Solving Physician Conflict

After more than 30 years in the trade, Gail Detraz has identified the single most important barometer for measuring a medical group's long-term success. And, oddly enough, it has nothing to do with overhead or the number of days in accounts receivable, she says. It's how well the physicians in your practice get along.

"When your physicians work well together there's a lot more harmony and a lot less stress and energy wasted on nonessentials, so you can focus on the day-to-day operations of the practice," says Detraz, a former practice administrator. If you don't have to waste time managing hurt feelings or scheduling to ensure doctors don't butt heads, she says, productivity improves, staff turnover reduces, and patients get a better office visit experience. "Patients notice when there's an undercurrent of hostility in the practice," says Detraz, who was recently named head of physician recruiting and contracting at Northeast Georgia Health System in Atlanta. "They pick up on a lot more than you think."

It's natural, of course, for colleagues in any profession to disagree. After all, we all bring our own priorities and personalities to the table. But headbutting can get out of hand in a hurry when you're dealing with doctors who aren't exactly renowned for their ability to confront conflict head on, says Jamie Claypool, a practice management consultant with J. Claypool Associates near Austin, Texas. "Doctors are conflict averse for many reasons," she says, noting avoidance leads to resentment and warring factions. "They do not learn [conflict resolution] skills in medical school and many are very reluctant to point fingers at colleagues for professional reasons." The truth is, however, that airing grievances with coworkers in a timely - and professional - manner is critical to developing a working relationship rooted in mutual respect.

When tempers flair

Claypool says it's time to intervene when the tension between two or more doctors is putting everyone else on edge. "You have to step in when it jeopardizes patient care, the morale of the practice, or finances," she says. That can be difficult, considering some of those doctors may be shareholders and technically your boss. But as office manager, it's your job to protect the interests of the group, and thus, it's your duty to facilitate resolution. The manner in which you approach the physicians, however, is key. "You have to maintain neutrality," says Claypool. "Take the high ground and find something positive about what each doctor has said. Never express personal likes or dislikes to any situation presented or you'll be seen as being in one court or another and that's not a safe place for an administrator."

The most effective way to keep the peace, says Detraz, is to give physicians an opportunity to vent. Hold monthly meetings (more frequently if a change of ownership or major investment is on the agenda) and provide the tools they need to reach consensus. "I lead the horses to water and let them discuss their issues independently," says Detraz. "I do help guide the discussion, but in the end, a decision does need to be made. They can't avoid conflict."

Just be sure you've done your homework ahead of each meeting, says Lee Ann Webster, administrator at Pathology Associates of Alabama in Birmingham. "The administrator has to work like a dog before the meeting occurs to get all the information and facts out there, and allow time to research alternatives because those questions will come up," she says. If some of the partners are pushing for a pricey equipment upgrade, but the rest of the group objects, for example, find out what other products exist that offer similar functionality. Likewise, if an office expansion is on the table, find out if it's more cost effective to move to new digs or convert wasted filing space into another exam room.

You should also distribute the agenda, along with all supporting documentation, days in advance of the meeting. "If it's an economic issue, have all the financial documents they need so they can hash it out and come back to you with questions," she suggests. "They have to have time to digest the data beforehand, and you have to have time to research alternative solutions. If you spring it all at them at the last minute, you're going to have another meeting."

The matter is more delicate when it's a single physician who is making everyone else see red. In that case, says Claypool, call that doctor behind closed doors and ask him in a nonthreatening way what's up. That way the physician won't direct anger at the messenger (you). Share with the doctor some of the comments made by patients, staff, and/or colleagues, and explain how his behavior is affecting the group. The physician may be so caught up in the rigors of his daily schedule that he is unaware of the effect he's having on others. "Tell them that you're afraid you're going to lose staff because they're stressed out and morale is down," says Claypool. If they disclose that they're dealing with a personal or professional crisis, find out what you can do to help them better manage their stress.

Governance

To reinforce the message of maintaining a professional demeanor, your employee handbook should also spell out guidelines for disciplinary action within the practice - including examples of behavior that will not be tolerated, says Claypool. And have each doctor in your group sign an agreement stating that they've read it. Likewise, your governance policy should include language that enables the practice to retain an independent third party to settle disputes that simply can't be resolved in-house - for example, when shareholders in your practice can't agree on whether to change the terms of the partnership agreement for incoming doctors. "Everyone's bylaws should include an arbitration clause that allows them to bring in a third party to help settle certain disputes," says Claypool. "Not all disputes can be settled by an administrator and a good administrator will recognize when they need to bring in a mediator."

You can't prevent disagreements among your doctors, of course. And, in fact, that's not even the goal, says Claypool, since confrontation is often the catalyst to positive change. But you can give doctors the tools they need to address their disputes in a professional forum. "Physicians as business owners do not want to face painful changes or may be afraid of facing changes in the practice," says Claypool. "But many times conflicts are the motivating force behind change or the status quo."

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the November 2011 issue of Physicians Practice.