Are you toast? Why owners fire practice managers

Not too long ago, I sent a questionnaire to the employees of a practice where I was scheduled to do a consultation. I was shocked by their responses! Employees reported that their practice manager was ineffective, showed favoritism toward certain team members, failed to respond to employees' problems, and set a poor example by coming in late, taking long lunch hours, and coming and going as she wished.

The practice owner expressed concern too. She said the manager, who was responsible for the practice's financial accounts, didn't enter invoices into the computer, posted items to the wrong accounts, and reported faulty information on financial statements. She was also paying bills late, and as a result, expenses such as bank charges and late fees were being assessed to the practice. My question: How on earth did this manager still have a job?

I asked the manager what she did on a day-to-day basis. She had a hard time answering me. She wasn't crunching the numbers anymore—she'd been relieved of many bookkeeping and accounting responsibilities when the practice had hired a bookkeeper. Someone else was in charge of inventory. A supervisor interviewed job candidates. She wasn't conducting employees' performance reviews. The practice wasn't doing any marketing. She wasn't keeping personnel records up to date.

So what was the manager doing? She told me she was solving a lot of problems in the practice. And based on how she was managing, I didn't doubt that. While I was in the clinic, I watched a client wait an hour and a half for an outpatient office visit. While this client was waiting, the doctor was available and the exam room assistants were piddling around. But the manager had no idea. She almost never got up from her desk to walk the floor, other than to use the restroom or smoke a cigarette. Instead she had her nose glued to the computer screen.

MEET WITH YOUR MANAGER

The problem at this practice wasn't just the manager—it was also the owner who didn't supervise the manager. Several years ago, when I started encouraging practice owners to hire managers, it was a foreign concept. Owners were used to overseeing management duties themselves. Now the pendulum has swung the other way, and most practice owners are comfortable hiring a manager. But your responsibility doesn't end when you hire a manager—you must still oversee that person and make sure he or she is doing the job effectively.

Remember, delegation is not abdication. Hiring a manager does not mean you can throw everything on his or her plate and walk away. You are in charge. And you manage your manager by inspecting what you expect. Sit down once a week (or more or less often if needed) with your manager and review the projects he or she is working on.

Keep a checklist of tasks that you review during your meetings together. For instance, your manager should provide you with a monthly financial statement, complete with accounts payable and accounts receivable. Every month he or she should report on your inventory and support costs compared to gross revenue.

At these meetings the two of you should also review personnel issues: new hires, disciplinary problems, performance reviews, training and CE initiatives, and so on. Your manager should also tell you about any problems with the facility, clients, or general practice operations.

Consider using a management report that outlines key indicators such as the number of new clients, average income per client, total transactions, individual doctor production, and so on. Have your manager pass this information along to you on a monthly basis. In short, you as the owner need to be fully informed about the management and operations of your practice. It's unacceptable not to seek this information from your manager. It's your practice, and you need to know what's going on. This is not micromanagement—it's common sense.

GET INVOLVED

As a practice owner, you should review your manager's work by spot-checking his or her duties. Open the accounting program and see if your manager is entering numbers into the computer correctly. Review employee files and make sure they're up to date and contain all the necessary information. Check the end-of-day reports against the bank deposit statements to verify that they match. Sit in on a performance review and observe how your manager conducts the review. Sit in on an interview or disciplinary meeting at least quarterly. Listen to how your manager deals with client complaints.

Will your manager resent you for being involved this way? Not if he or she is doing a good job. In fact, your manager should be happy to show you how awesome he or she is and be open to any constructive criticism you might offer.

START AT THE BEGINNING

You can avoid the entire issue of a manager not doing his or her job if you start with the hiring process. And hiring begins with an excellent job description. After all, if you don't have a job description, you don't know how to write the employment ad or interview for the position

A good job description will clearly state the manager's duties and responsibilities. If you don't have one, you can get them from many sources or create your own. To download a sample practice manager job description, see the related links below.

Where you find your manager is important. I've seen successful, profitable hospitals managed by very nice, well-meaning individuals who've worked their way up from kennel attendant to receptionist, technician, and now manager—with zero management training. Would you promote someone up the ranks to be a veterinarian? No. In the same vein, think twice before trusting your "baby"—that business you've worked so hard to develop—to someone without a college education, let alone someone without a business degree. This isn't to say that someone who doesn't have a business degree isn't competent enough to manage a veterinary hospital, but in most cases, you're better off making that a job requirement.

It's easier now to find a manager than it ever has been before. There are managers who've worked in dental or law offices who are out there flipping burgers somewhere. They'd love to manage a veterinary practice. You don't necessarily have to hire someone with veterinary experience. You can teach the manager that side of things. It's harder to teach good business and human resource skills.

Once your well-crafted job description has helped you hire the manager of your dreams, the next step is to train him or her. I strongly suggest using a phased training program that takes place over four weeks or more. With this approach, you break down the manager's job description into several components and focus on one component at a time. Different people such as your accountant and bookkeeper can be involved in the training, but as the practice owner, you oversee and review the entire process. Daily meetings between you and the manager may be necessary to help you gauge what—if any—changes need to be made to the process.

After you complete the training process, you must continue to oversee this person. Start with weekly meetings and annual performance reviews. Then build in CE opportunities. Just as with a veterinarian, a manager's training should never stop. Consider stating in the manager's contract that the practice will provide two to three days of CE per year at a cost of $500 to $1,000.

Speaking of contracts, it's important to have your manager sign one. In many instances, a manager can do more harm than an associate doctor when he or she leaves the practice. If your manager hasn't signed a noncompete agreement, he or she can solicit employees or clients, or divulge proprietary information. So spell out all terms and conditions of employment in the agreement and, in states where it's allowed, incorporate a noncompete agreement.

I helped the practice owner terminate the manager I mentioned at the beginning of this article. It was a sad event, and it affected a lot of people at that practice. But it was the best solution. The manager's job is hard; I know—I was a hospital administrator for years. It's also rewarding and critical to the success of the practice. But the owner is still the head honcho, and to hire someone and then let him or her loose without any oversight is just foolish.

Remember, don't expect what you don't inspect. Work with your manager to ensure the success of your practice. If you do, you may avoid the charred reality of firing him or her.