Practice Administrators Must Stand up for Themselves

Administrators face a unique challenge. As head of business operations, they are a pivotal part of the decision-making team. Yet, they are also employed by the physician owners, which puts them in a potentially awkward position when they disagree with the doctor's call in matters related to personnel or strategic direction.

To innovate effectively, however, office managers must be prepared to assert themselves, defend their position, and demand respect.  "Differences come up all the time and I think it helps when the administrator takes an assertive stance on those issues," says Jamie Claypool, a practice management consultant with J. Claypool & Associates in Spicewood, Texas. Those who work best as part of a team, she admits, do a little politicking in advance. "Good administrators test the waters first," she says. "They go in and see what side their physicians are on and try to gauge where everyone stands so they can gain consensus before they go into an adversarial meeting."

The other trick to the trade, Claypool says, is to make it clear from the start that you need your physicians' support - particularly when hiring and firing staff. "The doctors may be far removed from the performance of their staff and even seek to protect someone, but the administrator knows directly who is performing well, who is marginal, and who needs to go," she says. "If there are going to be controversial issues, they usually involve personnel, so you need their support on decisions like that."

To work together effectively, trust and mutual respect are imperative. That comes with time, but it's built by collaboration, joint decision making, and successful problem solving. "Hopefully, you've built that relationship so you feel like you're part of a team moving in the same direction," says Robert Wergin, a family physician in Milford, Neb. and president of the American Academy of Family Physicians, "That prevents the 'kill the messenger' mentality."

To foster a healthy working relationship, administrators should also treat their physicians as team members, not employees, lest they stir resentment. "The physicians shouldn't feel like you're dragging them down and giving them one more thing [to do]," says Wergin. When regulatory changes force change or financial problems arise, the administrator needs to be open, honest, and forthright. Explain why the change is necessary, provide examples of how other clinics are coping, and offer your opinion on how best to resolve [the issue]. Also ask for input.  "It's how you present it," says Wergin. "Listen, acknowledge their concerns and challenge each other's assumptions so you can come to some resolution together."