Growth Goals vs. Reality: Why You Might Need to Hire More Than You Think

Hiring is one of the most exciting parts of growing a group practice. It means more clients served, more revenue potential, and a bigger impact. But there’s a key mistake we see even the most thoughtful practice owners make:

They plan for growth... but forget about attrition.

If you’ve ever said something like, “I want to add 8 new clinicians next year,” you’re not alone. That’s a fantastic goal—but unless you account for the team members you’re likely to lose along the way, you’ll come up short.

Growth and Attrition Are Two Different Things

In 2025, losing a team member doesn’t necessarily mean something went wrong. The job market is more flexible than ever, and it’s easier than ever for fully licensed clinicians to go out on their own, move to another state, or accept another offer.

We’re seeing it across the board:

• Clinicians who relocate to be closer to family or work remotely

• Fully licensed team members leaving to start solo practices

• Competitor practices offering aggressive signing bonuses or perks

These shifts aren’t always predictable, and they’re rarely personal. But they are common. So if you don’t build them into your plan, your growth goals will fall flat.

Want to Grow by 8? You Might Need to Hire 12–14

Let’s say your goal is to end next year with 8 more clinicians on your team. Sounds straightforward, right?

But if you lose 4–6 clinicians over the year due to normal turnover (which is common in group practices), you’ll need to hire 12–14 just to end up at your target. That’s a 50% increase in hiring efforts—not because you’re doing anything wrong, but because you’re dealing with reality.

Failing to account for this means you’ll be constantly trying to catch up, filling holes instead of building forward.

Plan with Purpose: An Actionable Step

Here’s one quick way to build this into your planning:

Look back at the past 12–18 months. How many team members did you lose? That’s your baseline for expected attrition.

Then add that number to your growth goal. Want to grow by 5? Lost 3 last year? Plan to hire 8. Want to grow by 10? Expecting 4 to move on? You’ll need 14.

This simple adjustment creates a much more realistic hiring plan and helps you budget, recruit, and onboard with confidence.

Hiring Isn’t Just a Numbers Game—It’s a Timing Game Too

Another challenge we see is underestimating the timeline it takes to make a new hire fully productive.

• If you accept insurance, credentialing alone can take 90+ days—especially if it’s a new clinician or your first time with that payer.

• Even in private pay practices, building a caseload takes time. It typically takes at least 90 days for a new clinician to get full.

What happens if someone starts without a plan in place? They may sit around with no clients—and no pay—which isn’t great for morale or retention. It can be discouraging for them and stressful for you.

That’s why we recommend setting realistic start dates and building in prep time before a clinician’s first day. Market in advance. Set up your systems. Make sure they’re walking into a practice that’s ready to support their success.

Final Thoughts: Hire Smarter, Grow Stronger

Growth is an exciting goal—but it only works when it’s paired with real-world planning.

Hiring isn’t just about headcount—it’s about strategy. You need to account for the team members who will leave, the time it takes to fill seats, and the infrastructure needed to support your team.

So if you’re planning to grow by 8 next year—great! Just make sure your actual hiring target reflects what it takes to get there.

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Want help building a hiring and growth strategy that actually works? Schedule a consultation and we’ll walk you through the financial side of hiring, growth, compensation, and more. You deserve a team—and a business—that’s built to last.

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This article is designed to provide information only and should not be considered legal or tax advice. Because of the complexity of the law and the variables in your own personal tax situation, you can’t rely on our advice specifically related to your unique circumstances. In order to get the best tax savings and legal advice available to you, you should consult with your own accountant, attorney, or advisor regarding your particular facts and circumstances.

GreenOak Accounting specializes in working with private practice owners across the United States. For more information on our services, visit our website.

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