When your practice reaches a certain size, the next logical step is adding a manager. The practice has grown, the team is bigger, and you need someone to handle the day-to-day so you can focus on practicing.
Often the person who fills the manager role is your best team member. They know the practice, the patients, and the team inside out. That reasoning makes complete sense. But knowing the practice from the front line and knowing how to manage it are different skills. Without the right structure in place, even the most natural leader on your team will struggle to hold things together.
You’re pleased with who you chose. They’re capable, care about the practice, and genuinely trying. But decisions are still finding their way back to you. The team is still coming to you for answers. You’re still the person everything lands on. And now you’re also managing the manager on top of everything else.
Your manager isn’t the problem.
Why a New Manager Doesn’t Change How the Practice Runs
When a manager steps into the practice, they step into the same structure that already exists. Roles that weren’t clearly defined are still unclear. Processes that weren’t documented are still undocumented. Decisions that defaulted to the owner still find their way to the top — now they just go through the manager first.
Your manager does what any capable person does in that situation. They make reasonable judgment calls, handle what they can, and bring the rest to you. The team, who learned that you are the most reliable way to get anything resolved, now has a new first step — your manager. But when your manager doesn’t have a clear enough picture of how things should work either, the decision lands on your desk anyway.
Now you end up managing your manager instead of managing everything yourself. The workload shifted slightly. The source of the problem didn’t.
Why This Isn’t Your Manager’s Fault — or Yours
Your manager stepped into their role without the proper structure in place to work from. Without a clear picture of how the practice should run, what decisions are theirs to make, and what good looks like in their role, they will produce the same results as anyone else in that position. Capable people working without a clear enough structure to work with will always fill the gaps with their own reasonable interpretation. Because reasonable interpretations vary, inconsistency gets built into a practice without anyone intending it.
Your manager isn’t the reason the practice hasn’t changed. What they were given to work with is.
What Your Manager Actually Needs to Succeed
Your manager can only be as effective as the structure they’re working within. For them to handle the day-to-day without bringing everything back to you, several things need to be in place.
The leadership role has to be clearly yours — the vision for where the practice is going, the direction the team is working toward, and the standard of what good looks like across the practice. Without that picture coming clearly from you, your manager has no foundation to lead from.
From there, roles need to be defined — your manager’s role and every role in the practice. Your manager needs to know what decisions are theirs to make, what belongs to the team, and what needs to come to you. Without that clarity, every ambiguous situation finds its way up the ladder.
Processes need to be documented. Your manager needs to know how things get done in this practice — how situations get handled, what happens when something falls outside the normal, and how decisions get made at every level. Without documented processes, your manager defaults to their own judgment. With them, your manager has a clear picture of how the practice should run.
When leadership, roles, and processes are in place, your manager can do the job they were hired to do. Without them, even the most capable manager is working without enough to go on.
The Hire Was Right. The Foundation Needs to Catch Up.
Hiring a manager was the right decision. The practice needed someone to help carry the day-to-day. The missing piece is the structure that allows your manager to actually do that job.
Building that structure means looking honestly at what’s missing — the clarity about where the practice is going, the defined roles, the documented processes — and putting those pieces in place in the right order. When that foundation exists, your manager stops being a bottleneck and starts being what you hired them to be. The decisions that used to find their way to you stop landing on your desk. And the practice starts moving toward being genuinely owner-led — running the way you always intended, with a manager who can actually lead rather than just manage the chaos.
If you hired a manager and are still doing everything yourself, a 30-minute discovery conversation is a good place to start. No preparation required. Just an honest conversation about where your practice is and where you want it to be.
