It's not your fault, but it is your problem! He wasn't happy to hear that, but he recognized it immediately.
"So what can I do about it?" (A good, honest and useful question.)
You start with rewriting your future. "What the hell does that mean?" (from where he was thinking, it didn't make any sense.)
Rewriting your future has you define your ultimate Exit from the Practice. It could be by selling it to employee Physicians or a younger new Physician, it could be a plan to be acquired by a Group, Hospital or Network at some point based on a time or target Valuation. Start with the end in mind.
There are 3 questions to incorporate, here are the first two:
For you, what's important to accomplish in the Practice during the next 6 years? For you, what's important about how those accomplishments occur? After that, look at that future from where you are today in the present and identify the limits, opportunities, resources and assets you can access, in order to move toward that future. You want a robust Dashboard to tell you how the Business side of the Practice is Performing. You also want and Operational Dashboard to know how the Clinical side is Performing.
To tie it all together, you want to update the definition of your primary Patient. Recognize where you are in your Marketplace compared with other Practices. Identify how and why you are different and produce a balance between Reimbursement and Self-Pay Revenues. Reimbursements are declining and so are Margins. You want to balance it with things your Patients will value and be willing to pay for in cash.
He is spending this weekend on defining these things and then we'll review them. Take the 2 hours to work through this and you will be surprised at how much clarity you can gain about your future.