As every medical doctor knows, it takes about 25,000 hours of hard work to go from bright high school graduate to operating surgeon and many more years of experience and learning to reach the level of skill of a surgeon in the middle of their career. Not coincidentally, it also takes many, many dedicated hours to become a great medical practice administrator, and the majority of those hours involve on-the-job training. Administration is not a learned profession in the same way that law, medicine, and engineering are—professions for which a person goes to school, takes a test, and gets a license to certify their capabilities. Only through the collection of experiences over time can someone develop to the level of competency needed to run a multimillion-dollar medical practice.
One of the attributes to look for in a practice administrator candidate is raw experience. Have they spent enough years in the profession to know what they’re doing? (For tips on the interviewing process, see How to Interview Practice Administrator Candidates.) Somewhat paradoxically, the smaller the practice, the more important the role of the administrator. The administrator of a small practice must be able to do it all. This person needs to have a lot of practical, hands-on experience with every aspect of the job. For example, a hospital administrator can transition fairly easily to being the administrator of a $25 million eye clinic in a relatively short amount of time, but this person will likely struggle to fill that role for a $2 million eye clinic. They simply do not have the required experience in the trenches.
How to Interview Practice Administrator Candidates
Large practices may recruit regionally or nationally, which means flying final candidates in for an interview. Over the years, we have noticed that these interviews tend to get at the surface-level issues. In response, we developed an interview system to get more in-depth so practices can find the right person for the job.
Candidates should arrive in the afternoon because they are likely to be flying in from out of town. It is best to meet with them for lunch or dinner in an informal setting to get to know them and put them at ease. This is not the time for hardball questions.
Day of the Interview
Morning. The next day, candidates should come to the office to meet a large percentage of the staff. If it's a small practice, they meet for 10 to 20 minutes with each staff member over the course of the day. If it's a large practice, they may meet only the leaders and some of the senior staff, but they should have a chance to see most of the practice in action. Importantly, they should be given the full financial and performance data (eg, profit and loss statements, balance sheet) for the practice as though it is their job to see these numbers.
Early afternoon. After candidates have had a chance to see the practice, talk to the staff, and review the nuts and bolts of the practice, ask them to write out a couple of pages stating what they would do in their first 6 months as the administrator of the practice based on the information provided. Anyone qualified to do the job will quickly grasp what's happening in the practice and how they would make things better.
Late afternoon. Ask candidates to present their findings and recommendations to the doctors or search committee. This tests the candidates on several levels, including whether they can communicate orally, gather and put their thoughts down in writing, present them to others, and handle pressure. You're not looking for someone who has all the right answers. Nor are you looking for someone who has only two or three ideas for the practice. They should have 10 or 20 solid recommendations for how to improve the practice.
Evening. Assuming their reports and presentations are satisfactory, have dinner with candidates and continue to explore what they have seen and what they are thinking about the practice. If you feel really good about things, you can make them a formal offer at the end of dinner or wait until the next day for the board to make a final determination.
The second thing to look for is raw energy. The really great practice administrators in this field sustain a high level of energy throughout the day and the week. The job requires 45 to 50 hours per week for the average administrator in the average practice.
3. High Standards
You want someone who has extremely high standards for themselves and their organization. Ophthalmologists pride themselves on a performance standard of perfection, even though half of all ophthalmologists will inherently fall below the average line. For a practice to achieve excellence, the vast majority of lay staff must seek that excellence for themselves. The best administrators begin striving for perfection early in their careers but understand that the staff will inevitably fall short of this goal. If you have someone who is more lax about their own standards, their performance as the administrator of an ophthalmology practice will probably be unsatisfactory.
4. Excellent Communication Skills
The most effective administrators are lucid. They convey their messages clearly and in the fewest possible words. Whether they’re writing, speaking, or sending nonverbal signals, they make themselves clear to others. They help team members who are not quite getting something catch up with the rest of the team. They translate the board’s desires to the rank-and-file staff and then translate the concerns of the rank-and-file staff back to command.
Effective practice administrators must also be masters of numbers. They don't walk over to the billing department and ask, “How is billing going this week?” They ask questions that require a numeric response, such as, “What percentage of our open accounts are out over 90 days?” or “What is our current claims denial rate?” That numeracy extends to all dimensions of the practice. There are about 50 key performance indicators for a private practice, and the keen administrator must have command over each one. If you're interviewing administrator candidates, it's important to ask not just the subjective questions about how they've been working up to this point but also to ask objective questions, such as, “What is the average annual profit for a practice like ours?” and “If our profit margin is lower, what will you do?”
Practice administrators are not always subordinate to the doctors in the practice. When it’s appropriate, administrators must step up and be peers and discuss the difficult challenges in the practice. The doctors are, of course, better trained and are the owners of the practice, but they must respect the authority of the practice administrator in certain areas for the administrator to do great work. When vetting administrator candidates, you want them to be able to speak to you factually and not pull any punches.
To use an ophthalmologic term, the best practice administrators are multifocal. They see both the minutiae of the practice—the little things going wrong—and the bigger picture. Like a careful driver, great practice administrators can look in all directions, pay attention to the details, and be aware of the big picture.
8. Skilled Delegator
Even some of the best practice administrators have trouble delegating work to middle managers. When we visit a new client’s practice and the administrator is drowning, it’s most often because they’re not sufficiently delegating to the midlevel managers and department heads or they don’t have individuals in those positions who are strong enough to be trusted to work independently. It’s really important to have an administrator who knows how to get more done with more people, whether those people are inside the practice, vendors, or outside professionals.
The best practice administrators are usually the first to arrive and the last to leave. Although they may talk, walk, and think fast, they are not abrupt. They’re smooth, and in the urgent environment of a busy practice, they’ll calm everyone down and allow everyone to focus on what’s important. We’ve been amazed by the administrators who have held their organization together and shown by their example that their practice will survive the current pandemic.
Practice administrators need to know what the practice needs now and in the future. The ideal candidate has experience that aligns with the position description as it stands and the strategic plans or goals for the practice’s future.