Photo courtesy of Dr. Bethany Fishbein, whose daughter (pictured here) just made the crucial decision of where to go to college. Dr. Fishbein says the deliberation process before this decision was made reminded her of the difficulty practice owners go through when making decisions.
Making, rather than putting off, decisions
By Bethany Fishbein, OD
June 11, 2025
Over the last few months, our high school senior daughter was deep in the process of deciding where to go to college. She had several great options, each with its own pros and cons.
There wasn’t a wrong choice—but there wasn’t a clear winner, either. And until she finally made the decision, it felt like everything else was on hold.
Dinner-time conversation felt heavier than usual, and she started to dread interactions with adults, who would inevitably ask what she was doing next year. We couldn’t make any specific plans, book summer travel, or even start shopping for dorm supplies, because we didn’t know where exactly she was going to end up. The uncertainty was stressful, and it hung over everything.
Watching her go through it, I recognized the feeling.
Because lately, I’ve been stuck in that same kind of decision-making limbo in my own practices. We’re in the middle of some really big decisions about the future of the company, and what we want growth and our future to look like. None of these are emergencies, but each one is quietly pulling focus—filling my brain with noise and making it hard to fully concentrate on anything else.
And I know I’m not alone.
As practice owners, we make decisions all day—tiny ones, like which drop to prescribe or whether or not to see the patient who is running late, and bigger ones, like who to hire, what equipment to buy, how to grow and when to step back. But when the big ones pile up, and we don’t decide? The weight of those unmade choices can be even more exhausting than the work itself.
Unmade decisions take up mental real estate
My Facebook profile picture is a mug that says “My brain has too many tabs open.” And honestly, that’s exactly what unmade decisions feel like – like 37 browser tabs open in your mind, all running in the background, quietly slowing everything down.
Maybe you have a staff member who does good work but creates drama on the team. They might be your top seller or your fastest tech, but every time they’re in the office, the vibe changes. There’s tension, whispered complaints and an undercurrent of stress that affects everyone. You know they have to go, but something keeps you stuck – maybe the fear of losing productivity, upsetting the team dynamic or maybe just having a difficult conversation.
So what happens? Well, you feel like you can’t hire – because you haven’t decided to let this employee go. You avoid check-ins with the rest of the team – because you know what they’ll bring up. You hold off on investing in new technology because you’re anticipating their complaints. And you keep bringing up the decision in your mind over and over and over, exhausting you and leaving no time to think about all kinds of other things that could potentially move your practice forward.
Or maybe it’s a situation with an associate. The doctor is fantastic clinically, great with patients and well-liked by the team—but has no interest in a long-term future with the practice. So, the owner stays frozen. He doesn’t promote the associate to the community, doesn’t invest in the associate’s specialty area of interest and doesn’t make plans for growth – because what’s the point, if that doctor’s not going to be around?
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We spend so much time worrying, “What if I make the wrong decision?” But maybe the better question is: “What happens if I don’t make a decision at all?” Because indecision has its own consequences. Practice growth stalls. Opportunities are missed. Team morale quietly deteriorates. And all the while, the mental tabs just keep spinning, demanding attention and draining energy.
Decisions don’t have to be perfect—they just need to be made
We wait for the right time. We wait for certainty. But in most cases, clarity doesn’t come before the decision—it comes after. The moment you decide, your brain can finally stop running endless simulations and start moving forward.
That doesn’t mean every decision has to be permanent. Many aren’t. You can adjust. You can pivot. But even a decision you end up changing gives you something the unmade one never does: momentum.
A Simple Way to Start
If you’re feeling the weight of too many open loops, try this exercise:
- Write down every unmade decision—big or small—that’s been taking up space in your mind. Sometimes just seeing them all in one place can bring clarity.
- Ask yourself two questions:
– Which of these is actually urgent?
– Which one would bring the most relief if it were off my plate? - Pick just one to focus on this week. Block out 30 quiet minutes—no distractions, no multitasking—and give yourself permission to decide. Even if it’s not the forever-decision, choose something that allows you to move forward.
- Talk it through with someone you trust. A colleague, a mentor, or even a coach, can help you sort through the noise, challenge your assumptions and give you the push (or permission) you need to take action.
Sometimes the hardest part of decision-making isn’t lack of information—it’s the emotional load that comes with it. When you’re holding too many possibilities in your head, it’s easy to second-guess yourself or stay stuck trying to predict every possible outcome.
Closing Thought
Being a practice owner means living in a constant state of choice. But don’t underestimate the cost of not choosing and carrying decisions around with you day after day. It adds up. And while waiting can feel like avoiding risk, indecision is often the heaviest burden of all.
Sometimes the best way to move forward is to stop thinking—and finally, just decide.
Read another recent column by Dr. Fishbein
Bethany Fishbein, OD, is a practice owner, practice management consultant and certified executive coach. She can be reached at bethany@leadersofvision.com
