Most healthcare practices don't make it to year five. The statistics are brutal — and if you're building your own practice right now, you probably already know this. The real question nobody talks about isn't how to launch. It's how to stay.
Dr. Bermesola Dyer, DNP, APRN, FNP-C, founder of The Wellness NPs in Laurel, Maryland, is approaching her eighth year in practice. She built her clinic from scratch — self-funded, with her first patient being a close friend — and has navigated COVID shutdowns, staffing turnover, and in December 2024, a fire that condemned her building and forced her team to operate out of a single room.
She's still here.
In this episode of Grow Smarter, Dr. B shares what healthcare practice longevity actually looks like from the inside. No highlight reel. No theory. Just eight years of hard decisions, real mistakes, and the mindset that kept her going when quitting would have been easy.
Dr. B didn't launch The Wellness NPs with venture funding or a full team. She saved her own money, avoided debt intentionally, and started seeing patients while still teaching as a nurse educator at a university. Her first patient was a close friend who stayed her only patient for almost six months.
That slow start, she says, was actually protective. Because she wasn't over-leveraged, she wasn't forced into desperate decisions early on. Growth was measured — more compounding interest than explosive scale.
By year seven, things were starting to click. Revenue was improving. The team was stabilizing. There was, as she describes it, wind under the sail. Then, on December 12th, 2024, her staff called to say they were smelling smoke in the building.
"I thought maybe someone left popcorn in the microwave," she recalls. By the time she arrived, there were roughly 20 firefighters on the roof, fire trucks blocking the road, smoke and flames visible from the street. The sign on the door read: do not enter — building condemned. Patients kept showing up because they didn't know.
Dr. B's response wasn't to fold. It was to stabilize, regroup, and use the forced slowdown to audit her systems, processes, and onboarding — things she'd been too busy growing to fix. Since they couldn't focus on growth, she told her team, they would focus on getting their processes iron sharp so they'd be ready when they returned to their space.
That mindset — treating a crisis as a systems audit — is one of the clearest markers of a practice owner who will still be standing in year ten.
Ask any practice owner what keeps them up at night, and the answer is almost always staffing. Dr. B is no exception — but her background gives her an unusual advantage.
Before launching The Wellness NPs, she worked as a house supervisor for a hospital system, managing nursing floors and staffing gaps in real time. It was chaotic work that required constant creative problem-solving under pressure.
"I was pulling my hair out almost every night," she says. "But I realized now that it was really good preparation for what I'm having to do now."
Her approach to building a clinical team has been deliberately flexible. Rather than hiring full-time providers she couldn't yet fill, she built a per-diem, part-time model with designated schedules, rotating weekend shifts, and a culture built around family flexibility. Five nurse practitioners. Three registered nurses. Medical assistants. A practice manager. Virtual assistants.
The key to keeping providers reliable, she says, isn't contracts — it's culture. When someone has a sick child, the team covers the shift. The licensed staff have maintained a high level of professionalism. Higher turnover has come from unlicensed ancillary roles — a pattern common across the industry regardless of practice size.
Her honest assessment after eight years: staffing can make the practice or break the practice. And she's still refining the formula.
When Dr. B launched, she did what most new practice owners do — leaned on her personal network, reached out to friends and family, and built an organic social media presence. No ads. Just consistent content: patient testimonials, before-and-after photos, educational posts on Facebook.
"Social media doesn't cost much," she says. "It was just word of mouth and the testimonials — and then me going in and promoting and talking about the services."
As the practice grew and revenue started coming in, she invested in a healthcare-specific marketing platform that combined SEO, website management, newsletter distribution, and lead tracking. The shift made a measurable difference — The Wellness NPs now ranks in the top two for local weight loss searches in her market.
What didn't work: Google Ads and Facebook Ads both delivered poor ROI. Facebook in particular blocked significant amounts of their weight loss content. The money, as she puts it, was just going nowhere.
Her marketing sequence — organic first, platform investment second, paid ads last — mirrors the Grow Smarter Method exactly. Build the foundation. Get found locally. Then scale. Don't run ads on a broken foundation.
One of the most powerful segments of this episode is Dr. B's explanation of why obesity is so widely misunderstood — and why that misunderstanding makes her patients' lives harder before they even walk in the door.
Obesity, she explains, is a recurring, relapsing chronic condition — similar in nature to high blood pressure or cholesterol. It is not a moral failure. It is not a willpower problem. And yet patients arrive carrying years of shame, judgment from their spouses, discrimination at work, and the deeply held belief that if they just tried harder, they'd figure it out.
"I've had patients come in in tears," she says. "They're frustrated because they can't get the weight off. They're trying so hard."
The science tells a different story. Hormones, insulin resistance, sleep quality, microbiome health, genetic set point — all of these interact with weight in ways that go far beyond diet and exercise. The Wellness NPs uses a six-pillar framework that addresses root cause, not just symptoms. When done well, this work changes lives — not just numbers on a scale. Dr. B has patients who have stopped blood pressure and diabetes medications entirely as a result of addressing their body composition and underlying hormonal imbalances.
Her goal, stated plainly, is to change the narrative about what the disease of obesity actually is.
Eight years. A pandemic. A fire. Staff turnover, tight margins, and the daily weight of running something that is, as Dr. B puts it, inseparable from your life and your mission. She's still standing — and getting clearer, more patient, and more calculated with every year.
If you're building a healthcare or wellness practice and any part of this conversation hit home, watch the full episode on YouTube or listen wherever you get your podcasts. And if you want to connect with Dr. B or learn more about The Wellness NPs, visit thewellnessnps.com.
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Andrew Hong: Hey, everyone, welcome back to Grow Smarter. The show built for healthcare and wellness entrepreneurs who want to stop wasting money and start building practices that actually grow. I'm your host, Andrew Hong, founder of Toby Agency. And today's guest is someone I've had the pleasure of working with firsthand: Doctor Birx Dyer, aka Doctor B. She is a Doctor of Nursing Practice, a family nurse practitioner, and the founder of The Wellness NPs in Laurel, Maryland, a practice specializing in medical weight loss, hormone optimization, and menopause management. Doctor B isn't just a clinician; she's a business owner approaching her eight-year anniversary, which puts her in a category that most healthcare practices never reach. She's navigated hiring challenges, operational chaos, and even a literal fire to come out on the other side with a stronger practice and a clear sense of mission. Today we're talking about the staying story—what survival looks like past year five. Hey, Doctor B, how's it going?
Dr. B: Hey! It's going well, I can't complain.
Andrew Hong: So happy to have you here. We're going to talk a little bit about this eight-year anniversary—has it already passed or is it coming up?
Dr. B: It's coming up in April. We opened our doors to start seeing patients the last week of April 2019.
Andrew Hong: You had to navigate the Covid craziness that a lot of people had to do. Tell me a little bit about your background. How did you get into healthcare, and what inspired you?
Dr. B: I have been a nurse for 26 years, since 2000. I went to Johns Hopkins in Baltimore to get my bachelor's in nursing. I actually wanted to be a nurse because of Nurse Carol on the show ER. I worked for about ten years and then went back to become a nurse practitioner. I'm originally from California, but I moved to the East Coast to get my master's in healthcare administration and a doctorate in nursing practice. I eventually went back to California and had the opportunity to work in a medical weight loss practice. When I was in the hospital, I felt like a pill pusher, just pushing medications all the time. I wanted a better way to get to patients before they were having amputations or bypass surgery. In the weight loss practice, I loved helping them learn how to eat and getting their blood pressure under control. When I came back to the East Coast with the military, I worked on my business plan during a deployment. We definitely came in before the craze of GLP-1s and the weight loss specialty. We really want to focus on preventative healthcare, wellness, functional medicine, and root causes to help patients lose weight and keep it off.
Andrew Hong: You're one of the OGs who got into this before the GLP-1 craze. By the way, where in California are you from originally?
Dr. B: Born and raised in the Bay Area. I went to Cal Berkeley and lived there for the first 35 years of my life.
Andrew Hong: I grew up in San Jose in the South Bay. I moved to the DC area during high school, going to Langley High School in McLean. But in California, I went to Harker High School in Saratoga.
Dr. B: I went to Independence High School. I ran track and played the trumpet in the marching band.
Andrew Hong: We played them in tennis! That's why we hit it off so well. Fast forwarding to today, late February 2026, we actually met through Elite NP. There's no shortage of people trying to start practices today. Small business statistics show that 80 plus percent fail in their first year, and around 95% fail by their fifth year. Now that you're at year eight, what does that feel like? Are you stable, or are you thinking about growing more?
Dr. B: Getting closer to my 50s, my perspective on life and how hard I want to work is shifting. Last year, year seven, I felt like we were finally starting to get some wind under our sail and making a comfortable profit. Looking back, it took a long time to get our first patient—who was one of my closest friends—and she was my only patient for about five or six months. I still teach as a nurse educator and professor. I funded it all on my own because I didn't want to go into a lot of debt, which is probably why I'm still here, even if we moved slower than companies that took on debt. We had our five-year anniversary gala a few years ago, and seeing the testimonials and before-and-after pictures was incredibly rewarding. But at year eight, we had a fire on December 12th of last year. My staff called smelling smoke, and I thought it was just popcorn, but by the time I arrived, flames were coming out of the roof. There were about 20 firemen, roads closed off, and a sign put on our door saying the building was deemed unsafe.
Andrew Hong: Wow.
Dr. B: We were left without a place to go, having to tell our patients we couldn't see them. This whole year has been us trying to stabilize and regroup. If you're going to start a business, you have to absolutely love it, or it will be hard to keep going through rough times. Usually at least once a week I want to throw in the towel, but as a woman of faith, I pray, fast, and meditate, and that gets me through.
Andrew Hong: There are always tests of your resilience. What motivates you and keeps you going when a literal fire burns everything down?
Dr. B: It's a calling and a life's mission. I wanted to teach since I was five years old, and now I do a lot of educating and coaching with my patients and students. Seeing their transformations is so fulfilling that it fills my cup.
Andrew Hong: For those just starting out, my recommendation is often to avoid digital marketing and ads initially unless you have public testimonials. I suggest building a decent website and hitting the ground to talk to your network. How would you recommend getting those first few patients?
Dr. B: Reaching out to friends and family who already know you is key. In the beginning, I was really active on Facebook, talking about our services and sharing educational sessions and before-and-after pictures. It didn't cost much because we didn't do paid marketing on social media; it was just organic word of mouth.
Andrew Hong: Did you have a physical location when you first started?
Dr. B: I did.
Andrew Hong: That’s an important point, because if you only do telehealth, you effectively pay a marketing tax since you don't show up in local Google Maps searches. Moving on to building a team, how did you approach hiring as you grew, and did you use W-2s or 1099s?
Dr. B: I got guidance from my attorney and accountant and decided on W-2s for our core staff to avoid misclassification issues. We have five nurse practitioners, three registered nurses, medical assistants, a practice manager, and outsourced virtual assistants who are 1099. Staffing can be your most important asset but also a difficult liability. Before this, I was a nursing house supervisor, which prepared me for managing turnover and sick calls. I have a wonderful, solid core team of nurse practitioners and an executive team that have been supportive through Covid and the fire.
Andrew Hong: When bringing on new clinicians, did you wait until you were busting at the seams, or did you bring them on part-time to fill up their schedules slowly?
Dr. B: A lot of our providers are part-time or per diem. They have families and don't want to commit to 40 hours a week, so we have designated rotating shifts that work well.
Andrew Hong: Why does that work well for you? Many practices struggle with clinicians no-showing.
Dr. B: Our nurse practitioners maintain a high level of professionalism. I do see turnover and no-shows with unlicensed ancillary staff, unfortunately. We try to be a very family-friendly and supportive practice, offering flexibility for childcare and family issues, and we cover for each other. I also get very creative with staffing when needed, like stepping in myself.
Andrew Hong: Running a business requires problem-solving and resilience, and not everyone is suited for it.
Dr. B: The fire has exposed a lot of our deficiencies, which is actually a good thing because we wanted to scale. We only have one room now instead of five, so we are taking a step back to fine-tune our processes and onboarding. I also learned the hard way how important it is to have consultants, mentors, and coaches to help guide me, because it can be a very lonely space.
Andrew Hong: Let's talk about marketing investments. What was a good investment for you?
Dr. B: We found a platform called Patient Gain that helped build our SEO, send newsletters, and manage our website and leads. Before them, we had a pretty website but no traffic or leads. We used to spend a lot on Google and Facebook ads, but the return on investment just wasn't there, and Facebook was blocking our weight loss content. Now, if you search for weight loss places near us, we rank at the top organically.
Andrew Hong: The weight loss space has changed drastically. How has the mindset of the new weight loss patient evolved with the popularity of GLP-1s?
Dr. B: They are very educated and often come in demanding just the shots, without wanting to hear about anything else like blood pressure or hormones. We do a lot of educating to help them understand we are looking at root causes through our six pillars to help them lose the weight and keep it off. Obesity is a complex, chronic, relapsing disease process—not a moral failure or just an issue of diet and exercise. It's heartbreaking to see patients come in in tears due to frustration and discrimination.
Andrew Hong: You've also built a specialty in women's health and perimenopause. How does functional health tie into that?
Dr. B: We moved into women's health because we had patients on the top doses of GLP-1s who were doing everything right but still couldn't lose weight. They were complaining of hot flashes, low libido, and fatigue. A patient who was a midwife suggested we look into hormone optimization. We realized that as women go through menopause, shifts in hormones and thyroid function slow down metabolism and cause visceral fat buildup. We take a holistic look to get to the root cause rather than just being a pill chaser. If we listen to the body, it tells us what needs fixing, like the importance of getting enough sleep, which is highly underrated.
Andrew Hong: There are over 300,000 monthly searches for perimenopause symptoms. Going back to the basics like sleeping instead of following toxic hustle culture is so important. To wrap up, what advice would you give to your day-one self?
Dr. B: Get a support group and a team of professionals around you—an accountant, an attorney, a marketing person. Also, find a support team of like-minded business owners to bounce things off of, because your employees might not understand the difficult decisions and sacrifices you make. I've definitely grown and am much wiser and more patient today.
Andrew Hong: Entrepreneurship is truly about personal growth, and to get to the next level of success, you have to become a different person. Your story is inspiring. Thank you for being so transparent. I'll include all of Doctor B's and The Wellness NPs' information in the show notes.
Dr. B: Thank you for having me. To anyone developing a business: don't give up on your dreams. It's hard, but it's so rewarding and fulfilling if you love what you do.