"You can get past the dead end. You can break through the ceiling. I did and so have countless others."
In this episode, Justin sits down with Carissa, a family nurse practitioner who runs two thriving practices, to talk honestly about her journey and the challenges behind the scenes. Carissa shares what it is really like to manage both a med spa and a men’s health clinic, including the pressure of making every decision and the overwhelm that comes with an endless to do list.
Together, they explore why delegation is so difficult for so many NPs, how decision fatigue can quietly stall growth, and what it truly takes to move from being the solution to every problem to leading a business built to scale. If your practice depends on you showing up every single day, Carissa’s story offers a powerful look at what needs to change to create something sustainable and freeing.
Justin Allan Montgomery (00:00.947)
Okay, we are recording. Everyone today we’ll be talking to Carissa who is a family nurse practitioner. Currently she operates her own med spa wellness practice and she also has a men’s health clinic so she’s very very busy. The businesses are doing very well but she is needing help scaling, she’s needing help with some business decision strategy and letting go of responsibility. Hey, Carissa, how are you?
Carissa Cardiff (00:22.584)
Good. are you today?
Justin Allan Montgomery (00:24.031)
Hey, I’m good. Thanks for popping on here. yeah, tell us about yourself. Tell us, you know, how long have you a nurse practitioner for and what sorts of things that you’ve been doing that has led you to a position where you basically have two practices.
Carissa Cardiff (00:35.832)
Okay, well I’ve been a nurse practitioner for about three years and I actually opened my practice right when I graduated. As an RN, I have a heavy background in orthopedics and surgery, but I was working full-time remotely for utilization management for a hospital. So I was able to have my part-time practice in a salon suite. And then about a year and a half into it, I had a medical assistant who was helping me with all the things and I was able to lease my own building.
And in that building, I marketed two practices. I had my wellness practice and aesthetics practice, and then my men’s health practice, which I marketed separately. We just opened our men’s health location to separate the businesses. know, some of my guys were making comments about how girly it was in the med spa. And I am now, you know, we did just under 1.5 million gross last year. So we’re doing okay.
and it’s just me, I’m the only provider. have two medical assistants and a laser tech who comes in once a month, but I do everything else. And I do mean everything else.
Justin Allan Montgomery (01:45.407)
Yeah, okay. All right, so a few things there. So number one first, I want to talk about how you started this right after you graduated, because I get this question quite often, and it’s talked about in the Facebook group a lot of the times. And a lot of people, like me personally, I say go for it. But then there’s a lot of people also that say, you need experience, blah, blah, blah, blah.
And so I feel like the people who are like, you need to get some experience first are the ones who worked for three to five to 10 years before they started their own practice. And they just have that in their head. But in all reality, I think you could probably do this right out of school. So how was, how was that transition for you? Did you feel like it was stressful? Did you feel like you knew what you were doing? Like kind of just tell me a little bit about, you know, about that experience.
Carissa Cardiff (02:39.627)
pretty confident person in my, you know, my abilities and in most things in life, because I like to educate myself a lot. When I started nurse practitioner school, I knew that I wanted to not be in the insurance space. I already knew that that was something that I just didn’t believe was where medicine was going. And then I found the Elite NP podcast and I started listening to all of the things and it just made sense to do it the way that I did it.
And right out of school, I I already, I was educating myself. I was doing other courses on aesthetics and functional medicine, hormone replacement therapy. And so when I started, you know, it was, it was part-time, but I knew what I was doing and I felt really confident in that. The business part was the scariest part, but I didn’t, you know, I’d been an RN for a long time and I’ve been in the medical field for 10 plus years now.
And it just seemed like the best thing to do. Why would I want to work for someone else or work in the insurance space or work in surgery and be on call and do all of those things while trying to build a business? I had the perfect opportunity being able to work from home for utilization management full time. And then after that, being able to do what I wanted to do.
Justin Allan Montgomery (04:01.331)
Yeah, fair enough. Yeah, I mean, this stuff isn’t that difficult from a clinical standpoint. mean, you know, why do you need to have primary care experience, urgent care experience, ER experience, whatever, if your ultimate goal is to open up?
a men’s health clinic or a med spa or something like those skills don’t really translate over that that much, you know, I think that as long as you know, what sick is what sick is like and you understand what you know, you’re comfortable with and what’s within, know, what’s within your scope and whatnot. I think that I think what you did is exactly what a lot of MB should do if this is their ultimate goal. So, so I applaud you. Congratulations. All right. So,
Carissa Cardiff (04:44.595)
Thank you.
Justin Allan Montgomery (04:48.031)
So you have a few practices going right now. You said you did $1.5 million gross in 2025. So that’s impressive, especially at year three. So you’re doing something right, obviously. What’s your margin like, 40, 50 %?
Carissa Cardiff (05:04.521)
About 40, 50 % in the men’s health, 50 % plus in the men’s health practice and about 40 % on the aesthetics wellness side.
Justin Allan Montgomery (05:14.719)
Yeah, it’s about 45 % total. So I mean, you are, you are making more money right now as an NP three years out of school than most MDs will make ever. Yeah. Six, $700,000 a year. That’s more than most MDs make like surgeons. You know what I mean? So like
Carissa Cardiff (05:36.496)
and less student loans.
Justin Allan Montgomery (05:39.395)
and less student loans and less headaches. know, yeah, so congratulations. You’re killing it. Yeah, so it sounds like your business is at a point now where you are at a crossroads essentially, right? So like you are working yourself to death. You are doing way too much in the business it sounds like. You are textbook.
essentially at the crossroads. Like you are textbook self-employed right now, right? Like, you know, you are an entrepreneur obviously because you’ve scaled this to this this point, but you are also self-employed, right? Like you’re, you are a slave to your own business now, right? So yeah, so yeah, so you are at a pretty common place that most business owners get to.
The crossroads here is you can either go left or can go right. can take the blue pill, you can take the red pill essentially, right? So like you can either keep doing what you’re doing and go left, take the blue pill basically, right?
You can just keep doing what you’re doing, work yourself to death, do this for 20 years and have a business that basically stills 100 % relying on you. Sure, you’re doing very well, you’re making a lot of money, but do you have time to enjoy it? Do you have time to do anything else? And the answer is probably gonna be no, right? That’s if you go left, that’s if you take the blue pill. Now, if you go right and take the red pill, right, you do what most people never do, okay, because they’re scared.
They are scared of letting go basically. They don’t know what to do. A lot of people just get to a point where they just don’t know what the hell to do next. And so if you go right and you take the red pill, you build a business now that works for you. You go down a path that is unorthodox in nature. You go down a path that 95 % of people in this country
Justin Allan Montgomery (07:39.903)
never take, right? They work until they’re 65 years old investing in their 401k or they have a business where they’re working and by the time they’re just burnt out, you know, at the age of 55 or 60, they have a business they can’t sell because it’s so reliant on them that they don’t have an option, right? And so, how old are you?
Carissa Cardiff (08:03.686)
42.
Justin Allan Montgomery (08:05.087)
42, so you’re pretty much almost the exact same age as me. I’ll be 42 this summer. So yeah, so you’re in a very, very good spot. Like, do you really think that you can do what you’re doing right now in this capacity for the next 15, 20 years?
Carissa Cardiff (08:21.497)
I could, but I don’t want to.
Justin Allan Montgomery (08:24.255)
Right, only have one life right? Like do you like do you want that to be your life? Hell no, right? So So you are in a good spot. You have a very very good problem to have right now, but it is a problem nonetheless, so
How do you essentially, know, the three things that we wanna talk about here is scaling, business decision strategy essentially, and letting go of responsibility. All three of those things feed off each other and it’s essentially the same thing really. So we’re gonna talk about how to scale your business here. So with that said, what sorts of things are you doing now that is…
getting you out of the business. I mean you have another location, you have, I mean obviously a fairly large patient base, you know got a lot of patients, you’re doing a lot of different things. So tell me a little bit about kind of what you’re doing now and I guess it’s mostly like automation and key employees.
Carissa Cardiff (09:21.262)
So I have two medical assistants, one of which works the front desk at the aesthetics practice. And they draw blood, they do the labs, and they help me with patient management. And they’re really great. And then I have a laser tech that comes in once a month, and she can do lasers, radio frequency, microneedling. I just haven’t really pushed for more than that.
because when you have somebody who’s on the schedule only once a month, it’s hard to put patients on that schedule for all those different procedures. So I bounce around all day. wear different hats throughout the day. Like I’m literally going from a laser procedure to a radio frequency procedure and all of these things. And some of the mistakes that I’ve made are financing equipment for the med spa and then making
my entire business reliant on me. One of the things I wanted to do by opening up this separate space for the men’s clinic was to hire another provider, which terrifies me because I’m very controlling and I want things done a certain way. And I even feel like I almost built my business model based off of me. Like I have a, I do 15 minute consult, like free consults, like meet and greet appointments for my men’s health patients.
And I’m, you know, a 99 % closer. But am I going to find somebody else who’s a 99 % closer? I don’t know. Are they going to, you know, I live in the biggest small town ever. And providers are very notorious for entering a practice, being educated, and then going off and starting their own practice. So that’s a fear that I have. I have my husband.
who is a manager in his his salaried position. And I would like to actually take him out of that position and have him manage everything else here. But then my fear is, then we’re both here doing all the things. Does that make sense?
Justin Allan Montgomery (11:27.423)
Well yeah, you never get a break.
Carissa Cardiff (11:32.234)
Right. But he’s really good at managing people and systems and I’m not. I’m just a doer. just live, I fly by the seat of my pants every day and I’m doing all of these things and I’m just, things are falling on, you know, off the wayside business-wise because I just, I can’t invest all my time in doing all those things. So I have to choose and I prioritize my patients, of course. But I need somebody else to do all of those businessy things.
Justin Allan Montgomery (12:02.205)
Okay, so let’s go over, basically when you were talking right there, I wrote down five points.
your success in terms of scaling this thing. So number one, let’s just start, let’s lower bottom, like bottom tier first. And let’s kind of go up on a, you know, in a pyramid fashion, the least important employees to the most important employees. Okay. So let’s start with the MAs first. Okay. So you have two MAs, correct? So, okay. So have two MAs.
So you’re comfortable with MAs now, right? So what you need to do is that you need, and you understand the scope of an MA at this point, correct? Like you understand what they can pretty much do. Yeah, okay.
You know, they can do very, very basic clinical stuff and give injections, do vital signs and shit like that, right? And they, know, MAs are fantastic for administrative running your office. And then also having them there for, you know, doing some very basic clinical stuff. Like I said, giving an injection or something. So what you need to do is that you need to do an audit on your daily responsibilities for the next month, okay?
It’s gonna be something as simple as just making a note in your phone, okay, and just put, Chris’s responsibilities or Chris’s actions today. What did I do? And as you are going throughout your day, you just start listing out what it is that you’re doing, okay? And then I want you to just put like an asterisk or like, or a little dash and put how many minutes you worked on that, okay? This is gonna be kind of tedious, a little bit of a pain in the ass, all right?
Justin Allan Montgomery (13:48.871)
and it just kind of gives you something, you know, something more to do, but it will pay off. So what I want you to do is I just want you to write down what is it you’re doing and how much time you spent doing it. All right. This can be anything from ordering meds to calling patients to scheduling to whatever, right? Anything, everything that you’re doing on a daily basis, even clinical stuff, right? Everything, all right? And tally up how much time you’re spending. Estimate, doesn’t have to be exact, all right?
And then what I want you to do over a period of, you you might be able to get a good idea of what, this is within a week. Maybe it takes two weeks. Maybe it takes a month. Okay. But it shouldn’t take more than a month. All right. But you probably get a good idea after about a week. maybe two and then go over those things. All right. So I would basically then copy that list and go over to chat GPT or Gemini or something. Okay. And tell it.
I am looking to offload my work. I’m scaling my business right now. This is the list of activities that I am doing. Can you please categorize them and break them down from provider level responsibility down to like medical assistant responsibility and give me like a percentage. Okay. Basically prompt it and say something like that and then paste it in there.
and it’ll do the analytics for you and it’ll break it all down, break it into categories for you and that kind of stuff. Okay. And then you’ll have something a little bit more objective to use versus just this giant note that you have with all this stuff. Okay. Have it do that stupid busy work for you. And then you will be able to really, really visualize what it is that you need to delegate to other people. All right.
I guarantee you that in one day or over a period of two weeks, I bet you, could probably offload easily, probably 30 to 50 % of what is it you’re doing to another medical assistant. You hire a third one or you use the ones that you have. Okay. So get rid of the busy bullshit stuff that you are doing and have someone else do it. All right. You can spread those responsibilities amongst.
Justin Allan Montgomery (16:00.039)
you know, your MAs, right? But it sounds like you’re probably gonna need a third MA, more than likely, right? And they’re worth their weight in gold, 20 bucks an hour, 25 bucks an hour, whatever, pay them well so they do well, right? Give them little bonuses, make sure they’re appreciated, all right? My medical assistant at my men’s health clinic, they get a thousand dollar bonus in July, and they get a thousand dollar bonus a week or two before Christmas, all right? I just give it to them, just to give it to them.
They love it. It makes a big difference to their, you know, it makes a big difference in their life. Okay. I fill up their gas tank using my company credit card. All right. I buy them lunch and shit like that. I make it a good place to work. They’re not going to find anywhere better to work than my business, my practice. You know what mean? So you need to do the same thing. Okay.
So you do that, they will stay with you for a long, long time. I I’ve had MAs have been working for me for five years. They are not going anywhere else. They are just not going to, all right? Okay, so do that. Start offloading all that busy bullshit to someone else, all right? And then, so that’s the bottom level there. What kind of stuff that can you just offload to someone else, all right? Okay.
Next up is gonna be RNs, LPNs, right? You you have someone coming in once a month, that is, that’s bullshit. That’s, no, they need to be coming in once a week, okay? And if they’re not willing to come in once a week, you find someone else, right? They start doing all this procedural stuff for you, these lasers and all these other things that an RN can do, IVs and vitamin injections or whatever, okay?
So start then you go use the list start going up the pyramid your orange and your lpns or whatever What can I start giving them and that’s probably going to be from the sounds of it probably 20 of what you do if not more I don’t know you tell me
Carissa Cardiff (17:53.526)
Yeah, about that.
Justin Allan Montgomery (17:55.389)
Yeah, okay. So boom, all right. So essentially now just the first two levels of this pyramid now, your MAs and your RN that you hire, LPN or whoever, all right, you have now just offloaded probably 50 % of the shit that you’re doing. Does that sound accurate or am I overestimating that? Okay, 50%, right? You’ve just gotten back half of your time, all right?
Carissa Cardiff (18:15.958)
Yeah. Mm-hmm. Yeah.
Justin Allan Montgomery (18:24.383)
That makes your life a hell of lot easier, right? You can start focusing now on building this business so you can get this thing up to a million, two million dollars net a year so you can sell the damn thing and go live your life, all right? Okay, that’s the goal. All right, so do that. All right, next up here, it’s probably gonna be hiring that NP, all right? If you want to sell this business, you have
to stop seeing patients. All right? Not all the patients, but a lot of patients. Okay? Like I’m selling a practice right now for someone, because I do some practice brokering on the side. So I sell, you know, I sell practices on the side because I just, know this space and I’m good at that shit. And the issue we’re running into with this person’s practice that we’re trying to sell right now is that they
see too many patients. So we have basically had to basically stand back and I’ve now you know now I’m mentoring this individual basically for free because I want to sell their business for them and we’re going to wait three to six months before we go back to market with it because he needs to stop seeing so many patients. We need to get him down to 10 or 20 percent. That’s it. Right now he’s close to 50. It’s too many people. Okay.
So if you want to sell this business, you need to get into a position where you’re only seeing 10 to 20 % of all the patients and you have other NPs seeing the rest. All right? This is how you build a business that scales without requiring more time from you. All right? So you need to be looking at the return on your…
that you’re investing in the business and also the return of your time, right? You’ve put a lot of time into this business right now over the last three years. You put a lot of time into this. You need to start getting a return of that time back now, okay? You put a lot of time into it and now you need to start getting a return of your time back.
Justin Allan Montgomery (20:30.911)
Right now you’re not getting anything. You’re still putting time into it and you’re not getting anything back. Just like the money you put into it. If I put $1,000 into it, I better get $5,000 back or whatever, right? That’s my return on investment. Same thing with your time. You’ve put thousands of hours into this. Now you need to start getting back those hours. So if you put 1,000 hours into your business, you need to be getting to a point now where you get 2,000 hours back, okay?
The only way you do that is doing basically what I’m telling you to do right now. So you have to hire that NP. You have to, all right? Letting go of that responsibility is extremely difficult. We can talk about that after we’re done talking about this pyramid, okay? So you need to find some NPs, two or three of them, all right? Do not hire an NP full-time, okay? You do not want full-time NPs. You want part-time NPs or PRN NPs, but lots of them.
right? It builds a redundancy into your business. If one quits on you, you’re not scrambling and having to see all those patients because you got three or four other PRN NBs that work 10 hours a week. They can go ahead and they can see the more, you know, more of those patients. All right. So yeah, do not hire a full-time NB because if they quit on you, you’re fucked. So don’t do it. All right. It’s better to have multiple part timers than one full timer.
Alright, let’s build over. This is a redundancy in your business, right? It’s a safety mechanism. Okay. Alright. And then at the top is you and your husband. Alright, you guys are running the business. Okay. So that said, if you are able to have your MAs, your RNs and some NPs take 80 % of the load off of you, do you need your husband to manage this or can you do it yourself?
now that you have the time. All right. That’s gonna be a question you’re gonna have to answer yourself. It sounds like your husband’s a lot better at managing people and those sorts of things, so it might be worthwhile to have him do it, but I will give you a word of caution. If you try to sell this business and it’s you two at the very, very top operating it and doing all those kinds of things, it’s gonna be a little bit of a red flag to a potential buyer.
Justin Allan Montgomery (22:53.055)
because they give you 80 % upfront, right? Let’s say you get this thing to a million dollars, just for simple math. Let’s say you get this thing to a million dollars net and we sell it for seven or eight X, all right? You get seven or eight million bucks, all right? You get 80 % upfront. The buyer now is going to be concerned, okay, well we just gave them 80%, what’s to stop them from just leaving the country and go and live in Costa Rica and live in their best life, right? So.
With that said, there is a little bit of a risk with that, okay? So, and if you do sell it, your husband will have to stay with the business for at least one to two years, and you will too, after close, to allow their operational people to come in and take over your guys’ responsibilities, okay? So.
Carissa Cardiff (23:44.503)
I think for me, the scariest part, I mean, the idea would be that my husband would groom someone else to manage all of the things. And because I’m not good at that part, I’m really not. I’m not good at managing people. I’m a very direct person. just, I don’t know what it is about my personality. I have to remind people, I’m like, just remember, I’m actually nice. But the idea would be that he would groom someone else to actually run all of the things.
Justin Allan Montgomery (23:52.319)
Okay.
Carissa Cardiff (24:14.667)
And like I said, he’s better with people, know, managing people and he’s better with systems and processes. And so that’s, that might only hang up with that because I think that he would be excellent in doing that is that, you know, he makes, he has a management position here, which is actually really hard to find in his, his department. And since we’ve moved to this area, this is the best job that he has had. And it’s about $90,000 a year.
And so losing that income and relying on us to pay him that money, I guess is what gives me really bad anxiety because we’ve put a lot of eggs in this basket and opening up the new clinic. And, you know, I do have overhead, like I said, equipment finance to the other for the aesthetics practice and that kind of stuff. have marketing going out. Like that’s my biggest expense right now is marketing.
especially for the men’s health practice. And so I think for me, it’s just like a big fear that you’ll never get that job again. Like we won’t get that back should something go wrong.
Justin Allan Montgomery (25:25.375)
That is the risk of scaling a business. Every single entrepreneur takes that risk. You get to a point where you give up the job to focus on your business. We’ve all been there. I’ve been there, and most people that I know who scale their business, they have to make that decision at some point. And I said this in another podcast before, no one ever regrets that decision.
They look back and they always say, wish I would have done that earlier. Okay. I mean, you have a business that’s doing $1.5 million gross a year. So you have a proof of concept here, right? Like the business is, it works. You have proof it does obviously, right? You know, are there risks? You know, could things go south? Of course they can. Competition, economy takes a crap.
I mean, there’s so many different things, who knows, right? Most of the time, this stuff is out of your control. So you don’t really, don’t worry too much about it. You build some redundancies in place in your life to make sure you can weather those storms, right? The economy goes into a recession for a year or something. Can you weather that storm, right? Someone opens up another practice. Can you weather that storm with the competition? Okay.
So you build in redundancies to protect you from those storms, right? So the obvious one is the financial aspect of it. So if you are living way above your means, okay, one of the biggest things you can do is just cut back, right? You know, do you have, with the money you’re making, you should probably have at least a 12 month emergency fund that would support you guys financially, personally for one year, okay?
You should have that. We’re close to that right now. Do you?
Carissa Cardiff (27:26.98)
I it kind of, and I know you’re going to hate when I say this, it kind of hangs out in the business bank account. It’s there. It’s not that I’ve done anything with it. I know I need to do something with it, but.
Justin Allan Montgomery (27:39.007)
Okay, when we get off of this call, you are going to go open up an account with Charles Schwab or Fidelity or Vanguard, okay, a brokerage account, all right? It doesn’t matter which one, they’re all the same thing, okay? You’re gonna go open up an account and just as a post-tax brokerage account, this is not a retirement account, this is not a 401K, this is not an IRA, this is just a brokerage account, okay?
then you are going to connect your business bank account to that brokerage account and you are going to transfer over to that brokerage account all the money that you have in the account minus about three months of expenses. Okay. You should always have about three months of expenses in the bank for your business. No more than that. It’s not really necessary. Okay. About three months, just a, that’s just a, just in case, right. Always there. My men’s health clinic, it’s about 30,000 bucks.
I always have $30,000 on account. never have less. Anything more though, goes to a brokerage account. So on a monthly basis, that profit that you make, you move it over to your brokerage account. You should get in that habit every single month. When you start doing this for a couple of months, it’s fine. You get comfortable with it. Leave some money in there to pay taxes or open up another bank account. And just maybe put the money into a savings account for taxes or something.
Or you can just literally, you can put that over to your brokerage account too if you want to, okay? And just put it in some short term bonds. So that way you’re at least making 4%. At least you’re making something on it, all right? So what you can do is the money that you’re making, throw it over to your brokerage account and if you don’t wanna take any kind of risks in terms of investing goes, just buy bonds, okay? They’re safe, all right?
You can put basically all your money into BIL if you want to. Okay, it’s a short term treasury ETF. It pays about 4%. It is as good as cash. It is liquid, it is safe. You will not lose your principal value and you will make 4 % paid every month. It’s interest basically. You can put all your money in there and never touch it and just let it sit there and grow at 4 % if you want.
Justin Allan Montgomery (29:58.707)
You can make a lot more investing otherwise. Okay. We’re going to talk about everything you can invest in right now. It’s, you know, kind of beyond this, this podcast particularly, but you know, at least do that. All right. Get that money. Get that money the hell out of your bank account, your business account, that money sitting there. It’s a liability. You get sued. That money is, you know, you can’t transfer once, once a lawsuit hit you, you can’t, you can’t just transfer that money out. All right. Like that’s you can, but ultimately
The amount that you have in that bank account at the time of the lawsuit is basically up for grabs. So get that shit out. Transfer over to your personal brokerage account or the amount of money that you’re making right now. If you wanted to, you could do this. You know, you could do this in the next few months if you want to. It’s not something you have to do right now, but start a trust and open up the brokerage account in a trust and just throw the money into the trust account. Okay. It’s protected over there. All right. But get that money out. Get that money out of your account. All right. So.
Carissa Cardiff (30:52.515)
I will.
Justin Allan Montgomery (30:53.695)
You probably have then six to 12 months of an emergency fund built, transfer it over. You are financially stable for one year, right? A lot of shit can happen in one year, all right? If worst case scenario, I mean, I’m talking about absolute worst case scenario, probably won’t happen, but business closes for some reason. You go from $1.5 million to zero, right? It’s not gonna happen, but I’m just talking about absolute worst case scenario.
you still have a year’s worth of money in the bank, you will figure out what your next move is within a year. A year’s a very, very long time. You’ll figure it out. So you do that. So basically, you’ve taken care of the financial redundancy component of it. And in terms of competition goes, provide good care, good value at a reasonable rate.
get lots of five-star Google reviews, and if competition opens up, who cares? Right? It’s probably going to happen at some point. I’m sure there’s probably already competition already. So like, YouTube.
Carissa Cardiff (32:02.336)
Two fancizes just opened in the last month here. Yeah.
Justin Allan Montgomery (32:06.299)
Okay, like don’t worry about it because you’re going to be better than they are. Right? People are going to find more value out of you than that franchise. Okay? They’re just going to franchise medical practices are garbage. They’re cookie cutter protocols. They don’t they’re garbage. Right? So you will be better off. Right? You will have patients who are loyal to you, customers who are loyal to you. It’s not a big deal. All right.
So you put that redundancy in place, you’re fine. If you start seeing people start going over there, take care of it, nip it, lower your price, do whatever you have to do to keep those patients. All right. But oftentimes if a franchise opens up in your city, people will go there and then they will realize after a short period of time, three to six months, that the care kind of sucks. And then they will start looking for alternatives. And that’s a super hot lead.
and they will come over to you because the care over there sucks. That’s what happened with my men’s health clinic. We had a game day or whatever the hell opened up. We’re getting so many patients from that place because it sucks. Like, you know what I mean?
Carissa Cardiff (33:17.213)
Okay, to be fair, we already are getting patients from those places. And they just.
Justin Allan Montgomery (33:22.003)
There you go. Okay, there you go. So you don’t worry about it, right? that’s the risk. Those are the redundancies you put in place in your life to where if your husband comes over and quits his job and focuses on this business, right? Then it’s not much of a risk at all, right? It’s just, it’s just not. You can pay him $50,000 a year, $90,000 a year, whatever, all right? Pay him basically the bare bone minimum if you can, all right? Cause you don’t want to pay taxes.
You know what I mean? Right. Pay him the bare minimum. $50,000 a year. Just pay him something. So that way are you, you’re operating have an S corporation for tax purposes, I’m assuming. Okay. All right. So that means every dollar now of profit that you have, you’re basically saving yourself 15 % in employment taxes now. Right. So he’s actually in theory, getting a 15 % raise in reality. Right. I mean, he just, he just is.
Carissa Cardiff (33:52.081)
Right, that’s the plan. Yeah.
Carissa Cardiff (34:04.221)
Mm-hmm.
Justin Allan Montgomery (34:21.907)
you know, from a tax perspective. So, and then the, you know, the other thing too is, is that when he dives into your business and he begins systemizing things and creating operating procedures and all of these things, your business is just being fine tuned. Now it is being optimized and that’s what you’re going to have to do. If you want to work less and less in this business and have a business that’s going to be something that’s going to be something that’s
sold easily. Okay. Like these private equity firms are going to buy your practice. They’re going to absolutely just love all these operating procedures and they’re going to love how your business is fine tuned. Right. And so have your husband come in there and be the manager of it. You know, as long as you can tolerate that, if guys have a good relationship and all this kind of stuff. And once he’s in there for six to 12 months, he will completely understand how it works. He will
You know, develop all these operating procedures. He will fine tune the thing. And then at that point you look at your MAs, you have three or four at that point or whatever, and you figure out which one is the best one. Which one can take this over? Which one is, you know, which one’s the best one? You probably have someone in your mind, in mind probably like you have, right? Yeah. Train them to do it. Train them to be the manager and pay them well, you know, pay them 70, $80,000 a year.
Carissa Cardiff (35:40.464)
Yeah.
Justin Allan Montgomery (35:48.809)
They’re not gonna find a better job as an MA. They’re just not, you know? And that’s good money for them. And then they start managing it for you. And then essentially at that point, you have a couple of NPs working for you. And then at that point, all you and your husband are really doing is you’re still seeing some patients because maybe you enjoy seeing your men’s health patients. That’s all you wanna see anymore or something, okay? You’re still seeing some patients.
husband in you, you can look at the finances, you basically take it, you take care of it from a financial standpoint, right? Make sure no one’s stealing from you, you make sure the numbers look good, you make sure the expenses, you make sure your profit, you know, make, you you make sure your margin’s still sitting around 40%, okay? That’s, that’s all your job is at that point and marketing to get people in the door. That’s it. So that’s how you build that business in a way to where it works for you. Does that make sense? Any questions?
Carissa Cardiff (36:42.923)
No, it makes perfect sense. You just said all the things that I needed to hear. I just needed somebody to tell me these things. I already kind of knew them. It’s just it’s a it’s a really big leap for me. And because I am so busy, I don’t sit down and focus where I need to focus. I just living literally minute to minute.
Justin Allan Montgomery (37:04.529)
And that’s the issue. You just don’t have the time, right? You’re working so much in your business, you don’t have time to work on it, right? Yeah. So, start small. Start at the bottom of the pyramid first, okay? Do the audit over period of a couple weeks. Figure out where the big leaks of your time is and then seal those, seal the bigger leaks first. It might be the NP that you need first, maybe, okay? So, yeah. Now,
Carissa Cardiff (37:11.361)
Yes. Yep.
Justin Allan Montgomery (37:33.939)
Doing the free consult, you you mentioned that. So that sounded like kind one of your big pain points was like, you have a 99 % close rate or whatever, something ridiculous, right? You know, having someone else do that for you when you have that kind of close rate, they’re gonna have a lower close rate than you are, right? They’re just, probably going to. So just keep doing those then. If you have the time to do them, why not? That’s patient acquisition.
Carissa Cardiff (37:52.555)
Bye.
Justin Allan Montgomery (38:01.343)
That’s a true income generating activity in your business and that’s what you need to be focused on are those income generating activities. That’s an income generating activity, you can keep doing that. And if you want to sell the business later on, it’s fine. That’s not a problem. I don’t see that being a
Carissa Cardiff (38:16.372)
Well, what if, so what these 15 minutes consoles are, it’s basically a meet and greet, right? They tell me where they’re at, what they’re concerned about. I let them know how it works in our practice, the costs, and I’m very transparent about all the things. And then they all want to see me. And I get this question at least once a week. Is there another provider here? Are we always gonna see you?
And the answer right now is yes. And I always tell them, you know, I am going to hire someone eventually. But I, you know, I might, you know, try to keep my own patients. That’s the thing that I worry about the most is that I have a rapport with my patients. I enjoy my patients. I educate my patients probably to death. And I don’t want to lose that part of it all.
But I feel like if I was like, well, no, you’re going to see so and so and, you know, they’ll be great and, you know, they’ll handle all the things that might be a pain point for my patients.
Justin Allan Montgomery (39:17.951)
So yeah, and that’s pretty common. I mean, that’s a really common pain point for patients. They like to see you, right? So as you get a little bit more out of the business and you continue to do those free consults, you can do one of two things. You can start having maybe one of your MAs start doing those calls.
you know, or an RN or something, one that’s very, very knowledgeable about men’s health, someone who can answer the majority of the questions that those patients are gonna be asking you, right? I you’ve been doing this for a period of time now. Overall, for the most part, you can probably, off the top of your head, probably write down 90 % of the questions that you get, right? It’s the same questions over and over and over again, right? It’s the same concerns, the same questions. So we’re getting writing those down, all right?
Carissa Cardiff (40:06.386)
Mm-hmm.
Justin Allan Montgomery (40:11.423)
That way you can create a list, all right? And then the MA that you have in your practice who is the most knowledgeable with men’s health, they can begin taking some of those calls and test it and see, okay? I don’t do those calls anymore at my men’s health clinic. I just don’t, all right? My head MA does those calls, but he’s been with me for…
seven eight years now at this point and he understood he could see patients for men’s health now he could I mean you know what I mean he just he just could he knows exactly what I’m gonna do he knows exactly what I’m gonna order like he understands all the side effects now he understands everything now and so he can pretty much answer 99 % of questions from patients and then every once in a while I have to answer some really
crazy off the wall one or something. You know what I mean? So that’s that, you know, that’s that, that’s basically one thing that you can do is begin just slowly training that person in your business that you trust that knows this stuff to begin taking those phone calls. Okay. Now the other thing that you can do is you can, when they ask you, am I going to be, you know, am I going to be seeing you? All right.
If they ask you that, you can tell them, yes, you will be seeing me, all right? But once we get you dialed in, you know, it might take six months. My goal is to get you dialed in, like your testosterone level’s perfect, no side effects, nothing. Once we get you dialed in, you will probably start seeing another provider just for refills and stuff because everything is completely dialed in. There’s really no point after that.
And most patients, most mental health patients after they’ve been there for a year or two, they don’t care who they see anymore because they don’t care anymore. You know what I mean? They’re dialed in, there’s no issues, right? So you can kind of approach it that way. If they don’t ask you that question at all, then you can kind of mark it or something that says, okay, we can send this to this other NP, because they didn’t care. They didn’t seem like they really asked those questions. I didn’t really get that vibe from them.
Justin Allan Montgomery (42:35.593)
So start sending those to those other patients, right? Cause every single person calling you is not asking that, right? The ones that are, maybe you just keep those, that’s fine. Your established patients that you have now, you can begin asking them, you hey, listen, Joe, you’re completely dialed in now. Like there’s really nothing else. There’s nothing new here to talk about, you know, for your follow-up. Do you mind if you see this new NP?
Carissa Cardiff (42:41.871)
Right.
Justin Allan Montgomery (43:00.659)
you know, she or he’s great. They know what they’re doing. There’s, this is mostly for refills, et cetera. I’m still always available if you want to make an appointment with me. All right. So you just kind of slowly just start doing that. Start sending them off to the other people. And then before you know it, you know, you’ll have a group of people that just want to see you. They’re stubborn. They don’t want to see anyone else. And you know, it take a year or two to get to that point. It’s kind of what happened with my men’s health clinic, but like I have my patients now.
I don’t see any more new patients at all. Every once in a while I might see a new patient. But like, I have my patients that I’ve been seeing for five, six, seven years now, they don’t wanna see anyone else. Fine, whatever. I spend an hour to a week seeing those people. It’s not a big deal. You know what mean? So, that’s kinda how you approach it.
Carissa Cardiff (43:47.32)
Yeah. That makes sense.
Justin Allan Montgomery (43:51.314)
Yeah, okay, so, you have any other questions in terms of any other stuff goes before we talk about letting go responsibilities? I think that’s probably your big pain point.
Carissa Cardiff (44:04.526)
Um, I guess when, when hiring an NP or a PA or someone else with D patients, I think about like kind of how my business model is and how everything’s just kind of like packaged together. It’s not like I, I don’t charge for visits. My patients are basically paying for that with their medication management and things like followups and that kind of stuff. So if when you have another provider and you’re paying them, you know, productivity, right.
how do you determine like what that’s worth? Is it just kind of, you I don’t know, I guess there’d be a lot of math for me to do.
Justin Allan Montgomery (44:44.285)
Yeah, I feel like that really depends on kind of what they’re doing. So.
For like simple, like for visits, for medication management kind of stuff, you know, like men’s health or women’s HRT or weight loss, you know, something that’s just more medical in nature where it’s a visit and there’s a prescription kind of a thing. you know, those aren’t necessarily, those don’t need to be a percentage of collections in terms of the production goes. Those can just be flat rate things. Okay.
Because it’s pretty much, you know, these people are paying you every month for this. This is pretty much what they, you know, what they, you know, what they pay for, et cetera. So that can just be a flat rate thing that makes sense to you, you know, at my men’s health clinic. I’m sure you’ve heard me say this multiple times that, know, we pay new visits or a hundred bucks and follow-ups are 50. That’s way above market. Okay. Way above market. Most places do not pay that they pay, you know, $50 for new patients and 25 for follow-ups or whatever.
So you can pay them more to make it worth their while. You you want to put golden handcuffs on your providers, right? So they don’t go anywhere else. Like you want to, you want to put golden handcuffs on them. You want them to be reliant on you. You want them to be stuck with you, right? You want to pay them just enough to where the thought of them opening up their own business is too much risk. They don’t want to do it, right?
So, so yeah, so that’s kind how you would approach that. In terms of the other stuff goes though, like aesthetic procedures, like more like procedural based things, then I think a percentage is probably worth it, because they’re spending more time with it. You want them to do well, that kind of a thing. So, you know, you’re gonna have to run some numbers there to see what works for you. Cause I don’t know how much you charge for these various different things that you’re doing.
Justin Allan Montgomery (46:46.301)
But you know, something like 20, between 20 to 40 % seems to be fairly, you know, market or above market, but don’t pay, don’t give them a percentage of the point where you’re not making money, obviously, right? So the rule of thumb with this is that when you begin hiring other NPs or RNs to begin doing more of this clinical stuff for you, the rule of thumb is that you’re doing it yourself now.
And right now your margin is 45%. That’s you. You are doing it as the business owner, right? So all the profits yours. When you start paying other people to do this for you, that margin is going to go down. It’s just going to, right? There’s no way around it unless you increase your prices. And then if you do that, you start losing patience, right? So you don’t want to do that. So…
You want to maintain a margin on every NP or RN doing stuff for you. You want that margin to still stay around 25%. Okay. That’s where you want it to maintain is around there. All right. So you begin hiring a lot of these NPs and stuff and they start seeing more patients for you, et cetera. You are going to see a hit of your margin for a little while, but it should start making up.
as you get more MPs and you start getting more patients, et cetera. Okay. So you will probably settle, you’re probably, you you having a bunch of NPs working for you and RNs and stuff, the days of 50 % margin are probably over. Right. It’s very, very difficult to have a 50 % margin and have you out of the business and have people just doing it for you. Right. So the days of 50 % are done. You should settle around 30.
Carissa Cardiff (48:34.884)
Right.
Justin Allan Montgomery (48:40.351)
is about probably what you’re gonna be settling at once you’re completely out of the business. That’s still really good. You know what I mean? You know, because what’s gonna happen is your gross revenue is just going to skyrocket, it’s going to increase because now you have the capacity to really increase patient volume. And so where you’re at right now making $600,000 or $700,000, whatever it is, know, whatever your net profit was for 2025,
Carissa Cardiff (48:44.933)
Okay.
Justin Allan Montgomery (49:09.599)
You’re going to see a dip in that this year, but this is what I mean by investing in your business, right? You’re going to be investing money back into the business for staff. So that six or $700,000 in 2025, that net income is going to dip probably, all right? It might not, because you might just get a lot more patient volume and it might stay the same, but you might see a dip or it might stay about the same in 2026 and then 2027.
Hopefully you’ll start seeing that now go from six to 700,000 in 2027. It might go back to six or 700,000, which you made last year, okay? Or it might be a little bit higher than that. And then probably 2027, late 2027, 2028, is when you should start hitting that million dollars. Because now the business is working for you. Now you have your time back. You can spend more time marketing, income generation kind of stuff, getting patients in the door.
So just be aware of that, okay? You’re gonna see a little bit of a hit, so don’t be surprised when you do. Yeah.
Carissa Cardiff (50:12.586)
Yeah, it’s scary, but I mean, I really want my time back so bad.
Justin Allan Montgomery (50:19.135)
You’re gonna have to. Like that’s, you just, you’re gonna have to. That’s, that’s business. You know? Yeah, it happened with my men’s health clinic. I’m gonna start hiring a bunch of MPs. Like my, my, my, my profit stayed fairly stagnant for, for a little while. But I was able to get my time back. Like you can’t put a price on that. I was so much happier. Yeah. Yeah. So letting go of responsibility.
Carissa Cardiff (50:42.006)
Yes.
Carissa Cardiff (50:48.247)
Mm.
Justin Allan Montgomery (50:48.735)
Alright, this is something that’s very, very difficult for a lot of people and it just, it is what it is, okay? So you just have to accept the fact that you are going to just have to let go of these responsibilities. You have to just trust people. Like there’s, I don’t know any other way to put it. Like you just have to trust people that they’re going to do their job.
And if you pay them well and you treat them well, they’re gonna do a good job. Okay? Probably. Unless you just get some shit back in there, which happens sometimes. Okay? But if you’re paying them well, then you should be able to trust them. If you create clinical protocols and standard operating procedures for them to follow, you said you like things done your way, that’s fine.
They will continue, they will do it your way if you train them how to do it your way. Okay? Now with a provider, there’s always gonna be some wiggle room there in terms of clinical decision making and whatnot, right? I mean, there’s no way around that. Everyone practices a little bit different, but they still need to be following your clinical protocols, right? The last thing you want is to hire some NP that comes in to see men’s health patients and they follow the urological guidelines.
Carissa Cardiff (52:09.502)
Right.
Justin Allan Montgomery (52:11.475)
Yeah, that ain’t gonna work. Yeah, yeah, you know, so this is the clinical protocol. This is the guideline you’re gonna use is this clinics guideline. I don’t give two shits about the urology or endocrinology guidelines. We don’t make money that way. So if that’s what you wanna do, I’m not going to hire you. I would make it crystal clear when you interview these people, you’re gonna follow this clinical protocol. If you are not okay with that, tell me right now before we waste time. Okay, so yeah.
Carissa Cardiff (52:14.334)
Justin Allan Montgomery (52:41.939)
So when you interview these people, you need to kind of make sure you’re gauging them and testing them to make sure that they are okay with that. All right? Yeah. Yeah. You do not want textbook, you know, Nancy in there. You do not want that person in there. You do not want nursing professor Nancy working for you. That’s not what you want. You want cowboy Caitlin in there. That’s what you want. Yeah. All right. And trust me, there are plenty of those people out there.
Carissa Cardiff (52:48.828)
That’s a good point. I didn’t even think about that.
Carissa Cardiff (53:06.206)
Yes.
Justin Allan Montgomery (53:11.849)
Okay, there’s plenty of them, so don’t worry about it. But there are also lots of textbook and professor types out there too. And they will drive you nuts. Do not hire those people, okay? Yeah.
Carissa Cardiff (53:25.468)
feel like we wouldn’t vibe anyway. So that’s good.
Justin Allan Montgomery (53:28.159)
Would it? Correct. You wouldn’t buy. That’s right. Like I think I’ve said this in other podcasts before, but like I know I’ve said this at some of our conferences when people ask me, how do I, you know, how do I interview people? How do I talk to people or whatever? How do I hire someone? And one, one simple strategy that you can do is that when you are interviewing them, like I don’t have a filter on my mouth.
And when I’m interviewing people, make sure that that filter is even tuned down even more. Okay. I will make sure that I cuss like a sailor and I will talk shit during that interview. And if I’m sensing that they’re getting uncomfortable, I immediately know that you are not going to be a good fit here. So like, yeah, a little trick. Okay. So like, if you have a little bit of a filter, throw it in the trash before the interview. Okay. Like,
Carissa Cardiff (54:13.02)
That’s excellent.
Justin Allan Montgomery (54:23.263)
Yeah, if they vibe with you and they throw back a shit or something like that in their language, okay, we’re vibing. Okay, I think, you know what I mean, right? So yeah, so just that’s, you know, that’s kind of one of the tests that you can do. And another test that you can do as well is ask them this question. Where do you see yourself in two years, three years, five years? If they sit there and tell you that they see themselves in five years opening up their own practice, do not hire that fucking person.
Carissa Cardiff (54:51.772)
Great.
Justin Allan Montgomery (54:52.882)
Yeah, do not hire that person. Don’t and a lot of these people will be they’ll be honest with you. They’ll tell you that you’re like, I’m not gonna hire you then. No. Yeah. Yeah. So, okay. Any questions about letting go of responsibility?
Carissa Cardiff (55:08.766)
No, I mean, it’s going to be hard thing to do, but I don’t have any questions about it.
Justin Allan Montgomery (55:15.414)
You just gotta do it. I don’t know any other way to tell you. You just gotta do it. You just gotta trust these people. You got clinical protocols, standing operating procedures. You follow this and then you just gotta trust them. So don’t obviously go full blown here. Balls to the wall and hire three NPs. Hire one part time, right? Someone for 10 hours a week and test the waters. Let go of it.
Give it a few months, get comfortable with it. And as you start getting comfortable, that’s when you then open the floodgates or hiring other people and that kind of stuff as you get more more comfortable with it. Yeah. Another thing too, that’s ideal in terms of hiring part-time NPs, okay, is that you typically want to hire some NPs who work full-time somewhere else and it’s a good job. So like, as an example, someone who works at the VA, right?
They work for the VA. They know they get that pension after 20 years, right? And let’s say that you hire someone that works at the VA, but they just want to do, I don’t know, a Wednesday evening and a Saturday morning for you or something. Give you five to 10 hours a week. Great. That’s all I need anyways. I just need you to see some weight loss patients or whatever, right? Someone that works at the VA, they have that pension and they have really, really good benefits. Someone like that is probably not going to quit that job to open up their own practice. That’s not going to.
Right? Like they got 10 more years before they hit their pension. They’re not going to give that up. That’s someone that’s good. That’s someone you put golden handcuffs on.
Carissa Cardiff (56:50.667)
Okay. Or maybe someone who’s like in a union, you know, all of those kinds of things.
Justin Allan Montgomery (56:54.791)
Yeah, exactly. Or someone who just has a really good job, you know, who has three kids, you know, who’s the breadwinner. They can’t take those kinds of risks. Those are the kind of people that you want. You do not want, you do not want some ambitious 28 year old who just graduated in P school, who has the whole, their whole life ahead of them. You really don’t want that kind of person.
Carissa Cardiff (57:09.873)
really good sleep.
Carissa Cardiff (57:24.337)
Yeah, I have a couple of people in mind. just, it’s really hard for me to even think about relinquishing control or allowing, you know, I don’t know. I think it’s training them that gives me anxiety too, like having time to do that. But I just know I have to do it.
Justin Allan Montgomery (57:44.499)
Just have them shadow you. You know what I mean? Just have them shadow you. Like that’s pretty much it. You say, okay, listen, you’re just gonna follow me for the next couple of days, you know, or a week or two. Here’s the clinical protocol, study these, et cetera. I’m always available for questions. Anytime I’ve ever hired an NP, they’ll be texting me, hey, this patient I’m getting ready to follow up with has these labs. What should I do? I text them right back, you know? So, but after a little while, they just, they stop asking for help, because they don’t need it anymore.
Carissa Cardiff (58:12.732)
Yeah, I thought about when I do hire someone just kind of putting them through the courses, you know, the men’s health and women’s HRT courses, the really NP. That was just really helpful to have all the things I had the base knowledge, but like just kind of having an idea and introducing them into that realm if they’re not used to those kinds of things. That was something that I considered too.
Justin Allan Montgomery (58:42.451)
Yeah, you do that? Absolutely. You know, just be careful that they don’t get to the business sections.
Carissa Cardiff (58:47.313)
Well, there you go. That’s a good point.
Justin Allan Montgomery (58:51.741)
Right, just be a little careful there, yeah. So, any other questions?
Okay, well this was a scale your business master class. So yeah, hopefully you have a decent plan now. So.
Carissa Cardiff (59:06.277)
I have a lot of notes.
Justin Allan Montgomery (59:08.799)
Okay, good. All right. And then, this will be released in, you know, a couple of weeks or whatever. And people are listening right now. Obviously it’s out, but, uh, you can always re listen to it. You know what I mean? So yeah. Um, cool. I like the, uh, and the episode with you asking me a question, you have a question for me, personal curiosity, something like that.
Carissa Cardiff (59:26.989)
Where are you currently located? You seem like you’re all over the place these days.
Justin Allan Montgomery (59:32.307)
Yeah, I’m just at my house in Colorado Springs. So just here in right now. Yeah, it’s beginning of February and it’s like, there’s no snow. It was like six.
Carissa Cardiff (59:44.943)
Isn’t that weird? There’s, we don’t have snow here either.
Justin Allan Montgomery (59:48.51)
Yeah, where you at?
Carissa Cardiff (59:50.009)
In Montana, eastern Montana.
Justin Allan Montgomery (59:51.487)
Montana. Okay, gotcha. Yes, you’re just like, you know, 10 hours north of me or whatever. But like, yeah, it’s like, what is this? It was like, it was like 60 degrees on Sunday and I went hiking and like, I just carry my sun mullion all packed behind me and I hide for three or four miles or whatever. I was like, I had my, I was wearing a t-shirt. I was like, what the hell is this? It’s January, February, January. yeah, it’s crazy. Yeah.
Carissa Cardiff (01:00:16.304)
I’m a little bit frightened. We’ll see what the summer brings.
Justin Allan Montgomery (01:00:21.439)
Yeah, this summer is gonna, yeah, wildfires and the creeks and the river is gonna be pretty low and yeah, hopefully, I don’t know, hopefully we get a late winter or really wet spring or something. I don’t know. Yeah. So cool. All right. Well, listen, you got my email. If you want to do a follow-up six months from now or whatever, just email me and let me know. I’d like to know kind of how things are working out for you. don’t be shy if you want to do another follow-up.
Carissa Cardiff (01:00:47.416)
Okay, sounds good. Thank you so much for this.
Justin Allan Montgomery (01:00:50.271)
All right, you’re welcome. Take care. Bye.
Carissa Cardiff (01:00:52.142)
Great.
