A Nurse Practitioner Got Kidney Stones at His Last Job.

Most practitioners don't quit the day they decide they're done. They stay, absorbing the 15-minute slots, the insurance denials, the administrators deciding what they can and can't order.

And then one day, they're sitting in the parking lot with a headache before they've even walked through the door.

This issue is about what happens after that moment. The real version, not the highlight reel. Eight months in, two clinic locations, slow days included.

Chad Stencel, a family nurse practitioner from Minneapolis, joined me on the Starting a Business Simplified podcast to share exactly how he got here. His full episode is coming soon.

What he said was too good to wait.

After working alongside practitioners navigating both sides of this system for over a decade, I've seen what actually stops people. It's not the paperwork. It's not the business setup. It's not knowing what "after" looks like.

Chad spent years inside a large healthcare organization, working his way from internal medicine to quality lead for an entire cardiac division. On paper, that looked like success. In practice, he was developing kidney stones because he couldn't leave the operating room long enough to use the bathroom.

He'd pull into the parking lot and feel a headache arrive before he opened the car door. He and a close colleague eventually asked the same question: what if we removed the obstacle entirely?

Eight months ago, they opened True North Medical Care, a fully cash-based, direct-pay primary care practice with two locations in Minnesota.

Today Chad spends 60 to 90 minutes with one patient. He recently had a patient stand up and hug him at the end of a visit. He orders the tests he believes are clinically appropriate. He gives established patients his personal cell number.

He charges $250 for a visit that, within the insurance system, was recently billed at $1,288 for 15 minutes, with no stethoscope.

His wife and family say he's a different person. He said it himself:

He still has slow days. He and his business partner have both considered going back to W-2. Neither of them will.

Maybe you've sat in your own version of that parking lot.

Maybe you're excellent at what you do, and the system keeps telling you that time with patients is a liability, not the point.

Maybe you know you want out, and don't know what "out" actually sustains.

You're not imagining it. The system was not designed to sustain the people working inside it.

We were taught that leaving the system means having every answer before you move.

Here's the truth:

Chad and his partner spent six months researching before they opened. They talked to lawyers. They talked to accountants. They mapped malpractice coverage, referral networks, and state requirements. None of that is taught in clinical training, and large organizations don't teach it either, because they don't need you to know it.

You're allowed to not have this figured out yet. Clarity comes from moving toward the questions, not waiting until they're all answered.

Chad was direct about what surprised him most: getting patients through the door.

Facebook ads — nothing. Google ads — nothing.

Real money spent with zero return.

What actually worked was word of mouth. Patients who experienced something they couldn't find anywhere else told people. Those people called.

We were taught that visibility means advertising.

Here's the truth:

Chad's story is exactly why I built the Centered Care Directory, and he's already a founding member. Practitioners like Chad, who are skilled, patient-centered, and doing everything right, are still largely invisible to patients who are actively looking for them.

I kept hearing the same marketing struggle from independent practice owners across specialties, and I realized the missing piece wasn't their messaging. It was infrastructure. A place where the right patients could find the right practitioners without insurance as the middleman.

The Centered Care Directory is a curated directory connecting patients with independent, cash-based providers. Patients searching for client-centered, outcome-focused care outside the insurance system can find practitioners by location and specialty.

Just practitioners who practice the way Chad does, and the way you're building toward.

Normal.

Chad had days with one patient. He and his partner talked about quitting more than once. The question they kept returning to wasn't whether it was hard; it was whether they could go back.

For both of them, the answer was no.

This is what drives Chad to keep going. People are looking for the services we provide. It’s up to us to align with how they can find us.

Word of mouth is powerful and slow.

A directory built specifically for cash-based care puts your practice in front of patients already searching, without you having to chase them.

Here's where I'll be transparent about the directory's current state:

It's in its founding phase.

That means it's being built intentionally, starting with practitioners before opening to the public. The marketing to grow both sides, practitioners and patients, comes next. Like any new platform, it starts somewhere. That somewhere is the founding members.

You're getting in before the directory is fully marketed, before the administrative and marketing costs scale, and before the price reflects what it costs to run something actively growing.

Practitioners who join later will pay more because the infrastructure and visibility will already be in place. Founding members are helping build that foundation, and the rate reflects that.

If you've been inside the system and wondered whether a practice like Chad's is actually possible for someone like you?

Ask yourself what it would mean to find out the answer is yes.

You don't need a plan right now. Just let yourself consider it honestly.

The Centered Care Directory is currently open to founding members by invitation, for practitioners I know, including podcast guests and coaching clients.

The founding rate is $97/year, locked permanently. When the directory opens to the public, that rate closes.

If you're building a cash-based practice and want to be findable by patients who are ready for exactly what you offer, learn more about becoming a founding member.

Eight months in, two locations, patients hugging him on the way out. That's what the real version looks like.

Anything is possible.

Suzy Wraines