I didn't realize until well into the growth of my practice that there are distinct phases of growth that all businesses go
through. What I thought were unique trials and tribulations were actually common crisis stages between these growth spurts.
It wasn't until I was mired deep in these crises that I finally saw the obvious.
Dr. Brian Huss and his practice survived the traumatic side effects of growth as his practice evolved.
My goal from the beginning has been to build a high-quality, well-managed specialty surgical practice. I started a mobile
surgical practice by myself, and it eventually grew to accommodate three exceptional technicians and an SUV packed to the
gills with equipment. With the staff never more than a couple hundred feet away from each other, everyone knew everything
about the practice: our vision, our mission, and all about each other. We had lunch together and we could air any issues or
No one was late for work or they were left behind. We had a tight bond, a clear mission to provide the best patient care,
and a strong desire to get the work done. Very little management was needed, just guidance.
We started developing business systems early in the growth of the practice with a chance encounter and relationship with E-myth
training. An advertisement for the system came addressed to the previous owner of the home I had just moved into. I later
found that we had averted a major crisis with the development of our technical and business systems because we had adopted
The practice grew rapidly, and we realized we were going to top out in the number of surgeries we could perform in a day,
which would limit our financial potential. While the overhead was low in a mobile practice, the inefficiencies of the mobile
experience were beginning to take a toll. Developing a fixed-site surgical practice had been the eventual goal, and now was
The downward spiral
Initially everything went great in our fixed-site practice. We did the same things we had done for the last few years; we
just didn't have to worry about traffic. I took a pay cut to offset the increased overhead, and we were always profitable.
But as the practice got busier, I started seeing problems with the team.
There was less camaraderie because we had a higher patient load and increased job responsibilities. I had to start managing
the team more to make sure the work got done. Like most entrepreneurs, I used a dictatorial management style. That got the
job done, but I could see it starting to take a toll on the staff.
As we hired more team members, we diversified the job duties. We hired receptionists and exam room technicians, while my original
employees stayed in the back as surgical technicians. Of course, the whole crew no longer stopped to have lunch together each
day, and the staff started to drift apart.
Problems that we'd addressed quickly and easily early in the life of the practice now festered until they resulted in periodic
explosions. We no longer had a cohesive "provide the best care for the patients" and "get the work done" culture. I was so
busy producing that I had to start divesting my management responsibilities.
Stuck in a growth rut
The natural managers, from my perspective, were the team members who had been with me in the mobile practice. So I put them
in charge. And while they had everyone's respect from a technical perspective, they were not winning over the staff with their
"do it my way or else" style.
We continued to grow and provide exceptional patient care despite the rough management culture. But we lost too many competent
employees who just couldn't put up with the junior managers. And our annual growth slowed to a crawl with a gross profit of
a little over $1 million. I was at full capacity as a surgeon, and I knew the only way to grow further was to add another
My junior managers, which now included an administrative assistant, expressed a great deal of trepidation when I told them
we were going to add a surgeon. But we made the move and doubled our staff within a few months.