The approved framework for how SGA’s practices split across four Growth Manager roles — and the wave plan that brings every office into the growth engine.
The Decision — June 9
We did not try to finalize office assignments in one meeting. We agreed on the rules used to make them — the same rules that now govern every rebalance, hire, and acquisition.
Cohort philosophy, the hybrid model, the 12 assignment rules, named owners for data gaps.
Applied the rules to Growth Manager rosters and pulled the missing data fields.
The framework + the proposed 2026 cohort model + risks + the path to operationalize. Approved.
Where We Stand — July 2026
| Category | Count | Assigned To |
|---|---|---|
| Specialty | 56 | Jayme Monroe |
| General Dentistry | 168 | Split: Jenn / Kelly / 3rd Growth Manager |
Cohort Philosophy
Stays with Jayme. The two MODIS mis-routings were corrected.
Split across Jenn / Kelly / 3rd Growth Manager at ~55 each. Optimized for ROD + TZ + complexity.
Stay in their Growth Manager cohort. Amy + Growth Team layer in as added support. Don't carve them out.
The Hybrid Model
Higher layers override lower ones. If Lanthea's Mississippi ROD includes one Utah office, layer 3 (ROD alignment) trumps layer 4 (TZ clustering) — unless the UT office is the only one and not in a shared cohort, in which case it moves.
| Layer | What it locks | Why |
|---|---|---|
| 1 | Category — Specialty→Jayme; General→Jenn / Kelly / 3rd GM | Playbook boundary |
| 2 | Locked cohorts — shared websites + Cohort #s stay together | Brand & ops integrity |
| 3 | ROD alignment — one ROD = one Growth Manager wherever possible | Meeting load (the north star) |
| 4 | Time zone — cluster each Growth Manager within 1–2 TZs | Schedule burden |
| 5 | Count + complexity — target ~55 General per Growth Manager, weighted by tier and production | Workload fairness |
| 6 | Sub-type spread — pediatric, large case, FFS, etc. balanced across Growth Managers | Avoid expertise silos |
The 10 Assignment Rules
| # | Type | Rule |
|---|---|---|
| R1 | Hard | All Specialty (56) stays with Jayme Monroe. |
| R2 | Hard | Shared-website cohorts stay together (Coastal Jaw, Smile Dental Partners, Pony Express, Beaumont, Outshine, Miss Lou, Peak Family, LC Perio + 16 others). |
| R3 | Hard | Cohort #s (C01–C89) stay together. |
| R4 | Soft | One ROD reports to one Growth Manager wherever possible. |
| R5 | Soft | Each Growth Manager clusters within 1–2 time zones. |
| R6 | Soft | Target ~55 General offices per Growth Manager (Jenn / Kelly / 3rd GM). |
| R7 | Soft | Balance by complexity (RED count, production, new acquisitions), not raw count. |
| R8 | Soft | Pediatric / sub-type balanced across Growth Managers unless there's demonstrated expertise. |
| R9 | Red | RED offices stay with their Growth Manager; Amy + Growth Team layer in as added support. |
| R10 | Hire | The 3rd Growth Manager (starts Aug 1) ramps through the wave model — max 10 new offices per month. |
Risk Assessment
| Risk | Severity | Mitigation |
|---|---|---|
| Kelly's multi-TZ book — MI / CA / TX / MN plus the Southeast spans four time zones | Medium | Revisit a dedicated West/Mountain track once the 3rd Growth Manager is fully ramped |
| 3rd Growth Manager ramp — 53 offices for a new hire starting Aug 1 | Medium | Wave model caps onboarding at 10 offices/month; shadow pairing with Jenn or Kelly through the first waves |
| Pending assignments — 2 DHG offices have no Growth Manager until the crosswalk question resolves | Low | Open with Scott; both parked in Wave 3 with a note |
| Bus-factor on Jayme — a single Growth Manager owns 100% of Specialty | Low | Document specialty playbook; cross-train a backup quarterly |
| Pediatric / sub-type concentration unknown — no subtype field in the source data yet | Low | Add subtype tag; re-run the analysis at the next rebalance |
Adopt a hybrid model that uses ROD alignment as the north star, balanced by time zone, category, and workload complexity. Lock the hard rules. Pull the data we were missing — then apply the framework, not relitigate it.
Eight slides that reframe the model from a tactical office split into a scalable operating system + reusable decision framework.
Think in Cohorts, Not Individual Offices
The goal isn't dividing 224 offices evenly. It's designing a scalable operating model where every office is grouped into a logical cohort with a repeatable playbook. Three categories was too coarse.
Periodontics, oral surgery, orthodontics. Dedicated playbook. 56 offices — owned by Jayme.
Recently acquired offices needing higher-touch onboarding. Distinct ramp playbook.
Stage 1 work: website, GBP, NAP, scheduling. The baseline cohort for most General offices.
Practices ready for Stage 4 investments — paid media and larger campaigns.
Underperforming or turnaround offices. Stay with the Growth Manager; Amy + Growth Team layer in as added support.
Think in Growth Stages
SGA's growth model is a progression, not a flat catalog. Practices advance stage-by-stage. Cohorts map to stages. And many practices may never need Stage 4 — don't assume every office should eventually receive paid media.
The Biggest Strategic Question
Does a practice have one long-term owner, or does it transition between specialists as it matures? This is the single biggest organizational decision in the model.
One Growth Manager owns the practice throughout its lifecycle.
Stronger relationships · Better historical context · Easier accountability · Better revenue conversations
Requires broader skill sets · Harder to scale specialization
Practices transition between specialists as they mature.
Greater specialization · Easier process automation · Clearer role definitions
Multiple handoffs · Loss of historical knowledge · Relationship fragmentation
The Growth Manager holds the relationship across the lifecycle. Specialists own Stages 3–4 with the GM as the persistent thread.
Keeps the relationship + historical context with one Growth Manager. Adds specialist depth as practices advance. Avoids the handoff churn of pure Model B and the skill-stretch of pure Model A.
Clearly Define the Scope of the Growth Manager Role
Growth Managers own foundational growth readiness — Stage 1 and early Stage 2. Deeper practice engagement escalates to the Senior Growth Manager tier; specialist functions belong to separate owners.
Balance Complexity, Not Just Office Count
A simple office count is not an accurate representation of workload. Build a weighted workload score per office. And ensure each Growth Manager receives a balanced mix across tiers — never concentrate difficult practices with one person.
Each Growth Manager receives a mix of:
Build a Decision Framework — Not Just an Assignment List
A reusable framework leadership can apply any time — when a new acquisition joins, a practice changes growth stage, a new Growth Manager is hired, or offices need rebalancing.
Should practices be assigned by maturity stage (Model B) or by long-term Growth Manager relationship (Model A)? Our answer: Hybrid. The GM holds the relationship; specialists own Stages 3–4.
These reduce meeting load but cannot outweigh strategic cohorting or workload balance. Our answer: ROD alignment is the north star — but only after category and cohort rules are honored.
Growth Managers own Stage 1 + early Stage 2. Senior Growth Managers own clinical growth, operational consulting, and RCM. Specialists own social, paid media, and patient experience. Our answer: defined on the prior slide.
The operating model should still work at 350+. Our answer: cohort-based playbooks + weighted workload + hybrid ownership scales linearly. Pure relationship ownership doesn't.
2026 Is a Transitional Model
2026 is still a transitional year. The framework held through the July rebalance and should keep holding as the 3rd Growth Manager ramps — and when we're at 350 locations, not 250.
Approve the operating system, not the office list. Five cohort types, four maturity stages, a hybrid ownership model, weighted workload, balanced tier mix, and a defined Growth Manager scope. The office assignments rebalance many times. The framework should not.
What changed between the June 18 approval and today — and the Integration Plan that brings every office into the growth engine, ten per Growth Manager per month.
Decisions Since June 18
The Integration Plan
Every General office is ranked by quick-impact score and scheduled into a numbered wave. Waves are numbered, not hard-dated — a wave can slip without re-planning. Onboarding an office = intro call with the OM/ROD + Growth Readiness Briefing review + score tracker introduction.
| Wave | Target | Offices | Note |
|---|---|---|---|
| 1 | May 2026 | 10 | Launched May 1 |
| 2 | Aug 2026 | 10 | Launches with the 3rd GM's start |
| 3 | Sep 2026 | 32 | First full wave — 10 per GM |
| 4–6 | Oct–Dec 2026 | 30 each | Exactly 10 per GM per month |
| 7 | Jan 2027 | 23 | Ramp-down |
| 8 | Feb 2027 | 3 | Final wave |
The framework is approved, the split is written, and the waves are scheduled. From here, the office list rebalances through the framework — never around it.