The Cost of Leadership
If you’ve been leading a small O&P practice for any length of time, you already know this truth: leadership isn’t free. It costs something. Not in the financial sense—though there’s always that too—but in energy, peace of mind, and sometimes even relationships.
Most of us stepped into leadership because we believed we could make a difference—for our patients, our staff, our community. Over time, though, we discover that leadership is as much about the prices you’re willing to pay as the goals you’re trying to achieve.
I once heard Georgia football coach Kirby Smart talk about “the cost of leadership” in a way that stuck with me and I’ve seen all three show up over and over again in small O&P practices.
1. You’ll make painful calls that affect people you care about
Small practices feel like families. We watch techs and practitioners grow up, meet their spouses, start families of their own. So when leadership demands decisions that negatively affect someone we care about—a schedule change, a corrective conversation, letting someone go—it can feel deeply personal.
But this is one of the unavoidable costs of leading. Leadership means carrying the weight of choices that serve the mission of the business over individual comfort. The business exists to serve patients safely and sustainably—and that sometimes means a team member we love isn’t meeting expectations, or a process needs to change even if people don’t like it.
How to handle it well:
Take time to separate emotion from purpose. You can care deeply and act decisively.
Be honest and kind, but don’t sugarcoat. Most people appreciate clarity, even when it stings.
Remember: protecting the health of the business is protecting everyone who depends on it.
It helps to remind yourself that leadership isn’t about avoiding pain—it’s about choosing which pain moves everyone forward.
2. You won’t always be liked, even when you’re doing what’s best overall
This one surprises new leaders the most. You start off thinking, “If I treat people fairly, communicate well, and do the right thing, people will respect me.” And yes, many will. But there will always be others who see your decisions through the lens of how it affects them, not the greater good.
Maybe you tighten scheduling expectations, and someone thinks you’re being unreasonable. Maybe you promote one practitioner and another feels overlooked. The more transparent and consistent you are, the better—but you can’t lead and keep everyone happy at the same time.
The desire to be liked is human. The discipline to lead despite that desire is maturity.
Practical tips for when you’re the “villain” of the week:
Stay anchored to your values and the organization’s goals. Don’t make reactive decisions to win approval.
Listen carefully to concerns, but resist the urge to overexplain. Clarity doesn’t always equal agreement.
Build a small circle of trusted peers or mentors outside your practice—people who remind you you’re not crazy.
One seasoned leader told me, “If everyone likes me, I’m probably not doing my job.” It stuck with me. Respect grows slower than popularity, but it lasts longer.
3. You’ll be misunderstood and you won’t always get to explain yourself
In leadership, sometimes you can’t set the record straight. Maybe you’re working through a personnel issue that you legally can’t discuss. Or maybe you make a call your team doesn’t agree with but you can’t share the bigger context yet. It’s lonely, and sometimes unfair.
In small O&P practices, word travels fast. One misunderstood decision can ripple through the team by lunch. The temptation is to explain everything—to justify, correct, and convince. But part of leadership is holding your tongue and letting integrity speak over time.
When you feel misunderstood:
Ground yourself in the bigger mission: you answer to something larger than gossip or opinion.
Keep doing consistent, transparent work in all other areas—trust rebuilds faster than you think.
Recognize when to follow up later with clear communication once it’s appropriate; silence forever isn’t the goal, timing is.
You can’t give yourself a nickname and you can’t control the story people tell about you. You can control how you live it. Over time, consistency becomes your defense.
Counting—and accepting—the cost
The costs of leadership can sound heavy because they are. But they’re also what make leadership meaningful. You can only lead from a place of strength if you’ve accepted that being “the one who decides” also means being the one who bears the weight.
Still, there are things you can do to make carrying that cost sustainable:
Set realistic expectations for yourself. You’re not trying to be everyone’s friend; you’re trying to create a healthy, ethical, patient-centered business.
Invest in your inner circle. Whether it’s peers in other practices, your office manager, or a mentor, don’t carry it alone. Leadership is hard enough without isolation.
Use your litmus tests before making consequential decisions (your MVV) and ask yourself if you are holding true to those. Using that compass is the most valuable advice I can give.
Practice self-compassion. Sometimes you’ll get it wrong. Leadership is iterative—it requires course correction, humility, and persistence more than perfection.
Over time, the costs don’t go away, but they start to feel less like burdens and more like the tuition you pay for becoming a leader worth following.
When I talk with O&P owners who’ve led stable, respected practices for decades, none of them brag about being popular. They talk about the trust they earned, the standards they upheld, and the people who grew under their watch—even the ones who left.
That’s the paradox: the cost of leadership is real, but so is the return. You trade comfort for influence, certainty for integrity, and being liked for being respected. It’s not easy, but it’s worth every bit of the price.