Adjusting To Growth: How My Friend Builds Jobs in San Francisco’s High-Cost Market

By Rich DeGuzman, Senior Vice President of Sales, Vensure Employer Solutions

(small.news) — In my day job, I get a front-row seat to small businesses and enterprise organizations across North America and beyond. I see the data, the hiring trends, and the operational headaches owners face every day.

But this story hits close to home because the small business I’m writing about belongs to one of my best friends, Dr. G, a chiropractor who owns several clinics across the San Francisco Bay area.

Our families brunch together after church almost every Sunday. While the kids debate pancakes vs. waffles, we talk shop: How his practices are growing, what challenges his team faces, and how he can keep creating great jobs for the community.

Those conversations have given me a personal view into what the numbers really mean.

Small Businesses Are The Job Engine

Small businesses are the job engine behind America’s economic resilience. The U.S. Small Business Administration’s latest profile shows there are around 36.2 million small businesses, employing about 46% of the private workforce and creating nearly nine out of ten new jobs between March 2023 and March 2024.

That kind of impact doesn’t happen by magic. It comes from owners like Dr. G who decide, one position at a time, to take a financial risk so someone else can earn a living.

Two Sides of a Growing Practice

Dr. G operates within a national chiropractic franchise network. He serves hundreds of patients every month, balancing the built-in brand recognition of a franchise with a local, community-driven approach.

To make it work, he needs two very different teams:

– Front-of-house (FOH) staff handle patient intakes, scheduling, and paperwork—the first smile a client sees.
– Back-of-house (BOH) professionals deliver care: Chiropractors whose licensing and continuing education requirements add another layer of compliance.

Recruiting and retaining these groups require different playbooks. FOH roles emphasize customer service and cross-training so the front desk never misses a beat. BOH hires need specialized credentials, competitive pay, and flexible scheduled to attract top clinical talent.

The Employer Burden

San Francisco magnifies every challenge. Wages are among the highest in the country, commercial rents rise annually, and payroll compliance means juggling city ordinances, California labor laws, and federal rules. Multiple pay scales and benefit requirements for FOH and BOH staff adds hours of administrative work each week.

National surveys show small business owners spend five to 10 hours every week on payroll and HR tasks. For a multi-location clinic like Dr. G’s, that number is higher.

“I want to grow and bring more people into great careers, but every new role has to be justified twice—first on patient demand, then on the payroll spreadsheet,” Dr. G explained.

Tools That Make Hiring Possible

To keep hiring, Dr. G invested in a cloud-based HR and payroll platform that integrates scheduling with time tracking and automates tax filings. That move cut his weekly admin time nearly in half and gave him the confidence to keep adding staff.

He also built a structured 30-60-90 day onboarding plan tailored separately for FOH and BOH employees. “Technology keeps us compliant,” he said, “but it’s the personal touch in onboarding that keeps people here.”

Why This Matters Everywhere

San Francisco might be an extreme case of cost and complexity, but the pattern is global. From Toronto to Nairobi, small businesses face rising employment costs and administrative burdens. Their ability to hire shapes economic resilience far beyond their neighborhoods.

Policies that simplify compliance and provide affordable benefits directly influence whether owners like Dr. G keep creating jobs.

Sunday Brunch Perspective

Each Sunday when our families gather, these themes move from theory to reality. We talk about the next clinic Dr. G wants to open, how to recruit another licensed chiropractor, and whether new benefits could help retention.

For me, its more than friendly advice. It’s a reminder that every policy debate, every statistic, comes down to people we know and care about.

The Takeaway

Small businesses are the world’s most consistent job creators, but they need the right tools and supportive policies to keep hiring. When owners like Dr. G overcome business complexity and high costs of expanding their team, the payoff extends beyond their own bottom line: More local jobs, stronger neighborhoods, and a healthier global economy.

As Dr. G likes to say, “Every time we bring in a new staff member—front or back of house—we’re investing in someone’s career and in the community we serve.”

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