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Office runs better when manager clarifies authority

The manager of a Maryland family medicine practice had trouble getting the physicians to make decisions about important matters. It was bad enough with the three originating physicians from when the practice was set up five years earlier. With the addition of a fourth physician, the chain of authority became even more confusing.

With too many leaders and not enough followers, there was no way the manager could keep everyone happy.

So she told the physicians, “I need to be able to go to one of you when there are questions. Which one will it be?”

Everybody looked at everybody else for answers, so she suggested, “Let’s divide it up.”

What she did was assign each physician a management period. Each of the four physicians takes a three-month turn at being managing partner.

The duties of the managing physician are well spelled out. The managing physician is the one to whom the manager turns with problems she cannot solve. The managing physician also signs the cheques. He or she is the one who represents the other physicians in matters that affect the entire office. For example, if the office is undergoing an expansion and someone needs to sign off on part of the plan, it is the managing physician who does so.

Once a month, doctors hold a joint meeting and manager updates them on what has gone on.

Then they make decisions on the matters that are beyond the authority of the managing doctor.

There is a clear understanding on where the manager’s authority begins and ends, where the managing doctor’s authority begins and ends, and where the group takes over.

For example, the manager can authorize expenses up to $500. The managing partner authorizes expenses from $500 to $1,000. Anything over $1,000 requires the approval of the group.

The office manager also handles personnel. There are 24 staff and the manager has the authority to act alone in the decisions on hiring, salaries, disciplinary matters and adding new staff.

Setting up tiers of responsibility can help any group practice run more efficiently. But it is up to the manager to set the wheels in motion. This manager’s advice is to put a plan on paper, setting out the authorities and limitations and present it to the doctors as an efficient way to operate the business.

The benefits are many.

Every doctor gets a turn at running the practice, and all the doctors participate equally in the business decisions. And for the manager, there is only one person to go to when there is a question.

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