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Why isn’t your practice still growing?

Have you wondered why your physical practice seems to have stayed roughly the same size for the past few years?  With only modest fluctuations, you have about the same number of clinician days, active patients, and the same turn over now as you did before.   And yet, it wasn’t that long ago, it seemed as though your practice was growing effortless, year over year.
It’s much easier to grow when there are fewer practices competing in your area.  There are more clinics now and the competition is likely going to become more intense in the years to come.  Despite this, there are practices that continue to see low attrition and strong growth.  How do they do it?