Much like the differences between
men and women, there are fundamental differences in the ways the surgeon and the practice administrator function. Understanding how the other person works can make both jobs easier, and good communication is the key. Here's why.


After the Hire: Get to Know Each Other

"The administrator is the person who gets all the blame when things go wrong, and none of the credit when things go right," says James D. Dawes, MHA, CMPE, chief administrative officer at the Center for Sight in Sarasota, Fla. He knows a little something about the need for good communication: With more than 18 years of experience as a practice administrator, including the past three at the Center for Sight, he has to communicate with the practice's 15 physicians, including seven surgeons, across five locations.

Think about what you want your administrator to do and clearly communicate it. Jim Brocato, a principal consultant with Medical Consulting Group in Missouri, says the process starts with the doctor, or doctors, understanding what the goals of the practice are. For example, is the goal to grow surgical volume? Patient numbers? Capacity? Is there enough staff to cover these goals? Ultimately, you want an administrator who has the knowledge and resources to make those goals fit the reality of the practice, he says, while ensuring everything runs smoothly. The administrator needs to be the visionary who oversees the day-to-day work making sure those goals are being met.

Once you've hired an administrator with the right knowledge and resources, work with him or her  to set up a job description of what needs to be accomplished in the position, suggests Joan Wahlman, president of JD Healthcare Consul-tants in Houston, and vice president of Impact Medical Media. She says it's important to communicate the time by which things need to be completed—this afternoon, tomorrow or next week.

Have a written agreement about which decisions and actions the doctor will be involved with. Miscommunication problems occur frequently in this area. You need to have a clear understanding about which decisions the administrator can make without consulting the doctor first, Ms. Wahlman says, and which decisions the doctor wants to be involved with.

Mr. Dawes agrees, saying that proper controls need to be in place so the administrator is involved in appropriate decisions. For example, the administrator doesn't need to be involved when the surgeons decide on clinical care decisions of the practice, such as to use a new treatment or technique, but if there is a change in treatment, the administrator needs to be informed so he or she can relay the information to the rest of the staff. Mr. Dawes says this is why "administrators need to be involved in everything, but not necessarily in control."

Kevin T. Kelly, a regional practice consultant with the International Vision Network (Lin­denhurst, N.Y.) says the doctor may want to be involved in areas such as hiring and firing. The administrator should present the information to the doctor for the final decision on such matters.

Deciding on the amount of involvement the doctors need to have depends on the size of the practice, Mr. Dawes says. For example, doctors should be involved in firing decisions if they have direct involvement with the person being fired; if it's a large practice and the employee was only there three months, the doctor doesn't need to be involved in that decision, but if the employee was there for 20 years, the doctor might need to be consulted before any action is taken.

While the doctor doesn't need to be involved in every decision, Mr. Dawes adds, he does need to be informed of decisions—in a quick and timely matter. A note that "we had to let Jane Doe go," will do. It's important to let the doctors in the practice know about new hires as well.  

Trust each other. Obviously, this will take some time to develop, but the trust factor has to be in place or the doctor will always be second-guessing the administrator, Ms. Wahlman says. She suggests spending some time together outside of the office and getting to know each other by going out for lunch to discuss the practice. As with any relationship, professional or personal, "trust is the key element," Mr. Dawes says, "and once you lose it, you can never get it back."


Stay in the Loop

Have regular meetings to update each other. Have the whole staff meet first thing in the morning everyday to do a rundown on the day's schedule. The doctors and administrator should meet weekly to talk about the direction the practice is going in and to update each other, recommends Amelia Rogoff, co-owner of The Eye Group, a Florida-based ophthalmic recruiting firm. Mr. Kelly agrees. "Set up a dedicated time and place to meet, on a regular schedule," he says.

Meetings need to be productive and information-filled. "Doctors need to ask objective, numeric questions of their managers," says John Pinto, a San Diego-based ophthalmic practice consultant, and the manager must understand what these numbers mean for the practice. It helps keep the doctor engaged in the business end of the practice while showing the administrator there is trust and confidence.

Meet once a month to go over financial statements, expenditures, technology and patient volume numbers associated with growing the practice, Mr. Brocato says.  

The question of how often to meet depends, again, on the size of the practice, Mr. Dawes says. For a practice with a group of physicians, the administrator should meet with the board monthly. If there is a single-owner, the administrator should meet with him or her weekly. His rule of thumb: "The smaller the practice, the more frequent the meetings."

You can never communicate too much. Some doctors have a hands-off approach, while others like to have lots of information; it's up to each practice to figure what is best to suit its own needs, Mr. Kelly says.

Mr. Dawes agrees that the administrator needs to keep the doctors extremely well-informed about areas such as financial performance, business growth, industry trends, patient satisfaction and practice benchmarks. A common mistake he sees is not enough details passing back and forth between the two parties. It is essential for the administrator to "get as much information to the physicians as possible so they can make informed decisions about the practice. For example, physicians need to know about any financial trends and how they will impact the practice in the coming months, which is especially important when trying to grow the practice, he says, "because the physicians are the producers."

In the information age, communication doesn't need to occur face-to-face, Mr. Dawes adds. Mr. Dawes relies on e-mails and voicemails to update the surgeons in his practice; they can listen to them at their convenience during the day. Even sticky notes on a report or file can work to leave messages for each other. "Expedienct trumps pretty," Mr. Dawes says, a firm believer in "over-communicate versus under-communicate" and "under-promise and over-deliver."


Keep the Relationship Strong

Be open to change. As the doctor, you need to respect your administrator and realize you hired him or her to make your practice grow, and to do that, some changes might need to occur. "The sky isn't going to fall if someone makes some changes," Mr. Pinto says. However, Ms. Rogoff notes that the administrator can't just come in and start changing things around without discussing the changes with the doctor. The key to communication, she says, is listening: The administrator needs to understand the goals of the practice and make sure the changes move things in that direction.

Present a united front. It's also important the administrator and the surgeon be on the same page when dealing with the rest of the staff or the outside world. It's OK to agree to disagree with each other, Mr. Dawes says, but "it is important to communicate one message as a united front."

Remember that it takes a team effort to make the practice work well. "It is important the doctor doesn't micro-manage the administrator," Ms. Rogoff says. The doctor needs to stay engaged with what's going on in the office, but allow the administrator to do his or her job. Successful practices, she says, figure out what the doctor needs to be involved in, and what the administrator needs to be involved in, keeping in mind that certain authority should automatically come with the administrator's role. "They have to make sure they are constantly on the same page as far as how the practice is running."