Expansion or Distraction? The Hard Truth About Adding Associates or Opening a Second Location

For as long as I’ve been coaching practices—25 years and counting—one of the most common questions I get sounds like this:

“Kevin, should I bring on an associate or open another location?”

It’s not a new idea, but lately, it’s become the shiny object everyone’s chasing. Expansion has become synonymous with progress. It’s fueled by the desire to capture more market share, vertically integrate, or diversify income streams. I rarely tell anyone not to do it—but I’ve seen far too many leaders pursue growth in the wrong direction, only to create more stress and less profit than they had before.

Sometimes, expansion works brilliantly. But most of the time, the problem isn’t that you can’t grow—it’s that you’re expanding before you’ve truly optimized what you already have.

Here are five questions every business owner should answer before they decide to grow bigger.

1. Have You Truly Maxed Out Your Existing Facility?

I’ve walked into hundreds of practices that swear they’ve “outgrown” their space—only to find rooms collecting dust or equipment sitting idle. Often, with a few thousand dollars in upgrades or layout adjustments, they could boost production and profitability by 20–30%. That’s a far better return than spending hundreds of thousands on new real estate.
 

Before you expand your footprint, make sure you’ve extracted every ounce of efficiency from what you already own.

2. Have You Fully Leveraged Your Team?

Most practices I encounter haven’t. The owner or lead practitioner often carries too much weight because systems and delegation haven’t caught up with growth. The truth is, it’s almost never a space problem—it’s a leverage problem.

When your team is performing at 80%, it’s easy to convince yourself that more people or more space will solve the issue. But if the foundation isn’t strong, expansion only multiplies inefficiency.

3. Are You Ready for the Real Cost of an Associate?

Hiring an associate is an investment—and like any investment, it requires cash up front and patience before the ROI materializes. In most cases, their compensation will exceed their production early on. Unless you already have a steady flow of patients ready to fill their schedule, you’re financing someone’s ramp-up period out of your own pocket.

4. Do You Have the Cash Flow to Withstand the Dip?

Expansion will always have a cash gap. Rent, build-out, staffing, equipment, and marketing all hit long before new revenue does. You’re betting on future growth. If your current business isn’t throwing off significant excess cash every month, it’s not time to expand—it’s time to strengthen.

5. Do You Have the Time—or the Team—to Execute?

Every new venture requires time, leadership, and focus. If you don’t have an exceptional CEO-like manager to drive the rollout, it will fall on you. That means less time for your current patients, your existing team, and your personal life. Expansion isn’t just financial—it’s personal.

Growth can be exciting, but it should never be reactive. Bigger isn’t always better. Sometimes, the smartest move isn’t scaling out—it’s scaling up by refining what you already have.

If you’re wrestling with this decision and want an experienced perspective on your next step—whether to expand, hire, or optimize—let’s have that conversation. Schedule a Practice Strategy Call with me at Leverage Consulting.

Your next level of success might not require a new location—just a better strategy.