Are you toast? Why owners fire practice managers

Are you toast? Why owners fire practice managers

Don't get burned by a bad manager. You're the practice owner, and that means you need to keep a finger on the pulse of everything that's happening at your practice.
May 01, 2009

Not too long ago, I sent a questionnaire to the employees of a practice where I was scheduled to do a consultation. I was shocked by their responses! Employees reported that their practice manager was ineffective, showed favoritism toward certain team members, failed to respond to employees' problems, and set a poor example by coming in late, taking long lunch hours, and coming and going as she wished.

The practice owner expressed concern too. She said the manager, who was responsible for the practice's financial accounts, didn't enter invoices into the computer, posted items to the wrong accounts, and reported faulty information on financial statements. She was also paying bills late, and as a result, expenses such as bank charges and late fees were being assessed to the practice. My question: How on earth did this manager still have a job?

I asked the manager what she did on a day-to-day basis. She had a hard time answering me. She wasn't crunching the numbers anymore—she'd been relieved of many bookkeeping and accounting responsibilities when the practice had hired a bookkeeper. Someone else was in charge of inventory. A supervisor interviewed job candidates. She wasn't conducting employees' performance reviews. The practice wasn't doing any marketing. She wasn't keeping personnel records up to date.

So what was the manager doing? She told me she was solving a lot of problems in the practice. And based on how she was managing, I didn't doubt that. While I was in the clinic, I watched a client wait an hour and a half for an outpatient office visit. While this client was waiting, the doctor was available and the exam room assistants were piddling around. But the manager had no idea. She almost never got up from her desk to walk the floor, other than to use the restroom or smoke a cigarette. Instead she had her nose glued to the computer screen.


The problem at this practice wasn't just the manager—it was also the owner who didn't supervise the manager. Several years ago, when I started encouraging practice owners to hire managers, it was a foreign concept. Owners were used to overseeing management duties themselves. Now the pendulum has swung the other way, and most practice owners are comfortable hiring a manager. But your responsibility doesn't end when you hire a manager—you must still oversee that person and make sure he or she is doing the job effectively.

Remember, delegation is not abdication. Hiring a manager does not mean you can throw everything on his or her plate and walk away. You are in charge. And you manage your manager by inspecting what you expect. Sit down once a week (or more or less often if needed) with your manager and review the projects he or she is working on.

Keep a checklist of tasks that you review during your meetings together. For instance, your manager should provide you with a monthly financial statement, complete with accounts payable and accounts receivable. Every month he or she should report on your inventory and support costs compared to gross revenue.

At these meetings the two of you should also review personnel issues: new hires, disciplinary problems, performance reviews, training and CE initiatives, and so on. Your manager should also tell you about any problems with the facility, clients, or general practice operations.

Consider using a management report that outlines key indicators such as the number of new clients, average income per client, total transactions, individual doctor production, and so on. Have your manager pass this information along to you on a monthly basis. In short, you as the owner need to be fully informed about the management and operations of your practice. It's unacceptable not to seek this information from your manager. It's your practice, and you need to know what's going on. This is not micromanagement—it's common sense.