Special Considerations for Hiring an Office Manager

Medical practice office managers come in many varieties.
Which type of office manager is the best choice for your practice?

by Laura Sachs Hills

Recruiting an office manager for your medical practice is much the same as recruiting any member of your staff. The application process, preliminary telephone screening, interviewing, reference checking and making the offer are essentially the same. The office manager position, however, has several extra concerns that need your attention.

Which type of office manager should you hire?
Medical practice office managers come in three basic varieties: lay administrators, promoted managers and super-aides. Each has particular characteristics, and pros and cons, worth considering.

Lay administrators
A lay administrator is almost always hired from the outside specifically to manage a medical practice and may or may not have served in various office roles. The lay administrator generally has experience as a manager in another professional practice, or even in a commercial setting. He may have a degree or other training in business administration or accounting, and often has background, training and experience with computers, marketing and interpersonal communication.

Pros and cons
The lay administrator usually has significant management training and experience. He will have managed people and systems before, and will be accustomed to making decisions and delegating to others. Lay administrators often pursue continuing education to keep abreast of new developments in the law, management systems and computer technology, as well as to increase their communication and organizational skills. Many belong to a professional association for practice managers.

On the downside, any individual hired from outside your practice will not have an existing relationship with the doctors, patients or staff, or knowledge of your practice-specific activities and goals. Thus, the adjustment period for any outside hire may be long. In many practices, existing staff may resent, or even resist, the intrusion of a manager from the outside, particularly at first. Often, at least one person on the staff thinks he knows more than the administrator hired from the outside. Occasionally, a staff member (or several) will undermine the authority of a lay administrator or leave the practice, rather than take direction from someone hired from the outside.

Promoted office managers
This type of manager is promoted from a staff position and is no longer performing previous duties. Selection of a promoted office manager should ideally be based upon the individual's supervisory and organization skills and perceived potential to manage. However, this isn't always the case. Many medical practices promote from within to reward staff loyalty and good performance, or because the employee is a known quantity and seems like the safest choice. This is why many medical practices learn the hard way that a good receptionist, clinical assistant or bookkeeper doesn't always make a good office manager. The person also must have managerial talent and potential.

Pros and cons
The promoted office manager has an existing relationship with the doctors, patients and staff and is already acquainted with your office procedures and practice-specific activities and goals. In the best cases, the promoted office manager already has the respect of those he will manage and steps up to the position with the staff's support. Ideal candidates for promoted office managers are those who have already demonstrated leadership ability, and a willingness and desire to face new challenges and learn.

Some promoted office managers say they find it difficult socially to be pulled up from the ranks. They can feel isolated from co-workers they formerly regarded as friends and miss being one of the gang. Many find needed support and information when they join a professional organization for office managers.

In some cases, staff members may be jealous or resentful of the promoted office manager, particularly if staff perceives there was more than one good candidate for the job. As in the case of the unwanted lay administrators, there are occasionally resentful staff members who will object so strenuously to the promoted office manager's new authority that they take action by deliberately crossing or undermining the new office manager, giving him the cold shoulder or quitting.

The super-aide is usually the most senior or conscientious employee who is given the additional title of office manager. He is typically given no specific responsibilities except such vagaries as to coordinate the staff, nor is he relieved of previous job duties.

Pros and cons
The super-aide, like the promoted office manager, is already acquainted with you and your practice. He may experience the same kinds of challenges as the promoted office manager and may feel the same kind of isolation and resistance from other staff members. The super-aide may, however, find it even more difficult to establish his own authority in the new position, particularly if he has vaguely defined authority and responsibilities.

Existing among staff and patients who know the super-aide is a natural tendency to continue to think of the person in the former role and assume that nothing has changed because, in reality, very little has. Of course, it may not be practical for you to relieve your super-aide office manager of all previous job duties. Super-aides, however, generally do best when they have their job descriptions adjusted to relieve them of at least some previous duties, and are given new and higher levels of authority and responsibility. The most successful super-aides don't regard "office manager" as an empty title. Rather, they, and everyone else in the practice, see the step as a real promotion to a new level of responsibility. In many practices, much more can be accomplished if the doctors and the individual can expand the role to promoted office manager and leave former responsibilities behind.

Qualities to look for in an office manager
The best prospects to fill an office manager position in your medical practice usually will have had some verifiable experience in supervision and leadership, plus training in basic business management and accounting. Experience as a business assistant or clinical assistant in a medical practice does not necessarily indicate an individual's ability to manage. Nonetheless, such experience usually provides valuable insights and is desirable.

Writing the job description
The first step toward shaping the role of the successful office manager for your medical practice is to write a complete job description. It should define not only the office manager's immediate role as it has existed so far (or as you imagine it will be), but also how the job will evolve over the next few years, no matter who holds the position.

Broadly speaking, the office manager of a medical practice has overall managerial responsibility for:
  • Personnel
  • Facilities
  • Practice management systems (appointment scheduling, financial arrangements, collections, insurance processing, etc.)
  • Patient relations
  • Internal office communication
  • Marketing
What do these responsibilities mean specifically? Should the office manager set policy or merely carry out your orders? Should he have hiring and firing authority? Should your office manager make decisions about spending and, if so, is there a dollar limit? These are some of the questions your job description should address. Only you (and your partners) can decide how much authority you would like your office manager to have.

There are 10 important general qualifications to look for in an applicant:
  1. Education and/or experience in management or supervision; especially good experience supervising clerical or clinical personnel, including hiring, firing and performance assessment
  2. Above-average intelligence
  3. A positive, can-do attitude and an even-tempered disposition
  4. Proven ability to make good decisions
  5. Organization and the proven ability to plan and carry out projects to successful completion
  6. Ability and desire to learn and grow
  7. Sensitivity toward diversity
  8. Superior communication skills in reading, writing, speaking and listening
  9. Maturity
  10. A proven ability to set and reach goals

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