Maybe I am just a "people-pleaser," but I want to be a good boss.  I want my staff to like working in our office.

This is not entirely unreasonable.  I have tried to work by the motto: Your staff will treat your patients in the way that you treat your staff. If I demean them; if I gossip about them; if I have unfair expectations on them; if I don't pay them what they deserve, then I should not expect them to treat my patients well.

Office_Michael_650highOn the other hand, I am the boss.  I have high expectations that need to be met.  It is my vision that they are following, not the reverse.  I see the big picture, and need to be able to lead them in the direction that will accomplish the task we have before us: earning a living by giving high quality care.

This is a real hard balance to have.  There was not a class in medical school about how to be a boss.  The state of most practices betrays this fact.  How do you take a vision about how a practice should run and put it into job descriptions, expectations, and measurable goals?

Plus, there are saboteurs that are trying to undermine you reaching your goals: poor reimbursement, family crises, demanding patients, rising gas prices, emotional problems, office gossip, laziness, and that annoying static cling.  It is like we have to sail a boat over stormy seas, get to the right destination, keep everybody safe in the boat, and also avoid the meteors that are raining down on us.  It is far easier to fail than succeed.

I think this is an underestimated factor in the current healthcare crisis.  In the past, the margins were high enough that physicians could afford to be lousy bosses.  There was no need to maximize productivity of your staff, you could just run more tests or do more procedures.  I think many doctors are so pressured by running the business that they would rather quit or at least abdicate the role of boss.

599-2N16MRBURNS.highlight.prod_affiliate.4 So physicians join hospital-run practices so that they can "just practice medicine."  The problem is (and I have been in this situation) that hospitals don't really care how well the practices are run.  They don't need an efficient process, they just need people on their insurance rosters.  This means that those things that would make the practice of medicine run better are not high priority to those writing the checks.  This situation may be better for some, but most physicians like to have some degree of control (perhaps you have noticed).

So far, our practice is doing OK at this.  We have been able to be financially successful while keeping staff happy.  Here are some of the things we have done to keep things running well:

  • We have very clear expectations.  We have an employee manual that goes over most circumstances encountered in day-to-day life in the practice.
  • We try to listen.  Our physicians are meeting with the administrative staff and hashing out what is working and what is not working.  The physicians are the most important cog in the wheel (because they generate revenue), but they understand that a machine does not work with just one cog.
  • We try to be nice.  Tomorrow our office is closed for "staff appreciation day."  They come into the office in the morning to get caught up and then they go to the lake near our office and mess around together.  We sacrifice the revenue and pay them for the day.  They appreciate it greatly, and I do feel like this has paid off in loyalty.
  • MrSlate We don't avoid confrontation.  I have always said that one of the most important things you can do to maintain morale is to fire people.  You have to reassure the staff that we won't tolerate other workers who don't carry their load.  We also fire patients who don't treat our staff properly.
  • We delegate.  Micromanagement kills.  I have to let my managers manage, nurses nurse (no, not breastfeeding), and doctors need to be doctors.  We have to trust our staff to do their jobs.  As long as a job does get done, why should it matter how it gets done?

I hate being the boss, yet I would have it no other way.  Having a good boss is the only way a practice can survive.