Why "Learning How" to Open a Practice Is the Wrong Goal

Think about the last webinar you watched on opening a private practice.

You registered in advance. You blocked the time. You probably took notes. And when it ended, something shifted - you felt measurably closer to independence than you did 90 minutes earlier. More informed. More prepared. More like a person who might actually do this.

Now think about what you did on Monday morning.

You went to work. You saw your patients. You came home. The notes from the webinar went into the same folder as the notes from the last webinar - the one that also made you feel closer, the time before that.

Six months have passed since the first one. You are still an employee. You are also significantly better educated about what it would theoretically take to become something other than an employee.

There is a name for this pattern in organizational psychology, and it is not a character flaw. It is a well-documented trap - and understanding it is the first step toward not living inside it anymore.

The Trap Has a Name

In 2000, researchers Jeffrey Pfeffer and Robert Sutton published a landmark study on what they called the knowing-doing gap: the chronic disconnect between what organisations - and individuals - know they should do and what they actually do.

Their central finding was counterintuitive. They expected to find that the gap between knowing and doing was caused by insufficient information. Organizations that performed badly, they assumed, probably didn't know what good performance looked like.

That is not what they found. What they found was that many of the worst-performing organizations had extensive knowledge of exactly what they needed to do. They had consultants, frameworks, and reports. They had trained their people and run their seminars. The knowledge was present. The doing was absent.

The reason, Pfeffer and Sutton concluded, was that the act of acquiring knowledge had come to substitute for the act of using it. Planning, discussing, attending, and learning had become the organization's primary activity - not because anyone intended this, but because those activities felt productive, generated social approval, and carried none of the risk that actual implementation does.

For practitioners thinking about independence, this pattern runs exactly the same way. Every webinar makes you feel closer. Every course gives you a more detailed picture of the steps involved. Every notebook fills up with things you now understand. And the practice that exists in your notes feels almost as real as one that exists in the world - which is the problem.

Why Information Feels Like Progress

The brain does not naturally distinguish between knowing what to do and doing it. This is not a cognitive error - it is a feature of how goal-directed behaviour works. Neuroscientists who study motivation have found that the brain's reward circuitry activates both when you make progress toward a goal and when you acquire information that signals you're getting closer to it.

Learning how to form an LLC feels like moving toward having one. Watching a walkthrough of CAQH registration feels like CAQH is being handled. The brain marks both as partial progress - and partially satisfied goals generate less urgency than completely unsatisfied ones.

This phenomenon - sometimes called goal substitution - explains why the practitioners with the most detailed notes about opening a practice are often not the ones who open practices. Their goals are partially satisfied, over and over, by information that resembles but does not replace the activity itself.

The Loop Most Practitioners Are Stuck In

Once you can see the loop clearly, you will recognise it everywhere. It goes like this:

The loop is not a failure of intelligence or motivation. It is an entirely rational response to an environment where information is abundantly available and the steps between information and implementation are unclear, risky, and time-consuming. Given those conditions, the brain optimises for the thing that feels like progress and carries the least cost - which is learning, not doing.

What Knowledgeable Inaction Costs You

There is a financial dimension to this that is worth making explicit.

Every month you spend in the loop is a month in which the gap between your salary and your licence's revenue potential continues to compound. If that gap is $60,000 a year - a conservative estimate at a standard PMHNP caseload - then a six-month loop costs you $30,000. A twelve-month loop costs $60,000. Not in out-of-pocket expenses. In revenue that your licence is generating right now, flowing to an organisation that isn't you.

The knowledge you accumulated during that loop is not worthless. But it did not offset the cost. And crucially, it would not have taken twelve more months to acquire the knowledge that actually matters - it would have taken twelve months to stop acquiring knowledge and start building instead.

These are not the same things. The left column is comfortable. The right column is real. The distance between them is not more education - it is execution.

The Question Was Never "How"

Here is the reframe that changes everything, and it is worth sitting with rather than skimming past.

The question you have been asking - how do I open a private practice? - is not actually the blocking question. You know how. You have known the outline of how for months, possibly years. The PLLC, the NPI, the credentialing, the EHR, the website, the acquisition strategy. The broad structure is familiar to you. That is not the thing in the way.

The question that is actually blocking you is a different one: who is going to build this while I keep seeing patients?

That question has a different texture. It is not a knowledge question. It is a capacity question - and it has a direct answer that does not involve another webinar.

What Breaks the Loop

Pfeffer and Sutton's research on the knowing-doing gap identified one consistent pattern in organisations that did escape it: they stopped treating planning and doing as the same category of activity, and they created conditions where action - not analysis - was the default output of any given session or meeting.

For individual practitioners, the equivalent shift is simpler. It is the decision to stop asking "what do I need to learn next?" and start asking "what needs to happen next, and who is handling it?"

Those are different questions with different answers. The first sends you back to the resource library. The second sends you to an entity filing, a credentialing submission, or a system that builds the practice around your existing clinical work while your employment continues and your income stays stable.

You have already done the hard part. You earned the credential. You passed the boards. You built the clinical competence. The business layer - the entity, the credentialing, the billing, the acquisition - is not a test of your readiness. It is a set of administrative tasks that need to be executed in the right sequence, by someone who knows the order.

The practitioners who launch are not the ones who eventually learn enough. They are the ones who stop learning and start building - or find someone to build alongside them. The loop ends the same way every time: not with more information, but with the first concrete step that cannot be undone.

File the entity. That is all. File it and the loop breaks - because now something exists in the world that did not exist before, and that something has consequences. It generates an NPI number. The NPI enables credentialing. The credentialing enables the practice. Every subsequent step follows, because something real has started.

The webinar never does that. The notebook never does that. Only the filing does.

Emmanuel AJAO

Chief Editor, goCorporate™

Emmanuel AJAO is the founder and Chief Editor of goCorporate™. He has guided hundreds of licensed clinicians through the process of launching independent practices - from entity formation and credentialing through to patient acquisition and post-launch optimisation.