Sarah

Sarah had started the practice herself fourteen years earlier as a sole practitioner. she now had eighteen people and was still the most productive clinician in the building. seeing patients thirty hours per week and running the business around it. every significant staff decision came to her. every patient complaint came to her. every hire routed through the principal who was also the busiest clinician.

she had two senior practitioners who were technically capable of leading their own caseloads and managing their own staff. they had never been given the authority to do so. the practice couldn't grow beyond Sarah's physical presence. and Sarah was starting to feel the weight of that in her body in a way she hadn't named out loud.

the hiring process was the specific breakdown point. every time a role needed filling, Sarah ran the process personally. between managing the clinical load and running the hire, timelines blew out. two good candidates had withdrawn from processes that had taken too long. the practice was understaffed for three months twice in the prior year because the hiring moved at the speed of Sarah's availability.

within six months the practice had hired three additional practitioners without Sarah running every stage of the process. revenue grew from $2.8m to $4.1m in twenty-four months. the practice ran three days without Sarah present while she attended a conference. no clinical issues escalated. she came back to a team that had handled everything without needing the answer from her once.

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Sarah thought she was being a good clinician by staying close to the work. she was actually being the ceiling. structure changed the ceiling without changing the care.