Hiring The Right Operations Leader (with Greg Spruce)

We talk with ophthalmology executive recruiter Greg Spruce about why senior hires go sideways in ophthalmology and what to do differently before you make a costly leadership mistake. We break down how to match operators to your business stage, validate emotional intelligence with better references, and set compensation with real market data. 

• why leadership hires fail when the operating model does not match the candidate’s background 
• why ophthalmology experience can matter more than general healthcare experience for operations roles 
• how private equity life cycle and exit timelines change what “the right leader” means 
• what to screen for beyond a resume, including culture fit and physician relationship skills 
• how to spot emotional intelligence through the questions a candidate asks 
• why references from direct reports often reveal more than references from bosses 
• how to know when your org needs a new executive layer instead of stretching the team thinner 
• how to think about compensation using current market benchmarks across job titles 

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Transcript

Welcome And Guest Setup

SPEAKER_01 0:01

Greetings and welcome to iCare Leadership Live. This is the podcast for iCare leaders who want to level up their leadership, create better cultures, and improve the financial results of their clinics. Now, let's join the show. Okay, so my guest today is Greg Spruce. Greg is the founder of GRS Talent, which is a boutique executive recruitment firm. And you know, Greg has been someone that I've been connecting with for a while. We finally got to meet in person in Washington, D.C. Love chatting with you, and I'm really excited to have you on iCare Leadership Live, Greg.

SPEAKER_00 0:46

No, it's great to be here. Thanks so much, Mike. Thanks for inviting me on.

SPEAKER_01 0:49

Yeah, and you're coming to us from Lisbon, Portugal today.

SPEAKER_00 0:53

Yes, I am, as you know. Well, the first time we ever talked, I was somewhere different. I do a little bit of traveling around, mostly in the UK, but I'm in Lisbon right now for a month, kind of checking it out. So yeah, nice and sunny here. Can't complain.

SPEAKER_01 1:03

Okay, amazing. Well, everyone over here is probably jealous as it's heating up across the US. I suppose it's probably heating up in Portugal as well. But yeah, I saw that. Yeah, do you want to just talk about what you do and maybe your background a little bit and how you've come to this topic of leadership, recruitment, and and hiring effectively?

SPEAKER_00 1:25

Yeah,

Greg’s Path Into Ophthalmology Recruiting

SPEAKER_00 1:26

so obviously I am from the UK, so it's kind of strange that my entire niche is specifically the ophthalmology space, specifically in the US. But yeah, I obviously I worked in the recruitment agency for the first five years of me doing this. We had quite a big healthcare team in that that did different specialties and things, and then we found the niche of ophthalmology specifically. Um, we dove into that quite a lot. I was the one who kind of spearheaded that, and then we dove into that, and that's how I kind of fell into the niche of ophthalmology. I quite instantly fell in love with it because it's so relationship-driven, it's so, so small that everyone kind of knows each other. I'm a very personal person, so that worked really well for me, and it just seemed to work really well, and that's how I kind of fell in love with the industry and things. So that's how I got into the niche of ophthalmology to start off with. So I did that for five years for two different companies, did really, really well, and then back in September I decided to start GRS Talent. That's where I launched my own business, various reasons for that, but it's been an amazing move. So here I am now running GRS Talent and still in the ophthalmology space six years later.

SPEAKER_01 2:19

Amazing. Yeah, so that's you know, did you kind of just fall into the recruiting thing or did you intentionally kind of pursue that as a path?

SPEAKER_00 2:28

Yeah, I kind of fell into it. I knew I wanted a sales role. I'm a very personal person, like I mentioned, very relationship-driven, all of that kind of thing. I can talk forever, and that's what I wanted to do. I wanted to kind of thrive on relationships and people and stuff like that. And obviously, sales is a big one for that, and then recruitment specifically is even more so. So that's kind of how I went down that path. And obviously, like I did really well, enjoyed it and everything. So yeah. Okay, awesome. Well, yeah, makes total sense.

SPEAKER_01 2:50

Well, you know, as an HR professional, you know, I can completely understand the importance of good hiring, and it's not always done. It's just not always done well, and it's especially hard when hiring leaders, when hiring senior managers, or even middle managers, or even frontline managers. And so, gosh, I just really want to tap into your knowledge and your experience in that area because I don't know, is it fair to say that you've you've seen some people brought on and then you've seen who's worked and maybe who hasn't, and you've heard kind of some stories, and maybe I don't know, have you kind of pieced together the things that maybe help make a good match and what makes not such a good match?

SPEAKER_00 3:35

Yeah, of course. I didn't really touch on it at first, but I specifically hire within leadership, so executive leadership, regional directors, and hire mostly for the private equity, the bigger groups and some of the big privately owned groups as well, just to kind of clarify a little bit more information on what I do and things. But yeah, back to your question, of course. A lot of the time, because of kind of the nature of the work that I do, a lot of retained searches and high-profile searches and things for a lot of leadership candidates. I've definitely seen it go wrong. Sometimes from their side, they've got it completely wrong, and that's why they come to me to fix it. From my side, to be perfectly honest, and this is not trying to blow my own trumpet. When I've done the hire myself, I've never really seen it go horribly wrong. I think there's a lot of value you can get from using a recruiter, especially who's been in the space for a long time, because not only does the company do their own vetting process, I also kind of vet that person as well, and I probably know them on a fairly personal basis and things. So it's yeah, but in terms of from the company's perspective, they've definitely come to me with some crazy stories of when it's really gone terribly wrong. But then on the flip side of that as well, I've heard it go really right and they've picked the right person. It might not have been my candidate, but if they've gone forward with the right person, then obviously you can go extremely well and really turn a company around. So yeah, both sides.

SPEAKER_01 4:38

Okay, so yeah, I've got to ask. Now you've kind of you've made me salivate here on this thought. This question is what do you think when they've come to you and they've made mistakes? Maybe they've made multiple mistakes. Why do you think they made those mistakes?

SPEAKER_00 4:56

I think

Why Executive Hires Fail In PE

SPEAKER_00 4:57

it comes to a lot of reasons. A lot of what I'm going to talk about is specifically with private equity and private equity companies, because that's how I mostly deal with. But I think one big shift we've over the last few years is that private equity involvement has obviously risen up until the last couple of years. And I think what's happened is groups have hired really, really good leaders, specifically healthcare leaders, but not so much who fit the model of an ophthalmology MSO. And you can pull people from dermatology and dental and wherever else you want to try and pull them from. A lot if you do it right, it can be right. If not, it can cause problems because the operating model just isn't quite the same. And I think there's a shift now to that's happened, and now we really kind of streamline the operations because of wider market circumstances. We're realizing as a market collectively, when I say we, that we need people specifically from ophthalmology because they, yeah, they can lead people and yeah, they can kind of streamline operations from a broader perspective. But when it comes down to the actual ins and outs of ophthalmology and how it runs, now companies are coming to me and groups are coming to me and saying we need hands-on executioner leaders, we need people who not only can lead but can do the work as well. And I think that's a little bit of a don't know if this is the right wording, but a trap we found ourselves in. So I think that's a really example of of when you can get it wrong, is if you hire someone because of their leadership qualities, can definitely can go right. I'm not saying that it can't, but a lot of the time there's a lot finer details and things which need to be right for what needs to be done, and just off the back of that as well, from a private equity perspective, is you need to they need to understand where they're at as a company in terms of life cycle and stage. If you're a company that's going to exit in one year and then you want somebody to stay, and then this leaders the best at and wants to just stabilize things, it's probably not quite the right fit. So that's a massively important thing as well. Hiring the right person, but at the wrong stage of the life cycle of the company can also go terribly wrong as well.

SPEAKER_01 6:44

Interesting. Yeah, you know, you hit on something that I wanted to get into, which was you know, industry knowledge. And you know, my question was going to be you know, at a senior level, is healthcare experience critical? But you're you're saying not only is healthcare critical, but ophthalmology or eye care experience is often like a key element.

SPEAKER_00 7:11

Yeah, of course. I think it comes down to the role itself, uh, of course, but right now operations specifically, the practice of physician operations and things like that, groups are specifically looking for ophthalmology. It's even more important right now. You can go wider and like ASC oversight and things like that, then yeah, you can sort of branch out into some of the specialties. There's obviously other kind of transferable functions as well, but primarily within ophthalmology and operations specifically. Yeah, right now people are needing the the actual experience directly from the industry and things, so yeah.

Matching Leaders To Culture And Stage

SPEAKER_01 7:40

Okay, good to know. You know, so if I'm a clinic owner out there, and maybe I'm hiring for my good-sized clinic, maybe I've got a few locations, maybe I'm from a PE group, maybe I'm independent, and I'm wanting to hire a senior person, you know, maybe to run the whole operation. I don't know, what are the first couple things, you know, other than maybe do they have ophthalmology experience? What are the first couple things that they should be thinking about to know is this person like a good fit for this role or not?

SPEAKER_00 8:15

Yeah, I think I just touched on one in if it is from a PE group is the life cycle of the company. That is in the PE group specifically, that is vital for a high-level senior executive to know what they're stepping into, what stage they're stepping into, all of that kind of thing. Um trying to move away from the PE private equity specifically. But if you're a clinic owner and you need to understand who's right and things like that, it's very much have they got the scope and scale of a cut of a business of this size? Have they done it before? And depending on how I think when the physician relationships specifically and how the culture of the organization works, I mean you're a HI guy, HR guy, culture's probably a big buzzword for you, but I think culture is so so important when it comes to these the running of the practices and things, and having the people who can do the operations on the corporate side of things, but also liais with the docs and everything the way that it needs to be, and having that experience specifically as well, and kind of really nailing down exactly what the culture of the organization looks like, what the growth and the goals and the mission of the company looks like, if they'll get on with the physician with the practice owner or whoever's kind of running the show, those things are probably as crucial as the ophthalmology experience and things that they're probably first. First and foremost, is this person right for us and is it right for them as well? It goes two ways, and then their experience kind of speaks for itself as well. Okay.

SPEAKER_01 9:31

Yeah, you know, you talked about the the private equity life cycle, and I I think I think that's true, you know, in a any clinic, right? Because some clinics are trying to grow fast, and that might demand a different type of a personality. Some clinics are in a big change, they want to implement some changes and do some culture change, some mindset change. And that's a different kind of uh, you know, that's a different and that that that's can be demanding, right? Because when you're trying to make changes, if that uh person is not connecting with the staff and the leadership, it's not gonna go well, right?

SPEAKER_00 10:09

Yeah, no, of course. Yeah.

SPEAKER_01 10:15

This show is sponsored by Seasoned Advice HR Services, where I help eye care businesses to make more money and save more money by hiring better, retaining better, and reducing your HR risk. If you would like an HR assessment or ongoing HR support, please reach out to me at seasoned-advice.com. You know,

Emotional Intelligence And Reference Checks

SPEAKER_01 10:42

I try to impress upon the folks that I work with the importance of emotional intelligence and leadership. Is that something that's important in your estimation? And how do you determine that someone has the you know, the the leadership and the emotional intelligence to translate their vision to actually get people to buy into it?

SPEAKER_00 11:06

Yeah, I think from the leadership perspective specifically, is when you're doing the interviews, when you're speaking with these people, I think it comes from the questions they ask you, very much so like if they want to know the things like what the stage is, what the mission of the company, what's the team actually like right now, and when they dig into what's actually going on right now, more than like the kind of generic things of the job, I think, and then they come up with a solution straight away based on your answer. I think that's showing the way that they can come in with the the like the leadership qualities to do what needs to be done. The emotional intelligence side of things is obviously harder to grasp, that's a very hard thing to grasp from some interviews and um stuff like that. But I think a lot of it based on their experience, what they've done before, the type of people they've overseen. And a big, big one for me that I do most times I'm hiring especially leaders, specifically in operations, is comes from references, and that's not only from their bosses, but from the people who reported in who reported into them. I think you get so so much value from the person who reported into them, specifically more than their boss themselves. Obviously, that's important too. But when it comes to referencing and then the emotional intelligence, obviously, someone who reported into them has a really good idea of how they manage a team, how they do deal with things emotionally, and how that kind of thing works. So, yeah, that's that's one definitely a good way of kind of uh ironing that out and and finding out.

SPEAKER_01 12:24

I love that idea because yeah, if you can't find one person that you've managed that is willing to say, hey, this person is really adaptable and empathetic, then that says something, right?

SPEAKER_00 12:37

Yeah, of course. And that's what's usually easier to get a reference off them as well than their bosses specifically. So yeah.

SPEAKER_01 12:44

Yeah, they'll give you the real honest truth there. You know, that's funny because a lot of businesses out there they kind of downplay references and they say, you know, they're just gonna give me references who are gonna say nice things about them and stuff like that. Do you have any tricks for getting, I don't know, more honest references?

SPEAKER_00 13:05

Yeah, I mean, when we do them as a recruiter, I think it takes that kind of I don't really know how to say this, but it kind of takes something away, as in the person who's doing the references speaking to a recruiter, not directly to the employer that is gonna be employing this person. So where they if they were doing that, they might be like, oh, it's nice, like it helps that guy get a that person get a job, essentially, but if they're talking to a recruiter, it's more of a takes that out. Not really sure how I word that, but I think it is easier for us to extract more information as external recruiters from the references than it is from the company directly.

SPEAKER_01 13:37

That's interesting, yeah. So having a third party, and I've seen that with HR2, right? Having a third party, you feel like you can trust them. You feel like you can be more honest because hey, Greg, it's just this guy, Greg, he doesn't, you know, he doesn't have skin in the game, he just wants to find out what the truth is. So I'm gonna tell Greg, but I might not tell the company that's calling me, you know.

SPEAKER_00 14:00

Yeah, and sometimes as well, using a ex like an external third party like myself who's very relationship driven and things like that. If the reference of a senior executive comes from that person's boss, the likelihood is I've probably connected with them before. I probably know them on a fairly personal basis, and I probably might know them quite well.

SPEAKER_01 14:16

Yeah.

SPEAKER_00 14:16

So that can obviously benefit in them giving a very truthful reference as well. So dwelling on those relationships and things can definitely extract more information in the right way.

SPEAKER_01 14:24

I I've had that same phenomenon where I knew about a client, I knew about a potential hire, and I s and I was able to tell a client, hey, I actually know that person, and I can tell you a few things, or I can I can get a reference, a very honest reference on that person, even though I may not know them. And I'm sure you know who to avoid and who you can go to and all that stuff.

SPEAKER_00 14:46

Yeah, there's actually a few people in the industry that just come to me for a reference specifically, like even if the hire's not mine and it's not my process, there's a few chief HR, chief paper officer, and things that I get emails fairly frequently that it's just like Greg, we're thinking about hiring this person, they're in the final stages. Do you have any information? Do you know anything about them or anyone who's reported in or they've reported to? And they just come to me directly just for a bit of a bit of market insight on the person and a bit of intel.

SPEAKER_01 15:10

Wow, okay. That then everyone, everybody listening, reach out to Greg, become his friend, send him, you know, some nice stuff, you know, that because he's just got the scoop and people are trying to find out. You know, one thing I also think about is when it comes to hiring leaders, you know, clinics and PE groups, they've got to decide like what is the moment that we need to hire a chief HR officer, or what is the moment when maybe I've got three physicians, I'm not a big operation, but what is the moment I need to hire the next level of executive? You know, the next, you know, the person that's that's doing it right now, they're kind of okay. I could I could stick with them, or maybe I could go to a higher level. Do you know, have there been any learn any things that you've learned over the years about timing when it comes to when to fill like create a new position at a new level or add a new key role?

SPEAKER_00 16:09

I think it's

When To Add Leadership Layers

SPEAKER_00 16:10

a hard one to grasp because you don't exactly know how the future's gonna play out and things. But when it comes to adding a new role, I think it's just becomes when your team's stretch too thin. If you've got, I don't know, multiple directors all kind of chipping in on a VP role and none of them are quite ready for that. Maybe it's time you add that layer in and take some stress off those guys because what's gonna happen then is they're gonna be stretched too thin and they're probably gonna start thinking about something else. So I think it's but it's noticing those signs early is very difficult. It's quite easy to just kind of give people more responsibilities without adding that extra layer in. Yeah, I think comes to that, and then obviously analysing, making sure you keep on keeping eye on the data of the growth and all of that kind of thing to ensure that you're not growing too fast without realizing that maybe you need some more people to to do that. Um and this goes the other way as well. If you've got maybe a VP doing too much or an SVP doing too much of too many different things, and their role is so wide up across everything, it's analyzing that, maybe speaking to that person directly and finding out what their kind of problems are, what the issues are, and really going into that. And if they are doing too much and they feel like they're doing five different roles, then maybe it's time to hire someone to take one or two off them or hire a team underneath them that way. Yeah, I think it's a lot of just kind of figuring out the company structure, how it's working, and then looking into people's roles specifically, how they're doing, and then it comes off the back of that, I think.

SPEAKER_01 17:27

Okay, awesome.

Compensation Benchmarks And Market Data

SPEAKER_01 17:29

I'm guessing that a lot of your clients come to you for advice on compensation too. Like, hey, what is the going rate for this? Is that something that you get that question a lot? And and how do you help how do you help people think through that?

SPEAKER_00 17:43

Yeah, of course, I get it a lot. Obviously, I know you did your survey on that not too long ago as well, didn't you? But yeah, it's obviously a key thing for anyone, for the candidates themselves, the clients as well, of course. Quite open and honest with it about what the market pays. I think that works out the best for everyone. Um, the good the kind of good thing that I think people undervalue in what I do is I speak to people who are on the same job titles across every every big group across the across the nation. All the big ones, I kind of know them. So in terms of the intel and kind of market data I do have on those specific salaries and things like that, like I do have a lot of the information, so it's very valuable to do that. But I'm very open and honest with it. I think that's more fair for everyone, it makes the market more fair and things. Other than that, I yeah, okay.

SPEAKER_01 18:26

Yeah, so you just you you've got a lot of knowledge than there, then that brain that people can tap into. Absolutely. Yeah, we

The Most Undervalued Hiring Signal

SPEAKER_01 18:35

talked about industry, definitely wanted to talk about that optimology thing. I guess my last question I wanted to get into, at least for now, because I'm always thinking of new things, is there something that you see, like let's say a CEO or a senior executive comes to you and they want to hire a position? Is there something that you feel like they often tend to overvalue? Or is there something they tend to undervalue and then they later find out, oh man, I should have put more emphasis on you know this thing generally? Like, do you see trends in that area that if you could give one piece of advice, like, hey, you need to really put more emphasis on this trait or this skill set? Does that make sense?

SPEAKER_00 19:20

Yeah, I would say undervaluing sometimes is the specific ophthalmology experience and how important that can be, whether it comes to the title. I think sometimes it's looking at whether the put the ophthalmology industry experience of how it works, and that goes up for anywhere from RCM to operations specifically in a few of the different functions that can go a long way, like knowing exactly how it works to step in and kind of hit the ground running right away. If you look outside of that and someone might be good at what they do, but in a different specialty or in a different area, or especially one big one is from a hospital system. That's one thing we're kind of dealing with at the moment. There's someone from a hospital system who's come in and they just they make this like their decisions are kind of slow, everything's more bureaucratic. That's just how it is in a hospital system, which is completely fair enough. But it the PE world's a different world. So I think the ophthalmology, private equity world and things like that for the companies that I work for specifically, that is a is an undervalued thing in a lot of processes. Tough one. I'm not too sure. I'm gonna stick with that one, yeah.

SPEAKER_01 20:19

Okay, no worries. You know, sometimes, at least you know, at the staff level, you see technical skill maybe being overvalued and and and character being undervalued. Sometimes I see that. But I feel like at the higher up, the higher echelon a position is like you've got to check more boxes. You've got to have industry, you've got to have technical skill, you've got to have people skill, and you you you have to check them all. You know, you can't have one major box that's not checked, in my opinion.

SPEAKER_00 20:51

Yeah, no, no, I completely agree. And then there's a whole world of different if you've gone through company transactions, sales, the life cycles of different companies and things like that as well. So money's been in a very similar life cycle and company life cycle and with the same goals as what you're trying to do at the right time. Um, having that is something which is very, very valuable as well.

SPEAKER_01 21:09

Yeah, I think you're so right. Look at what what is it you're trying to do right now? Are you trying to do a bunch of acquisitions? Uh, have you done the acquisitions and now you're trying to, you know, market your your business to be sold? Are you trying to operationally improve? You know, like those are all different things. And so bringing on a person who has done that and has done it well, I think you're exactly right. You kind of started with that as finding that person.

SPEAKER_00 21:36

And even the the integration thing you just touched on as well, once you've done the acquisitions, there's some operators that are just so good at integrations and that's what they thrive on. They love that kind of messy environment, consolidating everything and really bringing in those big acquisitions and integrating them properly and doing it fast and doing it right. So if that's what you're going through, then an integration style operator is probably the best option. If it's more of a stable thing and you're not looking to grow, you're in a bit of a the organization's looking to kind of stabilize things and just cut costs and operate and kind of operate efficiently. There's definitely leaders out there who are excellent at that and aren't too and aren't like better at the integration side, they're better at the stability stabilization side. And I think that is crucial to understand exactly what the kind of main goals of what you're trying to do at that time is. And even in operations, there's operators who do this better than that one, and people who do this one better than this one, and it's analyzing the person and their experience. Have they done those specific things before? I think is really important too.

SPEAKER_01 22:28

Awesome,

How To Reach Greg And Final Takeaways

SPEAKER_01 22:29

man. Well, Greg, this this has been super awesome. I love chatting with you. Thanks for making time, even though you're on a completely different time zone here.

SPEAKER_00 22:38

How can people get in touch with I'm used to working these hours?

SPEAKER_01 22:41

How can people get in touch with you if they want to learn more about what you do?

SPEAKER_00 22:46

LinkedIn is probably the best thing. I post in there all the time. I'm pretty active on LinkedIn. I'll reply to all messages and things. So LinkedIn's the best. Yeah, just reach out to me on LinkedIn and I can give you all my contact information from there. I love to chat with anyone in the space, whether it's a quick chat about market insights, a quick chat about pretty much nothing, or if you're directly hiring than anything, I love to chat with anyone in the ophthalmology space.

SPEAKER_01 23:05

Awesome. Well, Greg, I'll put your LinkedIn link into the show notes. And thanks so much for joining me.

SPEAKER_00 23:13

Thanks so much for having me. It's been great to connect again. And hopefully I'll see you at the next conference.

SPEAKER_01 23:19

Well, that brings this episode of iCare Leadership Live to a conclusion. If you enjoyed this episode, please subscribe to the show on your podcast app and share it with someone who would value the content. I promise to bring you more guests and content to help make you a better iCare clinical leader. I also invite you to subscribe to my HR newsletter for iCare leaders. You can find information about that at seasoned advice.com. Now go out there and lead with confidence.