Doing it yourself versus having it done

Updated 2026-08-23 · Atiba de Souza

The honest version: which parts genuinely cannot be delegated, which parts should never be done by a physician, and the failure mode that catches almost everyone who tries the middle path.

The question is usually framed as a budget decision. It is not. It is a decision about which of your hours are worth the most, and about one specific piece of work that cannot be handed to anyone.

Which parts genuinely cannot be delegated?

Two, and they are the two that decide whether any of the rest works.

• Deciding who you are for. Nobody can make this call for you. An outsider can pressure-test it, structure it, and stop you fudging it — but the judgement about which patients you want and which you will turn away is yours, and it is the input everything downstream depends on.
• The substance. The actual explanations, the way you talk a nervous patient through a decision, the thing you have learned from doing this that other people in your field get wrong. This lives in your head. A writer can extract it, shape it and make it findable. A writer cannot invent it, and material written without it reads exactly like material written without it.

Everything else — the building, the publishing, the fixing, the maintaining, the technical work — can be done by someone else and usually should be.

Which parts should a physician almost never do personally?

The technical and repetitive work, because the hourly maths is brutal and it is not close.

Site mechanics, listing corrections, publishing workflows, tracking setup, ad account management. None of these benefit from being done by a physician, all of them consume disproportionate time when done by someone learning them, and all are inexpensive to have done well.

The trap here is that they feel productive. Fixing a listing produces a visible completed task in twenty minutes. Deciding who your practice is for produces nothing visible and takes weeks of intermittent thinking. Under time pressure people do the first and avoid the second, which is exactly backwards.

What is the failure mode that catches almost everyone?

Doing the easy half yourself, outsourcing the hard half, and getting a result that is worse than either.

It looks reasonable from inside. The physician keeps the strategic decisions "because nobody knows my practice like I do," and hands out the writing "because I don't have time." What actually happens is the reverse of what was intended: the strategic decision never gets made properly because there is no forcing function, and the writing gets produced against a brief that was never sharpened, so it comes back generic and gets rejected, repeatedly, until everyone loses interest.

The rule that avoids this: outsource the hours, never the judgement — and make the judgement first, in writing, before anyone is hired to act on it.

How much time does doing it yourself actually take?

More than the estimate, and the gap is not in the writing.

The writing is the visible part and it is not the expensive part. The expensive parts are deciding what to write about, judging whether a draft is any good, keeping it consistent with everything else you have published, and maintaining it as things change. A physician doing this properly is looking at several hours a week, sustained, indefinitely — not a burst.

That is affordable for some practices and not others, and the honest test is not whether you can find the hours once. It is whether you can find them in a bad month, because the months when this matters most are the busy ones.

When is doing it yourself genuinely the right call?

When the practice is very early, the budget is real, and you are the constraint anyway.

If you are pre-launch or barely launched, cash is the binding constraint, and your schedule is not yet full, then your own time is the cheapest resource you have and spending it here is rational. Build the substrate yourself, get it working, and hire when your hours become worth more clinically than they are worth typing.

The mistake is staying there past that point. The signal to change is simple: the first time your schedule is full enough that marketing slips for a month, you have outgrown doing it yourself. Not because you failed, but because the thing now needs to continue when you are busy, and it will not.

When is hiring the wrong call?

When you have not made the decision about who you are for, and you are hiring in order to avoid making it.

An agency hired into that vacuum will make the decision implicitly, by default, in the safest and most generic direction available — because that is the only thing anyone can do without your judgement. You will then spend six months disliking the output without being able to say precisely why. The problem was upstream of them.

Hiring is also wrong when the constraint is somewhere else entirely. If people find you and do not book, more visibility makes the leak bigger. Work out what is actually binding first — how a physician builds authority outside the exam room walks the three decision points that reveal it.

What is the middle path that actually works?

Keep the judgement and the raw substance; buy the extraction, the production and the maintenance.

In practice that means you talk and someone else turns it into material. You approve the audience decision and the positioning; someone else keeps every place you appear consistent with it. You never touch a listing, a tracking script or a publishing workflow again.

This costs less than full-service and produces better material than either extreme, because the one input nobody can substitute is still coming from you. What it requires is that you show up for the extraction — an hour or two a month of actually talking. Practices that will not do that should buy something else, and the questions to ask a partner will help you find out what you are really being offered.

For the budget side of this decision, see what building authority actually costs.