Regional manager

A regional manager oversees the day-to-day administrative operations across several practice locations, freeing the owner from personally handling the staffing, vendor and logistical fires that multiply once a group grows past a handful of offices. In Ryan's own framework for building a multi-practice group, hiring a strong regional manager is the hard checkpoint at three practices. He does not recommend buying a fourth location until that role is filled and genuinely taking the load off the owner.

The role only works well within a limited span: Ryan caps a single regional manager at five practices, wanting them physically present in every location at least one full day a week, because past that number they lose real touch with the culture and specifics of each office, and the quality of oversight quietly degrades even if the org chart still looks fine on paper.

Growing beyond five practices generally means adding a second regional manager, or specializing further (one leader dedicated to HR and recruiting, another to operations and metrics) rather than simply asking one person to stretch across more locations than the role can genuinely support.