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How small practices become big

February 15, 2022

2 minute read


Biography: Hovanesian is on faculty at the UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.


Disclosures: Disclosure: Hovanesian does not report any relevant financial information.


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As we hire three new physicians this year, my practice at Harvard Eye Associates in Southern California will approach the 20-provider threshold – an important milestone for us. When I arrived in 1999, I was the fourth doctor.

Growing to such a size might be undesirable for some. Indeed, in a large firm, no one makes all the decisions, and we don’t always agree. This certainly made us a target for generous offers from private equity firms, which we repeatedly and resolutely declined. More often than not, I am incredibly grateful to work with such a diverse, intelligent, and good-humored group of doctors and staff.

John A. Hovanesian

How does a small firm become big? Here’s some wisdom we’ve learned over the years.

1. Plan space. Again and again, you will quickly miss. Whether you own or rent, get more than you think you need. While you are married to your partners, you are not in your space. Moving involves challenges, but far worse is stifled growth. Go where the most expensive housing is and you’ll solve a lot of economic problems. Invest in a specialty-specific build and you’ll reap the rewards of efficiency for decades.

2. Protect your culture. It is your most valuable asset. This determines the types of doctors you will attract, the type of staff you will hire, and the type of patients you will retain. Value the staff as much as the patients. Train them, trust them, let them lead and recognize them. Then help them if they want to move on. Many won’t, even for more money. It’s hard to leave a place where you feel so precious and valued.

3. Hire new doctors before you think you’re ready. At a compound annual growth rate of, say, 10%, a two-doctor practice needs to hire a doctor every 4 years. A practice of 10 doctors must hire every year. To grow the fastest, time it so that demand rather than supply is the limited resource.

4. Hire doctors carefully and treat as equals those who perpetuate your culture. All of our seven partners have equal ownership and authority. All of our associates enjoy comparable staff support and clinical space, because we place the same value on their happiness.

Larger firms have many advantages: more flexibility in the holidays and benefits we can offer, more affordable equipment, top-notch leadership, research capability, and a giant celebration for every holiday season. . But most rewarding is the ability to serve more patients with multiple subspecialists, and each of them I would trust with my family. Every working day, I look forward to arriving.