You will love Gary Keller’s analogy of dominoes. If you find the right “first domino,” it will knock down all of the following dominoes.
If your domino doesn’t connect to the others, everything just stops.
The key is to create momentum. You do that by finding the first domino, the one tactic that connects to and knocks down the rest, so you can reach your goal.
Start with your big-picture goal three to five years out, then connect it to what you need to do in the next year, then the next quarter, and finally what you need to do today.
Keller also suggests time-blocking first thing in the morning, because your willpower deteriorates throughout the day. Protect that block for nothing but your first domino.
This book covers a lot of ground: multitasking reduces output rather than increasing it, not everything matters equally (the 80/20 rule), the questions you ask determine the answers you get, and living by priority beats living by urgency.
Most providers I talk with aren’t short on ideas for growing their practice. They’re short on a first domino. They’re looking at three or four opportunities at once, adding a new injectable technique, exploring medical weight management, upgrading their consultation process, and treating all of them as equally urgent. None of them get the focused attention needed to actually knock anything down.
The domino test cuts through that. Ask which single move, if you gave it your undivided attention for the next 90 days, would make the others easier or unnecessary. That’s your first domino. Everything else waits.
For a lot of practices right now, that question is landing on one of two answers. Providers already comfortable with neuromodulators and fillers are asking whether advanced technique training is their first domino, the move that lets them retain patients they’d otherwise refer out. Others are asking whether medical weight management is theirs, since it opens a second revenue stream and a patient population that overlaps heavily with their existing aesthetic base. Both are legitimate dominoes. Neither is the right answer for every practice, and trying to stand both up at once tends to knock down neither.
If weight management keeps surfacing as your answer, it’s worth treating like Keller would: one clear first domino, not a side project squeezed between everything else. IAPAM’s Certified Medical Weight Management Provider Program is built for providers making that exact call, and if advanced injectable technique is the domino instead, the Certified Aesthetic Provider Program is where that focus belongs.
Before your next planning session, write down every initiative currently competing for your attention. For each one, ask: if this were the only thing I worked on for the next quarter, would it make the rest of the list easier? Cross off anything that doesn’t pass. What’s left is your first domino. Time-block your first hour tomorrow morning for it, and nothing else.
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