For decades, veterinary practices have been moving away from the single doctor practice model and towards larger, multi-doctor practices. With practice growth comes increases in the number of employees, clients, and patients; growth of the facilities; and, of course, the finances become far more complicated. As a practice owner, the list of new tasks becomes seemingly endless. You may find yourself asking, should I hire a practice manager? Or perhaps you already have a practice manager; in that case the question becomes, do you really know what your practice manager does?
Situation 1: “My Hospital ADR”
Perhaps you are a practice owner whose hospital has seen some growth in recent years, but you feel like it could be doing even better. You’re not sure how to keep that momentum and maximize your hospital’s potential, and really, you’re not sure which of your genius ideas increases the practice revenues in the first place. It must be those cute baby animal photos you post on your practice’s Twittergram page. Those do get a lot of thumbs ups. Anyway, lately you’ve found yourself spending more and more time dealing with employee concerns, updating the hospital’s website, managing client complaints, checking whether your equipment has been calibrated in the last 15 years…Face it; you’re spreading yourself too thin. So you decide that the next step is to hire a practice manager to handle “all of that boring stuff” so you can go back to focusing on your one true love, medicine. You consider your options and decide to promote your head technician “since she already handles the inventory.” You start drafting an email to schedule a meeting… STOP.
Take a breath.
Now keep reading about someone else’s issues.
Situation 2: “I don’t actually know what my Practice Manager does”
You’re sitting at your desk on Tuesday evening inputting your practice manager’s paycheck and you realize, “I have almost no idea what my practice manager spends her time doing on a day to day basis.” Having spent the last 20 years at this practice and too proud to actually ask your manager herself, you decide to consult Doctor VIN to do some benchmarking—what do practice managers do at other hospitals? Forty-five minutes later, you realize you’ve somehow gotten sidetracked on when Apoquel is ever going to be available again. In the end, you recognize that really don’t know how your manager’s time is allocated, and, what’s more, you’re not really sure what she should be doing.
Situation 3: “I might as well be a firefighter”
A few years ago you were hired to serve as the practice manager for a growing veterinary hospital. You’re a technician by training, but you were excited to take on this new challenge and help the practice run more smoothly. Once hired, you had a few meetings with the owner where he mumbled a few things about human resources, client relations, and you think you heard the word ‘payroll?’ Anyway, the meetings lasted about 8 minutes each (and were interrupted every minute on the minute), and three days later, you began your baptism by fire. Fast forward three years later and no two days are the same. One morning you’re calling a tech to cover for an employee who didn’t show; an hour later you’re scheduling a repairman to come fix the air conditioner; that afternoon you’re trying to fix the website that seems to have crashed. You’re not actually positive what value you are supposed to have to the clinic, but you do know that you spend 90% of your time putting out fires. You pat yourself on the back for keeping the practice afloat.
It’s no secret that the average veterinarian is not known for his/her stellar business skills—but hey, someone has to own our veterinary hospitals, right? Each of the situations above presents different issues from different perspectives, but they all relate back to the same theme: what is the role of a practice manager, and how does that fit with the needs of your clinic?
In true veterinary form, we’ll frame our analysis in terms that we all know and love: the SOAP. The situations above will serve as our client-reported concerns, opinions and insights; in other words, we’ve already covered the “subjective” part. So let’s jump right into…
There are several measurable data that would likely be consistent across each situation above:
- The practice owner has no strategic plan.
- The practice has no organizational chart.
- The practice manager has:
- No job description
- No defined expectations
- No regular performance reviews
- No scheduled debriefings
- No accountability to track time
- No training in practice management
- No idea who he/she supervises
- The owner does not delegate to the practice manager, and there is often redundancy in duties.
All of the findings listed above represent concrete disruptions in the physiology of the business. Just as you list Sparky’s temperature at 104°F with an abdominal fluid wave, our list includes the lack of a strategic plan and organizational chart for your practice. You could probably come up with a set of 10 differentials for Sparky, but do you have anything for your practice?
Based on our objective findings, an anatomic pathologist might give the following morphologic diagnosis: moderate to severe, chronic, multifocal to coalescing, pinpoint lesions caused by iatrogenic hospitalopathy. Lucky for you, your hospital hasn’t made it to the necropsy floor yet, so we have some more differentials to work through.
There are five major systems that work together to keep a veterinary business alive: finances, marketing, human resources, facilities/maintenance, and the delivery of medical services. No one in our “subjective” situations had given serious thought to which of these specific areas needed assessment. In the first situation, the owner recognizes that his practice “ADR” and jumps right to treating it with a practice manager. In hindsight, how crazy is that? An owner needs to delve deep into the physiology of her specific business, identify which of these systems are diseased/neglected, and then determine a treatment—which may or may not be a practice manager.
Further, none of our hypothetical owners had a clear strategic plan; that is, an owner needs to develop her business and career goals and reflect on her reason for owning a practice in the first place: why did you decide to become an owner versus marching on as an associate? Is this just a job? A retirement plan? A means to provide new-fangled, fancy shmancy, top-notch patient care? Or is it some other reason? Before you can set a plan for your business, you need to have a thorough understanding of where you’re coming from, where you want to go, and what function you want your business to serve along the way.
As a parallel, if you’re a practice manager with a “laissez faire” kind of owner, maybe you’re not clear on which systems need help, where you fit into the grand scheme of the practice, and what value you are adding to the practice. You, too, should have a strategic plan for your career and how you want to advance yourself to where you’d like to be. Otherwise, you’re looking at a career of extinguishing fires until you burn yourself out.
So you’ve triaged your practice, taken a complete history, performed a thorough physical exam, done extensive diagnostics (we recommend full-practice MRI), determined which hospital systems were diseased, and come to the conclusion that the standard of care treatment is a practice manager. Congratulations, and a job well done. On the other hand, perhaps you already have a practice manager, and you’ve read thus far and thought, “Well I’ll be. I wish I had read this article years ago!” Either way, it’s time for our treatment plan.
First, you must pick people to fill the role(s) you’ve identified as needing to be filled. Neglecting to consider what you need from your manager before the hiring process makes it difficult to know when you’ve found the right person for the job. You might consider defining your “needs” and “wants” regarding a potential candidate, always keeping in mind that no one is perfect and some skills can be developed.[i] While it may seem like the natural path of progression and easier to promote someone in-house to a new position, success in one role does not necessarily indicate success in another. A great resource for an owner who has decided to hire or fill the position of practice manager is the Veterinary Hospital Managers Association (VHMA), which offers an accreditation program for practice managers and a database for employers and job seekers to connect. After selecting your cool new crew, you should build an organizational chart that pieces the functions of your specific hospital together in a hierarchy. What the heck is an organizational chart? Here’s an example:
Now don’t go printing that chart out and MacGyver’ing it to fit your hospital. Each hospital will have different needs, different roles, and, thus, a different organizational chart. There are many consulting companies that would be happy to help you develop one for your practice, so take the time yourself or set aside funds to have a consulting firm put one together for your hospital. You’ll thank me later.
Once all of the positions are laid out and you have a sense of who’s in charge of who/what, it’s time to work on job descriptions. The VHMA again serves as a great resource via it’s publication of detailed job descriptions for veterinary hospital office managers, practice managers, and hospital administrators. Keep in mind, these job descriptions are “stock.” Just like the organizational chart, you can’t hit print, hand it off to your practice manager and say you followed instructions. Having an accurate, mutually agreed upon job description sets the foundation for your manager’s success in the role.
From the job description, a practice owner and manager should set reasonable expectations and goals for the position. Rather than creating step-by-step roadmaps for how your manager will achieve those goals, it’s best to define ultimate outcomes and allow the manager to work to achieve them[iii]. Moreover, any set goals should be in line with the manager’s specific strengths and talents, and they should reflect the short and long-term goals of the practice itself. Having employees, especially the practice manager, on board with the practice’s goals will promote engagement and creativity (read up on transformational leadership if you want to learn more[iv],[v]). Finally, once a job description, goals and expectations are set, it is critical to establish regular, scheduled performance reviews. Think of these as the recheck appointments when treating a chronic condition. The prototypical INTJ veterinarian will resist having to do performance reviews like the dickens; however, they provide an opportunity to have an open and honest conversation, give constructive feedback, and set new goals and/or expectations. During these recheck appointments, it is important to both emphasize strengths and develop strategies to support weaknesses. Further, documenting all performance reviews is crucial to monitor progress, track trends, and in the unfortunate event that an employee ever needs to be terminated, having supportive documentation reduces your ultimate liability.
Of course, part of our treatment plan might involve taking a closer look at the management strategies and style of the practice owner. In other words, the practice owner might be a great veterinarian but a terrible manager. Even if it’s not intentional, an owner is always modeling leadership and, thus, must lead by example. This includes coming up with a plan for how you will supervise and hold employees accountable, delegating effectively, providing useful and regular feedback, conducting check-ins, and hiring wisely. Owners should also take the time to see managers in action: watch your manager give feedback, conduct job interviews together, review performance evaluations together, and, if applicable, sign up for your practice’s newsletter and social media publications[vi].
With your treatment plan in place, you’re ready to manage your condition. For once in your veterinary career, you get to decide the prognosis. So get to work, and tackle that hospitalopathy.
[ii] Modified from Tumblin, DL (referenced above).
[iii] Harvard Management Update. “How Great Managers Manage People.” February 28, 2008. Accessed July 22, 2015: https://hbr.org/2008/02/how-great-managers-manage-peop-1
[iv] Larson, E. Using Transformational Leadership to Improve Job Satisfaction and Empowerment. J Am Vet Med Assoc. 2014 Nov 15;245(10):1088-91.
[vi] The Management Center. “How to Manage Managers.” Accessed July 22, 2015: http://www.managementcenter.org/article/manage-managers/
 Modified from Tumblin, DL (referenced above).
 Harvard Management Update. “How Great Managers Manage People.” February 28, 2008. Accessed July 22, 2015: https://hbr.org/2008/02/how-great-managers-manage-peop-1
 Larson, E. Using Transformational Leadership to Improve Job Satisfaction and Empowerment. J Am Vet Med Assoc. 2014 Nov 15;245(10):1088-91.
 The Management Center. “How to Manage Managers.” Accessed July 22, 2015: http://www.managementcenter.org/article/manage-managers/