Rarely does being in the middle of anything, from strategy or innovation adoption to service offerings or pricing, result in an equitable return to your practice.

Yet every day, from coastal California to Carrollton, Georgia, aesthetic surgeons, cosmetic dentists, dermatologists and more fall victim to the deceptively alluring appeal of the middle.

I get it: the middle feels like less of a risk, even though we don’t want to admit it.   

The closer we get to the edges, whether with our beliefs, opinions, or actions, the more uncomfortable we grow with our autonomy, individuality, and vulnerability. After all, the edge is unknown or often uncharted, and there are fewer examples to follow: two things our loss-averse brains fear most.

But your proclivity for the middle is killing your practice, even though it feels “right.” And though the edges feel risky, that’s where you win.

In this article, I’ll explore the five most common ways your practice can get stuck in the middle so you can get unstuck for good.

Let’s go!

The middle-stage service

Every medical specialty, from dentistry to plastic surgery, follows the same evolutionary path, from one stage to the next:

  1. Accepted service: what patients will accept
  2. Desired service: what patients want
  3. Possible service: what patients never imagined

In the early stages of the industry, before competition enters the market, the patient accepts the service irrespective of its drawbacks, simply because she has no other choice. For example, in dentistry, think of the silver fillings that ruled the 80s.

But as competition increases, marketers and practice owners, informed by patients’ demands, assemble the desired service in an attempt to stand out from the crowd: not only does the patient need this service, but they want it, too. Keeping with our dental example, think of the tooth-colored composite fillings today.

In this middle stage, you’ve created a practice that patients need and want, but you’re awash with competitors that have also created something needed and wanted. So you spend your marketing dollars trying to make your offering more attractive than your competitors, and so do they.

You are here.

Few will ever make it out of this middle stage.

Those who offer the possible service, however, choose to play an entirely different game.

For example, StudioDental, the mobile dental practice that visits business professionals during lunch, competes in a category of their own. Not only do they offer the same desired services as their brick and mortar predecessors (like tooth-colored composites), but they’ve innovated their business model and reimagined the way we deliver dentistry, literally. No amount of marketing will convince business professionals short on time ever to use a traditional dentist again.

Today, the desired services are table stakes, and it’s difficult and expensive to compete here.

In your increasingly competitive industry, the future belongs to those who think beyond what’s needed and wanted and create something that’s also innovative and category-defining.

Think beyond the middle; think what’s possible- that’s marketing.

Pricing the middle

Most of you probably price your treatments and procedures something like this: you choose a price somewhere between the highest and lowest prices in your market based on how you measure up to your competition or colleagues.

I don’t want to price the highest- I’m afraid I’ll scare too many prospects away.
I don’t want to price the lowest- I’m not a commodity.
So I’ll price somewhere in the middle, maybe a tad higher- that seems fair.

But what you’re really communicating is this:

I don’t believe I’m the best.
I don’t believe I’m the worst.
I believe I’m somewhere in the middle.

Most patients will associate the high-priced practice with the best quality or most experience, whether or not they choose them. And though it’s hard to overcome the low-price/low-quality association some patients will make, others will look at low-price as high value.

Either way, most patients will perceive the high price and low price as best: best quality, best price, or best value.

The middle, however, as Harry Beckwith (author of Selling the Invisible) puts it, tells your patients:

“We’re not the best and neither is our price, but both our service and our price are pretty good.”

Pricing the middle communicates “pretty good,” but patients don’t buy pretty good.

The middle majority

While the majority of adopters (the middle) in your market may avoid the failures of early adopters who overinvest in innovations that never catch fire, they’ll never experience the opulence of being first, either.

Take Instagram: I bet you wish you went all in on IG five years ago when only a few brave doctors roamed the land. But most of you were asleep. Now, those same brave doctors have two-year waitlists, while the late adopters spend exponentially more time, energy, and money exploring an opportunity that has already been discovered.

Or the gold rush: When the late arrivals showed up on the coast of California in search of gold-plated promises, the first niners had already mined, panned, and bedazzled their trousers with gold. The middle majority didn’t strike it rich; they lost money.

While the middle majority sleeps, the early adopters reep.

Stuck in the middle with strategy

You can’t expect to achieve a luxury brand position while simultaneously promoting sales and discounts on social media.

You can’t be all things to all patients if you want to achieve a differentiated position.

And you can’t offer a premium price tag without the premium value.

Just like you can’t eat a deep-fried Twinkie (real thing) and expect to burn calories.

Straddling, or getting “stuck in the middle,” means that when you pursue one audience’s needs while simultaneously trying to accommodate (and benefit from) another’s, you get neither.

In the middle, you lack a clear market altogether: you’re neither inexpensive or differentiated. But you don’t get to have both, and you have to choose.

The straddler in the middle wants it all. But he gets nothing.

The middle lane mindset: best practices

We subscribe to “best practice idolatry” because best practices feel less like risks and more like guarantees. If they’ve worked for so many, surely they must work for me, too?

The worn path of incremental improvement feels safer (and surer) than pioneering the unknown. So we follow the other cars, with “10% better than last year” painted on our doors, until finally, like first-time freeway drivers sweating from our palms, we merge into the worn, middle lane: not too fast, not too slow, but safe. Alas, it tempers our anxiety. 

But how do we expect to differentiate ourselves from competitors, build a following of future patients on social media, or provide a unique patient experience in our ever-competitive industry by doing the same things everyone else is doing, even if we’re doing them better?

By definition, best practices are for everyone. And anything that’s for everyone is a direct path to homogeneity. Homogeneity is where practices go to die.

Though they feel like guarantees, best practices are false gods.

Building your practice using the same guidelines as everyone else will give you an “also-ran” business, indistinguishable from others. 

Instead, change lanes. Blaze your own path. Get 10% different, not 10% better, because someone will always do it “better” (whatever that means). 

Get the f@%$ out of the middle

Being in the middle of anything won’t get your practice anywhere:

  • Not pricing your services in the middle
  • Not competing in the middle against everyone
  • Not straddling the middle of two competitive strategies
  • Not falling in the middle of the innovation adoption scale
  • And not offering a middle-staged service offering

The middle is comfortable; it feels safer and less risky, but it’s deceptively costly and marred by mediocrity.

The middle is for everyone. And everyone cannot win.

If you find yourself binging on the middle, purge yourself of comfort, reach for the edges, and aspire to be more than pretty good– from there, everything gets easier.

Get the f@%$ out of the middle.


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