Dear Reader,
We hear it constantly: "Good systems are the foundation of a successful practice."
This is true. Systems streamline your work, reduce decision fatigue, and let you focus on what matters. Most practices need more of them, not fewer. The evidence suggests that thoughtful systems lead to sustainable practice growth.
But there's a significant part of this narrative that remains unaddressed: the space between implementation and results.
It's the period when you've carefully designed your patient flow, created your documentation templates, established clearer boundaries... yet somehow find yourself more overwhelmed than before. You quietly wonder if something has gone wrong.
This week, I want to examine that part of the journey: the weird, wobbly, uncomfortable middle of building capacity.
When we set up systems, we're building capacity. And it turns out that building capacity doesn't feel like a deep exhale at first—it feels like... effort.
And not just logistical effort. Emotional effort, too.
Systems = capacity (eventually)
Putting systems in place helps increase your capacity for patient care and whatever else you might want to create in your business or life.
For me, that "something else" is this newsletter, and the larger project it's part of – supporting clinicians in building their practices and creating effective systems. I've always known I wanted to do patient care and something else. This is that something else. At least for now.
Here's the honest truth: building capacity through systems requires an initial energy input. You have to take time to reflect on what's working (or not), troubleshoot the messy parts, and stitch together a process that was previously duct-taped together. All while still doing the work.
This part doesn't get talked about nearly enough. When someone's selling you a template or program, they rarely mention the awkward adjustment period. They make it sound like: "Boom! System implemented = instant capacity and flow!"
But that's not how it works.
I was reminded of this reality over the past two months. March and April were busier than ever in my practice, which is good, right? That's what we all want. But there were moments where I completely forgot about this uncomfortable period of system-setting and just felt... overwhelmed.
What I discovered was that strengthening one area revealed weaknesses in others once they're truly pressure-tested. Suddenly my lab ordering process and patient messaging system showed cracks I hadn't noticed before.
So yes, systems expand what's possible. But first, they usually just make you tired.
The uncomfortable middle
There's a moment in every system-building journey where you think, "This is worse than before." And in that moment, you are not wrong.
Because building capacity often means confronting what hasn't been working. It means sitting with inefficiency, outdated beliefs, and the awkwardness of doing things differently.
For me, overwhelm manifests as clenching down, holding too tightly to everything that needs completion. It feels like riding a never-ending rollercoaster without a seatbelt when I'd much rather be relaxing on the couch.
The irony? It's busy because I set up systems to make it that way. My systems are working, they're bringing in more patients, but I haven't yet built the secondary systems needed to support this growth.
It can bring up old stuff:
- Money stories.
- Fear of being "too much."
- The urge to abandon the thing before it's even had a chance to launch.
- The temptation to be more agreeable than you actually have the capacity for.
- Surprising emotional reactions to your own success or expansion.
This last one caught me off guard. We don't often discuss the emotional turbulence that can accompany expanding capacity or earning more money. Counterintuitively, sometimes the most resistance emerges right as you're breaking through to new levels of success.
Just when things are going well: when the schedule is filling up, when the revenue is increasing, anxiety can spike. "Can I really handle this?" or "Do I deserve this?" Our brains are wired to be suspicious of change, even positive change. New patterns mean uncertainty, and uncertainty triggers our threat-detection systems.
I remember when my practice first hit a significant income milestone. Instead of celebration, I felt a strange mix of pride and panic. I found myself worrying more about making mistakes, second-guessing clinical decisions I would have made confidently before. It was as if the stakes felt higher simply because more people were trusting me with their care.
The key is recognizing these reactions for what they are: not signs that you should retreat, but normal responses to growth that need to be gently acknowledged and worked through.
Practical ways to navigate the messy middle
When you're in this uncomfortable phase, a few strategies can help you push through:
- Retain your curiosity: What's working well? What's still not clicking? This investigative mindset helps depersonalize the friction.
- Take strategic breaks: Sometimes the most efficient thing you can do is step away. When you return with fresh eyes, solutions often appear that weren't visible when you were in the weeds.
- Regulate your nervous system: The discomfort of change is physical as much as mental. Regular meditation, breathing exercises, movement, and sleep can help your body process the stress of growth.
Remember, this journey is rarely a straight line. The path to capacity almost always includes detours, backtracking, and moments of doubt. That's not a sign of failure—it's just part of the process.
What happens on the other side
But if you stay with it—if you keep going through that uncomfortable middle—there is an other side.
When your primary systems become more finely tuned, and when the exposed weak spots get strengthened to allow the big picture to run more smoothly, capacity genuinely expands. The mental bandwidth returns. Suddenly, I have space to read a book, create something new, or engage in the activities I know nurture my health and wellbeing.
I've seen this play out in my own practice recently. After implementing a structured package system for new patients that creates a clear container for the initial stages of the relationship, I've experienced some of my highest revenue months ever. I received coaching on how to set up these packages—guidance that accelerated the process significantly—but even with that support, it felt initially like extra work.
Even with expert guidance, it took a full 6 months to refine the offering, learn how to explain it to potential clients, and manage my anxiety about changing my business model. But now that it's running smoothly, it's created exactly the kind of capacity I was seeking.
On the other side, systems buy you time. They buy you presence. They give you a sense of control over your schedule, your energy, and your creative bandwidth.
That's when capacity expands.
You get to choose what to do with that new capacity: feed it back into your practice, take a nap, or build a new offer that feels like the most "you" thing you've done in years.
It's not about productivity for productivity's sake. It's about opening up space—and using that space intentionally.
A few questions for you this week:
- Where are you running on grit instead of structure?
- What are you holding together with duct tape and vibes?
- Are there any systems you've been meaning to build but haven't (because, let's be honest, they sound exhausting)?
- What might become possible if you didn't have to hold it all in your head?
- What emotional reactions have surprised you when you've started to expand or succeed?
Capacity doesn't show up on its own. We build it. Slowly. Imperfectly. Sometimes, while crying and swearing under our breath.
But once it's built, it gives back. Over and over again.
And that, to me, feels like a pretty worthy trade.
With care,
Katy
PS: Want systems that create capacity? I offer 1:1 support for clinicians building systems. Learn more here.
