The Birkin Bag Problem

Why the hardest part of positioning a specialty practice can often have nothing to do with marketing.

Peter Beckwith Founder and Chief Blogger Mad Rose Media

Read time · ~6 minutes

I have been working with specialty clinicians for thirty years, and the same conversation comes up in almost every multi-doctor practice.

The senior clinician wants to know how to get the associates busy. The associates want more of the attention for themselves. Both are well meaning. Both think they are being fair. Both are wrong in opposite directions.

I think of it as the Birkin Bag Problem. The phrase is not mine. I owe it to a sharp clinician who used it to describe his own practice in one sentence.

We are selling Birkin bags in a world where no one’s heard of Hermes.

That is one of the cleanest diagnoses of the positioning problem I have heard from inside a specialty practice. The work is at the highest level. The reputation has not caught up. The market sees a shop. It does not see a name.

The technical fix for this is easy. The psychological fix is the hard part. This is a piece about the psychological fix.

In every multi-doctor specialty practice I work with, there is at least one clinician who is genuinely top of the field in a specific area. Top one percent in their lane, even when they are the last person in the room willing to admit it. The rest of the practice has access to something most early-career clinicians never get. Built-in proximity to a name like that.

Proximity is a transferable career asset. It is how reputation moves from one generation to the next in every field where reputation is the currency. Academic medicine has a name for it. The career development literature describes senior mentors and aligned divisions as the launch pads that carry junior clinicians into the next twenty years of their work. The recognized name pulls attention. Everyone close to it gets carried.

Most clinicians underestimate this asset because spending it feels like riding coattails. It is not. It is how careers compound.

I made this mistake in my own company. I am the founder. I am the one with thirty years of experience in this niche. I tell my team constantly that I do not want Mad Rose to be just about me. I want the agency to have its own identity, separate from mine.

My team kept pushing back. They told me, in so many words, that what I was calling principled was actually limiting. The agency could not do what it needed to do without me in front. I was the one with the language, the experience, and the creative judgment. To dilute me was to dilute the agency. To dilute the agency was to dilute every person on my team.

That instinct to flatten is honest. It comes from a good place. It is also wrong. The person resisting their own prominence is usually doing it for the right reasons, which is exactly why it is so hard to see past.

This is the central error. Equating equal presentation with equal opportunity.

It feels right because it matches the partnership ethic. Equal billing. Equal marketing. Equal voice. The intuition is that this protects the collective.

The market does not work that way. The market does not reward fair. The market rewards clear. The market rewards a recognizable name attached to a specific problem the patient or the referring colleague is trying to solve.

When a practice tries to give every clinician the same prominence, the market sees no one. It sees letterhead. It sees a list of doctors. It moves on to the practice it can remember.

This is not a moral failing. It is a structural one. The market has its own logic, and that logic does not care about partnership ethics.

This is the part associates miss most often.

The young researcher who publishes alongside a recognized leader is not being eclipsed. The leader’s name is the reason anyone reads the paper. The prot√©g√©’s name is the reason the field reads the next one.

The young surgeon who trains under a recognized leader is not standing in a shadow. The leader’s name is the reason referrals find the practice and why the platform exists at all.

The pattern repeats in every field where reputation is the currency. The leader’s name is not the obstacle. It is the engine. The clinician who leans toward the engine gets carried. The clinician who leans away gets left.

This one is for the senior clinicians who hand-wring about getting the associates busy.

Giving every clinician equal presentation looks fair. It feels collegial. It produces a generic brand.

A generic brand attracts generic patients. Generic patients commoditize the work. Commoditized work depresses the value of every clinician in the practice equally. In trying to be fair, the practice flattens its own ceiling. Then it complains about the ceiling.

Hermès does not behave this way. The Birkin model is one of the most disciplined exercises in brand restraint in modern business. The bag has value because Hermès has value, and Hermès has value because the company concentrates its name rather than diluting it across every product line that wants a lift. The result is a brand that does not just sell leather. It sells validation. Practices that try to flatten everything are not behaving like Hermès. They are behaving like a department store shelf, and the market treats them accordingly.

The opposite arrangement is uncomfortable, but it is the one that compounds. One clinician becomes the recognized name. The platform attracts a higher caliber of patient and a higher caliber of referring colleague. Every clinician in the practice benefits from the upgraded patient base.

The leader is not extracting value. The leader is generating it. Everyone close to the leader gets to share the lift, if they choose to step onto it.

This is the line I would hang on the wall of every airway and specialty practice in the country.

The market does not search for nice. It does not search for competent. It does not search for a fine practice in a fine suburb.

The market searches for the doctor who solved the problem the patient has. A patient who suspects airway driven sleep apnea searches for a name attached to a capability. A referring orthodontist who needs a complex case handled does not call the practice down the road. They call a name they have heard before.

The question worth sitting with is simple. When patients describe the kind of clinician they need, does anyone in your practice come up?

Of course someone does. That is the name that should be elevated as the thought leader so the brand can grow. A rising tide lifts all ships.

If the answer is no, the technical work is not the problem. The DSO down the street is.

Positioning is not about taking. It is about alignment. Alignment with the colleagues whose recognition can carry you. Alignment with the parts of your career that compound. Alignment with what the market actually rewards. The clinician who aligns gets carried. The clinician who refuses risks getting left behind.

Peter Founder and Chief Blogger Mad Rose Media

P.S.Our most passionate advice tends to be the advice we need to hear ourselves. I think this article applies to me as much as anyone reading it.