Judy Rapoza, a practice administrator in Fall River, Massachusetts, and Jayme Spangler, a biller from Hershey, Pennsylvania, represent staff at independent pediatric practices everywhere who keep their offices up-to-date and compliant with the demands of a fickle health care industry.

Budd Shenkin, a San Francisco Bay Area pediatrician who built his solo practice into what is now the region’s largest primary care independent group, suggests that pediatricians, like gardeners, use the inherent landscape and their creativity to grow their practices in a variety of ways.