BLOG: How small practices become large
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As we hire three new doctors this year, my practice at Harvard Eye Associates in Southern California will approach the threshold of 20 providers — a big milestone for us. When I joined in 1999, I was the fourth doctor.
Growing to such a size might be undesirable for some. Indeed, in a big practice, no one gets to make all the decisions, and we don’t always agree. It has certainly made us a target for generous offers from private equity firms, which we have repeatedly and resolvedly declined. Most often, I am incredibly grateful to work with such a diverse, intelligent and good-natured group of doctors and staff.
How does a small practice become large? Here is some wisdom we have gained over the years.
1. Plan for space. Again and again, you’ll run out quickly. Whether you own or rent, obtain more than you think you’ll need. While you’re married to your partners, you’re not to your space. Moving involves challenges, but far worse is stifled growth. Go where the most expensive housing is, and you’ll solve a lot of economic problems. Invest in a specialty specific build-out, and you’ll reap rewards of efficiency for decades.
2. Safeguard your culture. It’s your most valuable asset. It drives the kinds of doctors you’ll attract, the kind of staff you’ll hire and the kind of patients you’ll keep. Value staff as highly as patients. Train them, trust them, let them lead and recognize them. Then help them if they want to move on. Many won’t, even for more money. It’s hard to leave a place you feel so valuable and valued.
3. Hire new doctors before you think you’re ready. At a compound annual growth rate of, say, 10%, a two-doctor practice needs to hire one doctor every 4 years. A 10-doctor practice needs to hire annually. To grow quickest, plan for this, so demand rather than supply is the constrained resource.
4. Hire doctors carefully, and treat like an equal those who perpetuate your culture. All of our seven partners have equal ownership and authority. All of our associates have comparable staff support and clinic space because we value their happiness equally.
Larger practices have so many advantages: more flexibility in vacations and benefits we can offer, easier affordability of equipment, top-notch leadership, capacity for research and a giant celebration for every holiday party. But most gratifying is the ability to serve more patients with multiple subspecialists, and every one of them I’d trust with my family. Every workday, I look forward to arriving.
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