multiple locations and never stop growing.

I've bounced between these ideas over the years, but here's where I stand right now (strong opinions, loosely held):

There are only two true paths to success as a PT clinic owner. You can't get stuck in the messy middle.

What's the Messy Middle?

I heard this term a while back—can’t remember where—but it didn’t click for me until recently. The "messy middle" is this uncomfortable place where you're too big to be small but too small to be big.

Let’s take a trip back to 1584 for a minute. Imagine the middle as the vast Pacific Ocean. You could stay in Europe and build a solid business, or you could risk it all and sail to America for a shot at something bigger.

But you definitely don’t want to get stranded at sea (which, coincidentally, is one of my wife’s greatest fears).

That’s kind of like deciding between these two models.

The Case for Boutique Clinics

Positives:

• Agility: You can pivot quickly and adapt to market changes.

• Perceived Value: Being a small, independent clinic often means people see you as offering higher quality service.

• Manageability: Easier to manage and still treat patients if you love that part of the job.

• Culture: Easier to build a great culture. It’s not a guarantee, but it’s simpler.

Negatives:

• Limited Growth: Minimal opportunity for employee advancement.

• Resources: Fewer resources to compete with bigger clinics.

• Referral Challenges: Harder to secure physician referrals. When we had just 1-2 clinics, docs would say, “I just send to ATI because they’re everywhere, and it’s easy.”

The Argument for Large, Multi-Site Clinics

Positives:

• Growth Opportunities: Talented clinicians want to be part of something that’s growing.

• Expertise: As you scale, you can hire specialists for HR, finance, customer service, etc.—all the stuff you might not love doing.

Negatives:

• Employee Mindset: The bigger you get, the more employees act like employees instead of owners. When people feel like they’re helping build something, they go the extra mile.

• Culture Building: Tougher to create a unified culture across multiple locations.

• Profitability: More challenging to stay profitable and maintain cash flow while scaling.

So, What Kind of Business Do You Want?

This isn't a decision you make in a couple of hours. Think long and hard about the type of business you want to run and what your life looks like doing that.

A little context on where I’m coming from: My company is currently in that messy middle on the way to becoming a large company. (And yes, I still love my business. I just know where I am in the process.)

When we were small, it was simpler. I could talk to all my employees every day. I only had to figure out how to fill a few providers, and we had just one location to worry about.

Now, with 26 employees, if each one has an issue 5% of the time, I’m dealing with problems all the time.

So before you go any further, figure out what you really want.

If you're not ready to cross the valley of death, stay small and build a cash flow machine. If you want to grow big, be prepared to take risks and move fast. Always be thinking about how to replace yourself so you can focus on bigger things.

More on how we got here in the next one.

Cheers,
Zach