When administrators can’t go it alone

Getting physicians to take on leadership roles

You are a good practice administrator and value input from the medical staff. But when you ask for advice, either you are overwhelmed by too much input, or no one is interested in giving you guidance. What can you do? Convince one of the doctors that he or she has to take a more active role.

"We can’t leave every decision to practice administrators or office managers," says Barbara Kostick, MD, FAAFP, the physician leader of her five-physician practice in Fremont, CA. "We must understand that we have to provide guidance on hiring, training, and [defining] duties," she says. "And someone on the medical side has to help in making decisions on the budget and on capital equipment needs."

Kostick is quick to add that a good administrative manager is vital to the smooth running of an office, but neither the administrator nor the physicians can run an efficient modern practice without the cooperation of the other. "You need a medical person to evaluate the vaccines you have, the need for laboratory or X-ray facilities, or what a medical assistant’s duties should be," says Kostick. "You can’t leave these decisions to administrators to make in a vacuum. That’s just a disaster waiting to happen."

Susan Whittaker, vice president of the American Medical Group Association in Alexandria, VA, says that while there is little hard data on the number of physicians taking on this type of administrative function, it is a growing trend. "I know a lot of our members are taking on management functions on either a full-time or part-time basis," she says.

Even the best practice administrators, who have proved their value over years, must liaise with the medical staff, she says. "And the best method is to have one physician leader who is well-versed in the business of running a practice and who has the ears of the other physicians."

Getting the cooperation of the physician

Many physicians, however, are loathe to take on administrative duties. They got into medicine to practice, not to run a business. "But it’s just not possible anymore to just practice medicine," says Michael Robinowitz, MD, FACOG, chairman of the board of the Meridian Medical Group in Atlanta. He has spent the last several years in various management and leadership functions for his practice. "Medicine is a business, and you can’t hide behind the guise of not knowing or caring. If you try not to get involved, then you won’t last long in practice."

Practice administrators must clearly outline why a physician needs to take on a management role, he says. "Tell them they can either be told what to do by you, or always tell you what to do," he explains.

In one extreme, the practice is faced with having someone tell the doctors how many patients they have to see, how much money they will make, and how much they will spend on purchasing, Robinowitz says. In the other extreme, you have micromanagement, very likely an unhappy administrator, and a wasted salary for that function. "If the practice is willing to accept either premise, then fine, they can live without a physician leader. But I doubt that will happen."

Kostick recommends asking the physicians how happy they are with some of the specifics of their practice — such as the money they make, their pension plans, or their knowledge of federal health and safety requirements. "If they think about these things, someone will realize that a physician has to take ultimate responsibility," she says.

Defining the role

The division of labor between the physician leader and practice administrator will vary from practice to practice, says Kostick. In some cases, she says, the administrator will handle virtually everything, only letting the leader know what the plan is and talking through any difficulties. In other cases, however, they have many responsibilities in common.

Before thrusting a physician into the role, be sure you have a clear definition and division of responsibilities, says Kostick. "It’s something that the practice owners have to decide," she says, "but it might be worth spending a Saturday with a consultant to help come up with specific roles."

In most small- and medium-sized practices, the physician leader will still have to practice medicine, but in all likelihood, the time doing so will be cut. Even in Robinowitz’s 70-physician multispecialty group, he only spends 20% of his time on administrative issues — a change from a role in the past where he had more management responsibilities and less time for patients. When the group hired a full-time medical director, that percentage changed, allowing Robinowitz to spend more time practicing medicine. "In a smaller practice, that might be more difficult to maintain that kind of split."

Robinowitz admits some physicians may like some of the business functions, but not others. In larger practices, you may have the luxury of dividing the leadership duties between several physicians. For example, a doctor who likes dealing with coding issues can be encouraged to monitor duties relating to them. Regardless of how the practice divides the duties, at least one doctor needs to take responsibility for management issues, he says. "They can’t do nothing," says Robinowitz. "If they do nothing, then they are of minimal value."

There are no typical traits that make a good leader, says Robinowitz. Or if there are, they vary depending on practice size and specialty and the relationship the medical staff has with the administrator. "You have to find someone who is willing to trade medicine for administration. You have to find someone who is concerned, visionary, communicative, hard-headed, patient, compassionate, and credible."

An ability to communicate is perhaps the most important trait, he says. "I dislike the necessary confrontations, but you have to learn how to tell a physician that his performance isn’t up to snuff or patient satisfaction is low. This is a skill you can learn, but I know that physicians like to be liked. You have to be able to separate yourself from what you are saying."

Physicians who assume leadership roles must also realize that they are not going to be part of "the group" any more. "They may be practicing medicine, but they are also managers, and that will create some dissent and distance among the other physicians," says Robinowitz. "You have to recognize that reality, but not forget what it was like when you were part of the group."

A vital part of the practice

There is another benefit which you can use to sell the physician leader to your practice, he says. "You learn a lot about how the business is run and gain a broader perspective of practicing medicine."

Robinowitz says he thinks his leadership experience has also made him a better doctor. "You can’t divorce yourself in dealing with economics when dealing with a patient. Maybe the five or 10 minutes you see one patient doesn’t often have a bearing, but if the patient tells you he or she has no insurance or says his or her employer is leaving your group, then you have a better understanding of the patient’s concerns," he says. "I have learned how to improve patient relationships and how to run a more efficient office, and those are things that have a direct impact on customer satisfaction."

Leaders have a vital role to play in a practice, Robinowitz says. "I used to hate cancelling a patient’s appointment when a meeting came up," he recalls. "But then maybe the meeting allows you to solve a problem that will allow a physician to see more patients. You move from an individual perspective to seeing the bigger picture. You are in a role that will help a practice grow and survive."

Michael Robinowitz, MD, FACOG, chairman of the board, Meridian Medical Group, Atlanta. Telephone: (404) 609-5413.

Barbara Kostick, MD, FAAFP, family practitioner, Fremont, CA. Telephone: (510) 505-6016.

Susan Hogeland, CAE, executive director, California Academy of Family Physicians, San Francisco. Telephone: (415) 394-9121.

American Medical Group Association, Alexandria, VA. Telephone: (703) 838-0033. West Coast office telephone: (562) 430-1191.