In Search of ...

Need an office manager? Pay and benefits are important, but a successful search may depend more on patience. Physicians -- most of whom are accustomed to making quick decisions -- often don't put enough time or thought into hiring an office manager, says Elizabeth Woodcock, an Atlanta-based practice management expert.

"Until physicians come to realize that they are leading multimillion-dollar businesses, they will tend to hire the wrong people," Woodcock says.

Wrong as in promoting the longtime staff member who's easy to work with, but who may not have the ability to lead the staff or learn the complexities of a large-scale business.

Michael Fleming, a Shreveport, La., family physician and president of the American Academy of Family Physicians, agrees. "Most physicians try to get by with hiring somebody who was the file clerk and suddenly they're the manager but don't have the expertise or leadership. [Often] the physicians won't make the investment to educate that person," Fleming says. "It's not realistic, and it's unfair to the new manager."

Woodcock suggests looking at qualified outside prospects as well as internal candidates, especially if your practice is going through a stressful change, such as implementing new technology, moving or remodeling offices, or adding more physicians or service lines. At the very least, you'll have a better appreciation for any internal candidates for the job.

Whether you promote from within or hire an outsider, you'll improve the odds of finding the best manager by getting involved and not rushing things, says Paul Angotti, president of consulting firm, Management Design LLC, in Monument, Colo. Angotti, who has helped many medical groups locate new managers, urges physician leaders to:

o             Develop detailed job descriptions for managers.

o                Participate in interviews with top candidates.

o                Thoroughly check job and personal references.

o             Offer the right salary and incentives.

o             Create attainable performance goals.

Ensuring the right match

Job descriptions can vary widely, so it's important to tailor the description to your practice's specific needs. In many small groups, the manager devotes several hours a week to managing the billing department, in addition to supervising human resources and various other responsibilities.

Other practices want an administrator who will truly run the practice. Those duties may include managing finances, business policies, strategic planning, human resources, contract negotiations with payers, risk management, marketing, and information technology.

A detailed job description not only helps weed out the unqualified candidates, it can spur more focused questioning later on during interviews.

Angotti says he hands physicians a list of 40 management tasks -- more than most managers would be asked to tackle -- and asks them to mark which ones they would want their new manager to handle.

"You need to define what you want the person to do in excruciating detail so you'll know what to look for in the person's skill set and experience," he says.

Go for experience over training in most cases, suggests Dick Hansen, a Palo Alto, Calif.-based consultant with the Medical Group Management Association's (MGMA) consulting group.

"Physicians tend to give greater weight to a person's degree, but experience, a good track record, and the ability to learn are important, too," Hansen says. "I also caution them not to rule out somebody who wants to step down from a larger, more sophisticated organization because managers make lifestyle and family choices, too, just like physicians."

Tom Peterson, executive director of Idaho Emergency Physicians in Boise, says finding the right combination of personal attributes trumps both experience and training.

Peterson says successful managerial candidates should be able to:

o             Adapt to change.

o             Deal with daily stresses.

o             Handle pressure situations.

o             Be capable of learning.

"If I can find someone with those four characteristics, then I can make them into a manager. You can teach someone how to do a job; you can't really teach attributes like leadership or dealing with stress," Peterson says.

Interviews are telling

The interview is where you can look beyond the resume and figure out what kind of person the candidate really is. Peterson interviews management candidates up to three times, and his staff sometimes gets involved.

"We create some stress by having staff come in and interrupt to ask me questions so I can watch how the person reacts and see if they get nervous or it breaks their train of thought," he says. "It gives me a little indication of whether that person can adapt to change."

Angotti suggests basing interview questions on the job description. Will the new manager handle basic bookkeeping duties? Then come up with specific questions about education and past experiences with number crunching, including details such as what software they used.

Watching the candidate's reactions in group interviews with staff and physicians may help to show the person's true colors, says Deb Brown, a practice management consultant in Clemmons, N.C. "I ask them to tell me about their best day and their worst day at any job because that tells me what they need to be happy and productive and feel satisfied in the workplace," Brown says.

Scrutinize references

A resume may contain highly creative writing. An interview could be an Oscar-winning performance. That's why it's critical to check personal and business references carefully. Woodcock points to a Georgia practice that hired a new office manager but failed to fully check her references. When the books failed to balance after a few months, the physicians learned, too late, that she used an assumed name and had embezzled from two other practices.

"After hearing so many horror stories -- big and small -- I cannot emphasize enough that it is definitely worth the time it takes to check the references, educational degrees, and work history of the person who may be your next business manager," she says.

Peterson adds that while a candidate's personal references are almost always "ringers," they may inadvertently reveal things you'd like to know about personality or work style.

"I'll call a personal reference and ask things like, 'How would your friend deal with a stressful situation?'" he says. "Friends can be pretty honest whether they mean to or not."

Setting the right salary

Depending on the job's responsibilities, local market rates, and your practice's specialty, you might pay anywhere from $40,000 and $60,000 for an office manager, plus another 18 percent to 24 percent for job benefits, suggests recent data from the Professional Association of Health Care Office Managers

(PAHCOM). Managers at cardiology and orthopedic groups earned nearly $60,000 on average while those in primary practices earned around $46,000.

But other measures, such as the Annual Staff Salary Survey produced by The Health Care Group suggest that salaries average in the mid to low $40,000-range, depending on experience.

Expect to pay more for an administrator -- especially one with a graduate degree -- who can handle complex business and strategic functions such as creating financial models, business proposals, return-on-investment projections, and negotiating payer contracts.

Peterson says to consider offering a small bonus or even a share of the profits to attract the manager you want. Survey data from the MGMA indicates that medical practices with incentive compensation plans for their administrators tend to out-perform those that don't offer such incentives. (See the article on page 67 for more information about staff salaries.)

When a good candidate is missing one desired skill, either invest in training them or, suggests Angotti, find out what that task -- handling accounts payables, doing payroll, etc. -- would cost if outsourced. The cost of outsourcing the chore could be the basis of a lower offer, and a potential raise once the skill is learned.

Go for the goals

Don't expect the perfect office manager to stay around long if the employment situation is far from perfect.

"It's very important for physician leaders to treat the office manager as a colleague," says Nancy Heacock, director of physician network development with Lehigh Valley Hospital and Health Network in Allentown, Pa.

"Include the manager in big decisions and make him or her the first staff member you talk to about any critical decisions or big events in the practice," she says.

To integrate the new manager into the practice's culture, or acclimate the former rank-and-file worker to the new duties, Brown suggests physician leaders meet briefly with the manager two or three times a week during the first few months. Structure meetings around the manager's task list and "Keep asking them, 'How is it going?' and 'How did this week go?'" she adds.

"Not making yourself accessible is probably the biggest mistake I see doctors making with a new manager," Brown says. "Talking only while you're running between exam rooms or on your way out the door will lead to miscommunication."

Fleming says he and his administrator talk at least twice a day, even when he is on the road.

Consider setting both qualitative and quantitative performance goals for the manager to achieve during the first six to 12 months on the job, such as improving morale (qualitative) or controlling overtime use (quantitative).

Woodcock explains, "It's important for the manager to have a vision of where the business owner -- the physician -- wants the business to go. Out of respect for your manager and your business, you should set realistic expectations and make it a win-win situation for you and the manager."

"Physicians should try to solidify the authority of their new office manager because that authority will be thin at first, especially for a newly promoted internal hire," Angotti says. One way that physicians can avoid eroding their new manager's authority is to defer all administrative matters to the manager instead of making split-second decisions whenever anyone makes a suggestion -- a tendency Angotti calls "hallway policymaking."

But the best -- and cheapest -- way to retain a manager may just be a matter of using two words: thank you.

"The simple expression of appreciation from a physician to staff can mean more than dollars, probably because it seems so rare," says Peterson.

Finally, avoid making a hasty decision when selecting a manager, advises Brown. "This person will come to know everything about you and your practice, so don't make a snap decision."

It may take 12 weeks or more to fill an important management slot, so consider hiring a consultant to sit in as manager for several weeks or even months while you methodically review resumes, conduct interviews, check references, and negotiate a salary and benefits package to attract the candidate you want.

Robert Redling can be reached at editor@physicianspractice.com.

This article originally appeared in the October 2004 issue of Physicians Practice.