Human Resources: Managing the Manager

Kim Kruger has been the office manager at Auburn Family Health in southeastern Nebraska for 26 years. And she’s still happy.

The secret to her success? Respect.

“Knowing you have the support of your physicians means the world,” says Kruger. “They give me a pat on the back, and I’m good for another 10,000 miles.”

Kruger isn’t the only one out there for whom respect - and even a little admiration - can go a long way. Developing a good physician-manager relationship doesn’t require following a 10- or five-step plan.

In fact, there’s only one crucial truth to keep in mind: As a physician with your own practice, you entrust the business side of your practice to another person. That works only if you set clear directions and then let your manager get to work. Sure, you need to hold your manager accountable, but second-guessing, frequently overriding decisions, and not listening to opinions are all major no-nos. Respect your manager’s role. If you do that, the rest is just details.

A symbiotic relationship

As a physician with an interest in administration, Susan Turney has seen all sides of the physician-manager relationship. She is the CEO and executive vice president of the Wisconsin Medical Society in Madison and the chair of the board of directors for the Medical Group Management Association.

“Mutual respect is imperative,” she says. “What I learned right from the get-go is that conflicts between [a managerial and a clinical mindset] are inevitable. So the question becomes, ‘What can I do to make our relationship successful?’”

Turney believes a physician and a manager each bring unique and equally necessary skill sets to a practice. The goal for physicians, then, is to respect the role of the manager. “Embrace the fact that there is mutual dependence,” Turney says.

But that doesn’t always happen.

“There is a definite lack of respect for managers,” complains Barbara Geoghegan, president of the Central Jersey Chapter of the Professional Association of Health Care Office Management and the administrator for an orthopedic practice in South Plainfield, N.J. “I can’t believe how many doctors think that they can do this [manage a practice] on their own. That’s doing two full-time jobs. … The worst thing a physician can do is to dismiss anything the manager tells them, to not even give them the courtesy of a review. Lots of managers don’t have college degrees but have worked their way up. You don’t work in the trenches and not learn anything.”

Indeed, a difference in formal education - and, at times, gender - can play a negative role in physician-manager relationships.

That can be especially true in small practices. Large practices, in which a manager may lead a department of 50 physicians, tend to hire professional and experienced leaders to act as managers. “The manager role is almost always better defined” in large practices than in small practices, says Turney, “and doctors are more likely to defer.” She adds that the complexity of the management role in a large practice means “it’s not something physicians can dabble in. Sure, they may set goals, but they stay out of the day-to-day, hands-on management.”

A similar attitude would work well in smaller practices, too.

“People generally need to treat a manager like they treat a physician partner,” says Bruce Armon, who, as an attorney with Saul Ewing in Philadelphia, has seen his share of ugly physician-manager breakups. He says managers need the same time and consideration a physician would give another physician.

Of course, that means the manager needs to act like a professional as well. Jana Siwek, practice administrator for Delaware Neurological Group in Newark and a consultant, thinks some administrators bring contempt upon themselves. “People respect you as much as you respect yourself,” she says. “It’s all in your approach. … How comfortable is any physician going to be if you stomp around and talk to staff?”

If that describes your manager, consider asking her to adopt a more professional style, and specify what you mean. You may also consider hiring someone with more professional experience whose insights you will listen to.

Too many physicians employ a former receptionist or biller, or even a spouse, as a manager - only to find they don’t truly trust that person’s abilities. Someone who has worked his way up can absolutely be an incredible source of information.

But he also may not be up to the task. Not every person is a good fit for every job. If your manager can’t do what you need done, don’t hesitate to find a better role for that person. Ask yourself if you can see your manager running a million-dollar business in any other industry. If not, spell out what needs to change, or move on.

Planning is key

In fact, formalizing the physician-manager relationship - that is, specifically detailing your expectations and asking for reports in writing - can make a crucial difference in how well you get along with your manager.

“The best thing physicians can do is be clear in their expectations,” Siwek advises. “Even when people think the expectations are unrealistic, at least you aren’t setting everyone up for failure.”

Setting goals, objectives, and even specific tasks is especially important since the role of the “administrator” can be quite different from practice to practice. Some are glorified secretaries, some are financial gurus, others just oversee billing, and some do it all.

Just as physicians need to provide their managers details of their expectations ahead of time, managers should be prepared to provide fairly formal reports in return. “Doctors can’t read your mind, and you can’t read their minds,” Siwek says.

“A lot of times the managers feel the doctors don’t have a grasp of everything the manager does, and it can be everything from changing the toilet paper to paying the bills,” says Siwek. She solves that problem by writing regular updates to her physicians. She’ll let them know about changes in carrier policies, what ended up happening with a staff person, and everything else she has been doing. This process holds her accountable to bring open issues to a close, and she thinks it also makes her job more real to the physicians with whom she works. They may wonder why one thing isn’t done, but when they see the 30 other things that have been accomplished, they gain a more accurate perspective.

Siwek says her reports also give physicians the opportunity to advise her. “It encourages them to say they want this changed or ask if I can do something else. It opens a door and keeps it open.”

Who’s got your back?

If you do need to correct or redirect a manager, make sure you do so behind closed doors. The most common complaint of practice managers is that physicians don’t back them up in public, especially when it comes to decisions about staff or staff policies.

For example, say a manager decides a practice’s staff should eat breakfast at home rather than be snacking when the first patients arrive. She lays down the law. Staff members complain to the physician, and the physician changes the policy. That’s a slap in the face to the manager, and it will significantly diminish her authority with the staff.

“Doctors don’t stand behind their managers’ decisions,” says Geoghegan. She adds that physicians need to “recognize that managers are the lunchmeat in the sandwich,” stuck between physicians and staff. “It’s a very challenging place to be.”

Of course, it’s your business, and it’s your decisions that matter. But express your opinions to your manager privately rather than allowing staff to come to you with their complaints. Better yet, involve yourself from the beginning, letting managers know your thoughts before they are put in a position to set policy.

Establishing a relationship built on mutual respect may take a little extra work on the front end, but it’ll pay off when you experience less daily stress down the road. Who wants to come to work each day to face a manager brewing with resentment?

Pamela L. Moore, PhD, is senior editor, practice management, for Physicians Practice. She can be reached at pmoore@physicianspractice.com.
This article originally appeared in the September 2006 issue of Physicians Practice.