Thrive Consulting Collective
What should be in place
before you hire your first clinician?
Your first hire won't break the practice. It will expose everything that only exists in your head.
Right now, your practice runs on you. You know which patients get squeezed in, what gets billed and how, and what "no" sounds like when a request crosses a line. None of it is written down because it never had to be.
A second clinician can't read your mind. On day one, they'll guess. Some guesses will be fine. Some will cost you.
What breaks first.
- Decision rights. The new clinician hits a call only you have ever made: a refund, a schedule exception, a patient asking for something outside protocol. If they ask you every time, you've hired help that still routes through you.
- Scheduling and capacity. Visit lengths, protected time, and what you'll overbook are habits, not rules.
- Billing and documentation. Two clinicians who document and code differently produce different revenue from the same visits.
- Visibility into money. Once there are two producers, "how are we doing?" stops having one answer.
What to have in place before the start date.
- The decisions the new clinician owns, in writing, and the ones that come to you
- Scheduling rules written as rules: visit lengths, protected time, what can be overbooked
- One billing and documentation standard both providers follow
- A simple view of how money moves through the practice, starting with the two or three numbers that matter most
- A 30-day onboarding path: who they shadow and what they own by week two
What to check first, in this order.
Do your revenue sources tie? What you've earned versus what you've collected. How much of your provider capacity is actually sold. Margin by provider comes after those three, never before.
A quick test.
If you took two weeks off starting Monday, what would break first? That's your list.
What owners mistake for the problem.
"I need a better recruiter." Or more patients. Or a better schedule.
Most of the time, there's no roadmap. Nobody has shown the owner what to build first, so you don't know what you don't know. In my experience, the first thing that mattered was being able to see how money moves through the practice, and figuring out which systems were worth tracking. Everything else came after.
Who this is for.
A clinician-owned practice that is open and seeing patients, where you're the only provider, a first clinical hire or contractor is coming, and little is written down. If you already have a team and a manager, that's a different problem. If you haven't opened yet, this isn't the page.
Written by Natalie Mason, founder of Thrive Consulting Collective. More on how practice operations work here, or more in FAQ & Resources.