How to find a good practice administrator

Fill this position properly, and your practice will run much more smoothly.

By Steve Robinson, COE, FASOA

What is the greatest obstacle that physicians confront in their practices today? Insurance changes, vision care plans, Internet competition, the threat of socialized medicine? For the unprepared physician, these and other hurdles are like gremlins, lying in wait. But — should the physician attempt to gain the knowledge necessary to confront these challenges alone, or enlist the assistance of a qualified individual?

Namely, a practice administrator.

The gap between a practice’s medical and business sides is immense. Our medical training programs continue to produce highly skilled clinicians and surgeons who possess a mediocre amount of business principles or even worse, no knowledge. Newly minted physicians are routinely thrust into the outside world with this instruction: Go thou and run a business!

For physicians who lack business and personnel training, disastrous results ensue when they begin their practices, as they have no idea what to expect. The point: Assembling the physician’s team of support personnel is almost as important as his or her medical training.

These tips can help you fill the one position so critical to your success.

Your new right hand

The person to bridge this gap is the practice administrator. All too often, the physician is forced to rely on pure luck when making decisions about filling key staff positions — an approach that does not usually serve anyone well.

It’s the administrator’s role to ensure that the physician is supported by a staff who share the physician’s goals and can assist him on the clinical side. The administrator also heads that other group — dedicated to collecting what is owed and safeguarding there will be enough profits after operational expenses to pay everyone.

Who you choose to fill this position is key to whether the practice runs smoothly, performs well and becomes a pleasurable environment in which to work. Problem is, these people decisions are rarely made properly.

How to get it right? First, understand that deciding on a practice administrator requires a different approach to other practice personnel. The average practice advertises, accepts resumes, reviews applications, conducts interviews, makes preliminary decisions, performs some semblance of vetting and makes offers. Once the practice and prospective employee make their final decisions, everyone hopes for the best.

But, for the practice administrator, let’s add the following.

Clear, concise communication skills

It is critical that the medical and business sides of the house convey to each other what they expect in order to be successful. It is of the utmost importance that the administrator and the physician(s) are working from the same set of instructions.

Some practice administrators cannot communicate on the necessary level. That rare administrator who possesses the ability to communicate, to solicit from the physician just what the expectations are and then act on those expectations makes the difference. The physician must have this level of confidence in the administrator.

How do you ascertain if the prospective administrator possesses those abilities? Physicians are trained to make decisions based on all available data surrounding a patient’s condition, but in selecting a key staff member, not all available data are present. However, some valuable tools offer almost the equivalent of a CT scan when looking at the prospective employee’s qualifications.

Let’s start with: How well does the applicant express himself? Can the applicant formulate a reasonable hypothesis given a reasonable amount of information? To find out, you could give the applicant a set of circumstances that could lead to several different solutions. Based on her answers and approach, do you think the candidate arrived at the correct answer, or at least a good answer?

Here’s a scenario that would accomplish this: Employee Sally, who has a young child, is often tardy. Her lateness creates ill-will among her fellow workers in the insurance department. After the third transgression, the administrator must address the situation. The prospective hire is instructed to choose how she would address this scenario from the following alternatives.

1. Address this problem with Sally before other insurance department employees so they understand she is not getting away with this behavior.

2. Privately address the problem with Sally in an effort to solve the problem, giving her several options as a solution. List the options below.

3. Change Sally’s office hours so she arrives at a later time, allowing her to deal with her child.

4. Write up the situation with Sally, and place a warning in her personnel file.

5. Give Sally an administrative reprimand, and penalize her pay by 10% for the infraction.

6. Give Sally two week’s severance pay, and discharge her for chronic tardiness.

7. Tell Sally that she needs to make a better effort to arrive at her station on time.

8. Tell Sally that her actions are causing problems in her department and other people are unhappy that she is getting off light.

9. Tell Sally that the doctors are upset because she is chronically late and that they are forcing the administrator to take some sort of punitive action.

10. Other:

The answer or answers might not be straightforward. The prospective employee would need more information to know if, say, #4 or #6 could work; the answer would depend on policy manual stipulations and prior transgressions. Also, the correct action could be a combination of alternatives. Never take alternatives #8 and #9.

Writing skills

Related to communication and reasoning skills, can the applicant write? I don’t mean simply pressing the keys on a keyboard or indulging in the ancient ways of putting pen to paper. Require the candidate to write a letter explaining why you should hire her. Does she read? What was the last book she read and how long ago? What was the most interesting part of the book?

When assessing personnel, these tasks and questions are reasonable and legal to use in the decision-making process. Additional aids include spelling and personality profile tests.^1,2 Both are easy to administer, and the results would be useful. One personality profile test is the DISC test.

In this test, the candidate is scored on four areas: dominance, influence, steadiness and compliance. A good leader needs abilities in these areas, but no one person excels in all four. As a rule, good leaders will score higher in the dominance and influence areas as opposed to steadiness and compliance. The results of these types of tests are too broad to discuss here, and the physician(s) who use them should understand the implications of the test assessments. Many of the tests, including interpretations and explanations, are featured online. Use care in administering pre-employment testing; if the applicant is not hired, she may claim the test was the reason. Talk with your attorney for further advice.

Lastly, to make a successful choice in a practice administrator, it is important to convey to the prospective hire the practice’s expectations. Give the applicant a detailed job description, but expectations go far beyond this document. The practice philosophy, its goals and mission should be conveyed in such a manner that no mistake can be made concerning how one is expected to perform the duties listed in the job description. An example of a poorly written mission statement would be, “To offer excellent eye care to the patients who come into our practice.” On the surface, this would seem to be acceptable. The problem here is the ability to judge just what excellence in eye care is and who is responsible for what portion of the activity.

On the other hand, if the mission statement was, “We exist to enhance the quality of sight for our patients through caring service to the community,” we now have a statement that is inclusive of all the activities of all of the people in the practice. Following this mission statement requires the administrator to develop a training program that would have all of the employees pursue this caring service attitude in the performance of their everyday duties. A good administrator will incorporate the assistance of others in the practice in the development of this program. A good interview question would be, “What activities would you see as necessary to implement this mission statement?”

So far, we have only dealt with fulfilling the expectations of the practice for the prospective administrator. It is also very important for the practice to learn this person’s expectations with regard to his future with the organization. If there are signs the candidate is attempting to “escape” from his existing position or if the motivation is the amount of money he can make, the physician(s) should be extremely wary of this candidate. A simple question like, “Why do you want to leave your present position?” can pull the curtain aside on the real reason this candidate is talking with you.

What not to do

What usually occurs: The practice hires the standout personality at the best dollar advantage for the practice. This is probably the worst possible approach to hiring. Long after the joy of saving $10,000 by hiring the less expensive person is gone, the problems related to a failed administrator will linger.

That said, do not always hire the more expensive person. There will always be some dollar boundaries that one should not or could not venture beyond. But keep in mind that some flexibility should be available to the physician to make the best decision possible. There have been cases in which a dollar figure was set in stone and for just a few dollars more the practice could have gotten an A+ person. Instead, they settled for less and went through two more people before they acknowledged the shortcomings of their process. Turnover is extremely expensive.

Personnel choices can make life miserable or wonderful for all concerned. Which would you prefer? OM

FOOTNOTES

About the Author
	Steve Robinson, COE, FASOA, is principle consultant at S & R Consulting, Chattanooga, Tenn. Contact him at steve@srr2.com.