EP326: 2025 Retrospective - What Actually Worked (And Flopped) for Physician Entrepreneurs.

Transcript
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Hey everybody, welcome to another edition of Bootstrap MD, the podcast for physician and healthc care entrepreneurs. I'm Dr. Michael Luming. I have been a physician entrepreneur for over two decades.

And today we're going to do something a little bit different. We're kicking off a two-part series where I'm going to give you a full retrospective on 2025. And then next week we're going to look ahead about what's coming in the new year in 2026. So, in this episode, we're kind of hitting the pause on what we usually discuss, and we're going to have a look back at 2025.

What actually worked, what completely flopped, what trends most physician entrepreneurs maybe completely miss while they're too busy chasing that bright shiny object. Now, if you've been listening to this podcast for some time, or if you're part of my clients or in my mastermind group, you know I'm not interested in hype. I'm interested in what's real. And in 2025, I think gave us a lot of clarity.

Some of it was painful, some of it was exciting, but I think all of it was useful. So, here's how I want to break this down. Today, it's going to be the retrospective. We're going to cover the wins, the losses, the trends that flew under the radar, and then next week, we're going to dive into 2026 predictions, and my goal is to give you an actionable playbook that you can literally start implementing starting this week.

So whether you're a full-time clinician, you're thinking about your first site venture, or maybe you're already running multiple businesses, I think this episode is designed to help you make better decisions faster. So let's dive in. So let's talk about the big wins in 2025. What really crushed it this year?

And I think the clear winner was doctors who understood the power of cashbased and hybrid practice models. Not just being anti- insurance just for the sake of being contrarian, but strategic distance from insurance dependence. Because here's what I would see in my coaching clients and in my communities. Physicians who are owning that patient relationship.

They're not just writing prescriptions. They are absolutely dominating and insurance-based practices are keep getting squeezed. Reimbursements are not keeping pace with overhead. Prior authorizations, unfortunately, are getting worse.

They're not getting better. And the doctors I know who are staying purely insurance dependent spent a lot of 2025 playing defense. Meanwhile, the doctors who are building insurance models, maybe some insurance, maybe some cash pay, some membership models, they're building leverage. They weren't beholden to one revenue stream.

They could choose their patients. They could design their schedule. They had pricing power. And the key insight that I think from 2025 is that these microniches beat me to tellahalth every single time.

I've seen a number of physicians and companies are launching generic teleaalth businesses, weight loss, men's health, hormone optimization, and most of them are struggling. Why? Because they're competing on price in a commoditized market with zero differentiation. But the doctors who can narrow that even more, they're the ones who are winning.

I'm talking about physicians who are building a cashbased practice just in their area exclusive for let's say pmenopausal women who are in executives. They were run executive roles or the ones who creating a hybrid model for endurance athletes who have overtraining syndrome. They weren't just better doctors, they were better positioned. The lesson here isn't cash pay is good, insurance is bad.

The lesson is you need to own the relationship. You need to own the positioning and don't compete or the only variable is price. Now, the second big win in 2025 was content. Not just content as marketing, but content is building an infrastructure.

And I've been saying this for years, but I think in 2025 it was the year it became undeniable. Doctors starting YouTube channels, podcasts, email lists, they became their owned assets. And the physicians who build them didn't just get attention. They built trust at scale.

They build authority that translate into pricing power, referrals, and long-term leverage. And here's what happened. Algorithms are changing. They've been changing again.

Instagram reach dropped. LinkedIn engagement is becoming unpredictable and the doctors who bet everything on these rented platforms, they're getting burned. But the ones who are owning their distribution, they're fine. Better than fine.

They thrive. They're building their own podcast. They're building their own newsletters. Long form trust is going to beat short form verality.

the physicians in our mastermind that that we work with who are committed to just one long form platform, whether there was just a podcast or starting their own YouTube channel, a weekly newsletter, they saw compounding returns, not just followers, but actual patients, actual clients, actual business opportunities. And here's the thing that nobody is really talking about. Content doesn't just attract patients, it filters them. So, when somebody's listening to 10 of your podcast episodes before they book with you, guess what?

They're already pre-sold. I see it all the time. They trust you. They understand your philosophy.

They're not just price shopping. They're choosing you specifically. So, if you sat on the sidelines in 2025 thinking, "I'll start creating content when I have time." You missed a major window. The good news, 2026 is still early enough to build this, but you need to start now.

And you need to commit to consistency, not perfection. And if you're somebody who says, you know, I want to start my own podcast, but I'm not sure what's the right way to do it. Or maybe you've already started your podcast, but you're not getting the reach that you want. I highly encourage you to come to our podcast podfest.

Our physician podcastfest is happening in January in just a few weeks, happening in Orlando, Florida. It's part of the podcast expo, one of the biggest and the oldest podcast conference that that is out there. We have all the details and links in and we love for you to be a part of it. Myself and my business partner Dr.

Anne Trang and we've also got some amazing guests that'll be there as well. I think it's the best way to get started in podcasting. Again, go to the link below for you'll find out more information. Okay, let's go back to our retrospective.

The third win in 2025, and this actually got surprised me, is that physician investors are finally got smarter. And I mean finally, for years, I watched doctors get pitched on every shiny syndication, every passive income real estate deal, every crypto scheme, every startup that needed physician advisors. And again, I was a part of this as well. I'm not saying I'm totally on there as well.

I got caught into this as well. And a lot of doctors did get burned. Not because they were dumb, but not because they were busy. They didn't understand the deals and just sometimes it just deals didn't work out.

But I think 2025 was different. I saw a real shift in the physicians I'm working in. They stopped chasing the yield. They started asking better questions.

They focused on three things: cash flow, operator quality, and control. So instead of just signing up as just passive LPS and deals they didn't understand, they started looking for smaller, more hands-on opportunities, maybe some gop roles where they had some influence advisory positions where they could add value and get some equity business where they actually understood the model. They also stopped over diversifying. Instead of being in 12 mediocre syndications, they consolidated in maybe three or four high conviction bets where they knew the operators, they understood the risk and they had downside protection.

So what I think is the big lesson from 2025, diversification isn't protection if you don't understand what you're diversifying into. I think real protections comes from knowledge, comes from control, and comes from alignment when you have operators that are competent and know what they're doing. So, if you're a physician investor, I think 2026 is about fewer bets, higher convention, and strategic alignment. So, it's a little tease what we're going to have next week.

Not just going after what's the hottest deal, but do I understand the business and do I trust the person running it? All right, let's go on to what failed. Here's what they failed in 2025. Commodity tele medicine.

I think this is the biggest loser. I'm talking about companies they launched these cookie cutter tellah health businesses with no differentiation no positioning no moat again I love weight loss I know menhouse I love hormone replacement but there was a ton of them and these markets got absolutely flooded not only last year but the year before and the doctors who jumped in late thinking you know I just got to do what they're doing they're getting crushed because it's not becoming a race to mono on pricing when you're competing on just convenience alone you're competing against ventureback platforms who can lose money for errors. You can't win that fight if you're a solo physician or a small practice.

And worse, these doctors had zero leverage. They were dependent on platforms whether they were a tele medicine provider, a fulfillment pharmacy or marketing agency. The platform could change the terms, they could raise the prices or cut them off entirely and they had no recourse. The hard truth, if your business model is, hey, I'm a doctor on a platform, you really don't have a business.

You have a job with just some extra steps. The doctors who succeeded in tele medicine in 2025, they weren't just competing on convenience or price. They were competing on expertise, on trust, on positioning. They built niche authority.

They created proprietary systems. They own the patient relationship from end to end. So, if you're thinking about launching a tele medicine business next year in 2026, don't ask about just like what's trending. Ask what can I be the best in the world at?

because anything less than that is just a commodity and commodities won't build wealth. The second thing that failed in 2025 and again this one was hurt to watch was the passive income myth. I saw so many physicians buy to the idea of set and forget businesses, digital products, online courses, rental properties, syndications. Pitch was always the same.

Build it once, earn forever. But didn't really work out that way. Digital products require constant updates. Customer support and marketing.

The courses needing relaunching, content need to be refreshed, and there's community management. If you're into real estate, rental properties had maintenance issues. They have tenant problems and market fluctuations and syndications. Some have straight up underperformed or they went sideways.

Here's what 2025 taught us is that passive income isn't passive. It's less active than a full-time job for sure, but it's not zero. And physicians who underestimated that operational drag, they struggled. So, I saw doctors courses and then they wonder why they weren't selling.

It's because nobody knew anything about them. Marketing isn't passive. I saw doctors buy rental properties and they resent the time and the mental energy it took to manage them. I saw physicians invest in businesses they didn't understand and then panic when things didn't go as they planned.

Now, the lesson here isn't passive income is a scam. It's that passive income is a spectrum. There are some things that are more passive than others, but be honest. Nothing is truly handsoff, especially in the beginning.

Now, if you're building for leverage in 2026, be honest about the effort that's going to be required. Don't lie to yourself about how passive something will be. Build systems, yes. Automate, yes, but don't expect magic.

All right, let's talk about the third failure that I saw in 2025. AI hype without any integration. Now, I know a lot of you bought the tools chat GPT, Descript, Claude, Otter, you name it. Physicians, they were subscribed to everything, but almost nobody actually integrated these tools into their workflows.

Maybe they buy their AI scheduling tool, but then they still manually confirm appointments. They buy the AI note-taking tool, but they didn't review the output. They buy the AI content generator and then let it sit unused because hey, I'll just figure it out later. There was no time for later.

And then they wonder why they weren't seeing an ROI. Because ROI, return on investment, requires usage. It requires workflow change. It requires process redesign.

So here's the thing, the truth about AI in 2025. The techn is there. The problem isn't the tools. I think the problem is adoption.

physicians didn't commit to just learning the tools, testing them, and redesigning their systems around them. But the doctors who did integrate AI, they're the ones who are seeing massive leverage. I'm talking 10 to 15 hours a week back into their schedule. They're getting better content output, faster admin work, more time with patients, and more time off.

Now, this isn't happened by accident. It happened because they were committed. They were committed to learning, experimenting, and iterating. They didn't just buy tools.

They changed how they worked. Now, if you're sitting on a pile of unused AI subscriptions right now, don't worry. Don't beat yourself up in the head. But I want this to be the year 2026 to actually start implementing, not buying more tools.

Implement the ones you have. Just one tool fully integrated. That's going to be 10 tools that are just collecting dust. Now, let's talk about some quiet trends in 2025.

This may be the ones that most physicians completely miss because they were just too busy changing that shiny object. Trend number one I think is physicians who are shift from side hustles developing ecosystems. Physicians stop thinking in terms of these side hustles and start thinking in terms of ecosystems. So what do I mean by that?

Instead of just saying hey you know I've got a practice and I created a course they're building interconnected systems a practice that created a membership. It fed into it. A membership that led into creating a mastermind. A mastermind that fed into a podcast.

A podcast that fed back into the practice. So the doctors who built this way didn't just diversify revenue. What they did is they multiplied leverage. Every piece reinforced the other.

Every platform built authority that felt fed the next platform. So here's the key. I think the key is stopping saying yes to everything and start choosing fewer bets, but have deeper focus. Instead of just launching five separate mediocre things, build two extra things and make sure they're connected.

Another quiet trend that most doctors miss is this rise of community, membership, and education. This is really where I think it layers onto these clinical offers. We saw this in our mastermind constantly. Doctors who added a membership component to their practice, they're seeing their patient retention skyrocketed.

Doctors who added an educational lever to that, whether it be group coaching, developing workshops, courses, they extended the lifetime value and they deepened their impact. Now, patient care alone is capped. There's only so many patients you can see. There's only so much you can charge per visit.

But you can create an educational component to your practice which will scale. Community scales and the combination of clinical care plus education plus community. You're building a moat. So the physicians who figured this out in 2025, they're the ones entering 2026 with real leverage, real pricing power, and real freedom.

Finally, the third quietest trend that I've seen, doctors are choosing fewer bets and they're going deeper instead of wider. So, for us, the advice was, "Hey, diversify your income." And I don't believe that's completely wrong, but 2025 showed death that spreading yourself across 10 mediocre ventures is worse than focusing on two exceptional ones. So, the doctors went deep on this. They really committed to mastering in one niche, one business model, one platform, and it outperformed everything else.

and it wasn't even close. So, if you're entering the new year feeling scattered, feeling like you're doing too much and accomplishing too little, I think this is your permission slip. This is your permission slip to simplify things. Just maybe pick one or two things and then go all in.

Build mastery, build depth, build leverage. All right, that's my retrospective in 2025. So, what did we cover? We covered what works, cashbased models, content as infrastructure and smarter investing.

We also covered what kind of flopped commodity tele medicine passive income myths and AI tools that are just gathering dust. We covered the quiet trends that most doctors are missing that shift ecosystem, the building of power of community and education and the value of going deep instead of just going wide. Now, next week, we're going to dive into 2026. I'm going to give you my predictions for where a smart physician entrepreneur should lean in for your business, for your practice, for your investments, and then I want to get actionable.

I'm going to give you a playbook in 2026. Three specific decisions you need to make before the year really gets going. Now, if you find this episode was valuable, share it to a physician friends who maybe needs the clarity. And I will see you in part two.

Remember, as entrepreneurs, you're going to have your ups and your downs. Do a little something each and every day to get you closer to your goals and keep moving forward.