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Selecting and hiring a practice administrator. (Practice Management).

While physician leadership is key to a practice's success, selecting a top-quality non-doctor manager or administrator is vitally important, as well.

This is the person charged with setting up and maintaining office systems ranging from scheduling patients, to billing and collecting fees, to managing front- and back-office staff.

We consider managers as the lead non-physician overseers in a small practice of two to four physicians. They may simply be the most responsible staffers promoted from line positions or moderately qualified medical workers with previous management experience. Their authority is typically limited to managing the lay employees and overseeing the business systems.

Administrators, on the other hand, are typically considered mid- to high-level business professionals, often armed with an MBA or equivalent degree. They may be responsible for leading a larger practice (though "larger" may mean groups of anywhere from a few to hundreds of physicians) in all but the purely clinical aspects of its activities. Regardless of capabilities, though, even the finest administrator typically reports to the physician-owners or their physician-level governing body.

Difficult search

Doctors looking for qualified administrators these days report that it's harder than ever to find just the right person for their practice.

There may be many qualified applicants, but the proper choice depends partly on intangibles that make the selection difficult. That's one reason why practice administrators perceive that competition for these jobs is more intense than ever.

True, well-placed classified ads will amass a sizable stack of resumes, but medical management consultants note that most of them simply don't fill the bill. Given the job market, they see an overabundance of mediocre managers with little experience and many former hospital administrators trying to shift to practice management.

Finding a capable administrator with a credible group-practice track record usually requires screening out dozens of unqualified applicants.

Recruiting methods haven't changed much in recent years. Classified advertising still heads the list. Advertising nationally in professional societies like Medical Group Management Association or your own specialty's academy will gather a broader pool of applicants than just running an ad in local papers. Some state organizations post job opportunities, too.

The Internet also offers new openings for advertising. MGMA, for example, posts classifieds on its Web page (www.mgma.com) on a fee-paying basis. But don't bother with general employment Web sites, like www.monster.com. They rarely attract good candidates for specialized positions like practice administrator.

Also, consider hiring a professional recruiter to help find the right person for your practice. If you go that route, stick with those with experience in practice management recruiting. They understand the most about what it takes to run a medical practice today.

Whatever practical approach you take, increase your chances of hiring the right man or woman for the job by following five key principles. Three apply to the practice and the other two pertain to the candidates you consider.

Mind your P's ...

(1) Preparation

Don't underestimate the amount of work necessary to prepare your practice for a new administrator, especially when hiring your first professional manager. Carefully define the job before you launch your search. As you build a job description for an administrator, keep in mind what it really takes to run a practice in the 21st century.

Prepare yourself and your partners for working with a professional administrator, too. Carefully assess your need and your readiness to accept executive leadership. Too often, a medical group hires a "pro" then fails to grant the necessary authority to take advantage of his or her experience and training.

(2) Pay

Recruiting a top-flight manager is no exception to the trite saying: "You get what you pay for." Salary and benefits for skilled executives keep rising.

Surveys like those published by MGMA and The Health Care Group report average annual salaries from $60,000 for smaller groups to $125,000 for those with more than 25 physicians. (salaries at the manager level are lower, often in the high $30s and low $40s).

Plan to pay generously in the search process, too. It's good. to cast a broad net to catch a good manager and a national search can cost plenty. Recruitment expenses like national advertising, candidates' airfare and travel, long-distance moving expenses and recruiter's fees can add up.

(3) Persistence and patience

Going through a stack of 50-75 lackluster resumes can discourage anyone seeking the right person to run a medical practice. But don't succumb to the temptation to compromise. Take your time and put forth the effort required to find someone who will perform up to your standards. Settling for a candidate you're unsure about will bring nothing but misery for everyone involved.

... and your Q's

(4) Qualifications

Based on your job description, develop a list of basic skills needed to meet the job requirements. MGMA's educational arm, the American College of Medical Practice Executives (ACMPE), came up with a catalog of eight "knowledge domains" that contain the core competencies for modern practice administrators. Depending on your practice's situation, you'll have to decide which of these eight domains to emphasize:

1. Financial management

2. Human resources management

3. Planning and marketing

4. Information management

5. Risk management

6. Governance and organizational dynamics

7. Business and clinical operations

8. Professional responsibility

Be flexible when evaluating candidates' abilities. Don't get hung up on how many letters follow their names. A candidate with 10 or 15 years of successful group leadership may overshadow a candidate with a brand new MBA or MHA from a prestigious educational institution.

(5) Qualities

Once you find a qualified candidate, make sure he or she is the kind of person you can trust to run your practice. Look for ethical character and charismatic leadership traits. And pay attention to your own visceral response. Do you sense a "chemistry" that bodes well for working together in the future? There's nothing wrong with waiting to hire someone you just plain like.

Careful interviewing

Skill at interviewing becomes a major factor in choosing the right administrator. You need to probe critically for details.

If, for example, the candidate lists constructing a medical office among his or her accomplishments, ask direct questions about the project's size and complexity. To reveal depth of understanding, ask questions like, "How did the new office design improve work flow?" or, "Describe the building's ownership structure."

Asking for descriptions and specific examples makes it difficult for interviewees to bluff when confronted with their weaker subject areas. If candidates claim to have set up in-house accounting, ask about accounting software and chart of accounts structure. Non-specific answers may indicate only superficial knowledge. If candidates claim to have written a formal business plan, ask them to describe the plan and whether it was successful.

Ask questions that help you understand the leadership skills and style. Probe aspiring administrators' experiences in eliciting physician cooperation. Ask for examples of successes and disappointments. Try to discover if they learned what works -- and what doesn't. Consider describing a moderately challenging, real-life situation -- like an inter-doctor conflict -- and ask the interviewees how they would handle it.

Have applicants describe former employers' profit-distribution formulas. Listen to see if they can communicate complex ideas clearly. See if they understand collecting and analyzing data by asking which financial reports are the most important and why.

Discussing pay

Professional search firms usually ask about compensation needs and expectations early in the screening process. You can improve your search process by sending a compensation questionnaire to each candidate up front.

One fine consultant suggests asking these questions:

* What is your current salary and bonus? What amount do you seek in a new position?

* Describe your current benefits in detail. What benefits do you consider essential in a new position?

* What is your current bonus potential? How much did you receive last year?

* When was your last performance evaluation? What was the outcome? Did you receive a raise?

* Do you have financial guarantees you'll have to surrender if you leave your present position?

* Will your spouse's leaving a current job or seeking reemployment create a hardship for you?

* Will you need temporary housing? Do you expect difficulty in selling your home? What do you anticipate needing as a moving allowance?

Room to negotiate

If an applicant's expectations far exceed the package you plan to offer, you may decide he or she is out of your league. If, on the other hand, the position you're offering represents a big economic step up, it may indicate that the candidate is not ready to run your practice.

But don't let money become the sole deciding factor. If resume and references point to an outstanding candidate, invest the time and effort necessary to find out if there's room to negotiate compensation.

Make your final decision with as much objective information as you can. Don't ignore chemistry, of course, but don't simply hire someone for this critical job because the candidate feels right

A chance to succeed

Finally, when your hard-won administrator arrives on the job, don't expect miracles immediately. Most problems you want fixed didn't develop overnight.

Give the newcomer a chance to settle in, analyze the practice and develop action plans. And finally, remember this truism: "Highly successful practices consistently hire competent people and then stay out of the way to let them manage properly."

Advisory Publications, based in Conshohocken, Pa., is a monthly newsletter service that publishes The Physician's Advisory, a newsletter that includes advice on business, tax, management and financial matters involving health care.
COPYRIGHT 2002 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2002, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Publication:Physician Executive
Date:Sep 1, 2002
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