Smart growth isn’t about hiring, it’s about structure

If your practice feels like it’s constantly one call away from chaos, you’re not alone.

As patient demand rises and resources remain tight, practice leaders do everything they can to keep up — often ending their days overwhelmed. Schedules are maxed, intake is messy, and referrals go unanswered. The reflex is to hire: a new coordinator, an operations lead, or a marketing manager.

But more often than not, it’s not a staffing issue — it’s a systems issue.

What lean practices can teach us about smarter growth

As healthcare delivery evolves, practices of all sizes are rethinking what it means to grow sustainably. Many are exploring hybrid models (combining traditional fee-for-service with concierge elements), membership-based approaches emphasizing recurring patient engagement, or direct primary care (DPC) structures, which remove insurance intermediaries to streamline service. While these models aren’t the right fit for everyone, they reflect a growing interest in purposeful, system-driven practice design.

The most agile practices — regardless of structure — tend to have several key traits:

• Streamlined use of technology for intake, scheduling, and communication
• Clear workflows that reduce duplication and improve handoffs
• Task-specific support through fractional or contracted roles, such as billing specialists or IT consultants
• Proactive referral management with defined scripts and touchpoints.

These aren’t just for concierge or DPC practices; they’re replicable systems benefiting any practice, regardless of size.

When operational clarity is prioritized, teams accomplish more with fewer people. For example, a traditional primary care group reduced front-office strain by standardizing communication and refining intake protocols. The result? Improved morale, stronger patient access, and better care coordination without adding new staff.

The real cost of hiring too soon

Hiring frequently is seen as the fastest fix for practice strain. However, adding headcount before clarifying internal structure can become one of the costliest missteps.

When roles are unclear and workflows are inconsistent, the downstream effects can include:

• Chaotic onboarding
• Role overlap or misalignment
• Persistent communication breakdowns.

These inefficiencies often contribute to burnout. Physician burnout remains a major concern — driven not only by patient volume, but also by mismanaged workflows and lack of internal alignment.¹

Before hiring, pause to ask: “What specific gap are we trying to solve, and is it actually a staffing issue?”

Operational gaps frequently can be addressed through improved systems, realigned roles, or short-term support — all without increasing headcount. Growth requires readiness for volume. High-functioning practices share core traits that support sustainable expansion, enabling their leaders to prioritize, delegate, and measure progress even with lean teams.

Growth-Ready Practice Checklist

To assess your practice’s readiness for sustainable growth, evaluate these areas:

• Clear referral intake protocols to streamline communication
• Consistent, standardized patient communication
• Defined roles and responsibilities across teams
• Meaningful metrics, such as patient satisfaction scores and referral response times
• Documented growth and contingency planning.

Smarter alternatives to hiring

While it’s common for overwhelmed practices to seek more staff, clarity often resolves what headcount cannot. The following smarter approaches help increase capacity without team expansion:

• Fractional strategy: Engage part-time strategic support, such as interim operations leaders or workflow specialists, to quickly identify inefficiencies and establish improved processes without the long-term commitment of a full-time role.
• Outsourced outreach: Delegate marketing, patient engagement, or referral development to trusted contractors with defined scopes and measurable outcomes.
• Frameworks in practice: Use resources such as MGMA’s Patient Experience Playbook to enhance communication and workflow alignment without additional hires.²
• Operational coaching: An external expert acts as a neutral observer, quickly pinpointing hidden barriers — such as misaligned responsibilities or overlooked technology solutions — that internal staff might miss.

These strategies allow practices to adapt and grow without overextending their teams or budgets.

Case in point: Workflow reset

A mid-sized primary care clinic was experiencing persistent operational stress. Appointment requests were delayed, phone response times were inconsistent, and referring providers voiced concerns about communication breakdowns.

Initially, leadership considered hiring. However, a review of internal workflows uncovered:

• Inconsistent intake protocols
• Untracked referral requests
• Unclear call triage responsibilities.

Instead of expansion, the clinic implemented targeted operational fixes: a shared referral inbox, an intake checklist, and standardized phone scripting protocols. An existing staff member was reassigned to manage referrals during peak hours.

Within six weeks, referral response time improved by 30%, coordination strengthened, and internal stress decreased without new hires.

Don’t confuse chaos with growth

At every stage, the key question isn’t, “Who should we hire?” but rather, “What problem are we really solving?”

Often, the root challenge is process, not people. By first addressing structural gaps, practices can more clearly spot and strategically resolve underlying issues.

Sustainable growth is about doing the right things more consistently.

Smart growth is possible. You just have to build the right bridge.

References

1. MGMA. “Physician burnout still a major factor even as unexpected turnover eases.” MGMA Stat. 2024. https://www.mgma.com/mgma-stat/physician-burnout-still-major-factor-even-as-unexpected-turnover-eases
2. MGMA. Patient Experience Playbook. 2023. https://www.mgma.com/resources/patient-care/the-patient-experience-playbook