"You can get past the dead end. You can break through the ceiling. I did and so have countless others."
In this weeks episode Justin breaks down what nurse practitioners and practice owners can realistically expect as we head into 2026. He talks honestly about economic uncertainty, income plateaus, and why slower growth does not automatically mean you are doing something wrong.
He also highlights where opportunity still exists, from longevity focused care to higher value service models, and why positioning and structure matter more than chasing volume. If you are thinking about how to protect your income, adapt your practice, or prepare for what comes next, this episode will help you think more clearly about your next move.
Justin Allan Montgomery (00:03.694)
Hey everyone, Justin Allen here with the Elite Nurse Practitioner. Today we will be having one of these other solo podcasts. And then next week we should pick it back up with some interviews. So today I want to talk about mostly what can we expect in 2026 in terms of practice and business, right? So…
what’s going to be going on in 2026. So let’s just kind of caveat this with saying that this year I think is going to be a little volatile in nature. You know, the political landscape, geopolitical landscape, everything going on in the world, lot of uncertainty in our economy right now. I honestly wouldn’t be surprised if many of you
not necessarily have a decline in profit and income, but it might kind of plateau this year. It might stay fairly flat, all right? So if that happens, don’t be too surprised, all right? I mean, right now there are a lot of people are getting laid off and it’s not really being reported. A lot of it has to do with AI displacement. lot of big companies are…
cutting costs, AI is replacing a lot of people’s jobs. So the disposable income amounts might be low. We might be juggling multiple government shutdowns as well. I don’t know about you guys, but I know at my men’s health clinic when the government shut down, we definitely saw a little bit of a drop, especially with new patients. But we’re in an area where we have a lot of us.
these defense contractors and stuff like that. So if there are more government shutdowns this year, that could definitely contribute to it. And overall right now, the economy is, like I said, it’s very uncertain.
Justin Allan Montgomery (02:01.93)
Inflation is fairly under control. It’s still not at target, but it’s not out of control for the most part, okay? It has stabilized. Some areas are definitely seeing some inflation, some inflammatory, inflationary pressures on it, and others are not. Like the housing is really stabilized for the most part. But…
The big thing is it’s the job data. So the Federal Reserve has two mandates basically, keep unemployment low and keep inflation under control. And so what they’re concerned about right now is that unemployment is rising. The numbers that you see a lot online aren’t completely accurate because it doesn’t really take into account a lot of different factors. I’m not going to go over all those.
You know, if unemployment starts rising and inflation stays where it’s at, what you can see is a potential, I don’t think we’re have a recession by any stretch of imagination, okay? I’m not saying that. But I do think that it could be just a little bit of a slowing economy. Projections for GDP growth this year aren’t really all that great. lot of projections in Wall Street are overinflated right now.
Earnings estimations for a lot of these companies are way over inflated. So again, I think this year you can expect potentially a real plateau in income this year. Okay. If you’re growing fantastic, don’t worry about any of this. Okay. Like if you grow this year, great. And you know what guys, I can be totally.
Justin Allan Montgomery (03:49.593)
totally wrong here, right? I’m just telling you what I’m hearing and what some other experts are saying, kinda what I’m seeing, all right? So, if it stays flat this year, I wouldn’t be surprised, okay? If you do grow this year, great, you’re doing something great.
If you see a drop in your revenue this year, something’s going on. You really shouldn’t see much of a drop if you have established patients, okay? You could, I mean I know a lot of weight loss clinics out there definitely see a pretty significant decrease in patient volume, actually because it’s so saturated now. I wouldn’t get SEMA glue tight in GOP1s just about anywhere anymore. Interestingly enough, I was just in Mexico.
and was at the airport and in Mexico you know can go to pharmacies and just buy meds without a prescription and so I at this so I was at the Puerto Vallarta International Airport and there were some pharmacies inside there and I picked up some antibiotics and a couple other things when I was down there why not it’s all like name-brand stuff it’s dirt cheap and they had ozempic
Zepetide and stuff there and guys they’re like The prices on it were ridiculous like ridiculously low Okay, so like people were traveling to Mexico can literally just go these pharmacies and buy GOP ones if they’re already on it You know what I mean? Like if they go there and they’re already dialed in through you and they see this box Boxes of SEMA glue tied here for 30 bucks a box, you know, I wouldn’t be surprised if you buy it lose that patient You know what mean? So anyways though
Yeah, I think that some declines in revenue are probably gonna be more or less just a market saturation issue and people maybe just going elsewhere, cheaper options. know, peptides now, you can see, mean, you can get peptides pretty much anywhere online anymore. I’m not saying that you shouldn’t be prescribing peptides in your practice. You definitely should, because it is a great revenue driver and a lot of patients do still value compounding pharmacy grade.
Justin Allan Montgomery (05:53.775)
peptides and they do appreciate a provider monitoring them, et cetera, but a lot of peptides online, you can just get them. Now, the administration right now is trying to regulate peptides a lot more and kind of open it up. Now, if that happens, there’s just another thing I want to talk about for 2026. If…
The administration begins to regulate peptides, okay? It’s going to open the door for us as clinics, practices, to begin prescribing a lot of the peptides we used to. know, a lot of the old peptides we used to prescribe all the time, like TB 500 and IPA, Moralin, BPC, and all these things we used to prescribe fairly easily through most compounding pharmacies.
You know, can’t prescribe them anymore, but we’re gonna be able to prescribe those again. And so, hopefully that will open up some revenue channels for many of you who might be struggling to bring on some new services to your practice, okay? So, excuse me. So just kind of keep that in mind.
So yeah, I think that those are gonna be some things to be looking out for for more of a macro viewpoint here, okay? So again, this year might be a little bit bumpy guys, all right? For many practice owners in terms of growing revenue and whatnot. If you’re well established and have a good patient base and you have good word of mouth and that kind of thing, you probably are gonna be okay. If you accept insurance, you’re gonna be fine. You don’t have to worry about it whatsoever. I’m talking about more of like these really niche wellness cash based things.
It could be a bit of a bumpy ride this year guys, okay, so Don’t be surprised if it is and again, I could be completely full of shit right now Okay, like I’m gonna be fully full of shit. My prediction here is completely wrong. Okay, I mean, you know, you never know I mean, there are so many things going on in the world right now You never know if China invades Taiwan. We will have a recession in a world war. Okay, so it’s like who knows ultimately, all right
Justin Allan Montgomery (08:02.158)
But don’t worry about that. It’s out of your control. You can do nothing about it. All right, the only thing that you can do is save money, live a little bit below your means, and just be smart with your money, okay? If something bad happens, you shouldn’t be ill-prepared for it. All right, that’s the whole point of the Elite MP here is to live below your means, save money, have emergency funds, do this stuff the right way. If you do it the right way,
So like bad happen, John, scrambling and freaking out. All right. Okay, all right, anyway, I’m gonna get off my pedestal there. anyways though, so those are some predictions that I’ve been kind of thinking about here. So I just want you guys to be aware of that. Now, moving into 2026, what are gonna be some services that you really should be thinking about, okay?
I think that we are moving into a lot more… I think longevity medicine is really starting to grow, okay? And I think that this is going to be something that is probably going to grow a lot this year. Over the last two years…
Longevity stuff has really become a lot more mainstream. Okay, you can thank really two people come to mind for the most part here Brian Johnson with blueprint. Okay, you don’t know who this guy is. You really should start watching some of his YouTube videos. It’s Fascinating stuff. It’s entertaining If you don’t know who he is, he’s basically this tech billionaire
who doesn’t want to die, and he spends millions of dollars a year creating these longevity protocols, and he sells some supplements and stuff too. And his goal is to reverse aging, and he’s like successfully done this utilizing a variety of different lab markers and stuff. And he publishes all of this stuff for free. All his protocols are free. All the science, all the data is free. You as a clinician,
Justin Allan Montgomery (10:13.838)
If you’re not reading this stuff, it’s free guys, it’s on his website. Just go check it out. It’s pretty fascinating stuff. can integrate this stuff into your practice tomorrow if you just learn it, you know? So anyways, he’s definitely one of the…
guys on the forefront here and then Dr. Peter Atia as well you know he released a book I think it was like two years ago the art and science of longevity or aging or something I don’t know quote me on that it’s something like that you should look it up I’m sure it comes right up
I read that book and it’s some great stuff guys, it’s some really good stuff. So he’s kind of on the forefront of it as well. Now what’s happening is that these guys go on a bunch of different other podcasts, okay, and they begin talking to these podcast hosts. We’re talking about big podcast guys like The Joe Rogan Show is an example or Modern Wisdom and…
Huberman okay these are big shows and this stuff is becoming very mainstream okay a lot of people are discovering this stuff through these podcasts like I don’t know about you but I don’t watch the news anymore I don’t watch TV like I mostly listen to podcasts for a lot of my information and
This stuff’s becoming a lot more mainstream, guys. And so I think there’s gonna be a place for this in medicine, and I think it’s gonna continue to grow. And I think that a lot of patients are gonna begin looking for providers who are providing these kinds of services, all right?
Justin Allan Montgomery (11:48.175)
And the good news is that I don’t think it’s gonna be something that’s gonna become overly saturated, all right? Because number one, insurance-based practices will not be doing this stuff, okay? They are simply not reimbursed for these things, okay? So it is a cash gain first and foremost. A lot of these things are out of reach for most average people.
And by that I mean something along the lines of like a full body MRI as an example, as like a preventative tool, okay? I’m actually gonna go, I’m actually gonna get one of these. Just because, you know, why not? I mean, I have money, I mean.
So I’m gonna get one, get a clean bill of Hopefully. Like, you need a full body MRI, it’s probably gonna find some shit, you know? It doesn’t matter who you are, it’s probably gonna find some things, right? And know, cardiovascular testing, know, doing elective echocardiograms and stress tests, know, carotid ultrasounds, vascular scans, you know.
Essentially the rule of thumb with longevity medicine guys is that you want to rule out and prevent basically the top 10 killers of men and women. Now those killers are a little bit different for each sex, correct? But you want to rule those things out and so that’s kind of what you’re doing in longevity medicine. You’re ruling out the top 10 causes of death.
this is mostly metabolic disease, cardiovascular disease, and cancer. That’s pretty much it, and neurodegenerative disease. And so that’s, just to put it in a nutshell, that’s pretty much it, right? If you’re dealt a really bad card and get something super rare, well, that’s just the ledge of luck. I was just a universe guy, sorry.
Justin Allan Montgomery (13:47.413)
shit happens. But that’s kind of your job here. That’s kind of your goal, all right? That’s basically longevity medicine in a nutshell. And so if you provide these services, it’s a combination of both screening tools and then, you know, exercise is a big one. I that’s probably one of the biggest things. I mean, the best thing you can do for longevity is exercise. It just is, all right? It is even…
It’s superior to diet. It really is. Exercise is the best thing you could possibly do for your health. If you are an NP listener right now, and you do not exercise on regular basis, you need to get off your ass and exercise regularly. Every single day. No exceptions.
at a minimum, at least get 10,000 steps, okay? Like at a minimum, all right? But like, know, weightlifting and cardio, getting into zone two, if you don’t know what zone two is, look it up, I’m gonna go over that right now. You know, yoga, stretching, and then another big pillar here is good quality sleep. Like sleep is becoming one of those things where through a lot of this longevity medicine and a lot of this research and studies, like sleep now is being…
The importance of good quality sleep cannot be understated basically. Like the difference between good quality sleep on a regular basis and not is it’s night and day. It is apples and oranges. mean it the difference it makes in your life is I can’t even describe it. Like I have really put a priority on sleep in my life now. I’ve always been a pretty good sleeper but I never really prioritized it and I really make it a priority now. You know I wear one these little rings.
and like I’ve checked my sleep every single night and once I’ve begun tracking my sleep, I realize just how much little things can really make a difference. For many people, drinking caffeine after 12 o’clock can really affect their sleep. For me, I kinda seem to be immune to caffeine. It doesn’t really bother me. I can drink a cup of coffee at six o’clock and be in bed by eight.
Justin Allan Montgomery (16:03.118)
Another big thing would be like sugar as an example. If I eat something sweet after dinner, like if I have dessert, okay, I’m not talking about like one cookie, one little Oreo or something. I’m talking about dessert, like a scoop of ice cream and a brownie, something like that. It completely and utterly wrecks my sleep. It is crazy, like now that I’m actually aware of it. You know what I mean?
Like my HRV heart rate variability will go from 70 to like 45, like significant. The amount of REM sleep decreases, the amount of random awakenings decrease, like I feel it the next day. So, you know, I’m going off a little tangent here, but anyways though, like sleep is another big driver here too. Deep breathing.
Resonant breathing exercises like breathing exercises and meditation. That’s another big component of it. All right, and then you have The supplement side of it the prescription side of it, you know prescribing like that I have 500 milligrams of metformin every day for know anti-aging purposes as an example You know hormone replacement therapy and managing blood pressure like it’s all the stuff that you already know But it’s combined to prolong life prevent cancer prevent cardiovascular disease
that kind of stuff. So how do you monetize that? How do you monetize exercise? How do you monetize good quality sleep? Those sorts of things. It can be a little difficult to do that. So that’s where you have to start being a little creative. And the point of this podcast is not to tell you how to do this. I think about creating a course about it.
But you know, if you are an astute nurse practitioner and you can learn some stuff on your own podcasts and books, you guys can figure this out. So anyways, I think that is where a lot of medicine is gonna start going in 2026. And like I mentioned earlier about it being out of reach for many patients, by that I mean a lot of advanced diagnostic stuff, okay? Most people can’t afford a full body MRI. I mean, it’s like 5,000 bucks, you know?
Justin Allan Montgomery (18:20.226)
doing an elective echocardiogram, cardiac stress test. Like these things cost money, all right? So this is gonna be more for like your high roller kind of patient, but I will say this guys, there are plenty of people out there with money who will pay you to do this stuff, all right? Now for the patient, you the average Joe, you know, the average Jane, you know, what can you do for those people? You can create very simple protocols to just increase the value of what it is that you are already.
You can create a five page PDF on what you need to be focusing on and what steps you can take to improve your longevity, to improve your quality of life. And this stuff can be stuff as simple as exercise protocols, sleep protocols, different diets, et cetera. So anyway, I want you guys just to keep that in mind. I think that’s gonna be…
big thing that you will start seeing more and more of in 2026 especially 2027 or the next three to five years, okay? So if you are looking for a revenue diversifier in your practice, I think this is something you definitely should be focusing on. All right. Now what else? I think that more high-ticket concierge stuff
is also something that many of you should be thinking about in 2026. My goal is to help you guys succeed and to have a business that actually does well. And a lot of stuff that we talked about…
know, Elite MP has talked about and taught over the last five years. You know, I hate to say it’s still relevant. Don’t get me wrong. It is still relevant, right? You should still be offering HRT. You should still be offering some weight loss services. You know, should still be doing vitamin injections, et cetera, right? Functional medicine as well. But you need to be thinking about some newer stuff. And my goal is to help you succeed here. And so…
Justin Allan Montgomery (20:30.478)
I high ticket concierge kind of stuff is going to be something that I suspect we will see more of over the coming couple years. All right. So I want you to be thinking about how do you integrate a high ticket program into your practice? All right. Um, you know, this can be stuff guys, like I’m talking about, you know, it’s $5,000 to get started and included in that could be, you know, I don’t know.
physical kind of level stuff, High ticket concierge stuff. You know, I was talking to an NP at one of our conferences a few months back and she does extremely well with high ticket stuff in her practice, you know, charging $3,000 a month. And you know, these are for very high roller patients. But the beautiful thing about this is that you only need
to have 10, 15, 20 patients paying you that, and you’re making good money, Like, that’s the beautiful thing about it. You don’t need a huge volume, right? With HRT or weight loss, you need to have volume of patients to make good money, right? With a high ticket program, you don’t, you know? I mean, I’ve talked about this before about opening up like a…
high performance medicine kind of place here in Colorado where I live and I think it would probably do pretty well and you know I don’t want I don’t want a job I don’t want to go be at a clinic five days a week I’m cool with one day a week for very very high ticket people you know I mean I probably focus more like on men and you know that’s just kind of my niche I think that’s why what I focus on but I would charge like $5,000 a month
And basically, I kiss your ass. To summarize it up, I’ll kiss your ass. Text me anytime you want, whatever you need, fine, I don’t care, whatever, here you go. know what mean? So for that price, everything should be included, basically. So if you charge $5,000 a month for a high ticket concierge program, hormones should be included in that. Maybe some even growth hormone.
Justin Allan Montgomery (22:55.328)
a peptide, et cetera, okay? You get the patient what they want, essentially. These are high ticket conceder patients, okay? So, whatever that looks like for your practice, just be thinking about having a high ticket program, okay? If you are looking to open up a new practice in 2026, that would definitely be something to be thinking about.
It can be something very simple. All you need is one office in an office building or something. You do not need anything crazy. You don’t need multiple rooms. You don’t need supply rooms. You just need one office. A simple 300 square foot office or something, right? And you’re there one day a week. All you need is one new patient a month, spending $3,000, $5,000 a month. And before you know it, you have…
10, 15, 20 patients paying you $3,000 $5,000 a month. You do the math. 10 patients, that’s $30,000 to $50,000. Boom.
It’s not that hard, you know what mean? So I definitely think that that is gonna be somewhere that it’s probably going to probably grow in 2026, all right? I do still think functional medicine will continue to grow, okay? Functional integrated medicine. I think more patients are looking for that, you’re looking for those services. They’re just sick and tired of the healthcare system as it is, so.
I think functional medicine, integrated medicine is probably going to continue to grow. I don’t see any issues there. More people are doing it and I think that’s a good thing, but I’m still not seeing a lot of just functional medicine, integrated medicine practices. So I definitely think there’s probably a growth lever there as well. All right, so let’s be thinking about that.
Justin Allan Montgomery (24:44.558)
But I think for most of you in 2026, I would highly advise that you really focus on growth and scaling. know, many people that listen to this already have a practice. And so this year I want you to be really thinking about how can I grow and scale the business that I have.
How do I get it off the ground? How do I get it to the next level, right? So there are three phases of a business in terms of growth goes. You know, there’s the startup phase, which is like the first six months, you know, just getting the business up and running, getting some patients in the door, working out the kinks, you know.
and then six months to 24 months basically. That’s the phase where you’re accelerating your launch. You are getting your systems in place. You are automating things. You are working out the kinks in your business. You are optimizing your business for growth. You’re getting it to a place where it runs well. You are trying to slowly get yourself out of the business so it runs itself.
You’re just optimizing the business. That happens between six and 24 months. 24 months and beyond. That’s where growth and scaling really begins. Okay. That’s where you start hiring other providers, start seeing patients for you. That’s where you begin, you know, fine tuning your pricing strategies. That’s where you begin setting up your practice. So
it’s not a job anymore, it works for you. And you’re up your business in a way to where it actually sells, all right? So that’s kinda, those are the evolutions, those are the phases of a practice really, and most businesses to be honest with you. So wherever you’re at in that, I want you to really, really focus in on wherever it is that you’re at.
Justin Allan Montgomery (26:59.276)
You need focus in on accelerating your launch, optimizing your business, or really focus in on growth and scaling. right? So really make 2026 the year where you do that, where you really put some focus in on that. If you are just starting your practice, spend this year starting it right. Okay? Don’t just pick a service and just launch it. Okay?
You need to do your due diligence and you need to do your due diligence well. You need to succeed. You need to provide a service or product in your area that isn’t very saturated. All right. If you are thinking about opening up a weight loss only clinic in 2026, I wish you the best of luck unless you are just in an area where it doesn’t exist. there aren’t very many areas anymore where…
There isn’t some kind of weight loss clinic or some kind of clinic offering, GOP1 or whatever. So really be thinking about how am I gonna start a business, a practice that is a little bit different. So keep that in mind, because I want you to succeed. I don’t want you to open up some bullshit business and then you’re emailing me six months later wondering why you don’t have a single patient. Telemedicine only in 2026.
is not going to work. There are too many telemedicine only practices out there.
Justin Allan Montgomery (28:36.646)
I see more hybrid based practices, know, a brick and mortar plus telemed. I see far more of those succeed than I see telemedicine only practices succeed. For every 10 telemedicine practices that, you know, that open up, I would say maybe one out of three of them actually succeed.
For hybrid practices, that’s brick and mortar in a regional area, for every 10 of those that open, I would say probably six or seven of them succeed. So your chances of succeeding are a lot higher having a brick and mortar location. It just is, guys. It separates you from the telemedicine practices, and it’s a lot easier for patients to find you.
So I want you to be considering these things. Be really thinking about this stuff in 2026, I want everyone to succeed. So 2026, summarize all this up, it’s gonna potentially be a bumpy year. Again, I could be wrong. I could be completely wrong. But my job is to just make you be thinking about, you know.
things here. Maybe thinking about, thinking of things objectively based off of the macro environment of what we see. Okay. I don’t have control over it. You don’t have control over it. All you have control over over it is what you do with it. Okay. What’s going on in another state?
riots and protests and blah blah blah. All this shit is out of your hands. It’s out of your control. So don’t waste your mental energy on it. Okay? Focus on what you can control. All right? So just really be thinking about that. All right? Like it’s, it’s, it’s going to potentially be a bumpy ride this year. Okay. And that’s just the cycle of that’s just, that’s just the economy. That’s just the world.
Justin Allan Montgomery (30:33.422)
You have good years, you have bad years, you have kind of flat years. I think this year’s gonna be kind of a flattish year for many people. So just be thinking about that. And be really considering longevity medicine, concierge stuff, high ticket items. And just be diligent here, guys. Be diligent, be thinking about what’s going on in the world.
it can potentially affect your business and how do you leverage what is in front of you. When times are tougher, okay, if it is a flat year or a down year, usually opportunities will present themselves if you are looking for the opportunity. All right. I have made more money in down years than I have in up years because
during down years, everyone’s freaking out. Everyone’s panicking. Everyone’s scared. Do not have that mindset. Look for opportunity. Okay? I’ve made more money during down years than I have in up years.
because I’m willing to take a risk, I’m willing to take a chance. 2026 could be a flat or down year, and again, I could be completely full of shit and it might be one of the best years ever. Again, you you can’t listen to any kind of prediction from anyone. The only people who have the highest success, highest prediction rate successes are weathermen, and that’s for three days out. Everyone else has a poor history of predicting stuff.
financial advisors, finance gurus, economic gurus, blah blah blah. Okay? No one knows. No one can predict the future. All right, so keep that in mind. Okay, hope everyone enjoyed this episode. I’ll talk to you guys later. Thanks, bye.
