Common Pitfalls in New Practices: #3 Overhiring
By Dr. Ugochi Okoroafor, Board-Certified Orthopedic Surgeon | Owner, Niche Hand Surgery and Orthopedics
More People Isn’t Always the Answer
When you start a practice, hiring can feel like the clearest sign of growth. More patients, more demand, so you bring on more people. It feels productive. It feels like you are building something real.
But here's what I've seen happen to a lot of new practices: hiring too fast is one of the quickest ways to put real financial pressure on a new business. Every person you bring on is a fixed cost that shows up whether you had a busy week or a slow one.
Growth is good. Hiring ahead of what your practice can actually support is not.
How to Grow Your Team Without Overhiring
Staffing is not about optics. It's about matching your team to the work in front of you. Here's how I think about it as the owner of Niche Hand Surgery and Orthopedics:
1. Hire for the Work You Have, Not the Work You Hope For
It's tempting to staff for the practice you imagine a year from now. Resist that. Hire for the patient volume and workload that exists today, plus a small, realistic buffer. Cross-train your team to perform multiple functions. You can always add more people when the demand is steady and proven.
2. Know What Each Hire Actually Costs
A salary is only part of the number. You also need to consider onboarding, payroll taxes, benefits, training, equipment, etc. When you understand the full cost of a hire, you can make more informed decisions.
3. Solve Underlying Problems Before Hiring More People
Sometimes the issue is not too few people. It's an unclear process, a scheduling gap, or a task that a simple system could handle. Before you post a job, ask whether a better workflow or a tool would fix the problem for far less money.
4. Protect Your Margins
Your practice has to stay financially healthy to keep serving patients well. Keep a close eye on your payroll as a percentage of revenue. If new hires push that number too high, you may feel the strain before it shows up on a report.
Listen carefully. Then decide. Don’t let anyone quietly reshape your practice into something you did not sign up for.
Grow at the Pace Your Practice Can Support
I built Niche Hand Surgery and Orthopedics to last. That means hiring deliberately, paying attention to the numbers, and adding people only when the work clearly calls for it.
A lean, well-run team serves patients better than a large team you cannot fully support. Grow at a pace you can sustain, and your practice stays strong enough to keep growing.
If you’re starting a practice or you’re noticing your team has grown faster than your revenue, recalibrate before you hire again.
Stay tuned for the next pitfall in this series, where we will look at another common mistake physicians make when building an independent practice.
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