Shes not a physician, but in a healthcare related field. I think her company has a few hundred employees, but that’s just an educated guess. She is an employee, not in management nor is she a partner.
With dental and medical groups, everyone is in it together, especially if the owners have significant money in the plan. So the first step is to identify who the decision makers are, and then to set up time to go speak with them. She will need to educate them on what their options are first. Once they are open to the idea of improving a plan (and who would NOT want to save lots of money by upgrading their plan?) then there may be an opening to act. I also find that in smaller companies HR manager might take the active role as well, so that's another person to talk to. Quite often owners would defer to the HR once they make a decision to do something along the lines of making changes to their 401k plan, so you don't want to bypass the HR manager/director, who might be the first person she can get in touch with.
Also, the amount of effort spent on trying to make changes can depending on how long she'll stay there and whether she has some growth potential within that company.
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