Opinions of PP Practice Administrators/Staff?

[PracManCA]

Hi there folks long time reader, first time poster. I am a practice administrator for a private anesthesia practice and have always enjoyed reading "unabashed" opinion from you students/residents/attendings about the specialty that we have all grown to love.

I thought it would be worth posting here and soliciting opinions of what you feel like you gain from having dedicated non-clinical administrative staff, what you wish they did or didn't do, or anything like that?

So what you got? Feel free to ask me questions also. I handle HR, scheduling, coordinating interview's/extending offers, handling surgeon/staff complaints and most other non-clinical tasks that must be completed to keep a large business afloat.

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[Wiscoblue]

How much does one pay an administrator if we wanted to get one for our 9 person group in a small city in the Midwest? What value would one bring to a small group?


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[IkeBoy18]

how often are you entertained by AMCs?

 

[PracManCA]

how often are you entertained by AMCs?

Quite regularly and its is always a topic at board meetings/retreats. As our shareholder physicians continue to age and look towards securing their retirement the topic becomes much more relevant. I foresee eventually my group aligning with an AMC, especially if their method of "cost reduction" is seen as a positive by our hospital partners.

 

[PracManCA]

How much does one pay an administrator if we wanted to get one for our 9 person group in a small city in the Midwest? What value would one bring to a small group?

It's a hard question to answer because I am not familiar with the mid-west and do not know your current groups infrastructure/leadership structure. A good administrator can increase efficiencies across the board: payroll, interactions with billing companies/managed care companies, HR, scheduling, hospital relationships, ect. I also stay on top of actually putting the boards decisions they make at meetings into action. A lot of groups have issues actually enacting change after they decide on it.

Do you have any knowledge of how your rates average out against your competition or groups in like-areas? A good administrator with experience negotiating with managed care can be worth their weight in gold. It's basically creating EBITDA out of thin air. In terms of $$ its commensurate with experience. On the west coast an experienced administrator for a 10 physician group could make 100-150k.

 

[deleted126335]

Our practice manager was an incredible asset. He had lots of knowledge on payor contracting, HR issues, financial issues, medmal issues, day to day operational issues, anesthesiologist/CRNA issues, He was also a lay psychologist that managed a variety of dysfunctional personalities within within the group. Of course he was hoping that the docs would come through and pay him what he was worth to us. Didn't happen. He was very well compensated based on what his alternatives were in the marketplace. Grossly under compensated based on value added.

 

[PracManCA]

Our practice manager was an incredible asset. He had lots of knowledge on payor contracting, HR issues, financial issues, medmal issues, day to day operational issues, anesthesiologist/CRNA issues, He was also a lay psychologist that managed a variety of dysfunctional personalities within within the group. Of course he was hoping that the docs would come through and pay him what he was worth to us. Didn't happen. He was very well compensated based on what his alternatives were in the marketplace. Grossly under compensated based on value added.

I think this is the norm in the industry. The good ones add lots of value, but I think they end up in hospital administration/consulting/AMCs because of the pay/under appreciation they receive. Glad to hear you had a positive experience.

May I ask how you handle those tasks now without one? Do you have a part-time clinical part-time administrative physician leader? Do you outsource to a management firm?

 

[BuzzPhreed]

My opinion on practice administrators/HR people can be summed-up in two bullet points:

1) You're not an anesthesiologist. You don't become one by osmosis. I can hand you a book about the game cricket, for example, and you could read it cover-to-cover and think you understand everything about the rules and how the game is played. But until you suit up in uniform, grab a bat, and get onto the pitch and take a few swings, you'll never know how the game is really played. You can try to understand what we do without ever really knowing what we do. Just remember that.

2) Your job is to facilitate our needs. Not the other way around. We don't "report" to you. You didn't "recruit" or "hire" us; we chose to join. We can just as easily leave if we're unhappy. So, keep the bullsh*t corporate rules to a minimum, please. We have enough other regulatory **** to worry about.

So, sorry to be a dick. I've gone through this with administrators in the past (and am going through it right now currently with one who is... ahem... stepping on some toes and is about to get his ass handed to him).

The ones who truly "get" it inherently understand those two points. The ones who don't are just obstacles. Some administrators like to think that everything will cease to function if they're not there and/or that they're not doing a good job if they aren't actively "managing" the personnel. No. Just step in and help when we ask for it. Or, if you have an idea, speak up but don't expect that it is automatically going to be implemented. Remember that we are the reason you're there and not the other way around. We bill. You are a cost center.

 

[Mman]

My opinion on practice administrators/HR people can be summed-up in two bullet points:

1) You're not an anesthesiologist. You don't become one by osmosis. I can hand you a book about the game cricket, for example, and you could read it cover-to-cover and know everything about the rules and how the game is played. But until you suit up in uniform, grab a bat, and get onto the pitch and take a few swings, you'll never know how the game is really played. You can try to understand what we do without ever really knowing what we do. Just remember that.

2) Your job is to facilitate our needs. Not the other way around. We don't "report" to you. You didn't "recruit" or "hire" us; we chose to join. We can just as easily leave if we're unhappy. So, keep the bullsh*t corporate rules to a minimum, please. We have enough other regulatory **** to worry about.

So, sorry to be a dick. I've gone through this with administrators in the past (and am going through it right now currently with one who is... ahem... stepping on some toes and is about to get his ass handed to him).

The ones who truly "get" it inherently understand those two points. The ones who don't are just obstacles. Some administrators like to think that everything will cease to function if they're not there and/or that they're not doing a good job if they aren't actively "managing" the personnel. No. Just step in and help when we ask for it. Or, if you have an idea, speak up but don't expect. Remember that we are the reason you're there and not the other way around. We bill. You are a cost center.

You realize he's asking about administrators in private practice, right? They work for the practice. You seem to be describing some kind of interaction with an administrator for an academic department or AMC that didn't work for you but told you what to do.

We have 1 administrator and a couple assistants for her. Then again we are a relatively large corporation between MDs, CRNAs, AAs, and office staff it's roughly 150 employees (if you count partners as employees). They add a lot of value. Help keep track of both little details (expense accounts, sending gifts to the right people at the right time, christmas parties, etc) and big picture items (revenue trends, collections, contracts, etc). Our main administrator gets paid roughly 150K plus benefits.

 

[BuzzPhreed]

You realize he's asking about administrators in private practice, right? They work for the practice. You seem to be describing some kind of interaction with an administrator for an academic department or AMC that didn't work for you but told you what to do.

I am speaking specifically about a person I worked with at my last job who worked for the private practice group and was hired by them. She labored under the mistaken belief that everyone who wasn't a partner - CRNAs included (who hated her) - worked for her. And she often gave advice about what junior anesthesiologists and CRNAs needed to do in the OR to be more effective communicators, efficient caregivers, etc. when she had never set one foot in an actual OR and instead just needed to STFU.

And...

I am also speaking about a current practice manager who is overstepping his bounds, and works (in a convoluted sense) by the management group that is owned by the hospital - it is a very weird practice arrangement that is both private practice and hospital owned, multiple layers, that I freely admit I don't fully understand.

 

[BuzzPhreed]

We have 1 administrator and a couple assistants for her. Then again we are a relatively large corporation between MDs, CRNAs, AAs, and office staff it's roughly 150 employees (if you count partners as employees). They add a lot of value. Help keep track of both little details (expense accounts, sending gifts to the right people at the right time, christmas parties, etc) and big picture items (revenue trends, collections, contracts, etc). Our main administrator gets paid roughly 150K plus benefits.

Yes, this is great. This is the way it's supposed to work.

As a corollary, my father is a senior partner in a law firm and they have a non-legal staff that supports the practice. It's clear that they are needed to do the billing, administer benefits, etc. There's no way that their practice manager would start trying to dictate to any of the people who are actually bringing in the revenue about how to do their job. For example, when they had a problem with one of their associates some time back taking too much sick time, the HR person didn't approach that attorney and do an "on the spot" correction. No. My father, whom was responsible for this junior associate and basically under his (and one other partner's) wing so to speak, pulled him aside and dealt with it.

That's what I'm talking about. It's about understanding who works for who. And I'm not always convinced, based on what I've seen, that this is a fundamental understanding among some practice managers and HR people.

 

[deleted126335]

I think this is the norm in the industry. The good ones add lots of value, but I think they end up in hospital administration/consulting/AMCs because of the pay/under appreciation they receive. Glad to hear you had a positive experience.

May I ask how you handle those tasks now without one? Do you have a part-time clinical part-time administrative physician leader? Do you outsource to a management firm?

We are no longer a private practice group. He landed on his feet for more money, but IMO he should have been more generously bonused by the group with our buyout.

 

[deleted126335]

My opinion on practice administrators/HR people can be summed-up in two bullet points:

1) You're not an anesthesiologist. You don't become one by osmosis. I can hand you a book about the game cricket, for example, and you could read it cover-to-cover and think you understand everything about the rules and how the game is played. But until you suit up in uniform, grab a bat, and get onto the pitch and take a few swings, you'll never know how the game is really played. You can try to understand what we do without ever really knowing what we do. Just remember that.

2) Your job is to facilitate our needs. Not the other way around. We don't "report" to you. You didn't "recruit" or "hire" us; we chose to join. We can just as easily leave if we're unhappy. So, keep the bullsh*t corporate rules to a minimum, please. We have enough other regulatory **** to worry about.

So, sorry to be a dick. I've gone through this with administrators in the past (and am going through it right now currently with one who is... ahem... stepping on some toes and is about to get his ass handed to him).

The ones who truly "get" it inherently understand those two points. The ones who don't are just obstacles. Some administrators like to think that everything will cease to function if they're not there and/or that they're not doing a good job if they aren't actively "managing" the personnel. No. Just step in and help when we ask for it. Or, if you have an idea, speak up but don't expect that it is automatically going to be implemented. Remember that we are the reason you're there and not the other way around. We bill. You are a cost center.

You sound like the majority of the docs in our practice. They thought that because they were smarter than our practice manager, our accountant, our attorneys, they automatically knew more about those fields than people who had actually undergone formal training and been working in those fields for decades. In other words: Arrogant. There is the clinical side of anesthesia and the business side of running a practice. Because we excel at one does not mean that we excel at the other. There are no dummies in my practice. Most of us are the brightest guys in the room that we are in. We also don't know what we don't know.

It is another reason that doctors are deservedly labeled as the worst investors.

 

[BuzzPhreed]

You sound like the majority of the docs in our practice. They thought that because they were smarter than our practice manager, our accountant, our attorneys, they automatically knew more about those fields than people who had actually undergone formal training and been working in those fields for decades. In other words: Arrogant.

Oh brother. That's not at all what I'm saying. If that's what you got from my post you have serious reading comprehension problems.

The problem is that a lot of docs are simply spineless pussie$ so they hire someone to do their dirty laundry. Of course people with business experience need to be there to help run the business. They are not (or should not be) responsible for actively managing physicians or other people who actually bill and bring money into the practice. Did you even read my follow up post?

 

[PracManCA]

Hmm. Interesting discussion and thanks BuzzPhreed for livening up the conversation I bit.

I 100% agree with you that when it comes to a clinical discussion a business or practice manager should have no say in the discussion. My physicians keep a count to this day of how many times I've said some phrasing of "I'm not clinical" or "I'm not in the O.R". You are also 100% correct that just like any other company I work to the benefit of my shareholders, which are the anesthesiologists.

With that said, I work for the collective benefit of the GROUP of shareholders and not individual physicians. It is my job to make sure that the practice runs smoothly to the benefit and desire of the GROUP of shareholders. For example, when a physician makes a habit of being late to cases in the OR they get a call from me because in the employment agreement that our shareholder physicians drafted, that is the procedure in place. This isn't an "on the spot" correction like Buzz (if I can call you Buzz ) mentioned above but mostly a "what's up" phone call in an attempt to diagnose the issue. If there is a bigger issue then the physician will meet with a member or members of the board to discuss.

Also, because of how our practice runs (very lean) I often send physicians to different sites of service during the day, so in a way I guess I do actively manage the physicians to the benefit of the group. However doing so, often always increases their productivity for the day and puts more $ in their pocket. I for sure have never gotten a complaint for that.

In the end the chief physician has final say on any and all decisions made by the practice as a whole but over time he/she has delegated more and more responsibilities as they and the group in general become more familiar with me and my management style.

 

[BuzzPhreed]

Hmm. Interesting discussion and thanks BuzzPhreed for livening up the conversation I bit.

I 100% agree with you that when it comes to a clinical discussion a business or practice manager should have no say in the discussion. My physicians keep a count to this day of how many times I've said some phrasing of "I'm not clinical" or "I'm not in the O.R". You are also 100% correct that just like any other company I work to the benefit of my shareholders, which are the anesthesiologists.

With that said, I work for the collective benefit of the GROUP of shareholders and not individual physicians. It is my job to make sure that the practice runs smoothly to the benefit and desire of the GROUP of shareholders. For example, when a physician makes a habit of being late to cases in the OR they get a call from me because in the employment agreement that our shareholder physicians drafted, that is the procedure in place. This isn't an "on the spot" correction like Buzz (if I can call you Buzz ) mentioned above but mostly a "what's up" phone call in an attempt to diagnose the issue. If there is a bigger issue then the physician will meet with a member or members of the board to discuss.

Also, because of how our practice runs (very lean) I often send physicians to different sites of service during the day, so in a way I guess I do actively manage the physicians to the benefit of the group. However doing so, often always increases their productivity for the day and puts more $ in their pocket. I for sure have never gotten a complaint for that.

In the end the chief physician has final say on any and all decisions made by the practice as a whole but over time he/she has delegated more and more responsibilities as they and the group in general become more familiar with me and my management style.

I think you kind have confirmed exactly what I'm talking about.

 

[criticalelement]

I agree with buzzphreed. If I really wrote what i thought about you pracmanca they would throw me off the internet.

 

[Ignatius J]

Our administrators are a tremendous asset about knowing a side of the business you don't get to know in the OR. They also deal with a ton of other stuff where I just have to sign a paper and it's taken care of- credentialing, licensing, insurance, 401Ks, scheduling, etc.

 

[deleted171991]

Hmm. Interesting discussion and thanks BuzzPhreed for livening up the conversation I bit.

I 100% agree with you that when it comes to a clinical discussion a business or practice manager should have no say in the discussion. My physicians keep a count to this day of how many times I've said some phrasing of "I'm not clinical" or "I'm not in the O.R". You are also 100% correct that just like any other company I work to the benefit of my shareholders, which are the anesthesiologists.

With that said, I work for the collective benefit of the GROUP of shareholders and not individual physicians. It is my job to make sure that the practice runs smoothly to the benefit and desire of the GROUP of shareholders. For example, when a physician makes a habit of being late to cases in the OR they get a call from me because in the employment agreement that our shareholder physicians drafted, that is the procedure in place. This isn't an "on the spot" correction like Buzz (if I can call you Buzz ) mentioned above but mostly a "what's up" phone call in an attempt to diagnose the issue. If there is a bigger issue then the physician will meet with a member or members of the board to discuss.

Also, because of how our practice runs (very lean) I often send physicians to different sites of service during the day, so in a way I guess I do actively manage the physicians to the benefit of the group. However doing so, often always increases their productivity for the day and puts more $ in their pocket. I for sure have never gotten a complaint for that.

In the end the chief physician has final say on any and all decisions made by the practice as a whole but over time he/she has delegated more and more responsibilities as they and the group in general become more familiar with me and my management style.

Sounds like a glorified floor runner trying to make more money for the partners than what s/he costs. Also called middle manager. That's another piece of reality for the wide-eyed students: a non-physician PP bean counter ordering you around. Just like in every other specialty, right?

 

[PracManCA]

I agree with buzzphreed. If I really wrote what i thought about you pracmanca they would throw me off the internet.

That's ok doc, I don't mind at all. Different strokes for different folks.

 

[PracManCA]

Sounds like a glorified floor runner trying to make more money for the partners than what s/he costs. Also called middle manager. That's another piece of reality for the wide-eyed students: a non-physician PP bean counter ordering you around. Just like in every other specialty, right?

Sorry to say all of our physicians work on the same productivity model where a shareholder makes the same on a case as a non-shareholder.

We also give our younger doctors the chance for asc/office work where there days are shorter with just as much/more minutes than in the hospital OR.

 

[Wiscoblue]

Thank God we don't have a practice manager! We have a collection agency who also take care of credentialing, malpractice, payor contracts etc. we have a law firm that takes care of the other legal stuff. We do our own hiring and firing. Our billing company takes 5% off the top for all their services. We pay the lawyers only when we use their services. Works great for us. At my old practice 20 years ago, we had three secretaries who did all the work. One did billing, one did the paperwork and the third answered phones and took care of assigning anesthesiologists to one of 3 hospitals that we covered. And they did a bang up job without a fancy designation or MBA.

Buzz, I know what you're saying, the practice manager somehow feels like he is your boss and needs to tell you what to do and has to 'send' you to a different location or admonish you if you are late. He is your employee and his job is not to be your boss. You have not hired him to 'tell you what to do'. You don't give him a stick to beat you with. And pay him 150k to boot.


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[Mman]

If you aren't happy with how your group functions, it isn't the fault of the administrator for doing what they were asked to do in their job description. If your group doesn't like their employee, fire them. It's pretty simple. It's private practice. Your group can function however you (and your colleagues want). If you disagree with them, well then maybe you need a better job.

 

[Planktonmd]

Unfortunately in our current world, the old fashion model of physicians providing medical care and getting paid for it directly by their customers (patients, hospitals, insurance, government...), this model is no longer viable!
We can not compete in a world where medicine has become a cut throat competitive business geared towards one and only one target: Profit.
Anyone who might think that medicine in the US in the 21st century is still about patients and about healing is simply wrong!
With this understanding of what medicine today has become it becomes clear that you can't do this business without hiring professionals who understand this business and know how to navigate these uncharted waters.

 

[jwk]

It all depends on what your needs are. Do you just need someone to handle the little administrative crap you don't want to deal with, or do you truly need someone to manage your practice?

The business side of our practice is huge. There are at least 40 people working in our business office in addition to well over 200 physicians, AAs and CRNAs, NPs and RNs. Our COO is responsible for the day to day operations of that office. He's no slouch - JD/CPA. We do all our own billing and collections, payroll, HR services, credentialling, etc. The COO is employed by the practice and answers to our Board of Directors and dept. chairman. I have no idea what he's paid, but I'm sure he doesn't come cheaply and is worth every penny.

I've seen the dark side as well in a previous manager, when we were much smaller and farmed out all our services - our non clinical staff was only him and his assistant. He didn't know near as much as he thought he did, very few liked him, including most of the physicians, and we were glad to see him depart.

 

[BuzzPhreed]

If you aren't happy with how your group functions, it isn't the fault of the administrator for doing what they were asked to do in their job description. If your group doesn't like their employee, fire them. It's pretty simple. It's private practice. Your group can function however you (and your colleagues want). If you disagree with them, well then maybe you need a better job.

No it's not.

The practice managers work at the discretion and whim of the (sometimes "secret") senior shareholders. That's where their loyalty begins and ends. So the junior shareholder or associate or CRNA just needs to suck it up and do what they're told in that practice -- or move on. Which is what many of us have done. And that choice can be very painful and costly. As I've said before there was no gold in the handcuffs at my last job. Just a bunch of f*cking assh0les trying to boss me around dangling the false carrot of "potential" future partnership while some idiot with a management degree was whipping me from behind because the shareholders weren't man enough to do it themselves.

Look, I'm all for MBAs and marketers and salespeople and whomever else is important to an organization that is trying to grow and provide good, cost-effective care while maximizing the business end of things being involved and well-compensated. Where I draw the line is when they start to meddle. "If you send this person to 'X' clinical site, you can bill them out at 4:1 even though they will have to do all ASA4 cases with junior CRNAs". And the senior secret shareholders at their cushy clinical sites buy it because it lines their pocket and all the risk is on the individual carrying that medical license, not them. F8ck that ****. That's what I'm speaking to.

So, you don't like it? Sure you can leave. But to suggest that the people who don't like it actually have a say in changing things is simplistic, ill-informed, and naive and something that would more likely comes out of a fatcat grayhair who's only looking to cash in and couldn't really give a **** about the juniors in the practice. What I'm talking to is what really goes on in some ball-less practices where the MBA-types job is to line the pockets of a few select members at the top of the food chain. And the contract you sign with them, written by those same MBAs and their lawyers, makes it incredibly hard to leave.

AVOID JOINING THESE PRACTICES, SOON-TO-BE GRADUATES!

 

[Planktonmd]

AVOID JOINING THESE PRACTICES, SOON-TO-BE GRADUATES!

These practices are the only ones left out there for someone who does not want to work for an AMC or a hospital.
Virtually all the private groups that are still in existence are businesses owned by a few fat cats who run the show using some sort of a corporate structure, maintained by lawyers and accountants (administrators), and all the real workers (physicians, nurses...) are either employed directly by the fat cats or engaged in some sort of pseudo partnership with them
The end result: The fat cats get fatter and the workers remain workers.

 

[sevoflurane]

Good discussion. Thanks to PacManCA for starting the thread. Like always, there are 2 sides to a coin.
Harmony is the goal and can be attained. This is usually attained by mutual respect, fairness and good business sense. There are without a doubt, groups with members in them that try and position themselves against the rest of their own group. Sad but true.

Is it worth it to have an administrator on board? Not at my current gig... which I'm leaving for greener pastures. >90% MGMA year over year. It's easier to be efficient with a smaller group.

Where I'm going however, it's going to be a monster of a group. At this point, everything is in the hands of the board of directors who work in the ORs, take call and go to a lot of meetings. Is there room for an administrator? I don't know. I've looked into the financials of my new gig and they consistantly bring in more and more via new contracts, negoatiations with hospital administrators as well as constant negoatiations with the various insurance companies, malpractice companies, disability companies, health insurance companies, and other bennie companies. All this stream lines efficiency. Having an administrator can help with this no doubt. I'm not sure it is absolutely necessary. I'm sure that the good ones are worth their weight in gold.

 

[Mman]

No it's not.

The practice managers work at the discretion and whim of the (sometimes "secret") senior shareholders. That's where their loyalty begins and ends. So the junior shareholder or associate or CRNA just needs to suck it up and do what they're told in that practice -- or move on. Which is what many of us have done. And that choice can be very painful and costly. As I've said before there was no gold in the handcuffs at my last job. Just a bunch of f*cking assh0les trying to boss me around dangling the false carrot of "potential" future partnership while some idiot with a management degree was whipping me from behind because the shareholders weren't man enough to do it themselves.

Look, I'm all for MBAs and marketers and salespeople and whomever else is important to an organization that is trying to grow and provide good, cost-effective care while maximizing the business end of things being involved and well-compensated. Where I draw the line is when they start to meddle. "If you send this person to 'X' clinical site, you can bill them out at 4:1 even though they will have to do all ASA4 cases with junior CRNAs". And the senior secret shareholders at their cushy clinical sites buy it because it lines their pocket and all the risk is on the individual carrying that medical license, not them. F8ck that ****. That's what I'm speaking to.

So, you don't like it? Sure you can leave. But to suggest that the people who don't like it actually have a say in changing things is simplistic, ill-informed, and naive and something that would more likely comes out of a fatcat grayhair who's only looking to cash in and couldn't really give a **** about the juniors in the practice. What I'm talking to is what really goes on in some ball-less practices where the MBA-types job is to line the pockets of a few select members at the top of the food chain. And the contract you sign with them, written by those same MBAs and their lawyers, makes it incredibly hard to leave.

AVOID JOINING THESE PRACTICES, SOON-TO-BE GRADUATES!

So you describe some terrible organization and then blame the practice administrator for doing what they are asked to do? Puhleez. Blame the group. Not all private groups are bad. Not all are pyramid schemes. Not all exist to have "senior secret shareholders" screw the junior docs. In fact I've never heard of an administrator having anything to do with clinical decisions and staffing models. The closest ours get is by helping create models for us to evaluate based on various case volumes and payor mix at different locations. But the docs make all decisions about how to staff things.

Join a real group.

 

[Mman]

Where I'm going however, it's going to be a monster of a group. At this point, everything is in the hands of the board of directors who work in the ORs, take call and go to a lot of meetings. Is there room for an administrator? I don't know. I've looked into the financials of my new gig and they consistantly bring in more and more via new contracts, negoatiations with hospital administrators as well as constant negoatiations with the various insurance companies, malpractice companies, disability companies, health insurance companies, and other bennie companies. All this stream lines efficiency. Having an administrator can help with this no doubt. I'm not sure it is absolutely necessary. I'm sure that the good ones are worth their weight in gold.

To me it's a no brainer. Their salary is like a rounding error for a big group and IMHO no big deal to help things run more smoothly.

Now a small group is a different story because there isn't as much need for their services and the cost is relatively higher since it comes out of fewer pockets.

 

[BuzzPhreed]

Where I'm going however, it's going to be a monster of a group. At this point, everything is in the hands of the board of directors who work in the ORs, take call and go to a lot of meetings. Is there room for an administrator? I don't know. I've looked into the financials of my new gig and they consistantly bring in more and more via new contracts, negoatiations with hospital administrators as well as constant negoatiations with the various insurance companies, malpractice companies, disability companies, health insurance companies, and other bennie companies. All this stream lines efficiency. Having an administrator can help with this no doubt. I'm not sure it is absolutely necessary. I'm sure that the good ones are worth their weight in gold.

This is the same bullsh*t I was fed before I joined my last job. I'll be interested to hear your experiences once you're in the door. Are you going to be working with CRNAs? Solely and exclusively? Or not at all? Just curious.

So you describe some terrible organization and then blame the practice administrator for doing what they are asked to do? Puhleez. Blame the group.

You're either not listening or not understanding.

Of course I don't blame the administrator in that position. S/He's just a hench(wo)man. I blamed the group fully. They hide behind these people. They give them too much power over what should be clinical decisions made by doctors and nurses. And that's the point.

The whole set-up is a racket. And I'm admonishing people vetting a practice -- many of whom are going through that process right now -- to figure this out before you join. It's hard to do because they're like a pretty girl on a first date. If you decide you want her as your girlfriend, it's only a matter of time before she starts hanging around wearing no make-up and in her sweats not afraid to fart in front of you anymore, and you better like it because that's who she really is. Or, you break-up with her ass!

Oh, and what Plankton said.

 

[BuzzPhreed]

Let's go back to PracManCA's first post for a second.

Hi there folks long time reader, first time poster. I am a practice administrator for a private anesthesia practice and have always enjoyed reading "unabashed" opinion from you students/residents/attendings about the specialty that we have all grown to love.

I thought it would be worth posting here and soliciting opinions of what you feel like you gain from having dedicated non-clinical administrative staff, what you wish they did or didn't do, or anything like that?

So what you got? Feel free to ask me questions also. I handle HR, scheduling, coordinating interview's/extending offers, handling surgeon/staff complaints and most other non-clinical tasks that must be completed to keep a large business afloat.

I'm offering an opinion on what they should and shouldn't do like I was asked. I posted my first response above and I elucidated the reasons behind that. I don't care who has empowered them. Don't talk to me like I'm some uneducated ***** and stick me into a tenuous clinical situation without discussing it with me first because it's "what CMS allows" and you're really only catering to some out-of-current-practice grayhaired idiot who's spends more time in the office or on the golf course than in the OR and is going to determine how much bonus you get at the end of the year.

If you do that **** -- repeatedly -- don't be shocked and surprised when I turn in my resignation.

 

[IlDestriero]

We have a business manager for our large group. They are not involved in the clinical or day to day operations of the anesthesiologists at all. They manage the business side of the house. Scheduling, etc. is all done by us.
It's strange to think of them being anything but an employee of the group.

 

[Mman]

Of course I don't blame the administrator in that position. S/He's just a hench(wo)man. I blamed the group fully.

I am speaking specifically about a person I worked with at my last job who worked for the private practice group and was hired by them. She labored under the mistaken belief that everyone who wasn't a partner - CRNAs included (who hated her) - worked for her. And she often gave advice about what junior anesthesiologists and CRNAs needed to do in the OR to be more effective communicators, efficient caregivers, etc. when she had never set one foot in an actual OR and instead just needed to STFU.

You don't blame the administrator, you fully blame the group? Yet you rage on about the administrator and suggest they STFU. That's where you lost me. You just seem so bitter and angry.

 

[BuzzPhreed]

You don't blame the administrator, you fully blame the group? Yet you rage on about the administrator and suggest they STFU. That's where you lost me.

I blame the group for hiring her, empowering her, and hiding behind her. I blame the person herself for being a clueless assh0le.

You just seem so bitter and angry.

Duh! Ya think? The lies I was told ended up f*cking-up my entire 2013 (including a HUGE strain on my marriage). And I'm still paying for it all (in part) to this day. I'm trying to put it past me as I move into 2015, but the financial and personal ramifications have left a huge mark. That's all I'm going to say specifically on that matter.

RESIDENTS about to graduate and looking for employment: LEARN FROM ME!

 

[sevoflurane]

This is the same bullsh*t I was fed before I joined my last job. I'll be interested to hear your experiences once you're in the door. Are you going to be working with CRNAs? Solely and exclusively? Or not at all? Just curious.

You should know better: MD only.
Talk about hiring 2 AA's for offsite and endo... .
I'll report back, but my backup plan is simple. .8 FTE in a beautiful part of the world.
Closing on my dream home in 6 days biotch!
Life is short...

 

[PracManCA]

You should know better: MD only.
Talk about hiring 2 AA's for offsite and endo... .
I'll report back, but my backup plan is simple. .8 FTE in a beautiful part of the world.
Closing on my dream home in 6 days biotch!
Life is short...

The practice I work for is physician only, I could see how CRNAs would muddy the waters.

 

[PracManCA]

Where I'm going however, it's going to be a monster of a group. At this point, everything is in the hands of the board of directors who work in the ORs, take call and go to a lot of meetings. Is there room for an administrator? I don't know. I've looked into the financials of my new gig and they consistantly bring in more and more via new contracts, negoatiations with hospital administrators as well as constant negoatiations with the various insurance companies, malpractice companies, disability companies, health insurance companies, and other bennie companies. All this stream lines efficiency. Having an administrator can help with this no doubt. I'm not sure it is absolutely necessary. I'm sure that the good ones are worth their weight in gold.

Sounds a lot like my group. My board meets constantly, sometimes more than once a week via teleconference. I run those meetings (chaired by the chief and vice chief) and keep minutes.

I think what you've written in bold is absolutely right. No physician practice needs an administrator, but I think our docs will tell you (they went from having a physician only administration to one with a few extra staff credentialing/hr/me) that having us is a luxury. Instead of our board being on the phone till 10pm every night I might get them off by 8. Instead of them needing to be present at every client meeting its usually the chief and I. I think thats the real value we bring on top of the usual clerical, accounting type roles.

 

[BuzzPhreed]

You should know better: MD only.
Talk about hiring 2 AA's for offsite and endo... .
I'll report back, but my backup plan is simple. .8 FTE in a beautiful part of the world.
Closing on my dream home in 6 days biotch!
Life is short...

Good for you. I hope you will report back when you get settled.

 

[BuzzPhreed]

No physician practice needs an administrator, but I think our docs will tell you (they went from having a physician only administration to one with a few extra staff credentialing/hr/me) that having us is a luxury.

I don't think it's a luxury. I think it's a necessity. But what I saw happen is that as the practice grew and got more greedy, there were more and more "administrators" hired and less-and-less interest in the docs actually being involved in dealing with the hard issues. That's a problem. Deferring and delegating the difficult personnel management stuff to a non-MD/non-clinical person is a cop out.

When I resigned from my job I did it to the chief and president of the company. The a-hole administrator came to me afterwards and asked why I hadn't come to her to discuss it first. I believe my answer to her was along the lines of "are you f'ing joking"?