Thrive Consulting Collective
Fractional COO vs. practice manager:
what does a growing practice actually need?
Owners use these titles interchangeably and hire the wrong one.
A practice manager runs the operation as it exists. Someone at the COO level decides what the operation should become, and builds it. Those are different jobs, and hiring one for the other's work is one of the more expensive mistakes a growing practice makes.
Five roles, and what each one owns.
| Role | Owns | Doesn't own |
|---|---|---|
| Front desk / administration | Patient-facing flow, scheduling, intake | Policy, staffing, financial visibility |
| Office manager | Supplies, vendors, facilities, day-to-day admin | Strategy, revenue systems |
| Practice manager | Running the operation as it is: staff, schedules, daily problems | Redesigning the operation |
| Advisor | Guidance and a second opinion | Doing the building |
| Fractional COO | Designing and building the operating structure, then owning how it runs | Clinical decisions |
The question that decides it.
Who is going to do the building?
- If you have a capable person to hand the work to, you may only need guidance on what to build and in what order.
- If you don't, the work won't happen unless someone owns it. Advice alone leaves it on your desk.
What owners mistake for the problem.
"I need someone to manage my staff." Sometimes that's true. The tell that it isn't: even with a manager in place, every decision still routes back to you. That's a structure problem, and a manager can't fix a structure they didn't design.
Here's what I look at first.
I start with whether your revenue sources tie, then what you've earned versus what you've collected, then how much of your provider capacity is actually sold. Those three tell me whether you need someone to run what exists or someone to build what doesn't.
Who should read this next.
Owners who've just hired a manager and still feel like the bottleneck, and owners deciding whether to hire one.
Written by Natalie Mason, founder of Thrive Consulting Collective. More in FAQ & Resources, or on how practice operations work here.