Office manager is struggling; now what?

A column answering your questions about the business side of your practice

By Karen S. Schechter amednews correspondent— Posted Aug. 25, 2008.

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Question: Our five-member surgery group has been experiencing a number of problems, including reduced physician income and increased staff turnover. It seems that our practice manager might be in over his head. We don't want to terminate his employment with us, but don't know what to do to remedy the situation. Any ideas?

Answer: This thought regarding your practice manager is not atypical, and concerns a situation happening more and more. The idea that a practice manager is struggling to perform the duties of his or her job might be attributable to the increased complexities of managing a medical practice, reimbursement pressures, and perhaps a lack of training and support.

Here are some steps you and your partners should take:

Quantify what's wrong. Whenever possible, it is best to be as objective about a situation as possible. This removes the person from the problem and forces you to look at the what and why, rather than the who.

Information to gather and analyze may include a comparison of key accounts receivable performance indicators over the past few years, such as charges, revenues, adjustments and aging. It will also be important to look at financial statements from the last two to three years to identify positive or negative trends.

Once the problems are clearly defined, review them with the practice manager to gain an understanding of the related causes. It's at this time that you may begin evaluating the practice manager's strengths and opportunities for growth.

Ask the hard questions. Does the practice manager feel comfortable in his position? What does he view as his strengths and weaknesses? What resources does he think he needs in order to improve?

These questions should be included in an annual performance evaluation, so the answers should not be a surprise. Often, the questions have been asked, but nothing has been done to address them.

If you haven't had this conversation with the practice manager, then it needs to occur before making drastic changes.

If the staff is large enough, you might want to consider conducting an employee survey. Again, the questions should be objective in nature and responses anonymous. The results of a survey might provide useful insight. Beware that if you solicit ideas from the staff, it is important to respond to them in a timely manner.

Make a decision. Once you have completed the first two actions, there may be several alternatives to remedy the problem, based on the findings and the related root causes. Often, systemic problems require looking at larger concerns, such as physician leadership and governance, and overall practice organization. Once these problems have been addressed, it's important to look at processes.

Finally, after the processes, it's time to look at the person. Motivational authors Marcus Buckingham and Curt Coffman, in their management advice book, First, Break All the Rules, stress the importance of building on an employee's strengths.

Using this as a starting point, identify the practice manager's strengths to see if they can be built upon in a way that will benefit the practice.

Assuming the practice manager has strengths that will help sustain and grow the practice, the next step is to identify the resources necessary to help the practice manager in areas in which he or she is not as strong.

For example, if bookkeeping and numbers are not the practice manager's forte, then consider hiring a part-time bookkeeper. If the practice manager is more strategic, then consider finding someone else in the practice (or hiring someone) who can manage operational details and perform some of the daily functions.

The goal is not to increase expenses. Rather it is to optimize staff whenever possible and supplement only as proven cost-beneficial to the practice.

Conversely, if the practice manager's strengths do not benefit the practice, then it may be time for him to move on to another position in another practice. Typically, it's not advisable to demote a manager to a staff position because of the tension and resentment that might cause. However, it's not unheard of.

Whether the manager leaves or takes on a nonmanagement role, it will still be necessary to have a manager/leader in the practice to make sure that it operates smoothly and meets the necessary revenue goals. This may be accomplished by one or more of the physicians assuming management responsibilities, hiring a new practice manager or purchasing the services of a management service organization.

This is not a black-and-white situation and there is no single answer. But, quantifying the problems, addressing concerns with the practice manager and working toward a solution together should improve communications and, hopefully, lead to a productive work environment.

Karen S. Schechter amednews correspondent—

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