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Physician and practice administrator partnership

By Alice Anne Andress

We are all affected by the recent changes in health care. Specifically, changes that affect physician practices, whether solo or group. Many times, these constant changes demand immediate decisions, ones that cannot be analyzed or researched for months. Welcome to the world of the administrator and physician! For the purpose of this article, the term administrator will cover office managers as well.

Successfully confronting change requires administrators and physicians working together as partners in a team for problem solving and decision making. Because of the constant demands on physicians, it has become increasingly important to delegate responsibility of management issues to administrators in certain instances. Many physicians today feel that their administrators are efficient, capable and will rise to the occasion created by these changes.

Administrators are generally hired by physicians to perform management tasks for their practice; however; only a few administrators are actually in a position of authority. As physicians become engulfed by “marching orders” of patients, payors, insurers and regulators they must delegate more functions to the practice administrator. Therefore, administrators must be politicians, economists, personnel directors, counselors, efficiency experts, architects, police officers, purchasing agents, psychologists, engineers, teachers, and last but not least, facilitators. Administrators are trained to multi-task, to handle day-to-day personnel problems, patient complaints and cost saving measures. They are taught to handle patients, payors, insurers and regulators without missing a beat. They can concentrate on groups of people and generally do not work in a one-on-one environment. Physicians are trained in medical school to treat patients, to abide by the Hippocratic oath and to deal with people one-on-one. Therein lies the difference.

Often, in a medical practice, administrators are expected to relinquish all critical decisions to the physicians, whether they are knowledgeable about the area or not. In some practices, administrators find that they have ultimate responsibility but limited authority over those whose productivity and fiscal accountability they supervise. Many group administrators learn quickly that it is the physicians who make the major decisions as owners and producers in the practice and yet they are charged with implementing the decisions. Therefore, facilitating decision making, managing the personnel and business affairs of the physician practice are the ultimate responsibilities of the administrator.

Most physicians understand that they must change their management philosophies to deal with changes in health care. Although understanding the need for change does not make it easier, physicians across the country are adjusting their corporate culture in an attempt to keep abreast of developments. A recent study by Scott Z. Beethe (a study through the American College of Medical Practice Executives) surveyed medical groups about governance issues that identified fear of loss of income and the need to react to changes in health care have resulted in increased involvement in strategic planning for the practice, more efficient and effective practice governance processes and better educated administrators. Developing these skills will help to move the physician practice toward more effective decision making and delegation of managerial tasks. Many physician practices have already advocated such steps and are in the process of implementation.

The first step in creating this new physician/administrator team is for the physician to become better educated in leadership and management. Physicians must understand the importance of teamwork. It is the role of the administrator to encourage team development among the physicians and support staff by sharpening their collective skills in communication, leadership and motivation. The principle of teamwork can work at all levels within the physician practice. The problem that physicians have with this concept is that in medical school, they are taught to be independent thinkers so that they can assume responsibility and accountability for the welfare and health of their patients. Physicians may have difficulty in adopting the “group mentality” required when they become aligned with other physicians in medical practice. It usually becomes the administrator’s responsibility to facilitate effective communication and problem solving that will allow the physician practice to meet its goals. How many times do physicians say, “I just want to treat patients!”. Unfortunately, in today’s changing environment, this can be a dangerous mindset.

The second step in this process is the development of practice committees to support the organizational structure. Assigned members must be dedicated and accountable. Committees can be valuable in providing research for major decision making processes. They collect and analyze data, and then present recommendations to the board. This is not only helpful for practice governance, but also gets the committee members personally involved and invested in the problem and its solution.

The third step is the election of non-physicians to the board. Practice administrators bring value to the board meeting through their educational backgrounds and experience. Who better to understand the issues with daily operations than the administrator?

Physicians who are educated in leadership and management skills, as well as business matters, are better prepared to assume responsibility for guiding teams and partnering with administrators. They also need to understand the dynamics and techniques of group processes and will become more knowledgeable in financial statements, managed care contracts and negotiation strategies.

As physicians understand the message brought about by change, so must administrators. Administrators must confront their own ego discomfort with their supporting role that may hinder a true administrator physician partnership. Administrators can tend to ignore the fact that any one in an administrator role, whether it is in health care or some other profession, must support the performer. Administrators must be confident and affirm their role – as the commercial that states, “We don’t make the plane, we make it stronger.” Administrators must understand that, although they are in a key position within the organization, they are primarily “helpers” that use their strengths to benefit others to develop and succeed.

Administrators can make medical practices better when there is special chemistry between the physician and the administrator – when both bring their strengths together to create a successful medical practice by developing an excellent problem-solving and decision making team.

Physicians who work together with administrators as a team facilitate effective decisions and actions on the part of their practice and improve their prospects for the future. A smoothly run practice will assure quality health care at affordable prices and will attract premier partners in the marketplace. Teamwork will be required of administrators and physicians as they strive to preserve a position in the new health care arena.

Alice Anne Andress is Manager of Physician Services, Parente Randolph, LLC.

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