Most growth advice assumes you can add providers. Holleigh Seales can't. Rheumatology Associates in Birmingham runs seven physicians and nine providers total, the physician owners settled on that number deliberately, and the building has limited space and limited people to run new operations.

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So revenue has to come from inside the footprint. This episode walks through how that actually happens: wellness infusions as a cash option for immunocompromised patients, GLP-1s through a local compounding pharmacy, an in-house dispensary that took four years of vetting before the timing was right, and a concierge model she's still building consensus around.

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Joe Zboch of Hatch talks with Holleigh Seales about the pilot method behind all of it, why she runs every new service line herself before handing it to staff, and what a four-day workweek has done for a practice where people have stayed 10 to 20 years.

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👤 Guest Bio

Holleigh Seales is the practice administrator at Rheumatology Associates in Birmingham, Alabama, where she has spent eight years, the last four running the practice. All 60 staff report directly to her. Before Rheumatology Associates she spent a decade at PainSouth as practice manager, coming up through marketing and referral management. She also serves on the board of directors of Bundles of Hope Diaper Bank.

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📌 What We Cover

• Why a medium-sized rheumatology practice with no CEO or CFO puts every operational decision on one desk, and what that does to how you prioritize
• The four-day workweek: how it started with physician-owned admin Fridays and why employees driving an hour to an hour and a half each way made the math obvious
• Piloting a new service with one to three providers first, selected by interest, comfort with technology, and how they manage change
• Four to five years of vetting in-office dispensing alongside other Birmingham rheumatology practices before pulling the trigger
• How Medicare's Part D maximum out-of-pocket change made it possible to take back ownership of treating Advantage patients in-house
• Reading referral patterns for gaps: inflammatory patients get prioritized, while a large osteoporosis population comes in behind them
• Wellness infusions and GLP-1s as cash services in a specialty where biologics are expensive and reimbursement keeps declining
• The annual patient letter with her direct contact information, and why patients reveal what you need next
• Running the concierge pilot on her own shoulders so no one inherits a bottleneck she hasn't found yet

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🔗 Resources Mentioned

• National Organization of Rheumatology Management (NORM)
• Bundles of Hope Diaper Bank
• Hatch

Growth is not optional for an independent orthopedic group. Growth without the operations underneath it turns into a backlog nobody can work through. Joe Zboch talks with Alejandro Fernandez, CEO of Synergy Orthopedics, about why access is a strategy and operations problem first, with technology in service of that.

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Alex runs the largest private orthopedic group in San Diego: over 50 providers across 15 locations, plus physical therapy sites, an MRI center, and an ASC. They get into payer contracts as the real ceiling on access, why open scheduling became a basic expectation instead of an advantage, what makes workers' comp both attractive and unforgiving, and how falling MRI reimbursement pushed the group toward AI-assisted imaging for throughput. Alex also explains why a practice playbook is out the window six months after you build it, and where he expects AI to change the work first.

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👤 Guest Bio

Alejandro Fernandez is CEO of Synergy Orthopedic Specialists in San Diego, the largest independent orthopedic group in the region, with more than 50 providers across 15 locations plus physical therapy, imaging, and an ambulatory surgery center. He has spent 30 years running multi-site physician practices across dermatology, GI, and orthopedics, including CEO roles at Gastro Health in Miami and NavaDerm Partners in New York. The American Alliance of Orthopaedic Executives named him Practice Executive of the Year in 2024.

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📌 What We Cover

• Why access starts with payer contracts and credentialing rather than marketing or a booking page
• How a bigger group moves business from the higher cost of care into the lowest cost of care, and why payers reward it
• Why very few programs pay for quality and almost all of them still pay for volume
• What open scheduling looks like when it works: filling tomorrow's 10:00 AM no-show by texting the people already waiting
• How to give a health system a reason to partner with you when PCPs are getting acquired
• Why the sports teams run through workers' comp, and what a specialized team for prior authorizations and RFAs makes possible
• How falling MRI reimbursement and rising magnet costs turned throughput into the margin
• Why the playbook you built six months ago is out the window, and where Alex expects AI to change RCM first

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🔗 Resources Mentioned

• Synergy Orthopedic Specialists
• American Alliance of Orthopaedic Executives, which named Alex Practice Executive of the Year in 2024
• GE, referenced as the scanner platform for the group's AI imaging device
• OpenAI, ChatGPT, and Claude, named as the general purpose tools the practice is not using for its playbook work
• U.S. Department of Labor, the workers' comp carrier for the group's federal patient volume
• Hatch

Independent specialty practices keep hitting the same wall. Reimbursement is set by the government market, the cost side keeps climbing, and owner compensation flattens out underneath both. Joe Zboch talks with Larry Epstein, CEO of Pediatric Urology Associates, about what a practice CEO actually does when top-line growth runs out of room. Larry was brought in during a leadership changeover seven years ago, spent the first stretch assessing where the market was shifting and whether enough kids were still being born to support the service, and then took the group through partnership talks that ended with a health system merger. He walks through why three or four private equity reviews went nowhere, what "plan B" looked like, and the checklist he runs before signing with a health system. If you're weighing growth paths for a specialty group, this is the operational version of that conversation.

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👤 Guest Bio

Larry Epstein is CEO of Pediatric Urology Associates, a multi-state subspecialty surgical practice built around pediatric urological care and research. He has run clinical administration for health systems and medical groups with budgets up to 50 million and as many as 500 FTEs, led mergers and acquisitions at the regional health system level, driven EMR implementations, and turned around revenue cycle performance. The practice joined NYU Langone Health, where Larry moved into a regional practices role.

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📌 What We Cover

• Why operating margins for independent specialty groups have been shrinking since the RVU system took hold, and what that forces a practice to do about service lines and ancillary revenue
• How independent groups in the Metro New York market went from 75 to 80 percent of practices down to under 35 percent in about twenty years
• Why the birth rate is a growth constraint for a pediatric subspecialty, and what Larry assessed first when he arrived
• Why three or four private equity reviews went nowhere: no drug revenue and no owned surgical services to support the valuation
• What "plan B" looked like, including the ER and NICU coverage relationships that opened the health system conversation
• The red flags to listen for when a partner describes their 24 to 36 month plan for your service line
• How an in-office ultrasound credentialing conflict nearly stalled integration, and the 12 to 24 month commitment that resolved it
• Why referring physicians and patient access are the two things that protect volume through a transition

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🔗 Resources Mentioned

• Hatch
• Pediatric Urology Associates
• NYU Langone Health

Growth is not the hard part. Holding the operation together while you grow is. On this episode, Joe Zboch talks with Cecily Sheats, executive director and administrator at Creekside Surgery Center in Anchorage, about why operational excellence is a prerequisite for growth rather than a reward for it.

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Alaska makes the point unavoidable. The nearest referral centers are often Seattle or Portland, patients travel farther than Dallas to New York City for critical care, and you cannot solve a gap by posting a role and waiting. Cecily walks through the process improvement available before you spend on FTEs or technology, the three-legged stool behind her employee incentive model, and how she sets goals when no benchmark exists.

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She also gets specific about what her team actually does: department-level strategic planning, sticky notes and spirit animals in the break room, and a review process rebuilt so people walk out with something. Brought to you by Hatch.

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👤 Guest Bio

Cecily Sheats, MBA, is executive director and administrator at Creekside Surgery Center, a four OR ambulatory surgery center in Anchorage with 50 staff seeing up to 3,000 patients a year. She is also president of the Alaska Healthcare Executives Network, the independent Alaska chapter of ACHE. Before Creekside she ran cardiac, neuroscience, and orthopedic service lines for Providence in Anchorage, and she has worked in healthcare operations across California, Louisiana, and Colorado.

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📌 What We Cover

• Why the rate limiting factor for growth is usually the lack of operational excellence, not the lack of demand
• The process improvement available before you invest in FTEs or technology
• What "dare to reimagine, even in crowded spaces" looks like in an organization that remembers every idea that flopped
• How department-level strategic planning replaces the plan that ends up on a shelf collecting dust
• The three-legged stool behind her employee incentive model: organizational goal, personal accountability, team SMART goals
• How to build a unit of measurement when there is no benchmark, starting with "what are we solving for"
• Mapping the referral process end to end with partner practices when nobody shares an EMR
• The difference between "hey, great job" and "hey, I noticed," and why reviews became development sessions

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🔗 Resources Mentioned

• Creekside Surgery Center
• Alaska Healthcare Executives Network
• Providence
• Simon Sinek
• Lean Six Sigma
• SMART goals
• Hatch

Digitizing the front door usually gets framed as a tradeoff against the patient experience. Kaydi Siebeck runs patient access at Moreland OB-GYN Associates in Wisconsin, and she draws the line somewhere specific: the system takes the administrative tasks so her staff has more time for the phone call and the front desk conversation.

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She joins Joe Zboch of Hatch to talk through nine years of change at the front door, from paper charts running alongside an electronic medical record to a nurse care team model built inside the EMR. She covers what patient survey feedback and phone routing data told them, why patients kept asking for staff members by name, and what broke during the schedule build. She also gets into compassion training, what's your why, and why Moreland still answers every call live with no automated system.

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👤 Guest Bio

Kaydi Siebeck is Patient Access Manager at Moreland OB-GYN Associates, S.C., the largest independent OB-GYN group in the Waukesha, Wisconsin area, serving the community since 1960 and delivering through its partnerships with ProHealth Care hospitals. She runs scheduling, registration, and insurance verification, and leads the practice's system transitions and access technology work. She is a 20-year breast cancer survivor.

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📌 What We Cover

• Why the practice ran paper charts and an electronic medical record side by side, and what COVID forced them to look at
• Where technology takes over: e-check-in, document upload, automatic messages, orders and referrals placed
• Why Moreland answers every call live with no automated system, and what patients say about it
• "What's your why" and compassion training as a way to get buy-in for change and keep staff on board
• The nurse care team model: one schedule per provider's nurse, reserved rooms, blocked time for follow-up calls
• The survey comments and phone routing data behind the decision, including patients asking for specific staff by name
• What the soft opening caught: appointment types the system couldn't build and not enough rooms
• Where growth comes from for an OB-GYN specialist: family practice referrals, high schools, networking through the affiliated health system

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🔗 Resources Mentioned

• Moreland OB-GYN Associates
• Hatch
• Scaling Specialty Growth, hosted by Joe Zboch and Chris Poole

Patients want the robot and the better brace. Reimbursement is moving the other way, and the practice sits in the middle of that distance every single day. Joe Zboch, Director of Marketing at Hatch, talks with Thomas Fondren, CEO of Advanced Orthopedics of Oklahoma, about what it takes to run aggressive growth goals and stay lean enough to support them.

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Thomas walks through geographic diversification, service line diversification, and payer diversification at a physician-owned ortho group in Tulsa with 24 physicians and more than 300 employees. He explains why his company went self-insured in January of '26, what that taught him about selling to local employers, and why he shut down a bone health program that was clinically sound and financially underwater. He also gets specific about where AI is worth touching right now and where his group has not pulled the lever yet.

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👤 Guest Bio

Thomas Fondren is CEO of Advanced Orthopedics of Oklahoma, the largest independent physician-owned orthopedic and sports medicine group in Northeast Oklahoma. He stepped into the role in 2023 after roughly three decades in Oklahoma healthcare administration, including senior clinic operations and business development roles at Oklahoma City's physician-owned Healthcare Partners Investments. He is a University of Oklahoma graduate.

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📌 What We Cover

• Why the gap between patient expectations and payer reimbursement keeps widening, and how the practice manages it through payer relationships
• Diversification on three angles at once: geographic, service line, and payer, including orthobiologics, eight PT clinics, and an incoming rheumatologist with infusions
• Why cost and ROI get asked at the back end of the strategic plan, not the front
• What the practice learned about its own spend after going self-insured: pharmacy first, orthopedics second, and it owns both
• Building executive forums for local execs and HR benefits leaders, and what happened when Thomas ran this playbook in Oklahoma City
• Why the bone health program got canceled even though the drugs work
• The three or four AI categories worth touching: document management, prior auth, and coding
• Why the exec team's relationship with the board and shareholders decides whether an 18-month project survives month seven

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🔗 Resources Mentioned

• Hatch — episode sponsor
• Advanced Orthopedics of Oklahoma
• Ascension St. John
• Transcarent, Carrum Health, Contigo Health, Ready Rebound

Marketing is working, the phones are ringing, and then a new patient hits a completely different scheduling path than an established one. Joe Zboch talks with Jason Muchow, CEO of Advanced Bone & Joint, about what happens when you map that gap on purpose.

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Jason is five months into the seat at a physician-led orthopedic practice that has been in the St. Louis metro for over 40 years. He walks through his first 90 days, the patient journey mapping exercise his team ran from the point of decision through discharge and billing, and what he learned about where ABJ's patients actually come from now. The primary care base that used to refer consistently is mostly employed by the three health systems headquartered nearby. Word of mouth carries more weight. And employers, squeezed by medical spend running ten percent plus year over year, are becoming a referral channel of their own.

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You'll hear how ABJ separates friction caused by a tool from friction caused by how a tool was implemented, why a new EMR was not the move in month five, and how access gets framed differently depending on whether the patient came from Google, an employer, or a workers' comp adjuster. Hatch powers the 24/7/365 injury chat Jason mentions.

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👤 Guest Bio

Jason Muchow, MHA, ATC, BCS-O, is CEO of Advanced Bone & Joint, a physician-owned orthopedic practice serving the St. Louis metro from St. Peters, O'Fallon, and Wentzville. He spent nearly 17 years at Mercy, most recently leading orthopedics and sports medicine for Mercy Clinic and operations for Mercy St. Louis, where he helped design the Mercy Center for Performance Medicine & Specialty Care. He started his career as a certified athletic trainer and is a founding board member of the Athletic Trainers in the Physician Practice Society.

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📌 What We Cover

• Why the first 90 days went to listening sessions and anonymous surveys instead of a reorg
• The board's day-two charge: execute on growth and sustain the team already in place
• Mapping the patient journey from the point of decision through discharge, billing, and payment
• How to tell whether friction comes from the tool, the implementation, the training, or a bolt-on under the EMR
• Why online scheduling only worked for established patients, and what new patients had to do instead
• What happened to the local primary care referral base over the last ten years
• Word of mouth as a referral source in a market with 40 years of history behind it
• Employers and brokers as a new access conversation, and where orthopedic urgent care fits against the ED

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🔗 Resources Mentioned

• The First 90 Days by Michael D. Watkins
• Hatch, for the 24/7/365 injury chat capability
• Advanced Bone & Joint

Growth in a four-physician orthopedic practice doesn't look anything like growth in a health system, and the decisions that keep an independent group viable rarely show up in a strategy deck. This episode gets into what those decisions actually are: how a high-cost injectable came off the shelf when reimbursement stopped working, how it came back, and how a practice expanded patient access without hiring a physician or adding an office hour.

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Joe Zboch talks with Alissa Ashley-High, practice administrator at Orthopaedic Associates of Marlborough in Massachusetts, about balancing operational excellence against growth goals when there are no unlimited resources to fall back on. Alissa walks through the three questions every investment has to pass, the AAOE member benefit that made a money-losing service viable again, and OAM NOW, the virtual orthopedic urgent care partnership she launched this past year.

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If you're looking to scale referral operations to drive growth and efficiency, visit Hatch.

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👤 Guest Bio

Alissa Ashley-High is the practice administrator at Orthopaedic Associates of Marlborough, an independent orthopedic group that has served the same Massachusetts community for over 50 years. She has led operations there for more than eight years and has been a nurse since 2005, a clinical background that shapes how she runs the practice today. She sits on the board of the American Alliance of Orthopaedic Executives, where she works across its membership, education, and advocacy councils, and she speaks at the AAOE Women in Medical Practice Management Conference.

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📌 What We Cover

• Why growth and operational excellence can't compete in a practice without unlimited resources, and the three questions every investment has to answer first
• How sitting next to the core turns everyday conversation into the practice's operational feedback loop
• What a hyaluronic acid injection actually cost in staff hours before the practice stopped doing it
• How an AAOE peer-reviewed vendor relationship brought that service back without making it a revenue play
• OAM NOW, the virtual orthopedic urgent care partnership that expanded access without adding physicians or office hours
• Competing with Boston when you have no parking fees and no hidden facility fees
• Taking prior authorization and Medicare reimbursement to Capitol Hill with AAOE and AAOS
• Moving from 50 years of word of mouth into reviews, social, and a survey platform feeding Healthgrades, Yelp, WebMD, and Google

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🔗 Resources Mentioned

• Orthopaedic Associates of Marlborough
• AAOE, the American Alliance of Orthopaedic Executives
• AAOS, the American Academy of Orthopaedic Surgeons
• OAM NOW, the practice's virtual orthopedic urgent care partnership
• AAOE Women in Medical Practice Management Conference
• Healthgrades, Yelp, WebMD, Google
• Hatch

Growth inside a private specialty practice usually gets split across departments. Marketing runs demand, operations owns the front desk and the contact center, online scheduling belongs to IT and Epic, and real estate decisions come out of finance. This episode is about what changes when a practice stops splitting it up and builds a growth department instead.

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Joe Zboch talks with Blair Primis, Chief Growth Officer at OrthoCarolina, a physician-owned, physician-led orthopedic practice with over 130 docs and 40 locations across North Carolina. Blair walks through the three lanes his team occupies, the full funnel marketing attribution engine they spent five to seven months building, and what it turned up about their own online scheduling process.

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He also gets into the harder half of the work: standing in front of 80 to 90 shareholders at a physician retreat and asking them to move their slots around. Presented by Hatch.

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👤 Guest Bioㅤ

Blair Primis is Chief Growth Officer at OrthoCarolina, where he leads marketing, patient experience, and growth strategy. A Duke University graduate with more than 25 years in marketing, he worked at McCann-Erickson and McKinney before moving to corporate marketing at McDonald's. He first joined OrthoCarolina in 2009 and rose to Senior Vice President, later serving as Chief Marketing Officer at Flagship Specialty Partners before returning to OrthoCarolina in 2025.

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📌 What We Cover

• Why a growth department is still novel in private practice and mostly lives inside health systems
• The three lanes OrthoCarolina's growth team occupies: demand, supply, and experience, each with its own director
• How hub and spoke works in practice, with growth at the center liaising out to operations, IT, legal, and the ASC team
• The four or five data sources feeding the team, including Epic, Freshpaint, and Placer.ai
• What the full funnel marketing attribution engine uncovered: too many questions for patients to answer before booking online
• Why showing friction publicly invites competitors into your market
• Schedule first, solve later, and why the behavior change was harder than the data work
• The franchise parallel from McDonald's and why it maps onto a physician-owned practice

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🔗 Resources Mentioned

• Epic — electronic health record
• Freshpaint — privacy and compliance platform for marketing
• Placer.ai — third-party location and foot traffic data
• Google Ads and Google Business Profile
• Jerry Seinfeld keynote, on why he ended Seinfeld after nine seasons
• McDonald's corporate marketing and the franchise owner-operator model
• Hatch

Growth in a specialty practice sounds like a good problem to have. Keeping the wheels on while you scale is the hard part. In Episode 15 of Scaling Specialty Growth, Joe Zboch talks with Jessie Brovold, COO of Orthopaedic Associates of Wisconsin, about what it takes to run a competitive orthopedic practice with a growth mindset without burning out the team.

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Jessie walks through how OAW decides where to expand: pulling patient data by zip code and by department, studying the referrals that came in but never became visits, and using physical therapy as the first, lowest-cost way to test demand in a market before committing to a clinic or a surgery center. This one is for operations and access leaders who are building the plane while flying it. Hatch sponsors the show.

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👤 Guest Bio

Jessie Brovold is the COO of Orthopaedic Associates of Wisconsin, an independent, physician-owned orthopedic group serving southeastern Wisconsin. She started her career as an athletic trainer, boots on the ground in clinic, and still holds her license today. Over more than 16 years at OAW, she has led operations through the practice's expansion, from small satellite sites to new therapy locations and surgery center growth, while sitting at the board table every month with the group's physician partners.

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📌 What We Cover

• Why the best operations leaders can still do the frontline job in a pinch, and how that earns buy-in from the team
• Building the plane while flying it: keeping systems running and staff from burning out during a growth phase
• Access is not one thing. A patient will drive an hour for a one-time consult, but wants therapy in their backyard when it's three visits a week
• How to run an access gap analysis: patient data by zip code and department, county-level views, and the competitors already in a market
• The referrals that came in but never hit your books, and why the unclosed ones tell you where your access is too thin
• Why therapy is the wedge OAW opens first to validate demand before committing to a clinic or an ASC
• Four therapy sites in two years: two acquired with the lease and equipment at a discount, two built new, one co-located with the surgery center
• Advice for a first big build: bring the whole operations team in early, make lists so you don't start from zero, and use GPOs and peer forums

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🔗 Resources Mentioned

• Hatch, the show's sponsor, for scaling referral operations
• GPOs (group purchasing organizations) and industry forums, referenced as resources for practices taking on their first major expansion