11 points to consider when changing administrators
“There’s no limit to how complicated things can get, on account of one thing always leading to another.”
– E.B. White
“Success in management requires learning as fast as the world is changing.”
– Warren Bennis
Image: Adobe Stock
In our experience, while a few administrators thrive successfully in a single practice for decades, becoming at least as important to company success as the doctors themselves, the average administrator remains at their post for 5 years or fewer, eventually moving on.
Accordingly, in the average eye surgeon’s 30-plus-year career, you may be served by six administrators or more. Each passing of the guard can feel different — sometimes losing your administrator may be a relief, and sometimes it may represent a damaging step backward for the practice.
Here are a few things to consider when your next administrative transition arises.
1. When it is time to recruit a new practice leader, start at the beginning. Honestly assess the successes and failures of your outgoing manager. If your present administrator is being dismissed, why did you and they fail? Was it their original selection? Faulty onboarding? Insufficient clarity about expectations? Poor or delayed board oversight? If your administrator is great but leaving you for a better position, what could you have done to retain their services? If your manager is retiring, have you started early enough looking for a replacement?
2. Whether your practice is large or small, convene a search committee to find the new administrator. Include some or all owners and all department heads. Consider adding one or more outside advisors to backstop your decision-making.
3. Hiring a new administrator is a tactic that should be employed in the service of your practice’s strategic intentions. Before recruiting, affirm where you are heading in the next 5-plus years. (Your written strategic business plan should also be shared with finalists.) If your business plan is to double in 5 years, you will want a harder-charging individual with a history of development wins. If the plan is to hover at the current revenue and volumetric plateau, you need more of a caretaker who has core skills in operations and profit optimization.
4. A formal, written administrator position description should be reviewed by the board and department heads; take their editing suggestions seriously.
5. Practice administration is not a formal “learned profession” like medicine or law. It is a skill mostly gained through many years of experience and mistakes. Depending on the scale and seriousness of your practice, make sure you are hiring someone with sufficient experience and gray hair.
6. Job titles are important. The title should be “office manager” if you have a slow-paced or smaller practice. The title “administrator” fits if you have a larger practice but are hiring someone who is more of a caretaker to grow the practice at not more than 5% per year. “Executive director” or even “CEO” is appropriate for someone harder charging who you want to build your already large company at a faster pace.
7. Eye experience is nice but not essential. Leading an orthopedic, cardiology or similar practice is fine preparation for your candidate so long as the practice they come from has comparable economic and staffing scale and complexity as your practice. You can also consider individuals who have run large law firms, construction companies or the like. Anyone smart enough to do the job can learn the job. The only difference is preparation time — it can take a couple of years for the manager of a hotel to learn how to run an eye clinic. With this in mind, it is best to pick someone who has done this specific job in eye care before if they need to come up to speed quickly.
8. Do not overlook internal candidates. Some of the best managers we work with have come up through the ranks. If you have someone who might or might not succeed, such as a billing manager or lead technician, give them the interim title of “acting administrator” so they can go back to their comfort zone if they fail in a more senior role.
9. Be careful about hiring anyone whose prior occupation has been running clinics in a hospital context. Such individuals generally do not have direct financial responsibility and are backed up by deep teams of internal specialists, which means they do not develop their own 360° skills. With notable exceptions, health system executives can disappoint when they shift to a freestanding private practice.
10. Remember that administrators come in two basic levels that are analogous to staffing on the clinic floor:
- There are “tech-level” administrators. Like their clinical cognate, these individuals have less training and experience; they are able to gather information by rote and prepare a synopsis for the managing partner and board, but they cannot “diagnose, treat or refer out” tough business problems. Their authority and critical thinking skills are limited. They may be hugely valuable, like techs, but limited in their scope. Such administrators can be appropriate in smaller practices with an “MD-CEO,” a physician-owner who is the de facto administrator.
- There are “doctor-level administrators.” Administrative “doctors,” like real clinical doctors, have more training and command more authority. Such administrators know what data to secure and how to assess them. They know how to diagnose business problems and opportunities and how to treat them. Before treating, they confer with the board (ie, “the patient,” continuing the analogy) to secure approval (just like a surgeon secures an informed consent before operating). They are bold but cautious. They know the limits to their skills and when to refer a problem to outside specialists.
11. No administrator of mid-size and larger practices works just 40 hours a week. A 50-hour week is common in practices above $10 million in annual collections. It is important to not be shy about exploring every final candidate’s career commitment.
- For more information:
- John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the country’s most published author on ophthalmology management topics, including John Pinto’s Little Green Book of Ophthalmology, Simple: The Inner Game of Ophthalmic Practice Success and Ophthalmic Leadership. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.
- Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. With 35 years’ experience, her firm specializes in leadership, operations enhancement, financial benchmarking, executive and provider coaching, and management team development. Her book, co-authored with Pinto, is UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction. She can be reached at 609-410-2932; email: czwohl@gmail.com.
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