Why I Now Need A Practice Manager

My practice has grown to the size where I just don’t have enough hours in the day to do everything that needs to get done. I have put off hiring a practice manager as long as possible, but I have finally reached the point where I threw in the towel. I don’t want a practice manager, I need a practice manager.

There are a lot of behind the scene tasks that happen each day, and I had to learn to delegate. Learning to delegate is an important part of scaling a business. I’m hiring a practice manager to help me focus on big picture.

Why I Waited So Long To Hire A Practice Manager

My practice is my business. Like any business, the founder often describes their business as their “baby.”

I put so much sweat, hard work, and long hours into getting this practice off the ground. I often do think of this business as my baby in a way.

For 3 years I held out hiring a practice manager, because I figured I could manage the practice myself instead. However, I’m now so busy with all the other things that go on with running a practice, I just don’t have time to manage the smaller day-to-day tasks.

Salary: The average practice manager makes about $70,000 per year.

When starting a practice, I still do believe that is not practical to pay this much money to someone when in reality there is not that much to manage. Money is tight in the beginning. Minimizing costs is key, and hiring a practice manager is simply far too expensive. If I would have hired a practice manager my first two year, my take home pay would have dropped significantly.

More Money More Problems

As I hired more physicians, my practice of course grew. The good of hiring more physicians is more money coming in each month. We are closing in on a quarter million dollars per month in revenue. Insane to even type that as I still remember my first $3 paycheck from insurance companies 3 years ago.

The bad are the headaches that comes with “rapid” growth.

My staff has grown from just me and 1 part time employee 3 years ago to now 14 people on the payroll. I’m also in the process of hiring 5 more people to help grow the practice.

This type of growth comes at a cost. There are a lot of headaches as you scale a business. Each physician and each new hire has a personality and issues that they bring to the workplace. Managing these issues has become more than I have time to deal with on a day-to-day basis.

Examples of Issues

I no longer have the time or desire to:

  • Manage employee days off or their sick call out days.
  • Manage small grievances with workers and deal with small “write ups” with employees. One MA recently complained that another MA was spending too much time on Instagram and this had to be addressed. At this point my time should not be spent on these minor issues.
  • Dealing with inventory and checks on inventory. Making sure our vaccines or toner for the printer is in stock and accounted for.
  • Creating or changing new minor protocols for the work staff. For example, manager updating protocols to run eligibility ahead of new patient visits.
  • Talk to every drug rep or device rep that calls our office.
  • Dealing with protocols for unhappy patients and standing as a buffer between the physician and the patient for payment issues.
  • Posting new job availability and weeding through applicants / doing initial screen.

A Buffer For Everyone

One thing that I grew to hate was direct contact or availability.

Once a rep or patient has you on the phone or face to face, they are going to get 100% out of that time. As a physician and business owner your time is precious.

Having a manager can act as a buffer to avoid the prolonged issues that could have been dealt with my someone else.

For example, one patient got me on the phone for a question about a complaint with the clinic. He complained that he could not get through on the phone to our office. Despite us having a secure way to message the staff or ways to leave voicemails, the patient went on a fifteen minute rant about how bad this system is.

That 15 minutes was time that I listened to their complaint instead of seeing a patient, which of course put me behind schedule.

Addressing patient complaints is important. Hearing feedback is important. Having the physician do this while they could be seeing more patients is not an efficient use of the physicians time.

Looking forward to a little vacation time soon back in Hawaii

Qualities That Make A Good Manager

  1. Great work ethic ***This should be number 1-5***
  2. Calm and collected
  3. Personable
  4. Great leader
  5. Great problem solver
  6. Good at defining roles but don’t limit their role to only management. Not afraid to do the task that needs to get done.

Some Of My Questions When Interviewing An Office Manager

  • Have you ever managed a medical practice or other type of business before?
  • Have you ever created protocols for a medical practice?
  • Give me an example of something you instituted as a change in a medical practice and what happened after that?
  • Give me an example of something that failed that you managed and how you dealt with it?
  • Tell me about my clinic and how you would help us grow? ***I like to know that they at least did some research on our practice***
  • What if an employee calls you at 6am with a problem, what are you going to do?
  • How can you be an asset to my business?

Focusing On Running A Business

As you scale a business, different problems arise. I remember listening to a podcast by Peter Thiel where he was describing problems with scaling growth of any business.

He was talking about how every factor of 10 comes with new big problems.

Going from 1 employee to 10, or 100 employees to 1,000 employees has many issues that go along with that factor of growth.

I’ve since crossed the 10 employee threshold and expect to cross the 20 threshold by the end of the year. We are starting to feel that factor of 10 growth.

While I enjoyed being involved with my early hires, it is no longer feasible for me to do all the steps to hire anymore. I need to have a manager who can assist with the above tasks as we grow.

Promoting From Within

One thing that I’ve told all my employees is that as the practice grows, I want them to grow with it.

I interviewed a few possible managers but none stood out to me like one of my current employees. This current employee I already know. She has great work ethic, and a wonderful problem solver.

I’ve made her an offer to have her rise up into the manager role with an increase in pay as she develops those management skills.

One extra benefit of promoting from within is the huge boost in morale. All of a sudden my other employees are excited that they can learn new skills and move up in the company as the company grows.

My Next Steps

As I let the manager take the captain chair of some of these day-to-day issues, I set my sights on bigger picture items.

I’m currently in the process of hiring 2, possible 3 new providers (depending on scheduling).

I am also currently in the process of looking for a third clinic location to expand into. I’ve already begun talks with a wonderful doctor who is interested in being the main staff at the new location if it were to open.

I have also taken more of an interest in bringing on additional services that can bring in revenue for the clinic. This includes eventually running our own labs.

One big benefit to hiring a manager is that as I have learned to delegate more. I no longer find myself waking up at 4am or 5am to work on administrative tasks for the clinic. I feel like I am getting my balance back in life which is worth a lot.

2 thoughts on “Why I Now Need A Practice Manager

  • October 17, 2021 at 11:27 AM

    I have been practicing for ten years, and prior, I was in IT for 15 years. I remember precisely when I realized that I lacked some knowledge. It was when my practice was just big enough to be a headache. On the one hand, I was finally making good money, yet on the other, I was spending so much time documenting and dealing with non-clinical issues – it was not fun. So, I slowed down and went back to school to get an MBA – yes! It seems extreme, but that is what I did, and I do not regret the detour. Medical education glosses over business training as an after-thought, which will catch up with you when you open your first practice. Learning on the job is extremely expensive. One of the principles taught in business schools I wish I had known is the delicate balance between scaling a practice and maintaining good customer service. Here are some potential pitfalls clinicians find themselves in;
    1. Hiring without training. People who are the face of your company, on the phone or in person, can make or break the practice or drive you into early retirement. Pay them well and TRAIN them to be an extension of you.
    2. Money issues. Clinicians get very comfortable outsourcing the collection and management of their money. Go on youtube and watch a video on how to manage your practice finances. Most clinicians’ solution to money problems is to work more – trading life for money. Not cool!
    3. Scaling a practice. Everyone wants a bigger practice for reasons not well thought out. If your small practice is not well-grounded in policies and procedures, it sits on a shaky foundation. Growing that practice without taking care of the problems will only magnify the problems you have now. If you are sleeping 4 hours now, expect 2 hours when you have a larger practice.
    4. Technology. Almost every process in your office except the part that requires medical education can be automated. Investing in the right tech can save you a boatload of money on overhead. A self-scheduling system alone opens your front desk 24/7. Telemedicine gives a revenue option to practice while on vacation in Maui. Billing and EMR software come in different flavors. Frankly, some make you less efficient so, don’t just choose the one you are familiar with; make the sales rep work for your business; ask the software vendor to customize the software to reflect your business model.

    In summary, the decision to hire anyone should be based on need and a well-defined job description. I go to Starbucks more times than I should. What strikes me about the company is that the Baristas are all knowledgeable and adequately friendly every time. The coffee tastes the same, and the bathrooms are clean. If your practice was Starbucks, your staff would be knowledgeable and friendly like those Baristas at Starbucks. The patient experience would the same every time. Starbucks can do this because Howard Shultz laid the right foundation when the company was small. Barista training is 14 days before a new employee makes a cup of coffee for a customer. How long is your training? My point is, well trained front-line staff can save you the $70K of hiring an office manager.

    Ephraim M | Hutano

    • October 18, 2021 at 2:02 AM

      Love all of your points and very well said that many newer practices need to hear. Especially point number 2. we have to work smarter, not harder.


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