028: How One Practitioner Tripled Her Business By Finding Her Niche with Karen Cross





Ronda Nelson: Well, hello friends, welcome back. This is episode number 28 of The Clinical Entrepreneur podcast. My guest today is a friend and colleague, Karen Cross. She is going to drop some serious knowledge bombs about how to find your niche. Karen is going to tell us how she went from a very conventional background as a PA and how she migrated into the wellness world. Then, she’ll share how the best way to scale and grow a practice was to identify what she was good at, and then run with it from there. So Karen, welcome. Thank you so much for joining me.


Karen Cross: Thank you so much, Ronda, it’s my pleasure to be here with you today.


Ronda Nelson: I love having guests, I was so excited when I asked you and you said, “Sure, no problem.” Now, first give us a little bit of background about why you chose to be a PA, and then what led you over here to the light side from the dark side as we lovingly refer to it.


Karen Cross: I’ll pull off my Darth Vader mask now.


Ronda Nelson: Exactly, go ahead.


Karen Cross: Way back in the day, I started out as an RN, and I worked in trauma ICU and also worked in home health and had an awesome experience, but decided that I wanted to do more for my patients. I went back to school, got my master’s degree, and became a nurse practitioner. I’d worked as a family nurse practitioner, where you can be a solo practice and prescribe and the whole nine yards and that’s exactly what I did. I worked in conventional medicine for many years, specializing in endocrinology. I started in an endocrinology office and it turns out that I was the only female in a group of men doctors and they did not enjoy seeing thyroid patients, they were only wanting to see the diabetes patients. They shoved all of their thyroid patients my way, so I became really good at treating thyroid and reading numbers, and understanding what to do. I became the thyroid gal in the area and took off from there, but it was very limited because in an endocrinology office, what have you got? Drugs, that’s it.

You’re handing out prescriptions left and right. There’s no talk about diet, there’s talk no about anything else. The patients weren’t really getting better, they were just standing on a revolving door, come in, come out. And so, that’s when I started looking into natural health and natural medicine.

At first, I started to self-research and then started experimenting with my own health, with my children and we started to get better. It was like, “Whoa, what is this new world?” So then, I went back to school and got my doctorate in natural medicine. I opened up my own solo practice as a natural healthcare provider. That’s when the doors just kind of opened up, and here I am.


Ronda Nelson: How long have you been in practice?


Karen Cross: Oh, gosh. I’ve been in kind of solo practice for about 10 years total.


Ronda Nelson: And now you’ve come over to the light side, in this wellness world and you’re getting results. I would assume that you decided that you were just going to work with thyroid patients, or did it start that way? What was that transition like for you?


Karen Cross: Yeah, great question. It didn’t actually start out that way because I felt like, “Oh, gee, I’m worried, I’m a brand-new business and if I niche down too quickly, I’m not going to have anybody come into my door, so, I’m just going to kind of open my door to whoever.” And as it turned out, the people who found me, the vast majority, were women with thyroid issues, and they were starting to get results.” I didn’t do a single advertisement anywhere, I literally just opened it and it was word of mouth. It was word of mouth 100% of the way. They told their friends, “Hey, there’s this gal, she really knows what she’s doing with thyroid and Hashimoto’s,” and the patients just came. At that point is when I really just decided this is really what I enjoy doing, this is my passion. I mean, I, myself have thyroid issues, it runs in my family. So, not only was I good at it and I had the training, but I loved it. I decided to really just niche down and start focusing on only this one issue. And I’ve done that for eight years where that’s all I do is thyroid/Hashimoto’s, that’s it. It’s been amazing.


Ronda Nelson: Wow. Do you get bored?


Karen Cross: No, I don’t because really, the thyroid and Hashimoto’s are so complicated, as you probably know, that it couldn’t possibly be boring. Every single client is different. They all have their own set of issues and problems, and I don’t necessarily approach everybody the same way. I still get challenged where I get stuck and I need help. It is absolutely not boring.


Ronda Nelson: When you decided to take the big plunge and say, “Okay, these are the only people that I’m going to treat, these Hashi’s or thyroid patients,” let’s just put them in a bigger category, because not all patients have Hashi’s, but most of them end up having it. You’ve got this niche, so you’ve decided that you’re going to niche down. And you’re not advertising so everything is coming through word of mouth. How is it that? Did you talk to your patients about being sure to refer their friends? Like, how did that snowball start to happen, because I think you’re pretty busy right now, correct?


Karen Cross: I’m very busy right now. And my business model now is different than when I first started and I can explain that journey a little bit, but what we wound up doing was, as I was in business longer and longer, I started to get a little pickier on the kind of clients that I wanted to see.


Ronda Nelson: Yeah, girl, you’re speaking my language.


Karen Cross: Yes, yeah, we are totally on the same page. I decided to have my front office staff, (we have an online booking website,) and they would have to fill out their paperwork first in order to “apply” for an appointment. The people who didn’t fill up their paperwork didn’t get to come in, and people who filled out paperwork and had something completely different than what I would specialize in, we’d call them and very nicely explain, “This is not what we do and here’s who in town can see you,” and refer those people out.

Well, then, those people that our referral base understood that we specialize in thyroid and Hashimoto’s and they started to refer from that day, got to refer back to you and that’s how it went. I don’t live in a very big town, so pretty soon the word got out, not only professionally, but in the community. And that just went crazy.


Ronda Nelson: Oh my gosh, if I could smile any bigger, I would be smiling bigger because this is what I’m so passionate about, is finding the thing that lights you up. A couple of weeks ago, I sent out my weekly email to my community, called the “Practice Growth Strategies,” and I just said, “If you look at your schedule over the past week or two, pick 5 to 10 patients that you get so excited knowing they’re going to come in.

Once you get that list of those patients, start to identify what they have in common.” That’s exactly what you did. You were thrown those thyroid patients by the MDs, but you got good at it and because of your own personal history, which our stories always or almost always influence our why, what we do and why, you focused on that, and who you love to work with. It ended up really creating a tighter environment that was allowed to be able to blossom much bigger because you became the specialist for that particular condition. How long did you stay with that model of making them fill out their paperwork first, and if they didn’t fit, then out there you go?


Karen Cross: I had a brick and mortar with the whole Woodstock supplements and the whole thing. You would drive to work every day, but I’ve got three kids at home and my husband was going through a cancer journey not long after I opened my practice. And so, that was a lot of stress. And so, I started contemplating going more to an online model. I did that for years and three- or four-years’ brick and mortar, but I just had this calling, it was just an internal desire to work from home. God bless that desire because I was pre-setup for our time now.

I wanted to work from home and got some coaching on how to set that up. I do small group coaching, like a 12-week program where I carry these women all through the steps. And there’s such power in a group. At first, I questioned how this was going to work. It’s not one on one, but boy, they talk to each other and there’s the group energy. It’s just amazing. So that’s what I’m doing now. I’ve been doing that for several years, and I absolutely love it.


Ronda Nelson: So, how do you structure those group sessions? Do you have a fixed curriculum that you walk them through? You must.


Karen Cross: I did.


Ronda Nelson: And is that as an online, like an online course? Or is it like a membership? Or do you deliver that content via email? Like, how do you do that? You must have a sign-up and then you have the 12 weeks, and then you have another sign-up and then you do 12 weeks, is that how you run it?


Karen Cross: They do the 12 weeks and that’s it. So, it’s a 12-week from A to Z program. And again, those clients, I’m very picky because that’s a long time to work with somebody in that close of an environment. So, it’s an invitation only. We actually have a team and we have a phone call with them to make sure that they have the exact problem that we solve and that they’re fit to work with us and vice versa. And then, we invite them in. If they choose to join, then they’re off and running. I call them modules with their online curriculum that it is like pre-released to them once a week. It’s a video because I just got tired of saying the same thing over and over again. I just recorded it, but there also needs to be a lot of individualization along the way.

We run certain unique labs that are not found in conventional medicine, and then I have an online portal where I communicate with these clients as much as they want. I think I’m the only person doing this, where they literally can message me any time of day and I answer their question. Then, for some clients, I’m messaging back and forth three or four times a day, just to make sure that they’re being served and that they have all of their questions answered. And then, once a week, we do a live group Zoom call and we’re all on there. I do some teaching and we support each other and I answer questions and that’s how it is. It’s a beautiful thing.


Ronda Nelson: Oh, my gosh, I don’t know where you got this and where you figured it out, but kudos to you because in my opinion, it is the perfect business model, especially now that we have so much of the world that’s still under the cloak with COVID and the shutdown. You said something that I think I want every single viewer or listener needed to hear and that is that you’re very picky about who you admit. There are multiple reasons why that is the gem of the day because when you become the person that says, I am only going to allow these people into my club, and I’m using that term very loosely, but I have something and I know what I’m good at and I need to make sure that what you have fits inside the parameters of what I’m good at.

You’ve now set yourself up as being the expert or the authority on the thyroid, and only people that have that can get into the club, so to speak, or get into your program, and that only further elevates your brand and what you do, making it even more exclusive. And the long-term benefit of that is that your price can go up.


Karen Cross: Absolutely.


Ronda Nelson: Because you charge more money, you’re able to leverage it because you are the only person doing that. Think about, I always use this example, if you have a broken tibia, you aren’t going to go to your GP or the walk-in clinic and say, “Could you please set this?” You’re going to probably need surgery, it’s right at the ankle, you need pins, blah, blah, blah. You’re going to go to the orthopedic. And if you’re a child, you’re going to go to the pediatric orthopedic. And you’ve got to niche down to be able to leverage time for money in a scalable way that you can earn an income. So, talk to that for a minute.


Karen Cross: Absolutely. Just as a side note to that, not only do these clients have to have the exact picture of what I do, for instance, I don’t take on Graves because Graves is a whole other ballgame. Do they want the same thing? No. So, I don’t do that. But there’s a personality that we’re looking for, we’re looking for someone who’s motivated, someone who is willing to follow and can follow direction and someone who is his kind and going to fit in with the rest of the group because if we bring in a “Negative Nancy,” and she’s complaining the whole way, that’s going to bring down the other women.


Ronda Nelson: Everybody. That’s right. And that’s why what you did was create your expectations ahead of time. This is what I’m going to work with and having done group coaching so many times myself, I do the same thing where I’m super picky about who I let in because the synergy between those patients is phenomenal and it actually helps to leverage you as the leader. It takes the pressure off of you because they start to connect with each other and they go, “Oh, you have that, oh, that’s a great idea, I can do that.” They start to really form those relationships, which you’re at the base of all of that or at the forefront of all that, I guess. And that just further amplifies your brand and what you’re doing.


Karen Cross: Yes and so, the community, they form lifelong bonds, even though they’ve gone with me for a ton of weeks, these cells are off and running. They are friends for life, many of them because now, they’re not alone anymore. Because especially with autoimmune, you can feel so lonely out there and conventional medicine when all they’ve got for you is drugs.


Ronda Nelson: When you walk through, you said you did different kinds of testing with them. So, you obviously are ordering tests that are appropriate for each person. You’re doing individualized care, but you’re really bringing them together in a collective group setting. Them, when those 12 weeks are done, let’s say Mary comes in and she has Hashi’s and she’s got three other autoimmune conditions and one of them has to do with her gut, are you going to only focus on the Hashi’s? Or do you deal with her gut issues as well? How do you manage that when you have comorbidities happening?


Karen Cross: We deal with it all because that’s the way I have found to get someone in remission, which we’ve been able to do, or close to remission, which is always the goal. Almost everybody has a gut issue, almost everybody has an adrenal problem and an HPA axis problem, and then, maybe some self-infection thrown in there, as icing on the cake. We can’t just deal with the thyroid without all these other issues, which is why I’m never bored because it’s really complicated, so we deal with it all, the whole shebang.


Ronda Nelson: If we were in person, I would probably kiss you because I love this so much. So, what you really have done, and I don’t want to side trail, but I will put a link in the show notes to a podcast that I did about identifying your niche. When I talked about that, I use the analogy of Walmart, meaning that you can get every kind of everything in Walmart, you can get fingernail polish, toenail clippers, a pancake flipper, a waffle iron, and sheets for your bed. You can deal with everything you need inside Walmart, especially if it’s a supercenter store. You need your food, you don’t have to go anywhere else.

But you and I or the people listening, we don’t want to be Walmart’s on the outside. You can still do all that, you can still deal with digestion, you can still deal with other autoimmune and stealth infections and brain inflammation and joints and arthritis and all those other comorbidities, you still have to deal with that, but where the success or the riches lives is in the niches. And so, when you niche down, you now can say, like the analogy that I use, “I’m a TV and like the TVs at Walmart, people go to Walmart to buy the TV. And then, on the way out, they find out that you got toenail clippers, toothpaste, a pancake flipper, waffle iron, and sheets, you’re good to go. You can still be that “one-stop-shop,” where you can deal with all those health issues, but that’s not what you advertise.


Karen Cross: Yes.


Ronda Nelson: I love that. It’s the best.


Karen Cross: And it doesn’t take long for the community to learn who in town does this one thing. Because when someone is sick with something and they want to go the natural route and there might be 10 or 20 different options and you go to each of these people’s websites and they are not niched down. So, how do you choose? But if you’re the only one doing that one thing and you have that one thing, it’s a no brainer, you’re going to choose that person.


Ronda Nelson: That’s right. And so, if your niche is that you love thyroid, like yourself, you get thyroid patients. That’s what you’re known for. If digestive issues are your thing, that’s fine and you could even niche down further than that and say, “All I deal with is heartburn and reflux.”


Karen Cross: You could definitely practice on that one thing.


Ronda Nelson: Shut up, right now, shut it. That’s like a gold mine. You could build a whole practice on just menopause.


Karen Cross: Yes.


Ronda Nelson: And menopausal women, myself being one, yes, I’m way on the recovery side. So, hot flashes are very few and far between, but menopausal women will do or pay anything if you want their hot flashes to go away.


Karen Cross: 100%.


Ronda Nelson: All right, here’s my credit card, that will pay for anything. That’s the thing, though, if you’re a jack of all trades, you end up being a master at none because like what you said in the beginning when you got all those thyroid cases thrown at you, you had no choice but to just figure that crap out. Like, I’ve got to figure this out because these people need my help. And that’s what happens when you start to niche down, you become the expert.

Then, when they do come in and they have all these other coexisting conditions, you can deal with those too, and reach out when you get stuck. Find a community that supports you. And then, you can get those other questions answered, but be good at that one thing and then you start to leverage time for money, you start to scale because now you can charge more because you’ve created that elite specialist-type community and people want to be in. So, do you have a waiting list? How do you manage that? And also, the second question to that is, how many people do you turn away compared to how many people you take? I’m curious.


Karen Cross: Yeah, our turn-away rate is about 35%. No, I don’t have a waiting list at this time. And we do run into that, by January, I fully expect there to be a waiting list. Everyone wants to get healthy in January.


Ronda Nelson: Exactly.


Karen Cross: That’s typically what happens. There are certain times of the year where absolutely we are full. Right now, this is not that and this has been a little bit of a tough year COVID-wise, we are a higher-priced option. For many people, that’s been a challenge, but, yeah, we just kind of put our net out there and see who comes and then we screen really well. And we invite in and if not, we try to refer out. Again, we still are referring people out who we can’t help and we’re happy to hear somebody who can.


Ronda Nelson: So, when you decided that you wanted to take your specialty and you put it in an online medium, you’re still providing that individual care, but that takes a lot of pressure off of you because to your point, you don’t have to keep saying the same thing over and over and over again during those appointments. It’s such a time-waster, in my opinion. I think every practitioner should have some type of onboarding video series. If you didn’t do anything else, you create that onboarding video series and every patient needs to watch them. It will save you so much time and makes it so much more efficient for the patient. When you decided to put all of that together, how long did that take you to do?


Karen Cross: I did it really fast because here’s maybe what not to do, but this is what I did, was that I actually, and I had a coach, I had some coaching, this is one thing to people who want to do these online businesses is get a mentor, a coach who can help you put this all together, probably couldn’t have done it without that. I actually enrolled a couple of clients before I had the content ready. I mean, I knew what I knew, how to do, but I was literally one week ahead of that.


Ronda Nelson: It’s the best way to do it because let me tell you, there is no dang way you would get it done that fast if you didn’t know you had a deadline to get it done.


Karen Cross: I got it done because I had to. Had I not had that pressure, I probably could have dragged it out over a year. I got it done in 12 weeks. I just recorded each module as they came, put it out there when that was done. I’ve since gone back and revamped it a little bit and I update things, as I continue to learn and improve things, but yeah, that was the motivator right there.


Ronda Nelson: One of the things that I have done and it’s worked really well when you already have an existing audience. For you, because you were in practice, you already had that existing audience and patient base. But when you’re thinking about doing something like this, what I always recommend to practitioners is, cast your net and sow the seed and it can just be something as simple as, “Hey, I’m thinking about creating an exclusive, blank program, course, group coaching,” whatever you want to call, whatever feels right to you and is within your practice limitations. But you want to say, “I’m thinking about doing or creating blank. If you’re interested, message me.”

And that way, if it’s crickets, you know it was a bad idea, it’s not what your audience wants. So, go back to the drawing board, think about it again, and then, don’t do it the next day. It sounds a little inauthentic, if you do it every day, that you’re thinking about a new idea. Wait a little bit, and then maybe rephrase it and you’ll find that thing. When you look at those, those 5 or 10 people that are on your schedule and you go, “Yes! I love working with these people,” you’re going to see the commonality.

When you put that out there, you cast that net and you get people that are DM’ing you back saying, “I would love that, I would really love that. That would be so helpful for me, I would really love that.” Now, you know that you’re onto something. And Karen, I think that was probably the smartest thing that your coach told you to do was just do it, better to have it done than perfect because you always go back and fix it.


Karen Cross: Yes. And they knew that what people tend to do is drag their feet and they have to get it done. The short way is just to do it. And I love what you’d said about casting your net, I did that. Right when I was launching this program, I sent an email out. After all, I did it for a little while because I didn’t know how this was going to work. I had my brick and mortar and my own online at the same time. And then, when the online took off, I sold my brick and mortar. I’m done with that, but I did both at the same time because of fear of how this was going to work.

To bust the myth here that some of my colleagues would say is, well, none of your patients are going to join your program when they can just walk into your office and see you for a teeny fraction of the price. No.


Ronda Nelson: That’s not true.


Karen Cross: That’s what happened. I had at least five, six, eight people that have gone through my program who were my patients in my brick and mortar, and their results far superseded than coming into the office to see me. Why? Because they’re getting the whole kit and caboodle in a 12-week rather than just come back and watch you type thing.


Ronda Nelson: Never underestimate the power of community. People come for the community. Especially now, we live such isolated lives. Karen, I work from home, you work from home. Truth be told, it can be lonely, it can really be lonely. Sometimes, you wake up in the morning and you think, “Oh, I wish that I had just somebody to talk to,” like to walk into an office and say, “Hey, how was your weekend? Or what did you do?” You just miss that, but at the same time, it affords so much freedom, but you have to remember that community is what we need and we are in a time, up to this most current point in history, where more isolation is happening than ever.

And so, bringing people together and creating a place where they can come together, there is so much healing that happens and progress because there’s accountability. You’ve got a leader, somebody who’s challenging you, you’ve got content, you’re motivated, you’ve pre-screened those people, literally, you really did create the perfect environment for amazing success. So, I am so excited for you. What does it look like when they finish the 12 weeks? And then, what does your future look like? What are you moving toward? What’s the next big thing you’re going to do?


Karen Cross: When they’re done with the 12 weeks, they have an option to join a membership program. This is at a much lower cost and it just basically continues sending the community. If you want to stay in the community and continue to have access to me, then you can join our membership and they can leave or come and go as they please. For other people who don’t want to do that, that have gone through my 12 weeks, I have a one on one available for them. Some people just want to connect with me once a year, they want to go over their labs, go over what I call a tune-up. I give that to people that have gone through my program only as an option. That’s what I’ve got now.

Coming up, I’m going to be rewriting another program, putting it out there called the “Hashimoto’s School.” This is going to be kind of an interim or maybe a step towards the program for people who can’t quite do the whole 12 weeks, but they want something. I haven’t started on it yet, but I’m going to start on that and recording that, because there’s so much misinformation out there.


Ronda Nelson: So much. Dr. Google is the worst.


Karen Cross: Yes, yes. And so, I’m going to try to put some really valuable information that will help people. I truly believe you need that individualization, but just not everybody is that fit to do that or can do that, that something is better than nothing.


Ronda Nelson: Right. And sometimes, I think, too, when patients are sick, sometimes the thought of being in a community when you don’t feel good can feel a little overwhelming. I always say that sometimes the patients who are the hardest ones to work with, although they fit your niche are those who are just so sick. You just have to have grace and a lot of grace and patience and love and compassion for those patients because it’s not that they don’t want to do what you’re asking them to do, it’s just that they don’t have the capacity here because their bodies are so sick and they’ve been through the wringer with medical doctors or Dr. Google or whoever they’re working with and it’s not giving them results.

I love that you’re doing that because it’s like that it’s a little bit of a warm-up step in order to get them into your 12-week group coaching program. I do think that’s a perfect solution. I love that. Well, Karen, this interview has been the highlight of my day. You’ve just done so brilliantly, and I love what you’ve created. I think your model is absolutely perfect. If we had more practitioners in this wellness space that would be willing to get out of their comfort zone and just make the decision that, “This is what I’m going to be known for, period. And I’m not going to take anybody unless they fit these criteria.” Then, you start to be known as that person, refer out more than you take in, and then raise your prices. That’s where you start.

You don’t have to raise them huge, but just enough to create that, like, “Ooh, this person must be really good at this.” By doing that, that’s the way that you scale and grow a practice. Thank you so much from the bottom of my heart for being willing to be on the podcast with me today and for being part of my community and my tribe, which is how we’ve become friends and gotten to know each other. I just appreciate you so much. Thank you so much.


Karen Cross: Thank you so much, Ronda. Absolutely, it was my pleasure.




Oh my gosh, that was an amazing interview. You can see now why I really do love my friend Karen Cross because she brings so much to the table. Not only has she created a really viable business using the power of her niche or her superpower, but she was able to do that and be able to refer out the people she didn’t want, in order to attract the people that she did want to work with. And I love that. In fact, it is the exact practice model that I’ve been talking about for years: identify what you love, get really good at it, and then allow that word of mouth and that specialty expertise to get out into your community so that people know who you are and what you do best because everyone wants to go to a specialist.


So, if you want help, if you feel stuck, or if it feels a little bit overwhelming, all you have to do is go to and I will jump on a free call with you, and I’ll help you create the action steps that you need to take in order to start to make that shift. You don’t have to do it all at once. You can just make those little shifts a little bit at a time, and before long, you will be that person in your community that serves a specific set of people or works with a specific condition, and then everybody that has that thing is going to come flocking to your front door, my friend. So, until next week, take care. I’ll be back. Talk to you soon. Have an awesome week, my friend. Bye-bye.




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