Fam Pract Manag. 1999 Jun;6(6):52.
Getting paid for administrative work
My practice partner is more of a silent partner. He chooses not to take part in any decisions, whether it's planning the office Christmas party or updating our billing system for Y2K. How should I be compensated for assuming the extra, often time-consuming and distracting role of practice administrator?
Depending on your situation, you could choose one of three approaches: an equal split of profits, a productivity-based model or a fee for administrative work.
If your partner's productivity is greater than yours, based on real collections, an equal split of profits could already contain an element of compensation for your administrative activities, since they could be the reason for your lower productivity level.
In a productivity-based model, profits are separated into pools allocated to physicians for different types of work — such as clinical productivity, administrative responsibilities and management duties — according to an agreed-upon formula.
Another approach is to pay an administrative partner a flat fee before profits are distributed or an hourly rate for administrative work.
In your case, since you feel additional compensation for your administrative activity is warranted, consider informing your partner of your decision to adjust the practice's compensation method. If your partner objects to this unilateral decision, take that opportunity to discuss your practice's compensation philosophy and each of your roles in decision making and practice administration.
Since this can be an extremely delicate issue, you might also consider asking an objective third party to come up with a workable solution.
Confidentiality of diagnoses
Isn't it a breach of my patients' confidentiality to divulge their diagnoses when I write jury duty or work excuses or when I fill requests for records from the workers' compensation board?
Patient confidentiality laws vary from state to state. In most states, patients can waive the physician- patient confidentiality privilege through expressed consent or implied consent. Implied consent, in some states, occurs when a patient files a lawsuit for personal injuries. The law deems that the patient has waived the confidentiality privilege for any records that may be relevant to the case.
For a jury duty excuse, it's up to the patient to decide whether to disclose the medical reason for the request. If the patient is not willing to disclose the reason, he may not be excused from jury duty.
A workers' compensation board can request a patient's records if the patient has signed a consent for release of his records or if there is a state law that requires the records be provided to the board.
Simply filing a personal injury claim or seeking workers' compensation doesn't mean the patient has waived the confidentiality privilege for every medical condition for which he's been treated. The cautious approach, absent a state law requiring production of the records, is not to release confidential information about the patient without written consent or a court subpoena. This way, the patient has the opportunity to challenge the claimed confidentiality waiver, and the physician is not placed in the precarious position of evaluating what has been waived by implication.
Once the patient waives the confidentiality privilege, absent unusual circumstances, the physician should provide the information.
Office manager salaries
I will soon be hiring an office manager for my practice. Do you have information on current salaries for this position?
The Health Care Group, a consulting firm based in Plymouth Meeting, Pa., publishes an annual staff salary survey that includes average salary ranges for 25 medical office positions. The ranges are based on region and years of experience. The survey includes practices of various sizes but doesn't report separate salary ranges according to practice size.
According to its Staff Salary Survey 1999, the average salary for an office manager with less than two years' experience ranges from about $28,800 to $42,800, based on region; the national average is about $33,200. For those with two to five years of experience, the highest regional average remains about the same, the lowest jumps to about $32,800 and the national average rises to just over $34,800. For those with more than five years of experience, the lowest regional average is about $34,700, the highest is about $43,500 and the national average is nearly $36,900.
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