The job of managing a medical office can be unpredictable, because there’s not the luxury of answering to just one boss. Instead, there are as many bosses as there are doctors, and the doctors don’t always get along with one another.
For that reason, survival rests on neutrality, says management consultant Donna R. Gary of Legal Administrative Services in Sacramento.
The manager can’t form an alliance with any single doctor “but has to keep the relationships with all the doctors equal,” she says. The manager’s job is to be “the glue” that keeps everyone together.
Have courage: face the grouch
A major issue: Follow the chain of command.
No matter how disagreeable a doctor may be, “deal with the right person,” says Gary, who is herself a former office manager. Don’t go to a favorite doctor with something that’s in another’s realm.
Suppose the manager needs approval for a software purchase and Doctor A has responsibility for the office’s technology. But Doctor A is brusque and grouchy, so the manager takes the request instead to Doctor B where there’s a good working relationship.
Doctor A is going to hear about it and isn’t going to be pleased. And the situation could worsen. Doctor A could tell the others that the manager and Doctor B are teaming up for some sort of mischief.
Sidestep the criticism
Another scenario: One doctor criticizes another.
Don’t get caught in the middle; don’t join in.
That’s not easy when the doctor doing the criticizing is a favorite, Gary says. But it’s a necessity. Count on it that the other doctors will get wind of the conversation and lose trust in the manager.
The situation could also take an unexpected turn. If the manager later meets privately with Doctor Criticized about some other matter, Doctor Favorite could see the manager as a turncoat.
Stay out of the conversation, she warns. If that’s not possible, play the part of peacemaker. When the criticism starts, respond with, “That’s possible, Doctor Favorite. But you have to admit that Doctor Criticized does X really well, and that’s one of the things that makes this practice successful.”
Go no further. Don’t try to get the two to a point of agreement. “Just hope it will die there,” Gary says.
Present a solution and bow out
More political entanglement can come from physician demands.
One physician says, “Finish this project immediately,” whereupon another comes in with, “Put that project on the back burner and do this,” followed by another who demands to be put ahead of the other two.
The natural tendency is to favor whichever one is easiest to get along with or even the one who hired the manager, Gary says. But making any choice at all can be political disaster.
The safest approach is to ask the three to sort it out among themselves. But don’t make it a cry for help. That’s weak. “Always propose a solution,” Gary says.
Send an e-mail that reads, “I have three tasks I need to get done right away, one for each of you. In my mind, it should be prioritized as A, B, and C, and here’s why. Let me know if you see it otherwise.”
With that, there can be no accusation that the manager has chosen sides. Instead, there’s a proposed solution based on objective criteria, and any argument has to be contained among the three doctors.
It ain’t none of me!
The worst of all nightmares: A doctor asks the manager to participate in some unethical or even illegal activity.
The scenario can be quite serious, Gary says. Suppose Doctor Sly is cheating on the other doctors and tells the manager to give him all the financial documents pertaining to some matter and not let the other physicians see them. The manager gives him the documents, and then the others ask for them.
Once again, the solution is to stay neutral, Gary says.
Send an e-mail to all the doctors – including the cheating one – and address the issue as a detached observer: “Many of you have asked me about the financial statements for X. Doctor Sly told me to give them to him, which I did. Please contact Doctor Sly for the statements.”
However, she adds, if it turns out that all the doctors are shady, start looking for another job. Associating with an unethical organization can ruin the manager’s reputation and career.
Fall back and regroup – fast!
Another unfavorable scenario: The physician with whom the manager has worked most closely leaves, retires, or is ousted from the practice.
“It’s something to worry about,” Gary says. “It’s possible the manager won’t be there much longer.”
To maintain status quo, meet with the remaining doctors immediately to map out how the office will proceed from there.
Draw up an outline of the work in progress and whatever issues need to be addressed. Tell how each item has been handled and ask how they want to proceed from there.
Focus on how best to serve the practice, but at the same time be subtle and point out the valuable things the manager has done while working with the former doctor. For example, if the manager improved the collections by 15%, say so.
End the meeting with a positive comment such as, “I’m looking forward to working with all of you and doing what’s best for the office.”
“A manager who’s valued,” she says, “won’t be asked to leave because of one or two partner physicians.”
Let the money do the talking
Conflict. One doctor wants a staffer to go and one wants the staffer to stay.
The manager agrees with the latter.
The most logical approach is to illustrate the money side of it, Gary says. Show what the staffer’s salary is and point out that yes, “the office can get someone else for $500 a month less” but that has to be weighed against the cost of going through several people to get the right one.
Point out too that the office would have to give up X and Y services that the current staffer is doing well just to save the $500 a month.
Then back off and leave it to the doctors to decide.
First to thine own self…
A physician alliance may be good for the moment, but look to the future. It can end the manager’s job.
Gary cites one situation where there was a merger, and Doctor Adamant in the first office didn’t want Doctor Newcomer in the second office to come into the practice as a partner but as an employee physician.
Over Adamant’s objections, Newcomer came in as a partner. The conflict between the two was well known, and the friction between them continued.
After a few years, Doctor Adamant left, and there were hard feelings over the departure.
Any manager seeing something like that “needs to look down the road” and anticipate the possible consequences, Gary says. Teaming up with Doctor Adamant could be beneficial for the present, but once that doctor leaves, the manager inherits the war with the other doctor.
