Published 8/1/2008
Steven E. Fisher, MBA

Avoid these team-busting practices

What NOT to do if you want a strong office team

Building an alliance with your practice executive is key to ensuring that your practice runs smoothly, efficiently, and profitably. Last month, we looked at 10 tips for establishing an alliance with your manager. But sometimes, what you don’t do is as important as what you should do. Here are 10 “don’ts” that will help keep your team intact and functioning well.

DON’T undermine authority
permit violations to the “chain of command.” Your practice executive executes the directives that you and your partner(s) have established. Individual physicians who sidestep the executive and issue contrary directives will undermine the executive’s effectiveness and virtually guarantee that he or she will leave at some point.

DO NOT micromanage. You are paying your executive a salary to execute your directives (or those of the practice owners’ collectively). A competent manager with the necessary resources doesn’t need constant input from you. You can keep your finger on the pulse of the office through short weekly meetings with the executive, and a longer, monthly meeting. Develop agendas and keep notes of any decisions that are made. In addition, the executive should meet on an ad hoc basis with doctors who have resumed responsibility for functional areas such as finance, personnel, or marketing.

DO NOT ever show disrespect for your practice executive or criticize him or her in front of other staff. If you show disrespect, your staff will also disrespect the administrator, reducing his or her effectiveness and eventually triggering the executive to leave or be terminated due to (perceived) incompetence.

DON’T upset the playing field
enter into any joint investments with your practice executive lightly. Often these result in awkwardness and bad feelings. Although your motives for making the investments may include improved patient care, increased convenience, and financial return, the practice executive may focus only on financial return. Moreover, conflicts of interest and payout agreements can be problematic.

DO NOT treat your practice executive the way you treat your partners. A distinct power difference exists between physician owners of a medical practice and their chief executive. When disagreements arise, specific “rules of engagement” should be followed. The practice manager should adhere to these same rules in connection with his or her staff.

DO NOT put your administrator in a “no win” situation that will cause a certain percentage of the doctors to become angry with him or her. For example, do not involve the executive in discussions concerning distribution of physician income, a partner’s noncompliance with practice rules and regulations, or decisions to censure a doctor.

DON’T expect the unreasonable
leave establishing priorities completely up to your administrator. Develop a strategic plan that identifies what you want to do and when you want it done. If your executive comes to you and asks for assistance in identifying what to do first, recognize this is a plea for help so that he or she can help you build your practice.

DO NOT force your administrator to run the office as a “lean-and-mean machine.” Orthopaedic offices need to be run efficiently and effectively, but they also need to maintain the highest quality of care. A “lean-and-mean” philosophy may be perceived by staff and ultimately by patients as an uncaring, financially focused atmosphere, rather than a patient-centered, quality office.

DO NOT forget the positives and remember only the negatives. Businesses expect that a percentage of programs, projects, and initiatives will not be successful. A well-written business plan and appropriate due diligence can reduce the odds of failure, but return requires risk. If you tally the negatives but take the positives for granted, you create a negative environment that poisons relationships in the long term.

DO NOT become too dependent on your practice executive. Most orthopaedic surgeons intend to practice for most of their professional lives. Most practice executives, however, do not expect to work for the same employer or do the same job forever. You should anticipate that your executive may only remain with you for 5 to 10 years before moving on. Understanding this from the outset will make any transition more smooth and amicable.

For more information
Visit the AAOS online practice management center (
www.aaos.org/PracMan) for samples of strategic plans and operating budgets, sample employment agreements, and other tips on developing an effective team in your practice.

Steven E. Fisher, MBA, is manager of the AAOS practice management group and a former practice management consultant and practice manager. He can be reached at (847) 384-4331 or sfisher@aaos.org