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Nobody Is Paid to Notice · Chapter 4 of 8

Chapter 4

Ask one question before you spend

By Nick Cheremeteff, with Matt Phillips · Updated October 14, 2026

What it looks like

Someone pitches you something every week: an AI receptionist, a new website, more ads, a review tool. Each one sounds reasonable, and each one claims to pay for itself.

What’s behind it

“Will this pay off?” is the wrong question. Almost anything shows some return if you measure it generously, and your budget and your team’s attention are limited. Money spent on the third-best fix is money the best fix doesn’t get.

Every new tool also needs someone at the practice to set it up, learn it and check it. That time usually comes from the front desk, where people are already stretched.

What to do

Before any new spend, ask:

“Is this the biggest win available to us right now, in new patients or in hours back?”

To answer it, put your options side by side. For each one, write down what it should change, how you’ll measure that, and how many hours a week your team will spend on it. Then compare them with the leaks you found in Chapter 1.

Often the winner costs nothing new. Plenty of practices already pay for reminder, texting or online-booking features in software they own, and nobody has switched them on. Check what you’re already paying for before you buy anything else.

Questions to ask this week
  • Of everything we could fix this quarter, which gives us the most new patients or hours back?
  • Which features are we already paying for in our practice software, phones and texting tools that nobody uses?
  • How many hours a week will our team spend running this new tool?
  • How will we know in 90 days whether it worked?