Eyeworld

be successful it needs to feed on the ideas and energy of its leaders. If your administrator is burned out or has simply been drained of his/her creative juices by too many years in the same position, it may be time for a change. 4. Your manager's numeracy is not up to contemporary require- ments. In days gone by, the accept- able core competencies to run an eye clinic were things like product knowledge, an instinct for managing people, and marketing. Today, the number one competency required is numeric skills (followed closely by clear written and oral communica- tion and raw endurance). If your current manager is "not really into math," it may be time to exchange him or her for someone more nu- merate, or to at least buttress his/her weakness in this area with an in- house accounting resource. 5. Practices are merging, and only the strongest manager is needed going forward. This one is pretty straightforward, and as soon as merger talks commence, both managers pretty much know the score. In some cases, the leadership role can be shared, at least through an initial period of operations con- solidation. But in most settings, a zero-sum choice is obliged, with one winner and one loser. Have the class to make your choice early and help the loser find a new position in the community. 6. Interpersonal conflicts have risen to the breaking point. If you live with a teenager (or act like one in your off hours), you probably know all about "life points"—scores you build or shrink based on your success in a videogame. Administra- tors play the same game, only in real life. They start a new job in your practice with 100 points. Then they lose points whenever they argue with you unpleasantly or make a mistake, and gain points with criti- cal accomplishments. Lose too many points and a manager is pink-slipped —or in many cases should be. 7. Your present manager is good, but you've discovered some- one who is great. Unlike romantic relationships, a roving eye is good for business and it's perfectly accept- able to trade up every once in awhile. Even when you're not look- ing, you may run across a manager so superior and such a great fit with the needs of your practice that it trumps your loyalty to your present administrator. When this happens, do the right thing. Give your other- wise great outgoing manager signifi- cant notice, a generous severance package, and abundant support in his or her job search. 8. Your manager's life situa- tion no longer allows him/her to focus on your practice. Life changes. Your manager may have domestic wobbles, start a family, or start taking care of an elderly parent or spouse. If he or she has a new per- sonal challenge to manage, this can take away a critical slice of manage- ment time and attention needed to commit every week to your com- pany. The distraction may be perma- nent or just temporary. Offering a last chance to get back in the game or a leave of absence may be more appropriate in these situations than frank termination. 9. Your practice is faltering, you don't know why, and your ad- ministrator isn't struggling by your side to turn things around. Ideally, you're in this together. If your practice is on the skids and you feel like you're more engaged with the turnaround than your manager, talk about it. If on most days you still feel like the only sled dog pulling the harness, it may be a sig- nal to find another manager. 10. Practice revenue is shrink- ing, and economics no longer war- rant a higher-level executive. This is rare today, but we may see more of this in the future. In the typical practice, the "brains" of the outfit (your office manager along with var- ious outside accountants, attorneys, and other professional advisors) will cost about 2-10% of practice collec- tions. In a typical $1 million prac- tice, that might be $60,000 for an office manager, $15,000 in annual accounting fees, and another $20,000 for miscellaneous other ad- visors, or about 9.5% in all. The per- centile figure skews lower in larger practices due to economies of scale. A $10 million practice might have a $150,000 administrator, $35,000 in accounting fees, and another $60,000 in professional fees, for a total of about 2.5% of cash flow. If you have a high-priced administra- tor and your top-line collections are shrinking, it may be necessary to downsize the cost of your "brains" to fit new circumstances. In the fu- ture, we may see a trend in smaller practices long observed in optome- try, where an engaged physician- owner takes over running day-to-day operations. Experience shows this is not ideal, but it can work fine for se- lected providers in selected settings and in practices up to about $4 mil- lion in annual collections. These are 10 reasons to consider terminating your administrator. There is at least an equally long list of reasons to NOT terminate, and I've seen all of these in the eyecare board rooms of America over the last 32 years. They include: One-time errors and omis- sions. Remember that although you may hold yourself to standards of near perfection as a provider, the rest of the world is human. One or two crummy management decisions a month is par for the course. Firing as a direct result of scrupulous honesty about bad news. You want to create an envi- ronment where you administrator doesn't fear for his or her job every time he or she brings you the truth. Failure to recognize that no manager has a 100% complete skill set. Strong financial managers may need outside help for market- ing, IT, or HR expertise. Letting things build up in si- lence and failing to confront your manager in the moment when he or she disappoints you. You should give your administrator ongoing feedback—plus and minus—about his or her performance so that over time he or she will do more of what you like and less of what you dislike. Failure to provide progressive discipline. Rather than lowering the boom abruptly in response to poor performance on the part of any staffer, corrective action should be taken in stages—verbal warnings, written warnings, formal retraining, wage reductions, and the like. Judging your manager's job performance based on his or her affability or lack thereof. There are plenty of communicative incompe- tents in every industry who should be weeded out. There are also a lot of relatively dry, dour—but adminis- tratively brilliant—business leaders out there in the world of ophthal- mology. As a practice owner, it pays to know the difference and not sack an otherwise committed executive just because he or she doesn't smile and ask you to lunch every day. EW EW Ophthalmology Business 69 Friday Focus Surveys are a member benefit of the American Society of Ophthalmic Administrators. For membership information contact asoa@asoa.org or 703-591-2220. ASOA, 4000 Legato Road, Suite 700, Fairfax, VA 22033. www.asoa.org. ASOA Friday Focus Surveys Focusing on the BUSINESS of Ophthalmology 1. Given the current economic situation, what type of raises are you giving staff? Response Percent 1-2% 38% 3-5% 32% Less than 1% 3% No raise 27% ABOUT THE AUTHOR Mr. Pinto is president of J. Pinto & Associ- ates Inc., an ophthalmic practice manage- ment consulting firm established in 1979 with offices in San Diego. He can be con- tacted at 619-223-2233, pintoinc@aol. com, or www.pintoinc.com. May 2011 www.OphthalmologyBusiness.org

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