Four Group Practice Owners, Four Different Answers to "Should I Grow?"

This summer, I sat down with four group practice owners across the country on the Empowered to Lead podcast and asked each of them the same question: how did you decide whether to grow or stay where you are. Not one of them answered with a number. Not one said "once your team’s caseload hits this," or "once you can afford that." What they gave me instead was harder to put in a framework, and more useful because of it.

Frances runs a practice in Moose Jaw that grew from solo to 16 clinicians, mostly by accident. Bianca has held her practice at 7 contractors for four years, on purpose. Rachael just opened her third location in downtown Toronto, admitting the vision was always stronger than the practicalities. And Michelle has one contractor and still occasionally wonders if she's allowed to call herself a group practice owner.

Four completely different practices. Four completely different sizes. And underneath every one of them, the same real question: not "how big should I be," but "why am I doing this at all."

Growth without a why is just momentum

Rachael told me something I haven't stopped thinking about. Every time she expanded, the vision was stronger than the practicalities. She wasn't where she really wanted to be financially when she took her first space, her second, or her third. She took them anyway, because she could see the potential in the space and couldn't put the idea down.

That's not a strategy I'd normally recommend. But it's honest, and it points at something real. Rachael's growth wasn't driven by a spreadsheet telling her it was time. It was driven by a clear sense of what she was building and why, backed up by relentless work on her business skills, her numbers, and her team, even when the timing wasn't tidy.

Contrast that with Frances, whose growth happened almost passively. She never set out to run a group practice. She just kept noticing the gap between what her waitlist needed and what her own schedule could hold, and she filled it, one office and one hire at a time. Her growth wasn't about ambition. It was about capacity and demand, tracked closely enough that she always knew whether the next step made financial sense before she took it.

Both are legitimate paths to growth. The difference is that both owners could tell me exactly why they were doing it. That's the part that matters, not which reason they picked.

Staying small can be the disciplined choice, not the safe one

Bianca's story pushes back on the idea that staying small means playing it safe. She built her practice, hit a place where the numbers, the team, and the culture were all working, and made a deliberate decision not to keep adding. She's a full-time trauma therapist, a clinical supervisor, and running a second business alongside her group practice. Staying at 7 contractors wasn't a ceiling she hit. It was a boundary she chose to protect everything else she'd built.

Michelle's practice is even smaller: one contractor, one billing coordinator who happens to be her daughter. She told me she's asked herself more than once whether she can even call herself a group practice owner with a team that size. What changed that for her wasn't growth. It was clarity about who she serves, who her one contractor serves, and the confidence to turn away referrals and even strong clinical candidates who didn't fit that focus.

Neither of these owners is avoiding growth out of fear. They both did the harder work of deciding what "enough" looks like for them, and then holding that line even when a good opportunity showed up. That's not smaller. That's precise.

The plateau is not the same as failure

Frances described something every owner who has grown quickly will recognize: after a stretch of expansion, there's a plateau, and it can feel uncomfortable in a way that mimics failure. You're not adding offices. You're not hiring. It can start to feel like something's gone wrong.  And, honestly, you might miss the excitement of building and growing.

Her read on it was different. The plateau is when the real work of building systems finally gets the attention it needs, because you're not scrambling to keep up with growth anymore. That's not a stall or boredom. That's the stage where hiring processes, onboarding, and financial clarity get built properly and adjusted to where you’re at, instead of improvised under pressure.

If you're in a plateau right now, it's worth asking whether you're actually stuck, or whether this is the season to build the systems you didn't have time to build while you were growing.

What to do with this

If you're circling a growth decision right now, sit down with your actual numbers before you sit with the feeling. Rachael and Frances both grew, but for very different reasons, and both could point to what they knew about their revenue, their capacity, and their team before they made the call.

If you've been telling yourself you're staying small "for now," get honest about whether that's true, or whether it's a story protecting you from building the systems that would let you grow safely. Michelle's clarity about her ideal client didn't come from staying small. It came from doing the work most owners skip.

And if you're in a plateau, resist the urge to manufacture movement just to feel like you're doing something. Use the quiet to build the SOPs, the onboarding process, and the financial clarity that will actually hold the next stage of growth, whenever you decide to take it.

If you're navigating this as a group practice owner and want to be in a room with others doing the same work, the Group Practice Connection is where that conversation happens.