G N I W O R G S N I PA D E T C E P X E N U G N I G A N A M F O S E C N E U Q CONSE N O I S N A P X PRACTICE E Jeanne S. Holden C hanging government regulations, increasing costs, and declining reimbursements create pressures that encourage the growth and consolidation of ophthalmology practices. Other situations promote growth as well. Sometimes a practice decides to focus on a specific eyecare treatment and hires staff with that expertise. Other times a practice adds space to house new diagnostic or treatment technologies. Sometimes a practice opens a satellite office to access new markets. Practices are often getting bigger or preparing to do so. Detailed guidance for expanding a practice is widely available, but expansion often leads to unexpected challenges. "Growth involves a bigger staff and a bigger patient base. That means needing more EVERYTHING, from bathrooms to receptionists to technicians to parking!" exclaimed Stacey Koch, ABOC, practice manager/refractive coordinator of Seeta Eye Centers (Dutchess County, N.Y.).