An Orthopedic Surgeon Resigned Before She Had a Plan: Here's What Happened

We think we need the business plan. The website. The pricing. The perfect offer. The certainty that it will work.

Here's what I've learned after coaching practitioners through this transition: the internal decision comes first. The external structure follows.

This week, I want to share a story that captures this beautifully and introduce you to something you might not know about.

Some of you might not know this, but I've hosted a podcast called Starting a Business Simplified for the past three years.

Recently, I've started featuring clinicians who are actually building their own cash-based practices outside the traditional healthcare system. Real practitioners. Real transitions. Real stories about what it actually takes.

Dr. Adrienne Towsen is one of them. And her story captures something I see constantly in my work.

Dr. Adrienne Towsen is an orthopedic surgeon who spent 21 years in medicine, 19 of them at the same practice.

Then, private equity acquired her practice. Her income dropped by half. Decision-making shifted to "profits over patients." She felt exhausted, miserable, and completely out of alignment with why she became a doctor.

The timeline:

Here's what struck me most:

She resigned before she had the full plan. She made the internal decision first.

She couldn't even practice orthopedics due to a two-year non-compete. So she pivoted into hormone optimization, peptide therapies, and proactive wellness care. Building something entirely new.

Her approach now:

One thing that made the difference: Dr. Towsen hired a business coach early in her transition. She credits that support as critical to shaping her path forward, especially when she didn't have all the answers.

She didn't wait for clarity. She got support while finding clarity.

When Adrienne told me about writing that resignation letter, I recognized it immediately.

It's the same moment I've seen with dozens of practitioners I've worked with, and the same moment I experienced myself years ago when I walked away from systems that were depleting me.

The external stuff feels impossible until the internal decision gets made. Then it starts to flow.

You don't need permission from the system you're leaving. You need permission from yourself.

If any of this sounds familiar, you're in the right place.

Maybe you've been waiting until you have "enough" clarity to make a move.

Maybe you keep researching, planning, and preparing without starting.

Maybe you know something has to change, but you're waiting for the external pieces to fall into place first.

Or maybe you've already made the internal decision. You just haven't given yourself permission to act on it yet.

You don't need the full plan before you make the decision. The decision creates the plan.

Certainty doesn't come from more research. It comes from making a decision and moving toward it.

Adrienne hadn't fully planned her clinic when she resigned.

She had:

We were taught that planning creates confidence.

Here's the truth:

Internal foundation isn't about feeling ready. It's about:

The LLC, the office key, and the furniture came later. The real work happened before any of that.

One of the most important things Dr. Towsen did was get support early.

She hired a business coach who helped her shape her path forward when she couldn't yet see the full picture. That support was critical, not because she wasn't capable, but because building something new while leaving something familiar is a lot to hold alone.

I want to be clear: I didn't work with Dr. Towsen. Her coach was the right fit for her.

The point isn't who you work with. The point is that doing this alone often keeps practitioners stuck longer than necessary. Having someone in your corner can make the difference between spinning in research mode and actually moving forward.

If you're looking for that kind of support, find the person who feels like the right fit for you. If that's me, just reply to this email. I'd love to hear where you are. If it's someone else, that's exactly right too.

You're allowed to get support while you're still figuring it out. That's not a sign you're not ready, it's a sign you're taking it seriously.

"But what if I leave and the new thing doesn't work?"

Adrienne left without knowing exactly what her next chapter would look like. What she did know: staying in misalignment wasn't sustainable. Many practitioners find that once they commit, resources and opportunities that weren't visible before appear.

"Do I need to have my business set up before I resign?"

Not necessarily. Adrienne continued working for six months after submitting her resignation. That overlap gave her time to plan while maintaining income. There's no single right timeline, just the one that works for your situation.

If you already know what needs to change, ask yourself: What's the smallest internal commitment I can make this week, not to have the answers, and to trust that I can find them?

You don't need to write it down or announce it to anyone. Just let yourself sit with the question.

If you're exploring what a cash-based practice could look like for you, the Cash-Based Practice Starter Guide walks you through the foundations, scope of practice, business setup, pricing, and more without overwhelm.

Download it here and take the next step at your own pace.

Inside the guide, you’ll find:

This guide is educational, not promotional. It’s designed to help you think clearly and safely.

And if you're sitting with a decision right now, whether it's resigning, starting something new, or just admitting something needs to change, you can always hit reply. No pitch, no pressure. I read every response.

Building from the inside out isn't reckless. It's how sustainable practices are actually built.

Warmly,

Suzy Wraines, Healing-Centered Business Coach