Outsourcing vs. Delegation

person handing file folders to another person

Which support is right for your practice?

By Matt Slimming, PT, DPT*

I clearly remember the darkest years of my career, between 2006 and 2008.

I was (poorly) running three clinics and had just opened a full-service fitness center. I didn’t know how to run a clinic well at the time. Because of this, money was always tight, so I was still working over 40 hours per week treating patients while trying to handle my management responsibilities.

I was in a state of constant stress. I was supervising way too many people. I wasn’t helping my team, but instead responding erratically to every new challenge that came my way. My staff didn’t like me very much because I had allowed the stress to change my personality.

People now consider me to be a very positive person to be around. Maybe a little intense, but still almost always upbeat. But I remember back then actually wishing for a heart attack just so I could take a break. Dark days, indeed.

How did I get there? I had taken on too much without seeking the support and specialized guidance that I needed. I was trying to do everything myself, a sure recipe for failure — and maybe a heart attack.


Shouldering it all and teetering on the edge of failure isn’t uncommon in our field. Far too many practice owners avoid outsourcing because they assume the costs are higher. In reality, the cost of trying to do everything yourself can be much greater over time. Case in point: I recently received an email from an owner considering whether he should start using a billing company. If billing isn’t something he excels at, the stress and time lost is likely a much greater expense over time. By letting others take care of those things that he doesn’t have the time or desire to master, his resources can be leveraged for greater, faster growth.


We know we can’t do everything well. Regardless, how many things are you still trying to do yourself, even though it makes far more sense to give it to someone else?

If you’re in the fortunate position to have staff to whom you can delegate tasks — critical if we are to grow our practices — you must also consider how many people you can effectively manage. The “Rule of Seven” management concept says that managers lead best with just a handful of direct reports, typically seven direct reports.1 If you’re close to that number, it’s likely time to consider who on your team can manage others, or whether outsourcing some activities would make sense for your practice.

There are three main reasons to unload some of your responsibilities:

  1. You have more tasks than you can realistically do.
  2. You just aren’t good at some tasks and they take you away from other things you’re good at or enjoy.
  3. You’re striving for more work/life balance.

Typical activities that may be delegated or outsourced include HR, compliance, billing, digital marketing, and leadership training. However, there are many other areas that you might seek additional support, such as:

  • Staff Performance Management
  • Special Programs Implementation
  • Cash-based Services
  • Fitness Center Management
  • Comprehensive Clinic Management
  • Staff and Clinic Credentialing
  • Payor negotiations

Understanding what tasks you might seek support for can help you determine whether you have the right people on staff to delegate to, or whether outsourcing is the next best step.


Acknowledging that you need help is the first step. The next step is deciding what kind of help makes the most sense for your practice. Both delegation and outsourcing have different pros and cons.



Step 1: Identify the one item that is most responsible for taking you away from the job duties that you enjoy the most. What is the one thing that, if it was no longer all on your shoulders, would allow you to feel more energized and joyful about work?

Step 2: If you’ve decided to explore outsourcing, focus on finding a company that performs that responsibility well. It should be a company with specific physical therapy knowledge in that area.

Step 3: Have at least one long conversation with that company. Make sure all your questions are answered. Consider asking for references.

Step 4: Try to avoid being locked into a long contract. You want to be able to exit the arrangement if things aren’t working out and limit any potential losses.

Outsourcing tasks may offer you an opportunity to focus on growing your business that otherwise would not be available. Consider reflecting on your role in the company, those you may consider delegating to, and the potential areas for outsourcing. You may be surprised at the result. 

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1Rabbolini O. Servant Leadership and the Rule of Seven. Medium. https://medium.com/swlh/servant-leadership-and-the-rule-of-seven-27e516017b66. Published November 29, 2019.

Matt Slimming

Matt Slimming, PT, DPT, is a PPS member who owns STAR Management Company, STAR Physical Therapy and STAR Fitness. His passion is helping other physical therapists thrive without the headaches. He can be reached at matt@star-mgmt.com.

*The author has a professional affiliation with this subject.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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