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Fractional COO Services Notebook of a COO

Your practice runs on you. Let’s fix that.

Fractional COO and practice operations consulting for medical and dental practices. We install the scheduling, billing follow-up, team accountability, and reporting systems that let providers practice while the business runs itself. Built on 15 years of C-suite operating experience, including medical group clients.

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Who this is for, who it isn't

Built for practice owners, not hospital systems.

Good fit

You own a medical, dental, or allied health practice doing $300k to $5M+ in annual collections. Production is strong, but the operations behind it (scheduling, billing follow-up, hiring, front office) all route through you or one overloaded office manager. You want systems, not another seminar.

Not the right fit yet

You’re pre-launch, or you’re looking for clinical consulting, coding audits, or credentialing services. Our work is the business operating layer of the practice: people, process, cash flow, and reporting.

Not ready for a fractional engagement?

Start with The Small Business MBA.

The same operating playbook we install for clients, taught operator to operator for you to apply yourself. Foundation, market and revenue, operations, and scale. $19.99 a month, cancel anytime.

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A physician walks toward a glowing exam room in a calm, well-run practice, illustrated in the Notebook of a COO editorial style
Engagement options

Four ways to work with us, sequenced by depth.

Most operators start with the 90-Day Operating Audit and move into a fractional engagement after if the fit is right. Some skip the Audit and go straight to embedded. We figure out which on the strategy call.

Front Door

90-Day Operating Audit

$2,500 flat · one-time engagement

A second set of eyes on every function in your business. We tell you exactly where you are, what to install, and in what order.

  • Two strategy calls (kickoff plus delivery)
  • Function-by-function Asset Map placement (your sales, delivery, ops, finance, hiring, etc.)
  • 15 to 20 page written audit document
  • 90-day install plan ranked by leverage
  • Clear answer to "do I run this solo or bring in fractional support"
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Tier 1

Operator Sprint

$5,000/mo · 3 month minimum

Entry-level fractional engagement. We're embedded but lightly. Best for operators who need focused install work on one or two operating-layer functions.

  • 16 hours per month embedded
  • Fractional COO function only
  • Weekly 1:1 plus async Slack and email support
  • One operating system module installed per month (SOPs, KPIs, hiring, finance cadence, customer success, delegation framework)
  • Written documentation of everything installed
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Most Popular
Tier 2

Embedded Operator

$8,500/mo · 6 month minimum

The sweet spot. Twice the embedded time as Tier 1, plus access to one expansion function (CMO or CFO) at no extra cost. Best for operators in active scaling.

  • 32 hours per month embedded
  • Fractional COO primary plus one expansion function (CMO or CFO included)
  • Bi-weekly leadership team participation
  • Weekly 1:1 and async support
  • Two operating system modules installed per month
  • Written documentation of everything installed
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Tier 3

Full Stack Operator

$12,500/mo · 6 month minimum

The complete operating stack. COO plus CMO plus CFO all engaged. We sit inside your leadership rituals as fractional execs. For operators building toward exit or institutional scale.

  • 48 to 60 hours per month embedded
  • COO plus CMO plus CFO functions all included
  • Joins leadership rituals as fractional executive team
  • Complete operating system build over 6 months
  • Premium tier with priority access
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Project add-ons

Targeted work, time-boxed.

For operators who need one specific piece installed without a multi-month retainer commitment. Or for existing fractional clients who want to add a function mid-engagement.

Quarter Launch

$3,500 flat

Strategic planning intensive. We facilitate a focused 90-day plan for the next quarter, with measurable milestones and owner assignments. Done in one structured week.

Exit Prep / Sellability Sprint

$15,000 flat · 12 weeks

For operators looking to sell in the next 6 to 18 months. We close every operating gap that costs you exit multiple. SOPs, financials, transferable contracts, founder-independent operations.

Fractional CMO add-on

$2,500/mo on top of existing tier

Marketing strategy, positioning, channel architecture, sales process. Adds to Operator Sprint or Embedded Operator tiers.

Fractional CFO add-on

$2,500/mo on top of existing tier

Financial cadence, KPI dashboards, capital planning, exit readiness. Adds to Operator Sprint or Embedded Operator tiers.

What a typical engagement looks like

Three phases. Each one with a deliverable.

Most fractional engagements follow this rhythm regardless of tier. The depth of what gets installed in each phase scales with the tier.

01

Discovery and Audit (Month 1)

We get full access to your numbers, team structure, customer mix, sales process, delivery process, and financial cadence. We run the Asset Map across every function. By end of month one, you have a written audit plus a ranked install plan.

02

Install (Months 2 to 5)

We install operating system modules one at a time, in the order the audit prescribed. SOPs documented. Roles defined. Dashboards stood up. Financial reviews scheduled. Each module is handed off to your team with written documentation.

03

Handoff (Month 6)

You run the operating system without us in the room. We're available for monthly check-ins or quarterly reviews if you want continuity. Most clients either renew at a reduced tier or step into self-service mode here.

The honest "no" cases

Some operators reach out and the right answer is "not us, not yet, or not at all." Saying it upfront saves everyone time.

If you're under $300k in revenue: the operating layer isn't your binding constraint yet. Get to product-market fit on one customer first. Use the Foundation Builder Field Guide.

If you want a coach who hands you frameworks: we're builders, not coaches. We install systems. We don't sit in calls and ask Socratic questions. There are good coaches out there. We're not one of them.

If you want a one-month engagement: the operating layer takes 3 to 6 months to install honestly. Less than that is theater. We won't take the money for it.

If you want the install for $1,500/mo: embedded executive support has a real floor. Below the Tier 1 price the work shape changes from "we install this" to "we suggest you install this." That's coaching, not fractional.

Take the assessment

30 minutes. Free. We look at your numbers and figure out whether the right next move is the sprint solo, the 90-Day Audit, or going embedded.

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