Practice Management
June 2022

by Corinne Wohl, MHSA, COE, and John B. Pinto

Practice administrators are usually—and ideally—replaced with a lot of notice and pre-planning. But in today’s challenging workplace environment, an administrative changing of the guard can happen more abruptly than in the past.

The challenges of modern practice, compounded by COVID-19, have left managers and doctors alike with a bit of a hair trigger. We are seeing more managers unexpectedly leave, and more short-fused boards terminating their lay leaders. But mostly, there is so much demand for top-notch management, administrators who were once well anchored have become flight risks.

If your practice is especially dependent on one talented administrator who acts as the organizational glue, losing them can be a lot harder than losing a contract or having a physician retiring early. The difficulty is doubled when their departure is unanticipated.

Here are seven ways to have your practice prepared in the event of an abrupt need to replace your administrator.

1. Always know the kind of administrator you need at the moment. That will help you continue to mold the manager you have to your ideal needs and quickly launch a new search should the need arise acutely. To accomplish this, annually review and revise your practice’s short- and long-term goals. When you know and prioritize what the practice needs (e.g., marketing, more detailed financial management and reporting, improved HR policies, etc.), you are more likely to align your administrator’s attentions to your needs as a practice owner. This kind of annual assessment will help shine a light on missing administrative skills that can be backfilled with training or outside advisory support.
2. Rally your middle managers; this is especially important if your administrator is leaving under strained circumstances. During most planned exits, the administrator can hand off the baton and encourage the staff to move forward positively without them. When an administrative leader leaves under the duress of unplanned illness or other unexpected, abrupt circumstances, employees can react with fear, not knowing how this change will impact them personally or the practice overall. Staff need immediate and consistent reassurance that you have a definitive plan to move forward and that any stress or adverse impact on them will be temporary. The remaining managers and staff often use the opportunity of a departing administrator to step up and work together as a team to fill any gaps, especially when you as a physician leader step up and communicate specifically and consistently to the team.
3. Be prepared to step in substantially as the “MD/CEO.” In small and medium practices—those with eight providers or less—a physician leader stepping in results in fewer bumps during the transition. This is most commonly the existing managing partner, but it can also be another surgeon or optometrist chosen by the managing partner to take the helm. Everyone wants to know who is in charge. Don’t leave the team guessing. Help them remain focused on patient care and less worried about the transition to a new leader. As a bonus, the physician leader who steps in temporarily as an MD/CEO will be more capable of knowing the skills needed by the new administrator and better at assisting with the initial onboarding transition. To accomplish this, focus on the highest priorities. These will hopefully be aspects of the practice you are already conversant with, but they may be practice domains you will simply have to learn on the fly. They include:
   • Cash flow is paramount. You need to have a full understanding of revenue cycle management in your billing department (or outsourced billing service). Examine the written protocols. Know who is responsible for each role. Be prepared to run and interpret reports. If you are a solo practice owner, it’s smart to know even the granular basics before you lose an administrator, like how to post a charge and submit a claim.
   • In addition to bringing the money in, you may be temporarily responsible for accounts payable. In average practices this is typically not too hard; the managing partner or their designate is obliged to review invoices and sign checks. Now may be the time to engage a bookkeeping service to stay on top of accounts.
   • Understand all components of HR management and employee benefit administration; this is something that can often be pushed off to your CPA or a comprehensive payroll service in a pinch.
   • Communicate clearly and often with managers and general staff. Be aligned with your management team to the point of having them comfortable bringing you both the good news and the bad news. Without this, you could miss out on important information.
4. Get your priorities straight. As in medicine, triage. Separate out administrative duties and projects that can be pushed off for a later time when the new administrator is hired vs. those that need near-term attention. At any one time, an experienced administrator is juggling numerous projects and tasks. It is not realistic to expect that an interim administrator, a covering MD/CEO, or even a newly hired superstar administrator would be able to manage and complete all of your legacy activities on time. Learn which are the high-priority tasks that no one else could do in a pinch vs. those tasks that can be delegated, delayed, or even canceled.
5. Look within your mid-level management team for immediate bridge support. One of your department heads may be able to act as interim administrator. You may have an associate doctor who can fill this role. Many consultants and accountancy firms are willing to act as interim administrator.
6. Don’t delay the recruitment process for your new manager. Establish a search committee. Update the position description. It’s harder than ever to find a qualified administrator, partly because the field is so competitive and partly because practice complexities have grown so much in recent years.
7. Finally, when things calm down, perform an assessment.
   • Why did you lose your administrator in the first place?
   • Why with so little notice?
   • Were there signs you overlooked that they might be a flight risk?
   • Is it simply a matter of too little compensation, encouragement, praise, or face-to-face time?

Once you make the next administrator hire, close any gaps to help improve tenure in the future.

About the authors

Corinne Wohl, MHSA, COE
President
C. Wohl & Associates
San Diego California

John Pinto
President
J. Pinto & Associates
San Diego, California

Contact

Wohl: czwohl@gmail.com
Pinto: pintoinc@aol.com