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Fam Pract Manag. 1998;5(7):69-70

“Can't I just practice medicine and leave running the office to the office manager?” This is the most common question I hear from my clients. Physicians often tell me they didn't go to medical school to be managers!

But today, every physician has an integral part to play in managing the office, including managing the staff. Whether you own your practice or are employed by someone else, you have a stake in the outcomes your practice achieves. If you don't do your part to ensure that the practice performs optimally, you will take part in the failure of the organization — a failure to provide the best service and care for patients, a failure to thrive economically or both.

Whether you enjoy being a hands-on manager or would rather leave the business of medicine to someone else, you have four key management responsibilities:

  • Insist on clarity,

  • Support the office manager or practice administrator,

  • Encourage excellence,

  • Foster a culture of collaboration.


Any doctor who wants the staff to understand where the practice is going and how to get there must be committed to clarity in interactions with employees. Here are four areas in which being clear is especially important:

The overall purpose of the organization

What's the point of working in a medical practice? Why do people put in all those hours? What mission are you trying to accomplish? Let the staff know why you do what you do and what you hope to achieve by doing it, both in the long and short term. People won't work hard to carry out a mission they don't really understand. (Make sure you have a clear understanding of the mission, too, and don't tolerate activities that divert energy from it.)

The decision-making process

How much authority do you keep and how much do you delegate? To what extent do you want to be kept in the decision-making loop, and to what extent do you trust others to handle issues that arise? For example, perhaps you want to make the call to extend the day's schedule rather than leaving it up to the manager or scheduler. Your staff needs to know up front which decisions you want to make, which you look to them for input on and which you want to delegate.

Areas of responsibility and accountability

To help carry out the practice's mission, staff members need to know exactly what's expected of them. Make sure job descriptions and lines of accountability are clear. An organizational chart is key to defining these relationships.

Policies and procedures

Clearly stated (and written!) policies and procedures help staff members do their work quickly and accurately by making plain what they're supposed to do. No doubt you are more directly involved in some of these areas than others. But it's important for you, as a stakeholder in the practice, to do what you can to ensure that the practice's expectations of employees are clearly and consistently expressed.

Support for the manager

Another way you can help manage the staff is by supporting your office manager or practice administrator. Treat the manager as a professional, and ensure that he or she has the resources to be effective, such as current coding and CPT publications, updated software, opportunities for management training, access to the physicians and a budget for rewarding staff.

Have realistic expectations about the manager's responsibilities, and keep that position dedicated to running the office. Expecting the manager to carry out line duties such as collections or scheduling as well as supervise operations and personnel usually shortchanges the supervision.

Do what you can to make sure the physicians in the practice meet regularly with the manager to discuss issues including operations, personnel, staffing, equipment needs, reimbursement problems, patient relations, audits and many others. Maintain the integrity of these meetings by not letting patient care interfere; schedule them during nonclinical time.

And never undermine the manager's position by allowing staff to bypass him or her —even if the person wanting to make an end run is your own indispensable nurse. Publicly support the manager's position and consistently refer staff back to him or her for decisions. If you disagree with your manager's approach to a given issue, don't let the staff see it. Resolve your differences privately.


You expect excellent work from your staff, and you should. But practices also need to provide the resources work — everything from sufficient office supplies to a good information system. To improve their skills and gain new ones, staff members also need opportunities for professional growth. Even if you're not an owner of your practice, your attitudes can have a strong influence on whether your practice makes it a priority to meet the staff's needs. If you don't support the staff's efforts to improve, you can't expect excellence from them.

More directly, you can support excellent staff work by actively recognizing it. When an employee goes above and beyond the call of duty, say something about it publicly and document it in the employee's file so it can be included in the next performance review.

A collaborative culture

Finally, you can help manage your staff by fostering a collaborative culture. Part of creating that culture is being available — simply making time for interaction with staff members. Then use that time wisely. Show your staff you respect them, ask for their input, create opportunities for them to give it and show that you value it.

Staff members also need to know that you're interested in the work going on around you. Show the staff that you recognize the importance of what they do and how it affects the practice's performance.

One way to demonstrate that you value your staff and their work is by setting aside time in the schedule for them to meet regularly. If staff meetings are to take place before or after hours, employees should be paid a flat fee for the meeting time — perhaps $20 each, plus a meal.

Staff members really are the experts about your practice. They do the work. So ask for their ideas about issues facing the practice, and involve them in problem solving. Be willing to listen to their insights, and refrain from deciding too quickly. Where possible, reach consensus before making decisions that will affect everyone. Encourage the staff to take responsibility for outcomes. In other words, make them stakeholders, too.

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Copyright © 1998 by the American Academy of Family Physicians.

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