Management Essentials

The Office Caste System

By Farrell “Toby” Tyson, MD, FACS

The idea of a caste system existing in your ophthalmology practice might seem abhorrent. In America, we're raised on the notion that everyone has equal rights, but we sometimes forget that not everyone has equal talents, training and abilities. This discrepancy leads to a layering of roles, responsibilities, titles and pay grades within an organization. Most clearly seen in our military with officers and enlisted personnel, organizational hierarchy and its inherent boundaries facilitate efficient production and control within an organization.

Separating Work From Play

In the military, the officers do not socialize with the NCOs or other enlisted men to maintain respect and a good working relationship. This deters the officer from misjudgment in what might be a life-and-death situation.

The same is true for doctors — an appropriate social distance should be maintained between supervisors and workers. Hanging out with your staff at happy hour may make you feel more popular in the short term, but in the end you will lose their respect. The adage that “familiarity breeds contempt” is apt in that when your staff views you as a coequal, they start to feel a sense of entitlement and grow to expect leniency in the rules. As a cautionary tale, consider the bumbling boss on NBC's The Office, who prioritizes fun and socializing over productivity and is rightly seen as a pushover by the staff, who then mimic his dilatory work habits.

Many doctors, especially in small practices, feel the need to show their staff that they are “one of the gang” by engaging in after-hours social situations. At first this may seem like a good way to build esprit de corps. Inevitably, however, the doctor loses the respect of the staff and at worst becomes the subject of jokes told behind his back. This is a reason why the military has officer's clubs — they give officers a place to enjoy an evening with peers and not be under the scrutiny of the soldiers they command.

Familiarity with staff can become an extreme situation when a physician or manager starts having a relationship with staff. In the military, this is strictly forbidden because it disrupts the chain of command. In an ophthalmology office, relationships can be catastrophic. This is the ultimate creation of an office “pet” and breeds contempt among the other staff members. Respect is lost and a culture shift takes hold as staff mentally rewrite the organizational chart and believe that anything goes. And so goes the practice. The culture of professionalism and the strict codes of conduct that you devoted years to creating will unravel in short order.

While this sounds like a very lonely existence for doctors and managers, there are outlets. Managers should learn to develop good working relationships with other managers in the practice or industry. Doctors need to avail themselves of the professional relationships that are available locally and nationally. These relationships are both supportive and nurturing, as they are built with individuals who have the same life experiences — both good and bad — that you do. Through these relationships, problems can be more easily resolved or prevented.

Moving Up the Ranks

Caste systems can sometimes be viewed as fixed or hard. Just as in the military, with extra training, dedication and time, staff can work their way through the ophthalmology ranks. In my organization, we have several managers who have risen from entry-level positions. Their “in the trenches experience” is one of the intangible assets that make them exceptional. Almost all of them will tell you that the hardest part of making the transition from staff to management was not obtaining the core of knowledge but learning how to set the appropriate social boundaries. Sometimes it is easier to enter an organization from outside than to work your way up.

Like it or not, with the title of doctor comes certain role expectations. As the saying goes, “You can't have your cake and eat it too.” A leadership position is easier when you have the respect of those you lead, and respect does not come unless you have earned it. Team building and group interaction are very necessary to keep an organization moving forward. Just as the military has joint exercises, your practice must have everyone working together, but roles and boundaries must always be respected. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.