AUG 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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56 EW Ophthalmology Business August 2013 Administrator fit, fitness, and tenure by John B. Pinto "The difference between a good administrator and a bad one is about five heartbeats. Good administrators make immediate choices. They usually can be made to work. A bad administrator, on the other hand, hesitates, diddles around, asks for committees, for research and reports." –Frank Herbert O nly a minority of human pairings work out and last forever. Half of all marriages end poorly. Only about half of the eye surgeons brought in as owner-track associates actually stick around and become a partner. Your average practice lay staffer will leave you after just four years on the job. And virtually all of your acquaintances will fade away well before you grow old, even in the age of Facebook. And nowhere, at least in the business sphere of your practice, is this excess human churning more costly and frustrating than with your practice's administrator, whose average tenure in the average setting is about six years, more or less. Based on my experience, about 40% of you reading this column are ecstatic about your administrator or practice manager. Another 50% or so are equivocal or worst. Ten percent of you are in the hunt for a new lay leader, or will be within the next year. A lot of essentials obviously go into assessing the fit of your current administrator, selecting a new practice leader if and when this becomes necessary, as well as upping the odds for long tenure. Here are seven elements to consider in your own setting. 1. A desire to lead. Those who both work their way into leadership and are competent at it are foremost people who have a desire to lead. Of course, this trait alone, in the absence of aptitude, can backfire. A mere desire to lead does not always align with one's ability to do so. A desire to lead is a necessary but insufficient condition for holding down an administrative job. From my face-to-face discussions with thousands of midand senior-level managers over the last 35 years in the field, it's 2. 3. 4. clear that not all administrators are eager for the challenge. Many are in fact reluctant leaders, elevated above their innate comfort level and competency by well-meaning doctors. Seen from most surgeons' perspectives, this would be like taking on a cataract practice composed of nothing but complications. The exceptional surgeon might relish the challenge; the average surgeon would dread coming to work. If your administrator is out of his/her depth and knows it, he/she is going to be both miserable and disappointing on the job. Technical competence. Put this in doctoring terms. If called upon, I could probably fake it and talk to patients as though I knew what's happening to their eye and how I was going to treat it. But I've never mastered the body of technical skill to be able to actually do the job. Eventually, perhaps disastrously, I would be found out. In the business sphere, the highest technical hurdle is economic analysis. Every effort should be made to assure that your administrator is either already a master of the benchmarks, graphs, and statistics needed to competently assess your practice's health, or is at least progressing toward mastery in this area. Time commitment. Semi-retired ophthalmic icon and pal John Corboy, MD, quips, "If you're not smarter than your competition, you had better work harder and longer than they do." Ophthalmology doesn't cleave to banker's hours. The typical practice administrator, at a minimum, must make a 45 hourper-week commitment to the job. And 55+ hours per week is not unusual, including conferences, industry readings, evening meetings, and the rest of it. Vigor. The best and longesttenured administrators I know tend to be fit and vigorous. This has nothing to do with age. I fondly remember one large client's executive director who 5. 6. well into his 60s would race me up three flights of stairs to his office. And win each time. Dealing with intense people-driven problems all day—and often into many late evenings—takes a level of energy and durability that only the most fortunate and competent administrators possess in abundance. It's a simple question: Does your current manager have the juice needed to lead your company? Face time with the practice's medical leader. Your administrator will languish without regular face-to-face meeting time with the managing partner of your practice. This roughly weekly meeting should be arranged and kept as formally as a patient appointment time. In addition to one-on-one time, the best administrators, working as a collaborative duo with their managing partners, will meet every two to four weeks with the middle-level managers of the practice (head tech, billing supervisor, etc.). These "management committee" meetings are a time to hear firsthand how things are going in every corner of the company, sense the level of respect your administrator commands, and this provides an opportunity to send a signal to middle management that your administrator and his or her team enjoy the board's full support. (What? You say that your practice has not yet formally selected a managing partner? No matter what else you have on your plate for the rest of this year, that's job #1.) Very clear, written expectations about performance. Sometimes when I ask boards what they expect from their administrator this year, I get blank stares. What's worse, I get the same blank expression when I ask the administrator, "What does your board expect of you?" Every practice, even the smallest, should have a punch list of tactical goals for the year. An example would include large and small things like: • Complete Dr. Smith's buy-in transaction • Activate the new satellite office in Centerville • Launch a new senior vision screening program • Add two more techs • Boost practice profit margins from 32% to 36% by the end of the fiscal year • Refinish the reception chairs • Change over to the new phone system • Go live with electronic health records Your list should be reviewed at least monthly at a board level and will ideally show each task, the manager who "owns" it, the deadline, and a few updated progress notes. 7. Finally, there needs to be a sense of backing and support from the top. This doesn't mean that you should avoid frank discussions about performance gaps. But unfortunately, ophthalmologists, like most professionally trained people, are natural-born critics. They are fast to criticize and slow to praise. If you want a good manager to grow with the practice and become a great manager, the dominant message has to be, "We admire you and appreciate your work for us and our staff and patients. We think of you as a peer, someone as professional and competent at what you do as we as doctors are at what we do." Remember that in your position of power as a practice owner—with your administrator's fate and fortune in your hands—even an unearned stern glance can be demoralizing for weeks. To do his or her best job, your administrator needs to know he/she is liked, admired, appreciated, and secure. EW Mr. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979, with offices in San Diego. He can be contacted at 619-223-2233 or pintoinc@aol.com.

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