Lead From Where You Are

Written by James A. Stroud, CPA; 
D. Maddox Casey, CPA;
 Sae Evans, CPA on August 15, 2018

lead from where you are

After mastering self-leadership, the next step is to lead your physician partners and your office staff. Contrary to common belief, some aspects of this role should be filled by all physicians in the group. Yes, there may be a designated single leader for the practice, but that should not enable the others in the group to abdicate their leadership responsibilities. It is a common error to think “I will wait until I am the senior partner, or I will wait until I am the highest producing partner before I begin to lead our group.” Lead well from where you are and the group will be better for it.

The respect the practice receives is not necessarily driven by how well your group is led, but a dysfunctional medical practice will impair the regard in which you are held by those outside your practice. As a physician, you wield great influence and that opportunity is enhanced by a perception that all the physicians in your group are positive examples of excellence in patient care and of decorum. Your employees are also ambassadors for your group as a manifestation of the leadership they receive from you.

There are two aspects of leadership and one of them is often neglected in medical practices.  First, there is your directed leadership. This is the willingness to make decisions about strategic or tactical matters. Some issues should be handled by your practice administrator and some must be discussed with the full physician group, but many decisions should be made by the physician leader. The issues which the administrator should defer to you from day to day matters will depend on the experience of, and your trust in, your administrator. In today’s complex world of medical practice management, hire a capable person to manage the group and let them do the job without any micro management. Spending too much M.D. time making or reviewing every management decision is unwise. For the bigger issues, the physician leader must make the call. Even if you prefer to seek group buy in, make the decision first and deliver it as a recommendation to the group. Letting a physician group deliberate until a decision is reached is a recipe for the paralysis of analysis. Do not give any physician a veto power about decisions unless your group is very small or it is a decision of major magnitude, like selling or merging your practice.

The second aspect of leadership, and most often overlooked, is your permissive leadership. These are matters which happen because you encouraged them or permitted them to occur.  Permissive leadership is a hands-off approach and works wonderfully when all members of your group share a common clinical, behavioral and ethical work philosophy. At Warren Averett, when our team is assisting clients in the recruitment of a new physician or in a merger of medical groups, we always steer the discussion away from the monetary issues until we feel that the physicians involved have a compatible clinical mindset. Clinical compatibility could be perfect but there must also be a behavioral agreement among the physicians. Are the staff deserving of courtesy and appreciation for their patient support efforts, or are they paid to do a job and that is all the thanks they should expect? Is profanity acceptable in the medical practice? How casually may a doctor cancel clinic in order to engage in last minute recreational or travel pursuits? Are the practice policies regarding social media, taking vacations when other physicians are already off and fraternization with select members of the staff, hard rules which must be followed or are they only suggestions? We have been involved in mediating physician disagreements on every item listed in this paragraph, so we believe it is crucial to discuss these issues before physician employment.

If all in the group are clinically and behaviorally in synch, the remaining issues center on work ethic and most of those can be handled through the physician compensation plan. Physician start time, end time, pace in the work day, use of office talent, ancillary procedures performed, payer mix and procedure mix all impact revenue. In a production driven physician compensation formula, differences in these factors will make great differences in resulting compensation. There must be some similarity in work habits and ethic, as well as agreement that differences merit variances in compensation.

Where clinical, behavioral and ethical consistency exists among all physicians, and one doctor has the group authority to make decisions, there is harmony, productivity and profitability. We see it time and time again.

"Lead From Where You Are" was originally featured in April's issue of the Medical Association of the State of Alabama's quarterly magazine.

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