Are You Managing Your Practice or Is It Managing You?
By Ken DeRouchie - Solutions Magazine
Since 1990 it's been my responsibility to interview doctors throughout the country about specific areas of their practices that they'd like to improve. During this time I've spoken to thousands of practice owners in a variety of different situations. I've listened carefully to what they've had to say about the aspects of practicing that they find difficult or troublesome. It's been my pleasure to help them research solutions and implement changes in their practices and I'm happy to say that in many cases they've experienced growth and expansion as a result.
Changes in conditions throughout the world affect the marketplace. This has become even more evident in the interviews I've conducted recently. Doctors have to deal with issues today that didn't exist several years ago. The economy. Post 9/11 business and the impact of that dreadful event. Juggling patient time and management time. Increasing overhead verses net profit. Legal aspects that effect delicate Human Resource issues and their impact on staff management. Increasing government regulations in the health care arena. Changes in insurance. Internet marketing. The downturn in the national economy and stock market crash. The list goes on. It's a different world than when I began my career!
As I look over the responses to the interviews my colleagues and I have conducted over the past 18 months it occurred to me that I should share the information with those of you who are in the trenches week after week. I've also taken the liberty to address some issues point by point, as you can read in my comments below. It is my hope that this information will be of use to you and provide you with solutions to common hurdles and problems that practice owners face today.
Of the doctors we interviewed, 50% were Solo Practitioners and 50% had Partners and/or Associates.
Years as an owner
| 0-5 | 25% |
| 6-10 | 20.7% |
| 11-15 | 13% |
| 16-20 | 9.8% |
| 21-25 | 12% |
| 26-30 | 11% |
| 31+ | 8.7% |
Number of staff
| 0-3 | 20.7% |
| 4-6 | 34.8% |
| 7-9 | 17.4% |
| 10+ | 27% |
What do you like most about being the owner of your practice?
| Having control | 52% |
| Freedom/Independence | 38% |
| Flexibility | 6.5% |
| Enjoy the work | 5.4% |
As you can see from the above question, only 5.4% of the doctors we interviewed stated that the favorite part of owning their practice was the enjoyment of the work they do. That is ironic given that we know from past surveys that most of you became practice owners because you wanted your own practice and to be able to do things your way. You had/have goals and ideals that you wanted to achieve. Unfortunately, many of you told us that your practice controls you much more than you control it. My conclusion: That 5.4 percent are the only doctors who are fully in control of their practices and thus are able to enjoy the work they do.
The next three questions all reveal that staff management is a problem of some magnitude. Please read through the results of these questions. You'll find my comments and conclusions after them.
What do you like least about being an owner?
| Handling staff issues | 38% |
| The responsibility | 38% |
| Time commitment | 19.6% |
| Handling financial matters | 18.5% |
| Business/managerial duties | 17.4% |
What do you feel really needs to change most in your practice?
| Solve personnel issues | 31.5% |
| Improve production & growth | 13% |
| Improve business/management skills | 9.8% |
| Be more efficient | 8.7% |
| A better schedule | 8.7% |
What do you think is the biggest problem that you face as an owner?
| Personnel issues | 31.5% |
| Financial issues | 20.7% |
| Good business management | 17.4% |
The staff management issue, bar none, is the biggest problem plaguing most practice owners around the country. Most of the doctors I've talked to told me that if they could just practice medicine and not have to deal with the staff, they would be so much happier. There is a way to do that!
Before you say, "Easier said then done", read on.
The first step toward achieving your goal of eliminating staff management headaches is this: Obtain and use sound, thorough office policies and job descriptions for EVERY position in the practice. Every little detail of every job in the office needs to be outlined in writing. This enables your staff to fully understand and take responsibility for the job they have. It is also the only way I know of that allows you to hold them accountable for the functions they don't do.
Example: If it's stated in writing that they must perform "X, Y and Z", and they are fully trained to do "X, Y and Z". But they only do "X and Z", you know exactly where the breakdown is occurring. And so will they.
This may sound too simple to you. I can only tell you that I've seen the dramatic difference written job descriptions and office policies make in a practice. These differences come in the form of much less stress for the doctor but have the added benefit of greatly raising production, new patients, gross income and net income. A well trained staff who are all "on the same page" and truly working as a team is worth its weight in gold!
Incentive Programs:
When a staff is fully trained, has detailed job descriptions and office policies and actually uses them, they can achieve their goals and the goals of the practice. If they are given rewards for exceptional production and experience consequences for poor production they can control their own success within the practice. Moreover, they will be solely responsible for their own production. More often than not, staff who are managed in this manner rise to the occasion and become ideal staff members.
Just imagine being able to treat patients all day knowing that your staff is doing every job expected of them: They give superb service to your patients and clients, billing is being done properly, money is being collected and paperwork is all being handled by people who know what they're doing. Your stress is gone, your spirits are high and the office is a joy to come into in the morning.
The bottom line here is proper training. Unfortunately, it is something that's omitted in most practices. I know because doctors who are having staff difficulties tell me so. They either lack the motivational skills, lack the ability to train the staff or just don't have the time. When office policy and job descriptions are missing, the doctor is giving the staff permission to go their own way. If they are not taught the exact way to do every single job that is required of them, they will come up with their own methods. This usually leads to chaos and extreme inefficiency in the workplace.
Most times it is the doctor who has to finish projects started by the staff. It is the doctor who is constantly keeping an eye out for the things the staff missed. It is the doctor who stays late and comes in early to get caught up on work the staff was paid to do but didn't.
Have I made my point? Train your staff well and you will enjoy more success, less stress and a higher quality of life.
Rate the following as to how much you feel each is a problem in your practice. This is a scale of 1-10, with 1 being a major problem and 10 being no problem.
a) Getting enough new patients:
- 0
- 0
- 5.6%
- 4.5%
- 18%
- 9%
- 12.4%
- 21.3%
- 11.2%
- 18%
b) Sufficient net profit
- 3.4%
- 3.4%
- 6.7%
- 6.7%
- 24.7%
- 9%
- 7.9%
- 15.7%
- 13.5%
- 9%
c) Difficulty in getting employees motivated and productive
- 2.3%
- 1%
- 8%
- 8%
- 12.5%
- 10.2%
- 13.6%
- 17%
- 13.6%
- 13.6%
d) Having the quality of life you want
- 2.3%
- 1%
- 8%
- 2.3%
- 9.3%
- 4.6%
- 15%
- 15%
- 19.5%
- 23%
We hope these survey results shed some light on how your and your colleagues view various aspects of practice management. Feel free to give us any further feedback you may have on any of these issues.
Ken DeRouchie
Solutions Magazine Staff Writer
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