Key Elements of a Successful Medical Practice

by Ray Waldrup, CEO

Medical practices from all over the country visit Articularis Healthcare Group’s (AHG) Charleston, South Carolina locations and are taken back by the efficiency and caliber of AHG employees. Many are also puzzled by the lack of managers and supervisors we employ. Inevitably, someone always asks, “How do you develop and recruit employees?”

The cornerstones of a successful business are its People, Processes, and Culture (PPC).  Take Chik-fil-A, for example; it’s a fast-food restaurant chain specializing in chicken sandwiches, and it’s wildly successful. It’s rare to pull into a Chik-fil-A lot without a line of cars wrapped around the building and even more customers filing through the doorway. On these busy days you can still expect to receive your order in a timely manner, without error.  If you’ve been to Chik-fil-A, you know this is true. So, how is it that Chik-fil-A can consistently perform, but another fast-food restaurant falters under the same circumstances?

It’s simple: PPC. Chik-fil-A hires intelligent employees, implements efficient processes, and fosters a culture that appeals to its employees. It seems like a straightforward concept, and it’s certainly not original, yet many tend to over-think and over-complicate it.


I can walk into an office and tell you within 30 seconds the competency level of the staff. From how patients are being greeted to the staff’s personal appearance, the culture of the office can be identified quickly.

Early on in my career my mentors instilled in me a sense of personal responsibility and talent philosophy regarding the hiring process. Rather than let personal ego get in the way, I was taught to hire people that are smarter than me. Smarter employees bring innovative ideas and fresh perspectives to the table, and they’re a direct reflection of their supervisor’s leadership.

My recruitment perspective truly differs from others in that I not only seek intelligent candidates, I frequently seek recent college graduates. The market is full of recent graduates uncertain of their career paths and in need of a place to land while they figure it out. These individuals are often smart, teachable, and motivated. I’ve found individuals with experience lack initiative or intelligence needed to take the next step in their career, and I’d rather invest my time as a mentor to individuals that seek growth and success.

A colleague once questioned how AHG could afford to hire college graduates, “Don’t they all expect $50,000+ upon graduating?” The reality for many college graduates is that degrees do not frequently translate to instant jobs, and the type of degree they have may not align with their definition of success. Young adults are often told to follow their passions and pursue degrees that make them “happy.” However, jobs in many of these fields tend to be low-paying and hold them back from the life they imagine. All too soon these young adults, now young professionals, realize a financially supportive job may be a better option than following their passion. These are the individuals I’m seeking to recruit.

Although recent graduates are motivated and ready to learn, they’re all missing one thing: experience.  Most, however, realize the value of experience working with a reputable organization and are willing to put in the time to acquire and apply new skills. These employees require little supervision, and flourish when given some autonomy.

In contrast, employees that don’t understand the value of experience tend to move to the next job that will pay fifty cents more per hour. These employees frequently end up with many years of experience in a specific role without advancing their skills. They reach their peak in career growth early-on and plateau financially.

Over the years, we’ve had many employees leave to return to school in pursuit of nursing and professional degrees, often in healthcare, and many that have developed their careers through internal promotions.  We may serve as a launch-pad for some, but we’ll always be known as the place that gave them a foot in the door, so to speak.


People are an important aspect of a business, however, without a balanced approach to PPC the business will never reach its full potential. Processes are integral to every business. They are most effective when everyone knows about them and when they increase efficiency and reduce the workload.

The primary method of communicating processes should be through a policy and procedure manual. Each department should have a manual that is accessible by all employees, both new and veteran, for training purposes and as a reference. Additionally, all manuals should be updated to reflect any changes made to existing processes.

At AHG, issues with current policy and procedure are discussed at bi-weekly executive committee meetings for which all department managers are present. During this time, we address any issues and devise a solution that works across departments. I’ve been a witness to many practice managers, and even physicians, resolving process issues without consulting department managers first.  The fix may seem quick and uncomplicated, although often results in other unexpected issues that could have been avoided. Take advantage of the intelligent employees that you’ve hired, you might find yourself surprised by their creative ideas.


A medical practice’s culture extends beyond its staff; it’s conveyed to a patient from the moment they walk in until the moment they walk out. Workplace culture dipped for AHG and many other medical offices across the nation shortly after implementation of the electronic medical record (EMR).  Employee and physician burnout became a top concern for our organization. Doctors extended their hours in an attempt to maintain pre-EMR schedules, and many were taking work home to complete after a 12-hour day. Employees’ schedules reflected physicians’ schedules, resulting in overtime for many employees. Morale and quality of life plummeted and it was clear this was not a sustainable schedule. So, we developed one that is.

About five years ago we shifted to a four-day work week. With that change came other significant changes: physicians reduced the number of patient appointments on their daily schedules, patients no longer wait in the lobby past their scheduled appointment times, utilization of ancillary services increased, patient satisfaction increased, and physician and employee morale increased. We reviewed the impact of the four-day work week and upon doing so realized that we had effectively debunked the myth that a physician must see a greater number of patients per day to increase practice revenue.

At AHG we offer employees top-notch benefits, the ability to grow as professionals, and above all a team-oriented atmosphere. Our staff thrives in the culture we’ve developed and the efficiency in which they operate is a testimony. Over the years, employee tenure and development has increased, and recruitment has become easier.

AHG owes its success to its people, processes, and culture. Intelligent employees, efficient processes and a positive culture create a work environment that high-functioning employees gravitate to. If your practice is struggling, these are key elements to consider. I firmly believe community-based rheumatology practices need to stick together and welcome you to reach out to me with any thoughts or questions.

About Articularis Healthcare Group
Articularis Healthcare Group (AHG) is the nation’s largest rheumatology specialty group with 27 board certified rheumatologists, in 12 locations, spanning 11 counties.  For more information, visit, or call 843-793-6980.

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