Lay managers: Your key to practice success
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“There are no secrets to success. It is the result of preparation, hard work and learning from failure.”
– Colin Powell
“Effort only fully releases its reward after a person refuses to quit.”
– Napoleon Hill
I returned recently from moderating an annual retreat for a large longtime client. I am still unpacking the lessons reinforced by seeing, once again, this practice’s many success factors at work.
The chief impression? Although in the past the overwhelmingly prominent difference between average and exceptional practices once resided almost solely in the skills and ambitions of the doctors, we are now entering an era when the ability of the administrator is growing sharply as a key determinant of practice success.
It makes perfect sense that this should be happening now.
Over the last decade, there has been a great convergence in ophthalmology, with increasing agreement on surgical techniques and increasing documentation of the preferred care pathways. No longer are only the star surgeons doing vanguard procedures — such surgeons have generously shared their trade secrets with colleagues. As the “product” becomes more uniform and doctors come to a degree of comparative parity, the competitive advantage of one practice over another is shifting somewhat to a greater emphasis on the contributions that great management staff can make.
I am seeing this trend at several levels:
- Administrative salaries are continuing to rise. It is not at all unusual for mid-size and larger practices to offer salary and benefits packages that rival compensation for new employee doctors.
- Young doctors considering an employment offer are now asking for the first time about the credentials of the practice’s management team and asking for significant interview time with the administrator.
- Managers are joining the boardroom in increasing numbers and not only to listen quietly at the back of the room, but also to lend their opinions and even their votes in some cases.
- Doctors once brushed off the loss of their administrators. They now call in a panic, eager to recruit a “star” who can turn their practice around.
- Managers could once slide by just showing up for work and being affable. Today, as profits thin and competition grows, the low performance of an ineffective administrator stands out plainly and must be dealt with quickly.
These trends are especially seen in competitive urban environments, in larger practices and in settings where doctors are increasingly fatigued by the onslaught of new regulations, deeper oversight and falling fees. But even the smallest practices are ever more dependent on their office managers.
Indeed, the soloist’s loss of his office manager can be more crippling for that doctor than the loss of a senior executive director in a 20-surgeon office, where a fleet of middle managers can bridge the practice to its new lay leader.
What does it take to be a great administrator?
Unlike medicine and other learned professions such as law and engineering, practice managers should be credentialed not so much by their education, but by their experience, their judgement and their repository of cases histories. Raw time on the job and an accretion of experience often count for more than formal learning. An MBA, combined with many years of experience and trial by fire in an ambulatory care setting, is a useful adjunct and measure of career commitment. An MBA alone, set loose in most practices, leads to excessive theorizing, mischief and disappointment.
No manager knows everything or has equal skills in all aspects of running your business. Managers strong in finance can be appalling at staff relations and vice versa. All the same, today’s manager must have a broader skill set than at any time in the history of ophthalmology. They must especially be numerically sophisticated enough to understand the common financial benchmarks of the practice, objectively measure performance and set measurable goals.
Your manager must also be committed to continuous learning, and there has never been a richer environment for this. Given the opportunity for daily insight and growth in even the smallest practices, it almost takes a conscious effort to not learn something new about managing the practice every day that you are in the office.
Great managers enjoy the trust and respect of the doctors they work with, which leads to a positive spiral of greater influence, better results and even more respect. The opposite effect, a negative spiral, ensues when the doctors do not trust management. You can see this in settings where administrators are turned over frequently. In a minority of cases, this comes about because the practice makes serial bad choices in a new manager. More often, a frustrating game of “musical managers” is due to an inability of the doctor-owners to engage, inspire and trust their managers.
Superior administration of your practice is impossible without strategic intimacy. You must let lay managers in on your innermost desires for where you want the company to go in the future. The best managers will be able to collaborate with you — nearly as a peer — on a formal, written strategic plan.
Successful managers must be sufficiently mature and emotionally intelligent to operate in an environment that is not always entirely rational. The surgical specialties, particularly ophthalmology, are populated with high-strung virtuosos. The best managers I work for have a soothing voice and the ability to help their doctors see their life and work in perspective. The most disabled — and disabling — managers augment each small crisis and amplify their doctors’ sense of having lost control.
Your manager must strike a balance between the “thinking” and “doing” halves of their job. I see examples of excesses on both sides in my consulting visits around the country. The “thinkers” draw up brilliant plans but fail to implement. The “doers” dash from task to task but rarely step back to prioritize or see the big picture. Both kinds of administrators ultimately disappoint.
A manager’s obsession with business detail must match the clinical obsession found in ophthalmology. At the same time, surgeons need to recognize that there is a necessary fuzziness present in business affairs. Yes, some decisions come down to the numbers, but many decisions (dare we say, “most?”) remain educated hunches. “Should we terminate Sally or grant her 30-days probation?” “Should we merge with Dr. Harris, or will he drive us all crazy?”
Most managers are decent or better at directing their subordinates. But only superior managers are able to coach the team both up and down the ranks. Directing doctors in an appropriate manner, fostering mutual respect along the way, is a delicate art. It starts by making an unwavering commitment to advance the career of every individual provider in the group and knowing just what that means in very personal terms. For some doctors, it is a straightforward desire for more surgical cases. For others, more take-home pay. For older surgeons, the metric of career advancement may be more time available for teaching, research or other outside interests.
Finally, here is a success factor for managers that might be surprising to some readers. I think that one of the most important determinants of success for lay managers is a commitment to the field of ophthalmology itself. It takes years to understand not only the business, but the clinical and political nuances of the profession — the superior manager must be at least somewhat proficient in these last two areas.
Just as basic researchers, inventors and engineers have been edged out in recent years by CEOs for “hero” status in American business, I believe that practice managers will be enjoying a somewhat more prominent role in the future. They will be seen as more professional and conspicuous agents for change, co-responsible with their doctors for the success or failure of their companies.
- For more information:
- John B. Pinto is the author of several books on ophthalmic practice management, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. Available now for purchase at slackbooks.com. Receive 20% off with promo code PINTO20. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
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