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111 OPHTHALMOLOGY BUSINESS February 2018 digital.ophthalmologybusiness.org contribute to the practice's success. In many cases, these managers and administrators are long-term, hard-working, dedicated employees and will be worth investing in the resources it takes to bring them up to speed. a. Revise all management position descriptions, so owners and man- agers are clear about the perfor- mance expectations in the current environment. b. Identify weak or missing skills that are needed to achieve higher performance in each position. c. Create a development plan for each critical staff member, with a syllabus of skills to be tuned up. d. Don't just create a dry list of job skills, write down specific, measur- able goals and deadlines. e. Provide the resources needed by your administrator and managers. These may include: educational meetings, reading materials, pro- fessional coaching and guidance (your attorney to help the admin- istrator appreciate HR law, your accountant to train senior staff on how to read financial statements, your general practice consultant to formally coach executive per- formance). EW • One-to-one meetings with administrator and each depart- ment manager: weekly • All hands staff meetings: monthly or quarterly or even annually depending on practice size • Board/financial meetings: monthly in most settings • Department meetings, held by each manager: monthly or bi-monthly 5. Excess costs and insufficient revenue Profit margins have been falling over the past 20 years. Stagnation and even decline in third-party reimbursement, compounded by slowly rising labor, capital equip- ment, and general expenses are "scissoring" the average practice no matter where you do business. Even in the most technically vanguard practices, the adoption of direct pa- tient payments for premium services is barely keeping up with pressures in other areas. 6. Management qualifications lag behind rising business, regulatory complexities Not all office managers and ad- ministrators are up to the task. The primary cause is having not been educated or trained properly for the current day practice management challenges. It's easy to overlook that the pace of your practice success has outgrown your manager. It is common to meet an office manager that was hired 10 years ago when the practice had one doctor and five employees. The doctor han- dled the practice finances and the office manager was an all-around utility player, the glue that held the practice together. Ten years later, this practice has expanded to four doctors, 24 employees, and two locations. The office manager, work- ing hard and laboring 50 hours per week, has become responsible for areas where she has received little formal training. There are ways to correct this imbalance and retain the manage- ment team members that you think have the ability to continue to Ms. Wohl is president of C. Wohl & Associates Inc., a practice management consulting firm. She earned her Masters of Health Ser- vices Administration degree at George Washington University and has more than 30 years of hospital and physician practice management expertise. She can be contacted at czwohl@gmail.com or 609-410-2932. Mr. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice man- agement consulting firm with offices in San Diego. His latest ASCRS•ASOA book, Simple: The Inner Game of Ophthalmic Practice Success, is avail- able at www.asoa.org. He can be contacted at pintoinc@aol.com or 619-223-2233. About the authors digital.ophthalmologybusiness.org • New technologies • Strategic planning • Financial management • Business ethnics • Practice revenue • Business management • • Career development • Marketing practices Ophthalmology Business is focused on business topics relevant to today's ophthalmology practice.

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