Strike a balance as a boss

Cindy Daly, MD, an otolaryngologist in Leonardtown, Md., says she prefers her office to have a "family atmosphere." But she says the office "does need rules. I try to focus on mutual respect and understanding." She's clear with staff about her expectations and her fairly crisp personal style. "I'm not good with someone who cries if I criticize them."

For many physicians, finding, managing and retaining an office staff that is collegial, cooperative and efficient is essential to success. Being too personal with staff can be a problem. But so can a lack of communication. A limit in contact between many physicians and their support staffs can create tension and divisiveness and cause a drop in patients as the air thickens with unspoken issues and unaddressed conflict.

"Doctors will go months without speaking to their staff because it's so much easier to send an email to their practice manager, but it doesn't work," says Terry McGeeney, MD, president and CEO of TransforMED, a subsidiary of the American Academy of Family Physicians that helps physicians manage staffs and patients. "For a very, very successful practice, the staff's morale is essential. If the doctor is feeling worn out or having a bad day, the staff will be rallying around him or her."

How do physicians balance friendliness with employees with the professional need for a highly functioning team?

Experts and physicians such as Dr. Daly say the key is setting boundaries. There is a time to be personal and a time to be professional -- and a time both can mix. The physician defines those boundaries as he or she wishes. Doctors who have created the right mix of personal and professional for their practices say it's a process that begins before a staff member is even hired.

For Alieta Eck, MD, an internist in a four-physician practice in Piscataway, N.J., her staff "is like our family. We have picnics and Christmas parties at our homes. They fill in for each other so that the doctors do not have to micromanage their schedules. They share their personal issues with each other and with the physicians as well."

With 23 years in practice, managing two full-timers and seven part-timers, careful hiring has proven key to success, she says.

"We generally hire people known by our staff," she says. "We look for people who are diligent, have proven character, are friendly and people-oriented. If they have patience and have a good amount of common sense, we appreciate that. Many patients tell us that they made the decision to come to us because of the kind voice they heard on the phone. They have canceled appointments in other offices because they did not feel welcome.

"We find that the Golden Rule is best -- treat others the way we would want to be treated. Treat them as professionals, and give them as much responsibility as they can handle. As an example, today we came into the office and found that our lab had been completely reorganized and cleaned. Our staff had some free time and simply did it."

The need to fit in

Five years ago, Dr. Daly had to fire a staff member who was popular with patients yet refused to do necessary office work. Dr. Daly says she now asks situational questions when hiring -- "What would you do if ...?" -- to weed out applicants who won't work well with her, because she especially values resilience and self-reliance.

Dr. Daly prefers to keep staff as long as possible. With 13 people aiding her three-person practice, she focuses most of her attention on her receptionist, a 26-year-old whose mother also works in the office, in billing. "We meet very frequently, because she's everyone's first impression of me.

"We do annual reviews very religiously," Dr. Daly adds. "Sometimes we have to do it a little more than that."

Though she is sympathetic to personal issues that can affect staff efficiency, Dr. Daly is also strict and clear about her standards. "You can't take it to work. We're all dealing with difficult stuff, and if you bring it to work, you're seriously jeopardizing your life here. If you've had a fight with your boyfriend, go outside! This is not my expectation of how work is supposed to go."

Kenneth Christman, MD, a plastic surgeon in solo practice in Dayton, Ohio, has retained one staff member for 30 years, one for 25 and the newest one for 10 years. "I try to treat them well. I want to keep them happy. A lot of people don't understand there's a high unseen cost of high turnover. You lose efficiency. You lose loyalty."

Dr. Christman says he treats them "like family. I probably make more mistakes than they do, so when they do make one, I try not to get too worked up about it. They're not going to get fired if they make a mistake."

His compassion goes beyond mere words, as he has even offered one staff member the chance to bring her elderly, ailing mother into the office with her if necessary.

"You have to be understanding and take these things into consideration," he says. "A lot of times you have to make exceptions for such moments. My practice is small enough that I want to make exceptions. It helps the office run more smoothly."

Brian Brady, MD, an internist in Scarsdale, N.Y., has a staff of five. Like Dr. Eck, he has hired "from a pool of friends and acquaintances," seeking people who are "personable, who can be courteous, who can relate to people and who have some common sense." One member of his staff is a bit more challenging, he admits. "She can be pretty blunt, but she's efficient and has good computer skills. Working the front desk is a tough position."

Dr. Brady works with a physician partner and, after 22 years, has seen and managed an array of emotion in the workplace, including tremendous shared grief when his partner's son was killed in an accident. "That cast a real pall over the office. You have to cut people a lot of slack rather than keep them at a professional distance. Our staff works together very well. They socialize together and have even gone on vacation together. But they can be snappish, and some conflicts at home play out in the office."

However, Dr. Brady and his partner feel little need to micromanage those conflicts. "They're pretty much self-policing that way."

Establishing boundaries

If staff isn't able to negotiate the difference between personal and professional, a practice might have to restate boundary lines for them.

"Boundaries are my biggest challenge," says Varesh Patel, DO, a family physician who shares his Orlando, Fla., practice with his father and manages 10 employees.

When conflicts arise among his staff, Dr. Patel delegates their resolution to the office manager. "It makes for a very difficult working environment, and I just need to stay out of it. Our office manager has been with us for 20 years, so I just need to trust her judgment."

Dr. Patel schedules quarterly meetings with his staff and celebrates their birthdays with a cake and lunch. "Every few weeks we'll order lunch for everyone in the office and pay for them." This year's holiday bonus -- taking staff and their spouses to a show and dinner -- was especially generous, with the practice spending about $2,000.

Investing time, attention and personal interest in your staff is crucial to running a profitable and well-run practice, Dr. McGeeney says.

"Patients will perceive office tension. The healthy environment sets patients up for a better experience."