Is Your Office Manager Limiting the Growth of Your Vein Practice?

You have a growing practice and you are considering opening another vein practice across town to increase market share. Is your office manager ready and able to oversee a larger, more complex practice?

A successful practice needs an administrative leader who is capable of functioning as a project manager, can analyze data, and is willing & able to develop short and long-term strategic plans. In my experience, it is very common for office managers to have started their careers as receptionists, billers, and even nurses. If you are planning to continue using an office manager with one of these backgrounds, you may quickly find that this individual will be insufficient to handle the demands that a growing practice will have without further education and/or guidance.

In an expanding practice, your office manager must take charge of a growing and diverse group of employees who may be either at a main office location or at one or more satellite offices. Today’s office manager should no longer help out routinely if the office is short staffed, but rather must concentrate on the duties of managing and providing leadership and guidance to a busy staff while simultaneously attending to their own duties. (This is not to say that on occasion the manager can’t answer a phone, check a patient in, or put a patient in the exam room on a hectic day. Sometimes everyone must pitch in to get through the day. If, however, this is the rule and not the exception, you have a problem with how your office manager perceives their role in your practice).

If your practice is growing and busy, your office manager must deal with issues such as payroll, accounts payable, budget issues, personnel management, QA / QI initiatives, physician productivity / income division, revenue cycle management, upgrading technology and patient satisfaction.

If your office manager isn’t able to perform these operations in a satisfactory manner, you need to consider the following options:

  1. Train your office manager to become a practice administrator. If your office manager is a valued and loyal employee, this is a viable option. In addition, this individual already knows the specifics of your practice. However, an office manager with a nursing background may not have the desire to learn finances, computer technology and the specifics of revenue cycle management. An RN may not want to give up clinical duties to take on the added business responsibilities required, even if additional compensation is offered. If your office manager needs to take CE courses to obtain new skills, consider paying for the classes. A reasonable salary increase and the cost of a few CE courses could be all that is necessary for your office manager to become a competent practice administrator.
  2. You may decide to hire an experienced practice administrator away from another practice. This person will most likely have a vast amount of knowledge and experience to perform the job efficiently. Look for someone with experience in running a comparable sized practice. Expect to pay a premium to attract someone away from another practice. In the health care industry, competition is intense for practice administrators who have the training and skills to be a practice administrator in a large and complex practice. Recognize, too, the importance that the right personality and chemistry play in structuring the practice administrator’s role. While education and experience is important, the practice administrator and the physician-shareholder(s) must be on the same page for the leadership team to thrive.
  3. Hiring an administrator from another industry is a third option. You may find that administrators with similar skills in another industry can easily adapt to managing a medical practice. The new practice administrator may need a few months to become adjusted to your medical practice. If you go this route, you should have someone on staff who has a strong billing and operations background until the new practice administrator becomes more familiar with these tasks.

It is crucial that you plan now for any changes in the size or structure of your practice. Whether you are merging, expanding, or becoming affiliated with another organization, the correct choice of a practice administrator could alter the future of your practice.


  1. Financial Management. Operating budget, cash flow projections, purchasing, accounts payable, payroll;
  2. New Business Development. Help to develop new markets, new services, practice marketing, relationship marketing;
  3. Physician Collaboration. Attend Partner meetings, record decisions made at physician meetings, work with physician productivity and income division matters, physician compliance issues;
  4. Revenue Cycle Management. Audit EOBs to verify that you are being paid at contracted rates; manage payer and patient A/R;
  5. Personnel. Coordination of all personnel activities (recruitment, interviewing, supervision, evaluation, discipline, termination), communication with staff (weekly, monthly, quarterly meetings) and change job duties as required; and
  6. Operational Protocols. Monitor IT initiatives – claims submission, networked computers, phone system, EMR, web site portals, appointment scheduling system; develop appropriate operational policies within departments.

There is no way an employer can entirely eliminate employee turnover. There is nothing you can do when people move, change careers or retire. However, there are certain steps you can and should take to minimize employee turnover. Focus on factors that are in your control.

Salary, Benefits, Raises
Make sure that you are paying your employees a competitive wage and benefits package, but not an exorbitant one. If you underpay your employees, you will be able to attract only those who are not very competent, whom you probably will let go, and/or those who are just starting out, who will learn all they can from you, gain some experience, and move on to better-paying jobs. Either way, your salary policy will generate turnover rather than prevent it.

On the other hand, if you are overly generous with salary and benefits, your employees will expect your generosity to extend to their annual raises and performance may suffer if you cannot fulfill their expectations. At any rate, you probably will not get much more work out of them than you would have if you paid a competitive salary, and your budget will suffer. In a related area, base your raises on merit, not only to encourage those who work hard and learn well, but also to show others what they are missing by not performing well.

Job Descriptions
Formulate job descriptions based on the work that needs to be done. A typical vein practice with (1) physician FTE basically needs a receptionist, an insurance coordinator, a medical assistant, an RVT, possibly a sclerotherapy nurse, and an office manager. Medical practices tend to grow and expand. If your practice changes significantly, so must your staffing. You likely will need to add personnel and also adjust your job descriptions to ensure that everyone is doing work that must be done and no one is doing work that has become irrelevant. If a medical practice has too few employees, they will become complacent and burnt out. If many of your employees are doing irrelevant work and no one has been assigned to do work that has become relevant (or if you assign the wrong employee to perform new tasks) your employees will become confused and frustrated.

Work Environment
Establish a congenial, comfortable working environment, centered on a convenient and functional office with compatible coworkers. Hire employees that play nice together. Develop each employee’s sense of worth and self-esteem. Reward good work publicly, but point out errors behind closed doors. Conduct regularly scheduled staff meetings and publish an agenda in advance for staff input. Assign pertinent presentations to alternate staff to keep everyone involved. Let your employees know what is going on with the practice, if there are any changes they should be aware of, and what you expect of them. Listen to your employees. Do not tolerate griping, but if an employee sincerely believes that there is a problem in the office, quietly investigate the situation, make any necessary adjustments, and communicate the changes to the staff.

If you ask medical staff employees how their last pay raise was awarded to them, replies will probably range from the humorous to alarming examples of employer insensitivity. Unfortunately, many physicians, their practice managers, and administrators do not know how to use salary increases to motivate employees. In some cases, they fail miserably.

A pay raise should always be coupled with a sincere effort to evaluate work performance. Thus, the employee is made aware that their compensation is tied directly to their performance. The evaluation should be scheduled at least annually, with new employees evaluated more frequently during their first year of employment. The strengths and weaknesses of each staff member should be discussed, along with goal-setting for the next year’s performance, and a review of the prior year’s accomplishments.

For a meaningful evaluation, honesty is essential. In order for the employee to fix a problem, you must first identify it. Listen to what the employee says in response to make sure you have understood the true circumstances surrounding the issue. If someone is clearly performing below expectations and, even after discussion, is unable or unwilling to change or to improve, then that employee is a liability for your practice and should be terminated. It is important for your practice’s success that your employees earn their salaries by providing a meaningful contribution to your practice.

Make sure that you stick to how well the employee has performed the requirements of the job, rather than an evaluation of the person. Focus on objective measurements of work performance and behavior to the extent possible. If subjective factors come into play, try to be concise about your point and illustrate it with concrete examples. There are many forms available to document and facilitate the evaluation process, or you can design your own to identify the issues important to you. Make sure that the same form is used for all employees within each department

If practice finances generally permit generous pay raises, emphasize the connection between the employee’s good performance, your practice’s overall success, and the pay raise you are giving. If practice finances won’t permit you to give the kind of pay raise you’d like to give to a good employee, explain the situation and stress your appreciation for the employee’s performance and loyalty.

Hire self-motivated, pleasant, hard-working employees and reward them with a competitive salary, adequate benefits, and merit raises. Communicate effectively with them. Provide a cordial working environment. Make sure everyone is doing the right job the right way. Following these simple suggestions should keep your employee turnover to a minimum.

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