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Your indispensable role as practice CEO
The managing partner needs to have a particular set of key skills and resources to keep a practice moving forward.
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“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” – John Quincy Adams
“A good leader takes a little more than his share of the blame, a little less than his share of the credit.” – Arnold H. Glasow
“The task of the leader is to get his people from where they are to where they have not been.” – Henry A. Kissinger
Few ophthalmologists go through years of training all the while anticipating with pleasure the correlate job they will have as an enterprise leader. Accordingly, when they finally join a practice and move up the ranks to eventual ownership, they are all too happy to throw leadership and management duties entirely into the lap of their administrator.
More’s the pity, especially in the present practice management minefield, because even the most profoundly gifted and dedicated lay administrators lack three key attributes for total medical enterprise leadership:
- They are typically not practice owners and thus speak with less skin in the game and less ultimate decision-making authority than a physician-owner.
- They are unlikely to ever understand the “product” as intimately as the physicians they serve (in the way, for example, the engineer-turned-CEO understands a company’s product line).
- And they don’t bear the same malpractice responsibility as physician-owners for adverse patient care outcomes.
Leadership at the top of every practice, irrespective of size, should be the shared responsibility of a single lead physician, typically called the “managing partner,” along with an orthodox administrator or, in larger practices, executive director.
Success as a physician leader is driven by several factors. Many of these are readily measurable: your accessibility, the raw hours you commit and your command of business details. But some of these are less objective: your “room presence” and gravitas during meetings, your active listening skills and your intuition to pick up on brewing problems.
Here are the key skills and resources that every managing partner should possess, along with core duties and a checklist of monthly activities.
1. Your broadest charter is to work with the practice’s administrator to translate the board-mandated mission, goals and policies into daily operations.
2. One is typically obliged to spend 5 to 10 hours per week in the job as managing partner in the average ophthalmology practice. This can stretch to 15+ hours at times of change or stress.
3. The managing partner must possess financial acumen sufficient to evaluate monthly reports and monitor progress toward agreed volume and profit targets. This gets easier over time with support from the administrator and practice CPA.
4. You have the ability (and widely held credibility) to actively mentor fellow doctors and not avoid uncomfortable situations or healthy, necessary conflicts.
5. The ability to communicate directly and clearly, in writing and orally, is important. You do not need to be a great orator, but you do need to be a very good one to command the board’s attention and convey your thinking.
6. You have sufficient discipline to stick to board-agreed directives and not succumb to “mission drift.” This is harder than it sounds but is made much easier with a formal, written plan and aligned co-owners.
7. Working together with the administrator and external practice accounting resources, you are responsible for hitting agreed performance targets. You are on the front lines as the board’s disciplinarian, responsible for assuring that an appropriate cost-benefit analysis is conducted for all new projects, policies, capital equipment purchases and other initiatives.
8. You are your practice’s chief “coach,” working with the administrator to help doctors know where they stand compared to their profit and volume goals; you intervene briskly if any provider’s volumes or revenue lags below agreed targets.
9. You hold numerous committee positions. At the very least, you sit on the practice management committee, composed of yourself, selected senior department heads and the administrator, which manages day-to-day operations. Of course, you also chair the practice’s board of directors.
10. You are in charge of outreach and ongoing market assessment. Like the “face man” for a college fraternity, you maintain ongoing, senior-level contacts with the practice’s sources of patients and payers in the regions.
11. Alone or with the practice administrator and outside advisers, you are in charge of planning and development, preparing (and at least annually revising) the practice’s strategic and business operations plan, and leading the board approval process for each subsequent edition.
12. You are deeply involved with all provider and senior staff recruitment activities, and you guard the organization from inappropriate hires.
13. You provide board-level oversight for the continued maintenance of a comprehensive, written tactical plan, summarizing all key practice activities and projects, those responsible for their completion and agreed deadlines. In consultation with shareholder doctors and in concert with the administrator, you have the authority to reward and reprimand the practice’s lay managers for their performance in meeting agreed goals and objectives.
14. The managing partner typically has a level of spending authority higher than a rank-and-file owner and equal to or greater than that of the practice administrator. This spending authority is typically subject to ongoing adjustment based on practice performance.
15. You are the practice “cop,” providing a first line of clinical practice oversight and, when needed, provider discipline. You conduct risk management, utilization and quality assurance reviews and, in consultation with the board, have the ability to suspend or revise any clinical practices believed to be inappropriate. You are responsible for applying a progressive discipline system to misbehaving partner and associate doctors, ranging from informal peer counseling to termination.
16. You work to resolve provider-to-provider conflicts, including compensation modeling, scope-of-practice issues, staff and patient assignments, and the myriad other frictions that surface in even the most harmonious practices.
- For more information:
- John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist, The Women of Ophthalmology, Legal Issues in Ophthalmology, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams and a new book, Simple: The Inner Game of Ophthalmic Practice Success. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.