AE July/August 2018 Vol 27 No 4 - 28

JULY/AUG 18 // COVER FEATURE

Added Jimmy Smith, practice administrator of Utah
Eye Centers (Wasatch Front region): "We've grown
from 3 MDs and 20 employees in 1 location to 10
MDs, 3 ODs, and about 120 employees among 4
locations. It doesn't matter how prepared you are, there
will always be some growing pains."
Some of the most common unanticipated consequences of growth involve staffing, culture, and
satellite offices. Here, then, is a look at what practice
administrators are saying about their practices' growing pains, how they managed these processes, and
the lessons they learned.
STAFFING
Many practices increase staff during an expansion. But
this can raise unexpected issues such as delays related to
hiring and a realization that the management structure
is insufficient for a larger practice.
Hiring. "The initial goal of expansion is often adding
physicians," said William (Bill) Koch, COA, COE,
CPC, administrative director of Texas Retina Associates
(Dallas) and ASOA immediate past president. But,
he said, "In a highly competitive metropolitan area, it
can take several months or more to bring in enough
patients to justify the increase. In rural underserved
areas, doctors may get busy immediately, but they may
not want to move there."
Further, Koch noted, when a practice increases the
number of clinicians, it may need to expand equipment and staff to support them-if possible, at the
same time. He added that there will inevitably be some
delays, for instance, while getting new physicians credentialed and licensed.
Expansion might also drive staff turnover. For
example, when Advanced Eye Care, SC (New Lenox,
Illinois) grew from 8 to 18 employees over a 5-year
period, the tenured clinical staff refused to accept
new expectations and reporting requirements. According to practice administrator Christine Sykora,
JD, this ultimately led to a need to replace all the
technicians. Additionally, the practice decided to increase its clinical staff from 3 to 5. "Finding so many
qualified replacement employees on short notice was
quite a challenge," Sykora said. But, she pointed
out, "It gave the practice an opportunity to candidly
analyze what wasn't working."
Management. Sykora realized she simply could not
oversee everyone and everything in a larger practice.
"Our challenge was creating a management hierarchy

28

AE // July/Aug 18

"Growth involves a bigger
staff and a bigger patient
base. That means needing
more EVERYTHING, from
bathrooms to receptionists
to technicians to parking!"
-Stacey Koch, ABOC,
Seeta Eye Centers
for oversight and training," she said. "We needed a clinical manager to whom the clinical staff would report
and who would work in collaboration with me."
Bill Koch agreed. Practices need to modify their
organizational structures to accommodate growth
and a larger staff, he said. "That's why I was brought
in to Texas Retina as Administrative Director. Now,
we have a CEO, an Administrative Director, and a
Clinical Director."
Leaders must also learn to delegate, asserted Stacey
Koch. "When Seeta Eye had 7 technicians and 5 staff, I
could manage it all. Now that we have 12 technicians,
9 administrative staff, and an in-house Lasik Department, my lead technicians are in charge of our two
full-time MDs, and my business manager supervises
the business staff. I delegate things I used to do, from
ordering laser and retina supplies to writing schedules."
CULTURE
Yet the biggest challenge for an expanding practice may
be culture management.
According to Andrew Maller, MBA, COE, principal
and senior consultant at BSM Consulting (Scottsdale,
Ariz.), what and how people communicate changes and
gets more difficult as the practice gets larger. It becomes
especially challenging when a practice has more than
one location. How does the practice continue to
connect effectively with patients, doctors, and staff? In
Maller's view, practice culture is "who we are, what is
important to us, and how we go about our day-to-day
business. If we can't be effective at communicating, it is
hard to achieve our goals."



Table of Contents for the Digital Edition of AE July/August 2018 Vol 27 No 4

AE July/August 2018 Vol 27 No 4 - Cover1
AE July/August 2018 Vol 27 No 4 - Cover2
AE July/August 2018 Vol 27 No 4 - 1
AE July/August 2018 Vol 27 No 4 - 2
AE July/August 2018 Vol 27 No 4 - 3
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AE July/August 2018 Vol 27 No 4 - Cover3
AE July/August 2018 Vol 27 No 4 - Cover4
http://www.nxtbook.com/ygsreprints/ASOA/ae_jan_feb_20
http://www.nxtbook.com/ygsreprints/ASOA/ae_nov_dec19
http://www.nxtbook.com/ygsreprints/ASOA/ae_septoct19
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http://www.nxtbook.com/ygsreprints/ASOA/g105962_ae_mayjun19
http://www.nxtbook.com/ygsreprints/ASOA/g104576_ae_marapr19
http://www.nxtbook.com/ygsreprints/ASOA/g103212_ae_janfeb19
http://www.nxtbook.com/ygsreprints/ASOA/g99529_ae_novdec18
http://www.nxtbook.com/ygsreprints/ASOA/g97160_ae_septoct18
http://www.nxtbook.com/ygsreprints/ASOA/g96528_ae_julyaugust18
http://www.nxtbook.com/ygsreprints/ASOA/g93925_ae_mayjune18
http://www.nxtbook.com/ygsreprints/ASOA/g92298_ae_marapr18
http://www.nxtbook.com/ygsreprints/ASOA/g89361_ae_janfeb18
http://www.nxtbook.com/ygsreprints/ASOA/g86698_ae_novdec17
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http://www.nxtbook.com/ygsreprints/ASOA/g77256_ae_mayjun17
http://www.nxtbook.com/ygsreprints/ASOA/g74401_ae_marapr17
http://www.nxtbook.com/ygsreprints/ASOA/g72340_ae_janfeb17
http://www.nxtbook.com/ygsreprints/ASOA/ae_novdec16
http://www.nxtbook.com/ygsreprints/ASOA/ae_septoct16
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http://www.nxtbook.com/ygsreprints/ASOA/asoa_mayjune2016
http://www.nxtbook.com/ygsreprints/ASOA/asoa_marapr2016
http://www.nxtbook.com/ygsreprints/ASOA/asoa_janfeb16
http://www.nxtbook.com/ygsreprints/ASOA/ae_novdec15
http://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct15
http://www.nxtbook.com/ygsreprints/APTA/g52750_apta_25ada
http://www.nxtbook.com/ygsreprints/ASOA/asoa_julyaug2015
http://www.nxtbook.com/ygsreprints/ASOA/asoa_mayjune2015
http://www.nxtbook.com/ygsreprints/ASOA/asoa_marapr2015
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http://www.nxtbook.com/ygsreprints/ASOA/asoa_novdec14
http://www.nxtbook.com/ygsreprints/ASOA/asoa_sepoct14_AE
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http://www.nxtbook.com/ygsreprints/ASOA/ASOA_MayJunAE
http://www.nxtbook.com/ygsreprints/ASOA/ASOA_MarAprAE
http://www.nxtbook.com/ygsreprints/ASOA/ASOA_JanFebAE
http://www.nxtbook.com/ygsreprints/ASOA/ASOA_no4eZine
http://www.nxtbook.com/ygsreprints/ASOA/asoa_fall_2013
http://www.nxtbook.com/ygsreprints/ASOA/asoa_no3_ezine
http://www.nxtbook.com/ygsreprints/ASOA/asoa/asoa_summer_2013
http://www.nxtbook.com/ygsreprints/ASOA/ehr_cust_survey_Apr2013
http://www.nxtbook.com/ygsreprints/ASOA/asoa_no2_2013_ezine
http://www.nxtbookMEDIA.com