Wins and Lessons Over the Last Year with Veteran Entrepreneur Dr. Sarah Merritt

If your business isn't working the way you expected, it's not because you're bad at business. It's because no one ever taught you.

How it actually works.

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Hi docs. Welcome to the Entre MD podcast where it's all about helping amazing physicians just like you. Embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms.

I'm your host, Dr. Umna. Well, hello everyone. Welcome back to another episode of the Entre MD podcast. We're going to be looking inside the OntraMD business school. I have Dr. Sarah Merritt here. She is a rock star physician entrepreneur, has been in the on trendy business school for a number of years. I'll let her say how many years that is. She's considered an og, I guess, or elder. I don't know. We change our minds all the what that title is, but this is going to be a fun interview. I've been looking forward to it. We've tried to schedule it for a few months, really at this point, but in the meantime, she's only gone on to learn more lessons, create more wins. So it's gonna be an even better episode. So, Dr. Sarah, welcome to the show.

Thank you. Thanks for having me.

Yeah. So I'm gonna give you a moment to introduce yourself to the lovely people of the on trendy community so they get a feel why I'm so excited that you're here on the podcast today.

Sure.

My name is Sarah Merritt. I'm an anesthesiologist and interventional pain fellowship trained doctor. I'm also board certified in addiction Medicine and my practice does primarily acute and chronic pain. We also treat some patients with addiction problems. Our practice is called Lifestream Health center and we're located in Bowie, Maryland.

Love it. All right, guys, buckle up. Get ready. So first of all, I just thought of this question like two minutes before you came on and I'm like. And I'll let you start off by saying how long you've been an entrepreneur, how long you've been in the entrepreneur business school, but at this point you're a seasoned entrepreneur, right?

Yes.

And what is one thing you'll say as a seasoned entrepreneur, one thing you've learned, one piece of wisdom you now have just because you've done this so long?

Um, I think it's really that entrepreneurship for that early entrepreneur or for me, I think I see a lot of similarities in the things that don't change. And, and that you're really just betting heavily on yourself. And if you're ready to bet heavily on yourself over will the system do this for you? Can you trust big medicine to create the opportunities for you that you deserve? Or are you ready to bet heavily on myself? On yourself. For me, that was like a no brainer when I had an opportunity to kind of slide into an existing practice and become an entrepreneur. I've been, I've been unemployed from, by other entities for 10 years at this point. And we're making it work. It's, it's been a ride and a journey and something that's been a source of a lot of growth and learning. So my very first year, you know, we moved to Maryland and I was working part time in my current practice and I didn't own it. I had a favorable rate. So I wasn't paying a ton of overhead, but I was paying some overhead. I was seeing some patients and I was probably working two or three days a week. And at that time I didn't have much moonlighting and I probably made $70,000 that year. And so I like called my accountant at the end of the year and I had pulled some from my own savings and called my accountant crying. And like, I don't know if I can do this. And trying to, I don't know what I was looking for, but trying to kind of figure out, you know, does this make any sense? I haven't been an entrepreneur before. I don't have any entrepreneurial supports. You know, what, what do I do? And I ended up deciding to continue and that I was going to work more and go from being more part time to putting more, more effort into it. And, and so then I got in a position where I was making enough money to feel like I was, you know, supporting myself as a physician. And then ultimately I had an opportunity to buy the business. And, and what I would say is that I was able to make basically a 10x leap from that 70 to 700 over this period of time. And that's been super encouraging. And as doctor And I were just speaking, that's a lot of sales, marketing. Just getting out there, letting people know about your stuff really drives a ton of that to get to that level. But for me, I think that the next leap is just a whole other type of leap.

Okay, that's crazy. You know, I'm laughing. So, first of all, I had no idea. I didn't know about this story at all. But the second thing is there was a critical moment, which was after your first year, you call the accountant, you're crying, you're like, I don't think I can do this. And you had options to quit or to keep going. Right now at that moment, there was no way for you to know that you're going to go from 70,000 to 700,000 to a million to a multi seven figures. Like, you probably couldn't see it at the time. Yeah, you probably couldn't see that you would acquire. Because if you quit, you wouldn't have acquired the practice.

No, right.

Like, and so in those quote unquote, really dark moments, it's so important not to make decisions based on the moment, but based on what is possible. Like that. I mean, like, I have chills. Thinking about that is so crazy.

Yeah, there, there are big, big moments of deciding and, you know, to. I think I was trying also to dabble a little bit. Right. You know, well, we'll see how this works out. Let me try this a couple days a week. And at the time, my kids were littler and I enjoyed having some time home. And that wasn't necessarily a bad decision. But from a decision of growing the business, it's really important to be all in on whatever you're doing. And I think after that, maybe after that initial year of like, okay, there is some, there is some something happening here. It's not enough yet, but there is something happening here. Even though I think it was upsetting that I hadn't done more, I could see the way forward ultimately and that I did feel like I could, could grow it and could, could do more.

Yikes, this is good. Okay, well, thank you for sharing that. Thank. I mean, like, thank you. That was Good. So in the entrepreneur business school, and I guess in the entrepreneur community, we have this concept of eating frogs, right? Which just means doing these things that are seemingly really hard things you typically will procrastinate on, but give you the big, like, they move the needle the biggest in your business. So tell us about some of the frogs that you've eaten over the last 12 months. The really slimy, big, ugly, yucky ones that you've eaten.

All the unpleasant things, I mean. And I still have more frogs to eat, believe it or not. I might be working on it, making an effort. So there's a book called Eat that frog that Dr. Oona has familiarized me with. And as a result, I have a little frog on my desk at home, and I find him as a source of inspiration, just something cute to look at and a little reminder of, like, the things that are really important in your business to get at. And so I enjoy the frog on my desk. What are the frogs that I've been eating? Gosh. Working on standard operating procedures in my practice, that's been a frog. Because I'm a clinician, I'm a doctor. I really enjoy seeing patients. I enjoy counseling people. I actually like talking to patients, which not everybody enjoys or wants to do, but I actually enjoy that part. And so to dig deep and really change the business and set up the things for the business to work the way that it needs to, that's been a big frog for this year. Diving into financials, looking at my own QuickBooks versus just, oh, the accountant will do that or the manager will do that. These have been frogs that I've encountered talking to possible employees to recruit new bodies to the clinic, talking to doctors that we might want to partner with in some way. They're. There is just like an immense number of frogs that are the important things that will move your business that, frankly aren't the most pleasant. And it's real easy to hide in the exam room and do the work and see the patients and sign the notes, and that's what needs to happen sometimes. But is that really what's going to move the needle forward? And on the one hand, like having a good product, like doing a good job in your business, that does lead to growth in the business and more customers, more patients, more referring doctors, more referring practices. So the product is important, but it's. There's so much more than that.

All right, now, those really are some of the ugliest frogs, because I'm sure people are going like, oh, man, I've been hiding from that, right? Because you're talking about the things that will make your business sustainable, make it a business asset, put you in a position where if you wanted to work less, you could. But these are things that even I, these are frogs for me too, right? Who wants to do SOPs like standard operating procedures, like, who wants to do that? Look at the process. Because when you start looking at the process in the frog, there are other frogs. Like, this is a frog that has babies. You know what I mean? And there's just so much you want to throw it away, especially when you're like, yeah, but you know, my clients are being seen, my patients are being seen, there's no problem, then why should I touch it? Right? So you talked about that. You talked about diving into financials that used to make me break out in hives because I'm like, I don't want to see it, don't want to talk about it. And again, you're not building a sustainable business, not doing that. Right? Recruiting, collaborating, I mean, those are all the frogs. So thank you for sharing that and making that distinction of creating a good product, doing a good job, and then working on the business. Because they are two separate things. And as entrepreneurs, we have to keep our eyes on both. So. So good job eating the frogs. Now, the reason why I asked for that is because in your business over the last 12 months, you've created a lot of wins. And it's not because you're lucky and it's not because it just works out for you. These are some of the things you did, right? Like you dared to do the ugly stuff and it created some beautiful stuff. So let's talk about some beautiful stuff now that we've talked about frogs. So what are some of the wins? And you can go business personal, like all the things. But what are some of the wins you created in your business and in your life over the last 12 months?

Yeah, well, we've had our highest year in revenue ever in 2023 in my business. And we've been at a certain level, but that we're close to, but we've really notched up 10% and more over last year. And then what's really interesting about that, as you can imagine from a staffing perspective, we actually have five full time equivalent clinicians in the practice currently. Well, last year I had six. So I have one less clinician and more revenue. So that's great. This is like where you want to be as a business. We, last year was tough and we were trying to grow and had Some hiccups with that. But really where we've gotten to is seeing more patients growing. Our revenue, even though the revenue growth is actually bigger than the patient growth is small, and it's just made us more profitable overall. And so at the end of the day, if you don't have any profits, you won't be able to continue in business. Business. And that's just business 101. That as much as a physician, we don't want to think about money all the time. Oh, I'm not really here for the money, but it's just not sustainable. I can't pay to be here and I can't be coming out of my pocket to get to work every day and to support my staff. And even if I think they're wonderful, it just doesn't make sense. So profits are important. And that we've been able to reestablish a level of profitability, that's something that's sustainable and good for growth and for the future of the business. These are like, probably the big story of 2023 for our business.

Yeah, that works for me. And when people hear 10% growth. Now, let's be very clear. Okay. I remember when you came to share your story during one of our live workshops and you're like, yeah. And I had already crossed the seven figure mark before I came into entre business school. And this was years ago. So when we hear 10%.

Yeah. It's a thousand dollars. Yes.

Yes. This is lovely. This is beautiful. And doing it more efficiently because now you did it with less clinicians and all of that. So that's just wonderful. Congrats. I'm happy. I'm happy to hear that. And we are really big in the entrepreneur business school about this concept of building your dream business and building your dream life simultaneously. Right. Like, we already waited Med school, all those things. We kind of put our lives on hold for most of us. And we're just not going to do that again. Right? We're not going to do that. Entrepreneurship. So in the midst of eating these frogs, creating this year where you had your highest grossing year ever, did you have to give up your life or did you. Were you able to create a version of your dream life for this phase of your life?

Yeah, B. Absolutely. I've. I've created the. The version of my dream life for this phase of my dream life. Absolutely. I haven't worked clinically on a Friday and five years. I don't know, long time. That's just not something that I've had to do now am I working? Yes, but it's admin from home or if we take a long weekend as a family, then I can do that and I can do these things from elsewhere. And it just gives me a level of flexibility. And so I haven't compromised that. There are weeks that I have three clinical days. That really just depends a little on the schedule. So I'm trying to make sure that I have capacity, I want to see enough patients. I'm, you know, involved in my business. I enjoy doing that work, but I have to have time outside of it for the CEO work, for the admin work and then just to not be overworked. Right. For self care and all of those things outside. So yeah, I think that in terms of making this happen, no, I have not taken on any bigger number of clinical hours. It's just been a matter of working smarter and trying to focus on things that matter and get my team in tune with the outcomes and the things they can do that will drive success for the business.

So we didn't have to burn out to create that. And this is really important. Right. Because we want to have both simultaneously. And one of the things I work on as an entrepreneur is you probably heard me say this a gazillion times, like I'm not willing to build a business at the expense of my family. I want my kids to see entrepreneurship as a great thing. Right. Because they didn't lose their mother, they didn't lose their mother to it and my husband didn't lose his wife to it. And so in the process of doing this, how have you been able to balance? Like for instance, did your family have to suffer for that? Were you able to maybe even spend more time with your family? How did that play out?

Yeah, I don't think my family has had to suffer. I have attended two field trips this fall for my kids class. I have a boy in elementary school and a boy in middle school. And so I've been able to attend school events for them and that's been really fun. We have long weekends and things that we do as a family, I do in order to make sure everybody is cared for. We do actually have an au pair and that's been a really, I think that's been really advantageous for my family. I know different things work for different families, but I think it's so important to consider if you have two high earning professionals in your household, having a family member or a nanny or an au pair really makes sense. And on the one hand, my kids are currently 11 and 13, they're not babies. There's a line of thinking that would say, well, you don't need that person. Well, they don't need her, but I need her. It's not for them. It's for me. Just that extra. That extra support, that extra layer of another adult. And frankly, it's good for our marriage also, because then when it's date night, when it's time to go out, I don't need to think about dinner. I don't need to make sure people are fed like it's going to happen. Oh, that's been delegated.

It's been delegated. I love it. And you know how much I love the concept of realizing, one, that we need help. There's no prop. And two, there's no. We don't need to entertain guilt about getting help. I love that you say, yeah, they're 11 and 13, but I need her for me. They may not need her, but I need her. Taking all of that help and really just prioritizing your family, you know what I mean? So I hear you talk about the date night and all of those things, so I'm glad that you're having it all, in a way. Right. Because you're building the business that's working. You're building the family, like you're building all of this. And as we go along, we can just make it better and better. Right. Because it continues to evolve in the best way possible.

Yeah. We're always looking to achieve more and do more. And, yeah, this is the version of where I am right now, and I love it, and it is sustainable, and I anticipate only being able to do more.

Love it. Oh, my goodness, you have no idea how much I love it. Okay, now, in the entrepreneur business school, we talk about winning or learning, right? So if we're looking at the last 12 months, we don't say, where did you win? Where did you fail? Like, that's not what we say. We're like, where did we win and what lessons did we learn? And what that really does is it makes us so much wiser. Right. Imagine having all these challenges, making mistakes, all of that. And you don't pull any lessons out of him. You don't learn anything. Which means in the next 12 months, you're just going to repeat the same thing.

Right.

And so what are some of the lessons you learned over the last 12.

Months as an entrepreneur?

I know one that kind of fits with a pithy saying that has kind of stuck with me is a saying that Michael Eisner from Disney is credited with. And so one of the books we read this year in the Entre MD Business school was the Ride of a Lifetime by Bob Iger. And he describes his predecessor who had said, at some point, micromanagement is underrated because we all think, oh, we don't want to be micromanaged, or we don't want to micromanage other people. And so that all sounds bad, right? We should just trust our people and they'll do a great job and everyone's happy. And it's just not that simple. So this is where that saying really resonated with me, because my inner optimist and person that wants to support people, oh, well, if I just get this practice to like, a certain size and, oh, before I met Dr. Una had, we were doing multiple seven figures. Great. So this thing's just going to take off on its own. Right? I did what I needed to do. Now just hire some nice people and we'll ride off into the sunset. And oh my gosh, there is just so much more to it than that. And so for me, that kind of saying is kind of the opposite of what I used to think. That I used to just think, hire good people, trust them. And that's true. To hire good people and do trust them and do give them freedom and don't lord over people over their shoulders and watching their work. But on the other hand, like, you have to be plugged into your business. You need to know what's going on. You need to be setting the agenda, you need to be setting the plan. And the team, frankly, needs you for that. And so I don't think I'm truly advocating that anybody be a micromanager. But I think that's kind of like a silly way of saying it's not just all about, oh, hire good people and trust them. And I'm just the person in the background. No, it's not that. Because as a leader, it's critical that you're plugged in and involved and aware, or else you're not going to be able to lead.

That's a multimillion dollar lesson right there. Right. Okay, so I have a question for you based on that. How long. You may not have an exact time, but just arrange. How long did you resist the reality of that? Right. Because I know I was just like nine years. Yeah, she says nine years.

I think nine years.

Because what you're doing is you're giving somebody the gift you've taken one for the team. They don't have to wait nine Years. Right. They just need to come to terms with it.

Right.

So for you, how did that play out? So what are the. Some of the things you had to change because now you're this person who. You're responsible, you're plugged in and all of that. If you're, if your team were to say, oh, my goodness, Dr. Merritt, like her, her level of leadership was 10x over the last 12 months. Why would they say that?

Yeah, I mean, I think interestingly, I just find myself engaging almost in little ways and teaching more because even the way we use our electronic medical record, even the front desk will message with certain things. And whereas I might have previously ignored something or thought, well, the manager should address that, I might chime in about something, hey, let's make sure we're doing xyz. If I had some feedback. But the other piece of it maybe too, if we're talking about like feedback and plugging in with individuals on the team would be, we maybe want to praise people publicly, but to correct privately. And so while I might get a message on a group chat and I read this message, I'm like, oh, that's a disaster thing. That person just did that. I'm not going to get back on the group chat and correct that there. I might pull that person aside, send that person a direct message and say, hey, here's how we're going to do xyz. And versus just like thinking that somebody else's job, you know, that as the leader and the teacher and that I need to know, you know, how we do things. I'm not looking at those corrections and teaching moments as somebody else's job. And like, on the one hand, in an ideal world, if I'm an owner and I have a business that operates without me, I mean, that would be great. But I'm not there. And so I need to do this. It's not my role to sit back and assume the business will figure it out for itself. That's not going to happen. And if it has a hope of getting there, it's going to be through me getting it there.

Man. You, I mean, you've been talking about frogs and big wins and all this stuff, like all episode long. This is so good. And I like that you started with teaching because that's the thing I resisted the most. I was like, you're a good person. I hired you how to do this. I don't want to have. I believe in you. I don't want to have conversations about it. I don't want to deal with It. I was in so much resistance, like, why do I have to train people? Why do I have to do that? But the truth of the matter, like you alluded to, there is no freedom unless you do none. There's no freedom. And so he talks about teaching more, no longer ignoring things that needed to be coached or feedback that needs to be given, praising publicly, correcting privately, and all of that. And so now that you talk about this, I feel like the number one myth when you're starting a business is build it and they will come. Right. Which is like, oh, yeah, it's great here. Why is it. Why is the whole world not here? Right. Yeah. And the second, as your business becomes more established, is hire good people and trust them, and they'll take care of everything. That's the second myth.

Yes.

Yes.

I believe that too.

So you give me a whole new philosophy in an organized way. I'm like, I like that.

Yeah. The things that we've learned as we've gone along.

Yeah. And the beautiful thing about this is once we learn that level of leadership, when we now want to replace ourselves, we know exactly what to do. This is how you do this. This is how you do that. And then we can truly walk away. But we can't skip this step to go over there.

Yes. That's so vital. Yeah. You can't skip the step. And it doesn't just happen by itself. It happens by your work, by your investment, by your. Yeah. Leadership and involvement.

Yeah. Even though both of us, two seasoned entrepreneurs, we hoped. We really hoped it would take care of itself. It didn't. Yeah. So I know that you have great plans for the next 12 months, and I guess my question to you would be, how are you planning to show up differently over the next 12 months? Right. Because you have this big dream. I want to see it. I know it will require your evolution. Right. Nothing changes till we change. So how. How are you planning to show up differently?

Yeah, I want to show up as a leader, as someone who is delegating more, giving more to the team, and not just, oh, I'm delegating this. You figure it out. But delegating with direction, delegating with involvement, I think that's the kind of leader that I need to be for this place that I'm at in my business. And we're all on our own journey. Right. That for my journey and for my moment, I think that's where I am. And so I anticipate showing up that way, working with my team to grow. You know, what we do and grow our impact over the next 12 months.

I love it. You know me, I'm already, I have my popcorn. I'm ready to celebrate. I know I have to wait. I don't have to wait a number of months, but I'm looking forward to it. So I want to say thank you so much for really drawing back the curtain and sharing this, and especially from your perspective as somebody who's been at this for a number of years, because I know it will resonate so deeply, because our problems as entrepreneurs are pretty much the same, right? They may wear different outfits, but they're the same. So thank you for sharing that. Now for you're in the entrepreneur Business School. You've been for a number of years. And I know, like, lots of people listen to the podcast, they have questions. Many people are like, I listen to the podcast for a year or two. Of course they come into the school and they're like, oh, man, I should have joined sooner. But we don't do regrets. What would you say to the person who's thought about it? They're on the fence, they're building a business. Maybe they're even in cruise control. They just like, it's fine. What. What would you say to the person thinking about it?

I think for me, I've been in the business school, I think, for two and a half years, and I just knew that I needed something to take my business to the next level and to improve. And in some ways, I mean, I kind of joked with Dr. Una one time before about being like a remedial student, because I just, I haven't 10x' ed my business yet. Dr. Una, here's these folks that start up and immediately 10x their thing. I haven't done that yet. For me, there is the inner evolution, and the inner journey has been huge. I think my ability to do that outside of the Entre MD Business School is really questionable. Would I be able to make these leaps and make these jumps without a group? Leadership, accountability, those things? And so I do think if you're looking to start a business from scratch or infuse life into an existing business or either of those things and more, that the Entre MD Business School for a physician could be an amazing place to be.

Yeah. And in my eyes, you're a rock star student. I don't know what you're talking about. Remedial. You're a total rock star. And I say that because you do the difficult work. Like, we talked about frogs, and we could have made the whole episode about frogs. You know, and you do the difficult work that creates the big impact. And so I remember when my business started getting bigger, I was like, why are these changes not happening as quickly? And then it dawned on me, you're not. This is not a kayak anymore. This is a cruise ship. So when you do shift, the shifts are bigger, but they take a little longer.

Yes.

You know what I mean? And if you don't have the tenacity to keep eating frogs until then, that big jump from like really big to much bigger, you're just not gonna see it. You know what I mean? And so you eat frogs. And that makes me excited because you're turning the cruise ship for sure.

Thank you.

For sure. So if you're thinking about it again, we are not. We want to help you on your journey. Making that like next step and all that. You can schedule a call with my team on tremity.com. they'll walk you through it, answer any questions you may have. It is not a high pressure sales buy this now or you suck type of thing. We just don't, we don't do icky sales. Okay. Where we want to create win situations. That's what this is about. So, Dr. Sarah, where can people find you? And now if you're listening to this, I want you to follow her on social media. If you are in the area, I want you to figure out how you can support her business as well. Because she's come and she's given so much value and the entrepreneur community, we support our own. So where can we find you?

Yeah. So my practice is called Lifestream Health Center. Our main location is in Bowie, Maryland. We have a couple of offices in Baltimore as well. We're on the web@lifestreamhealth.com and Facebook as Lifestream Health Center. Instagram Lifestream H C L I S E S T R E A M thank you.

Love it. So find her, go to our website, follow her on social media, let her know. Thank you so much for that interview, Dr. Uda. It was amazing, right? Because these are real life lessons from real entrepreneurs. So. So you've been in business for over a decade, right? Do I put it that way or. A decade?

Yeah. So I started part time at the practice where I am now in January of 2014 and I did not own the business, but 10 years is a right nice round number. And I was working for myself. I didn't have a W2 at that point kind of side gigging, just doing some 1099 work basically at that point. So that was the start 10 years ago, the start of what I'm doing now.

Yeah, that's the start of entrepreneurship. Love it.

That's right.

Well, congrats on being an entrepreneur for a decade. That is no mean feat. Most people would crash or burn or avoid it or stall. But you're still in your, I'm in this hyper growth stage and that's, it's just beautiful to watch. So thank you so much for coming to share your story. For you, the listener, I want you to take a screenshot of this. I want to post it on social media. Say, do not pass gold. Do not collect 200. Go straight to listen to this podcast episode because it's just full of liquid gold.

And it's possible. I mean, Dr. Una is the champion of this. We are the cavalry. We are the people that are going to change medicine, save medicine. And this is how you do it, is by finding a way to get out there and do it on your own.

Love it. And once there are enough examples of what is possible, it's a wrap. Right? That's what's going to happen. It's a complete wrap. So thank you again and for everyone listening, I will see you on the next episode of the Ontremity podcast.

If you enjoy listening to the On Trendy podcast, you have to check out the On Trendy Business School. It's the number one business school for physicians who want to build six, seven and multiple seven figure businesses. You get the coaching, the accountability and the community you need to do the.

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To find out if this is your best next step, book a call with my team. Entre md.com call that's entre.com call I can't wait to celebrate all the wins.

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