How to Maximize the Last 5–10 Years of Your Practice

Estimated reading time: 5 minutes 

A great set of questions came in from doctors who are 5–10 years from slowing down—or who are around 60 and want to work less but earn the same.

Let’s go through this practically.

1. “I’ve Got 5–10 Good Years Left. What Are My First 3 Moves?”

If I’m coaching someone in the back half of their career with a solid but flat practice, here’s exactly what I’d do.

Move #1: Block Low-Value Patients

Put all routine care on one half day or one full day per week.

That’s it.

No scattering it across your week.
No letting it fill prime-time slots.

Structure creates margin.

Move #2: Buy Back Your Time With a Scribe

If you can afford it, hire a scribe.

Yes, maybe $30,000 per year.

But:

• You stop charting at night.
• You stay present with patients.
• You increase efficiency.
• You reduce burnout.

In the back half of your career, energy matters more than ever.

Move #3: Focus Only on What You Love

If you have 5–10 years left, why are you still doing things you hate?

Choose what you enjoy:

• Shockwave
• PRP
• Orthotics
• Surgical cases
• Sports
• Regenerative care

Whatever lights you up, lean into that.

And yes—start taking more time off.

2. “I Have 20 Google Reviews. Competitors Have Thousands.”

This one’s simple.

They’re not necessarily better.

They have a system.

If someone has 1,000+ reviews, it’s because every patient gets asked automatically.

You have two options.

Option 1: Organic

Use a QR code on a card, hand it to every patient and ask at checkout.

Option 2: Automated

Use a system like Swell.

It integrates with your EMR and automatically sends text or email review requests to patients.

That’s how you scale reviews.

You don’t need thousands overnight. But you do need:

• Consistency
• Replies to reviews
• Reviews embedded on your website

Reviews absolutely influence referrals.

3. “Good Feet Sells $1,200 Prefabs. I Can’t Sell $350 Customs.”

There are three things I would look at.

Presentation: Use a Dynamic Demonstration

Go visit the Good Feet store.

See how they present.

They:

• Do gait analysis.
• Create a structured demonstration.
• Control the environment.

You need your own version of that.

For me, I might:

• Show heel eversion.
• Show X-rays.
• Show collapse.
• Explain the long-term effects.

Demonstrate, don’t just recommend.

Belief

If you don’t believe orthotics work, patients won’t either.

Confidence transfers.

Raise Your Price

If you’re charging $350, that’s too low.

We charge $600–$700+.

Low price can signal low value.

Sometimes I also start with a prefab and credit it toward custom orthotics if needed.

But the basic formula is:

Belief + presentation = sales.

If you struggle with this, go shadow someone who does 10+ pairs per week.

One day of observation could change your income permanently.

4. “I’m Paying $400 a Month for Marketing. Is That Enough?”

$400 per month won’t get you much.

That’s only $100 per week.

You might get one blog or some basic maintenance.

Before spending money on ads, however, make sure you already have:

• A fully optimized Google Business Profile
• Consistent SEO content
• Email-list marketing
• Tracking phone numbers
• Proper analytics

If your Google Business Profile isn’t even filled out, that’s basic.

You need to ask your marketing vendor a simple question:

What are you actually doing for me?

Cheap marketing usually equals cheap results.

5. “How Do I Phase Out Low-Paying, High-Volume Stuff?”

This is repetitive—but it works.

• Block nail care into one day.
• Reduce unnecessary follow-ups.
• Use 10-minute slots for simple checks.
• Keep 20-minute slots for higher-value visits.

Then increase your average visit value.

Here’s some perspective from my practice:

• One amniotic case = 15 routine visits
• One Liposana = 15 routine visits
• One shockwave package = 2–3 visits
• One orthotic pair = 6 visits

You cannot scale with office visits alone.

You need to layer in appropriate:

• DME
• Procedures
• Office dispensing
• Packages

6. “I’m 60. I Want to Work Less But Make the Same.”

Here’s a realistic five-year plan.

Step 1: Drop Bad Insurance

Stop taking plans that pay poorly.

You cannot work less if your payer mix is weak.

Step 2: Compress Low-Value Care

One half day.

That’s it.

Step 3: Tighten Follow-Ups

Use:

• Fewer unnecessary visits
• Proper coding
• 10-minute slots for simple cases

Step 4: Increase Average Visit Value

Go from $100 per visit to $200 per visit.

That alone changes everything.

Step 5: Remove One Half Day

Then eventually remove a full day.

Replace volume with value.

That’s how doctors in their 60s can maintain income while regaining freedom.

The Bigger Idea: Protect Your Energy

In the back half of your career, it’s not about grinding harder.

It’s about:

• Structuring smarter
• Pricing confidently
• Eliminating drag
• Protecting your energy
• Increasing value per visit

You don’t need 10 new systems.

You need three or four disciplined changes.

Key Takeaways

Block low-value visits into one structured day.

Buy back your time with a scribe.

Raise orthotic prices and improve your presentation.

Automate Google reviews.

Evaluate whether bad insurance contracts still belong in your practice.

Increase average revenue per visit so you can reduce volume.

The goal isn’t simply to produce more.

At this stage of your career, the better question may be:

How can I build a practice that earns well without consuming all of my time and energy?