Speaker, Author, Consultant, Fraud Examiner

We live in a credit-card society. Want something? Whip out the card. Worry about paying for it later.
Recently, the Federal Reserve released Q3 stats showing household debt is rising sharply. CBS financial analyst Jill Schlesinger discussed this today on CBS Mornings, reminding viewers that many Americans are living beyond their means, treating credit as a form of income.
I’m not a CPA or financial advisor—but I’ve spent nearly 30 years helping healthcare practices understand their money in and money out. And what I’m seeing is clear: personal debt and practice debt share the same destructive patterns in spending.

Part One: Personal Spending and Debt

My own cost of living has increased by about 25 % in the past few months, with another 10 % increase expected in January. That’s not inflation—it’s financial whiplash. From insurance premiums to groceries, repair parts to service, everything costs more.
Growing up, I watched my dad—a general contractor—bid jobs at night with no guarantee of income. When cash flow was tight, dinner was navy beans and cornbread. Grocery shopping with Mom meant digging through the unlabeled-can bin for bargains (with the warning: “Don’t pick one that’s dog food!”).
They never explained their finances, but I absorbed the lesson: cash flow is a matter of survival.
Today, I use Quicken (since the DOS days) to track every transaction from my bank and credit cards. That system helps me understand—not just see—where my money goes.
Here are some personal spending guidelines I share often:
  • Pay off high-interest debt first, usually credit cards. Once that’s gone, apply those payments to the next highest debt—often your car loan.
  • Avoid paying interest whenever possible. Use interest-free financing strategically. Many medical, dental, and veterinary offices, as well as retail stores, offer CareCredit (Synchrony Bank) or similar options with deferred interest. These can help spread out costs only if you pay them off within the allotted period; otherwise, the accumulated interest will sting.
  • Low mortgage rates? If your mortgage rate is low, it may make sense to maintain steady payments rather than rush to pay off the loan and restrict your cash flow.
  • Know your incoming expenses, your bank balance, and your long-term financial commitments, and plan around them.
  • After paying off revolving debt, set your credit card to autopay the full balance each month. Just seeing that withdrawal coming curbs spending more effectively than any budgeting app.
  • Build a savings buffer for the emergencies that will always happen when you least expect—or can least afford—them.
These are simple, not easy. But the goal isn’t perfection—it’s about controlling your finances instead of them controlling you.

Part Two: Practice Spending and Debt

Debt doesn’t just affect our personal lives; practices face it too.
During the pandemic, many practice owners turned to lines of credit and SBA loans to stay afloat. Fast-forward to now, and those debts are still lingering—sometimes growing. Interest-only payments might look manageable, but they don’t touch the balance. You’re renting your debt, not paying it down.
Here’s what I see most often:
  1. How have those balances been reduced? Too often, they haven’t. Payments continue, but the principal stays almost untouched.
  2. But do you actually know the cost to the practice? Years ago, I began adding the loan interest percentage to the loan name in the Chart of Accounts for easy reference. For example: “Dry Gulch LOC 6.25 %.” Transparency and oversight matter.
  3. I also began splitting out Loan Interest per loan, allowing practice owners to see—at a glance—what each loan truly costs them every month. The results are always eye-opening.
  4. One client recently told me that before we redesigned their accounts payable software, their supply bills were outrageous. Once we categorized every expense and assigned a designated team member responsibility for verifying needs and pricing, their spending dropped significantly. That’s the power of financial organization.
Practice debt is a cost of doing business, yes—but it should never become a burden so heavy that it threatens the practice itself. When debt becomes an albatross around the owner’s neck, it drags everything down with it.

Why Both Fronts Matter

The behaviors are the same, whether personal or professional:
When trust replaces oversight. When habits override accountability. When “we’ve always purchased from that vendor” becomes the reason nothing changes, debt takes root.
A small practice is just as vulnerable as a family household. A homeowner with maxed-out credit is no different from a practice owner with a maxed-out line of credit.
Debt thrives in silence and secrecy. Transparency and oversight kill it.

What You Must Do Now

PERSONAL
  • Download all transactions to an accounting software on a monthly basis and categorize them. Pay attention.
  • Create a list of all debts, including their interest rates and repayment terms.
  • Pay off high-interest revolving debt first.
  • If your debt is overwhelming you, contact your creditors and request some form of relief.
  • After paying ALL revolving balances, set your credit card to autopay the full balance each month.
  • Build a cash savings account to buffer against emergencies that will always happen when you least expect them, or want them.
PRACTICE
  • Design your Chart of Accounts for management, not just for taxes. Include separate lines for each loan and its interest rate.
  • Hire someone outside the practice to generate reports and oversee monthly expenses.
  • If you don’t have a patient payment plan in place—get one. Not having one in place does not help your patients afford care and can, in many cases, confirm the suggested treatment plan.
  • Treat growing debt as an emergency. Reduce unnecessary overhead, implement spending reviews, and develop a structured repayment plan. Your team can be most helpful and may, in fact, see many areas that can improve the bottom line. Ask them.

Final Reflection

There’s a Saturday Night Live skit from almost twenty years ago that still rings true today. Steve Martin and Amy Poehler sit at a kitchen table while Chris Parnell passionately explains his revolutionary financial concept:

“Don’t buy stuff you can’t afford.”

The skit is hysterical—and painfully accurate. It captures the heart of what many of us often forget: spending money we don’t have is not a sound financial strategy. It’s avoidance dressed up as progress.
Sometimes, we need to be reminded that the new, shiny object we want to buy comes at a greater cost than the satisfaction and pride of ownership it provides.
Suzy Orman had a segment, “Can I Afford It,” on her The Suze Orman Show. I have watched many of those segments of callers wanting to buy new, shiny objects, but she forces them to look at their current financial picture, evaluating their debt, savings, retirement, income, and many other aspects of their financial health. If you have never watched any of those segments, I encourage you to do so, as they will teach you how to review your financial health before spending on your new, shiny object.
Both the Saturday Night Live skit and “Can I Afford It” segments are available on YouTube or the Suze Orman Website.
Debt—personal or professional—isn’t evil. But ignoring it is. And pretending it’s someone else’s job to manage it? That’s when trouble begins.
If your finances—whether for your home or practice—feel overwhelming, know this: you can regain control. It begins with visibility and intention.
And, yes, I do realize that many are struggling to make ends meet. This article about debt is not meant to shame anyone. Ignoring the mounting debt will not help relieve the stress you feel. It can be overwhelming, stress-inducing, and provide feelings of hopelessness.
Because debt doesn’t disappear on its own.
It waits quietly—until you do something about it.