fix this practice

Who's Minding Your Practice?

While your practice may have several managers, remember: You're the boss.

RICHARD S. KATTOUF, O.D., D.O.S.

Q As an independent private practice owner for 20 years, I'm reflecting on just who is in charge of my practice. My office manager refuses to accept constructive criticism. My optician is territorial and anchors my attempts to set my optical apart from the competition. How do I deal with this mess?

Dr. J.D. Rounds
via e-mail

A: Practices throughout this country echo your dilemma. The excuse I hear most often is,"As my practice grew, I enabled certain staffers to make more and more critical decisions with no supervision." While considering the staff's ideas is good for their morale, you must remember that all final decision lie with you, the owner (doctor).

When an unchecked manager prevents the doctor from, for instance, making a change, such as altering office hours, simply because he personally doesn't like the change, then the manager doesn't have the best interest of the practice at heart. Remember, real control problems occur when the owner enables this type of behavior.

No respect

Dr. Z.A. Shala faced a similar problem. During my on-site visit, I gave each employee a questionnaire that enabled them to give me their perception of the practice. Holly, the manager, demeaned Dr. Shala in her assessment.

Holly had the attitude that this was her office and these were her patients. This is common and extremely dangerous. After discussing the situation with Dr. Shala, I told Holly that my client had lost control of his practice to her, and I was going to teach him how to recover it and prevent this from happening again. "This practice will fail without me!" was Holly's angry response. Holly then attempted to recruit support from fellow employees to leave the practice. I assured the other employees that I would temporarily take on the manager's role, and the practice would be fine. Holly left the practice alone.

It was evident that Holly had intimidated the staff. They were "afraid" to go to Dr. Shala with any complaints about her. I appointed department leaders who each reported directly to Dr. Shala about any and all decisions. Now, morale and practice growth are both at an all time high.

The territorial optician

Dr. T.L. Rose's optician, Chad, made all the optical purchasing decisions with no spending limits. As was the case with Dr. Shala, Dr. Rose enabled this behavior.

When I evaluated the practice's finances, the cost of goods (COGs) was 43%, 14% over the national average. T.L. had a new patternless edger but due to Chad's resistance, the staff performed little lens finishing. I recommended in-house lens casting and in-house anti-reflective coating capabilities, which would lower Dr. Rose's COGs to 22% — a 21% reduction in costs while maintaining high lens quality.

Chad refused the change stating that casting was inferior to surfacing. Some digging revealed he received perks under the table from one lab for providing them with surfacing work. Chad left.

Both of the aforementioned examples illustrate the importance of overseeing delegation — something at which many O.D.s fail. Some O.D. fear they'll lose key employees by taking back control, causing financial harm to their practice. Rest assured: In all cases of either changing the employee's behavior or terminating their employment, the practice benefits. OM