Hiring an executive in a medical practice

By Sherry L. Migliore, MPA

A strong management candidate for a medical group executive position is not always easy to find. While there is no “perfect candidate,” the attributes to look for when hiring an executive to administer a medical practice are summarized below.

Leadership

First and foremost, an administrator must be a good leader of both staff and physicians. He or she must be able to gain the respect of both groups and should have a demonstrated track record in doing so in other organizations.

Much has been written about the qualities of leadership. In a medical practice, leadership involves providing guidance to the physicians in defining a clear vision and strategic plan for the organization. The administrator must then be able to communicate the vision and strategy to the practice employees and obtain their buy-in.

Being a leader also means providing a role model for both staff and physicians—the administrator must be “caring” yet “professional.” Many times, administrators find they need to help physicians relate more effectively to each other and also to their staff.

Communication

A leader must be a good communicator. He or she must be able to develop and maintain a strong communication structure, something that is often missing in medical practices. This includes establishing a decision-making process among the physicians that provides for implementation and follow-up on a timely basis. Depending on the nature of the issue, implementation may occur among the physicians, or it may occur at the operational, or staff level. In either case, the administrator must facilitate two-way communication between the physicians and the staff.

A leader must also be counted on to maintain confidentiality. This is a quality often missing in medical practices. Physicians must be able to confide in the administrator and vice versa. Sometimes there are issues that should not be shared with the staff. The administrator must establish a culture of respect for confidentiality and confidential issues within the organization.

Strategic Thinking

An administrator must be able to take the organization beyond its day to day, operational, “fire-fighting” focus, a common concern in many medical practices. He or she must guide the practice through a process that is oriented towards the future—where is the practice going and how is it going to get there? A strategic vision and plan provides a roadmap for the organization to follow by providing a connection between the decisions employees make every day in the course of their work and the direction in which the practice is heading.

Change Management

Developing a vision and plan for the practice often involves making needed changes within the organization. It is the administrator’s role to manage these changes. This can be a challenging task, since most people resist change.

This is particularly a concern, for example, when physicians hire an executive level administrator for their practice for the first time. The physicians often do not understand the impact that this change alone will bring to the practice. Employees often resist the new administrator because they have become accustomed to going directly to the physicians for resolution of their issues.

If the practice has mid-level managers or other professionals, they may also be resentful of a new “authority figure.”

All of this poses a challenge to an administrator, who must be sensitive to the issues and handle them with a great deal of finesse. It is important that the physicians not undermine the administrator by allowing employees to circumvent the administrator. This defeats the goal of the physicians becoming less involved in the practice’s day to day activities, while also rendering the administrator ineffective.

Team Building

An administrator must be able to build and manage a team—a team comprised of the practice’s employees as well as the physicians. In many practices, physicians do not function well as a team. This is because physicians are independent thinkers and decision-makers both by nature and by virtue of their medical training.

In addition, there are often a variety of personality types within the physician group. Therefore, physicians may be in the habit of making organizational decisions without consulting each other, creating an atmosphere of chaos within the organization.

The administrator must help physicians and staff to work together to solve problems. Team building often involves conflict resolution and, ultimately, finding alternatives everyone can live with. When conflict arises, the administrator must creatively look for middle ground by focusing on points of agreement.

Negotiation

Negotiations occur every day in a medical practice. Administrators must be able to negotiate effectively with payors, patients, vendors, landlords, referring physicians, hospitals, regulatory agencies and the community in general. The complexity of today’s health care market requires the ability to work with a wide variety of stakeholders to accomplish the practice’s goals. An administrator who understands the importance of creating “win-win” situations is a true asset for the practice.

“Firm but Fair”

A good administrator must handle employee situations with both fairness and firmness. He or she must be able to listen to all sides of an issue and make a decision based on what is best for the organization as a whole.

There is often a temptation to make decisions on the basis of how they impact one individual in the practice. This is characteristic of the way medical practices handle employee issues when there is no authority figure in the organization. However, what may appear to be fair for one employee may not be fair to others in the practice or appropriate for the organization overall. The administrator must, therefore, balance the needs of individuals against the needs of the organization and make his or her decisions accordingly.

Technical Skills

An administrator should possess a variety of technical skills, including:

· Financial management and analysis—budgeting, forecasting, cash flow, debt structuring, accounts receivable, cash flow, capital expenditures, reimbursement, fee setting, accounts payable.

· Personnel management—developing and implementing policies and procedures, including position descriptions, organizational structure, performance evaluations and knowledge of legal issues impacting human resource administration.

· Computer skills—proficiency in the use of computer software such as Word, Excel, and other programs. Knowledge of practice computer systems and generation of reports to use in management of the practice.

Balance of Professional and Personal Life

While there may be a temptation to hire an executive who will spend 60 hours at the practice, this is not generally a good sign. Physicians should look for administrators who have a sense of balance in their lives—someone who enjoys spending time with family and friends, and who has outside interests and hobbies. Research shows that the most effective executives are those that are able to balance their work and personal lives.

If an administrator spends so much time at work, this is often a sign that he or she has poor organizational and delegation skills. This may cause resentment by sending a message to other employees that they also are expected to spend all their time at work.

In conclusion, finding a medical practice executive who has to know “a lot about a lot” can be a time-consuming and complex process, particularly for newly created positions. A practice should take time with the process and ensure that the candidate has the “right stuff” to lead the organization into the future.

Sherry Migliore, MPA is Director of Consulting at PMSCO Healthcare Consulting. Located in Harrisburg, PA, PMSCO is a subsidiary of the Pennsylvania Medical Society.