We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing. While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention. The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast). So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict. Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff? We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue. It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to
Does your specialty have an association just for practice administrators and managers? Specialty practice management associations like the AOA (for ENT administrators), ADAM (for dermatology managers), and others are some of the most lively and valuable networking and education groups around. If you haven't looked into whether your specialty has a practice management association, it's definitely worth your while to investigate. Not only do these groups offer the chance to network with other managers in your specialty (who understands your world better than someone else in the same role?), they often have other benefits to help you succeed in your career, such as: Benchmarking and compensation surveys Discounts on products and services Specialty focused coding help Annual conferences and regional meetings Online education, webinars, and certification programs for skill-building Job boards To save you the time of investigating, here are some of the specialty focused administrator and manager groups that we're aware of. (If you're a member or representative of a specialty practice management group we've omitted here, please contact us so we can add your group to our list.) Specialty Association Website Dermatology ADAM (Association of Dermatology Administrators & Managers ada-m.org Emergency Department EDPMA (Emergency Dept Practice Managers Association) edpma.org ENT AOA (Association of Otolaryngology Administrators) aoanow.org Neurosurgery NERVES (Neurosurgery Executives Resource Value & Education Society nervesadmin.org Oncology AOPM (Association for Oncology Practice Management) oncpracticemanagement.com Ophthalmology ASOA (American Society for Ophthalmic Management) asoa.org Orthopedic AAOE (American Association of Orthopedic Executives) aaoe.net Pain Medicine SPPM (Society for Pain Practice Management) sppm.org Podiatry AAPPM (American Association of Podiatric Practice Managers) aappm.org Radiology RBMA (Radiation Business Management Association) rbma.org Reproductive Medicine ARM (Association of Reproductive Managers) asrm.org/arm Rheumatology NORM (National Organization of Rheumatology Managers) normgroup.org Urology AUAPMN (AUA Practice Managers' Network) auanet.org
Yahoo! reports that a recent study by the Workplace Bullying Institute showed that bullying -- defined as "abusive conduct that is threatening, intimidating, humiliating, work sabotage, or verbal abuse" -- is a problem at nearly half of all US workplaces. They also found that 27% of all adult Americans have directly experienced it, 21% have witnessed it and 56% of perpetrators are bosses. More discouraging, the study found that employers are doing little to combat bullying. Among employers who had received complaints about bullying, only 12% established policies to combat bullying, and only 6% reported a zero-tolerance approach to eliminating it. And, the researchers also found that all this bullying has a high cost in employee turnover: 61% of employees who were victims of bullying either quit, were fired or were forced to quit. Medical practices exist to help patients, and usually most of the employees in a practice were attracted to the field for that reason -- so you wouldn't think that bullying could be a problem in the practice workplace. But bullying is something we often uncover in working with practices, especially when we're brought in because of high turnover or operating problems that the physician owners are having trouble solving. Despite being rooted in a caring profession, medical practices often have characteristics that make it possible -- even easy -- for bullying to take hold. These include: Physician owners are most often with patients and have little time to observe ordinary interactions between staff Physicians often dislike the management side of their practices and become too trusting of and over-reliant on one or a few key managers -- who then have too much power Managers spot the opportunity to seek excess power from uninvolved physicians -- becoming expert at managing upward and hiding the true nature of their relationships with staff* Physicians may have experienced very demanding, bullying (or quasi-bullying) environments throughout their medical training -- and may adopt the same management style almost automatically, without appreciating the costs When our analysis of a practice suggests that a manager, supervisor or physician colleague may be creating a threatening
Just back from speaking at the wonderful Association of Otolaryngology Administrators (AOA) annual conference -- what a valuable event. It's such a great experience as a speaker to participate in such a well-attended, well-run event. In both of my sessions, attendees were so attentive, taking notes, asking great questions, and making great comments and sharing anecdotes about their own practices. The attendees were helping each other as well as benefiting from content from all of us speakers. I have no doubt all attendees will go home with dozens of ideas to improve their practices' profitability. I was just one of dozens of qualified presenters -- what a download of information for the attendees. And they were clearly so motivated to soak up as much information as possible. (For example, I tried to sneak into the talk before mine -- which started at 7:30 AM! -- on the Affordable Care Act. Standing room only, despite the early hour.) Physicians may sometimes doubt the value of sending a manager off to a conference like this. The cost may be in the neighborhood of $2,000 when travel and downtime are figured in, so it's not a trivial expense. But just one coding tip that brings more revenue or marketing tip that brings more patients -- or compliance tip that avoids an audit -- would pay for that expense many times over. And the network that attendees can form is absolutely priceless. This is especially true when your specialty has a dedicated practice administrators association like the AOA -- but, even at the larger/general practice management events like MGMA, medical office managers will meet like-minded professionals they can bounce ideas off of and gain advice from in the future. In tight times, cutting out conference attendance may seem like an easy choice. However, you may be unknowingly hurting your practice's chances to grow new revenues, stay ahead of regulatory issues, or nip costly problems in the bud. It's useful to be picky about attending events -- make sure they'll have a variety of relevant subject matter that is important to your practice. But don't
If you follow this space, you may already know that I'm dubious about the value to physicians of stopping out for an MBA. As an MBA-holder myself, I think the coursework can be overkill for independent physicians who just want to run their practices better (this is less the case for those that intend on corporate careers, of course). So much of modern MBA training focuses on things that aren't generally relevant to the small/medium business owner (and, therefore, the typical private practice physician partner). Even worse, some of the business basics that doctors need most usually aren't well covered by MBA programs -- managing people; the minutia of local, state and federal regulations; the marketing of a small, local business; real estate finance; negotiations, etc. The other issue facing physicians (and sometimes practice managers, too) is the opportunity cost -- and actual cost. The opportunity cost is the income lost by taking time off from practicing/working to attend an MBA program, and the actual cost is the (often very high) tuition at business schools. For many, perhaps most, private practice owners and managers, it just may not 'pencil out' to take the time and invest the money*. One solution that can work well as a substitute is taking local classes (e.g., nights and weekends) that focus just on what you really need and want to learn. This can be a reasonable approach -- and even a trial to see if further investment in MBA education is of interest. But, there is also the issue of having to attend class at set times -- not always convenient ones. Now, though, there is a better alternative: MOOCs, massively open online courses. Incredibly, some of the most prestigious business programs in the country, including Stanford, Wharton and Columbia, are making some of their most valuable content available through the free platforms like Coursera and EdX. And it's not only self-directed -- i.e., you take the classes at your convenience -- it's FREE! (Yes, unbelievable.) Lest you think this is just throw-away content, Business Insider has kindly assembled a list of some of
The Harvard Business Review has a great tip today, entitled "Always Say Yes to Networking." I love this tip because it emphasizes how important it is to maintain personal connections with the friends and associates in your network -- and to think of networking as the process of keeping in touch and maintaining relationships, not just meeting up for the purpose of job-hunting or other goals. Most of the physicians and medical office managers and staff we work with do little or no networking at all. This is such a missed opportunity. Staying in contact with your network is great for your morale and your perspective -- not just your job prospects. It's harder, perhaps, for medical professionals to break away for coffee or lunch with a friend or colleague. But, social networking can help -- I'm personally so grateful for the friendships I've rekindled using Facebook. Find whatever ways work for you to keep in touch with the people you've met along your journey. Read the HBR tip here.