Building your primary care practice’s office staff can be a daunting challenge. Physicians are busy caring for patients, and many lack formal training in hiring and human resources—yet hiring decisions can be key determinants in the success level of your practice.
The office manager is an especially crucial member of your staff. He or she must be a “Jack of all trades,” possessing both clinical and business acumen. In addition to keeping the office running smoothly, the manager has to supervise practice staff, handle patient complaints and oversee bookkeeping and finances. So, how do you find the right person to hire?
I spoke with experts on the subject to discover how your primary care practice can hire the right office manager. Here are top characteristics to look for, warning signs to look out for and questions to ask to identify the best candidates for the job.
Experience and Education
The amount and type of experience and education required for success as an office manager will vary somewhat from practice to practice. All candidates should have at least a high school diploma; in most cases, a college degree (or beyond) is best. The necessary background will depend largely on how many of the practice’s business and/or medical functions your office manager will be expected to assist with.
“I’ve known successful office managers with college degrees and without; with decades of experience and with none,” says Joe Mull, president of Ally Training & Development, an agency that specializes in leadership development training for healthcare managers. He notes that most practices require their candidates to have either higher education or equivalent experience working in the healthcare industry (or some combination of both).
The necessary level of education will also depend partially on the size of the practice, says Brian White, managing partner of Competitive Solutions, a consultancy that helps grow physician practices. Small to midsize practices may not require (or be able to afford) a manager with an advanced degree, such as a Master of Business Administration (MBA). However, “For a large practice of 10-15 physicians, you should be expecting someone who is an MBA-level, and can handle the strategic decision-making… of the practice,” White says. Such a person can help grow the practice and take the business in new directions.
Even more important than education is a candidate’s work experience, says Tom Ferkovic, managing director of consulting firm SS&G Healthcare. The person you hire must be able to handle operations, staff, bookkeeping, billing and finances—and the level of business-savvy they need will depend on the experience of the physician(s) in charge.
“A physician [who] is active in running the practice requires a manager with less experience,” Ferkovic says. “[A physician who] delegates a lot needs more. Three to five years of experience is good for a non-complicated, less-than-five-doctor practice.”
In addition to experience with finances and a degree of business acumen, Linda Ryan, a registered nurse (RN) who ran a busy medical practice for 15 years, looks for something extra in an office manager: they, too, should be an RN.
Of her own experience, Ryan says, “I was able to jump in when it got crazy and help. I could give a shot, I could do a physical, I could do a hearing test—I [had] all those skills. And that’s really helpful when you’re short-staffed or inundated with patients.” This, she adds, puts the manager more in touch with the practice’s clinical staff, and fosters respect for the manager amongst the team.
Qualities and Characteristics
In addition to their degree or years of experience, there are some important qualitative and behavioral characteristics the office manager you hire should possess.
Personality, Ryan says, is key. Your office manager must be friendly, even-tempered and outgoing. They must have excellent people skills, and be able to communicate effectively with everyone who passes through the office: physicians, clinical and administrative staff, patients, drug company representatives and other clients or partners. Your manager should also be empathetic towards everyone in the office, and should enjoy talking with, listening to and helping others.
White emphasizes the importance of strong leadership capabilities. Your office manager, he says, must lead the way in meeting daily patient care responsibilities while also completing all necessary administrative work. They need to help streamline routine processes and effectively motivate practice staff to work more efficiently. And, of course, all good leaders know when it’s best to handle things themselves, and when it’s best to delegate.
Your manager must also be an effective negotiator who can quickly mediate and resolve conflicts, says Mull. Medical offices are high-stress environments, and it’s not uncommon for, say, a patient who has spent a long time in the waiting room to become irate. The manager you hire, Ferkovic says, must be unafraid of stepping in to help resolve issues amongst staff, physicians and patients.
Ferkovic also notes that your office manager must have an excellent eye for detail, with a strong follow-up to ensure things get done. However, a good office manager is “able to see the job as more than just schedules, reports and other operational responsibilities,” says Mull. “The manager influences the atmosphere and relationships on the team.”
Questions to Ask During the Interview
To help surface the qualities you seek in an office manager, there are some key questions you can ask candidates during the interview process. How the candidate answers these questions can be an important indication of how they would perform in the role.
Ryan asks candidates, “What did you like best about your current or past position?” The answers you want to hear, she says, include: “I loved the doctors; I loved the patients; I loved my team. I loved how it was a dynamic job, never the same two days in a row; I loved when it all ran well.” These answers evidence effective interpersonal skills and a desire to improve operational efficiency. They also indicate that the candidate understands and appreciates the fast-paced, fluid nature of medical office work.
Ryan also asks candidates what they liked least about their current or previous job. Acceptable answers include low pay and unreasonably long working hours. However, she says, almost any other answer is merely a reflection of poor performance on the candidate’s part: for example, “To say that it was really disorganized, well, you’re the manager—so that’s your fault.”
Another important question Ryan asks is, “What hours do you want to work?” The right answer: “What hours do you need me to work?” She wants to hear that candidates are willing to work a variety of shifts, including evenings and weekends, so that they get a chance to work with all members of the staff.
“Managing a medical practice is typically not a 40-hour-a-week job, and the manager needs to not be looking at the clock,” Ryan says. “They should want to be there as much as they need to.”
White, too, suggests digging into candidates’ work histories. The questions you ask, he says, should cover: “What leadership roles have they been involved in? What successes have they had? What failures have they had in the past, and how did they respond to those failures? What did they perceive as the most important elements of the role you’re going to put them in?” You want to determine what their plan is for your practice, White says, and “find out how they would execute that plan on a day-to-day basis to make the practice efficient and operationally profitable.”
Ferkovic advises asking open-ended questions and “listening for decisive, yet thoughtful, answers.” Have candidates provide examples of the biggest surprises they encountered on the job, the hardest decisions they had to make, what sorts of choices they made and why, he says. These answers can shed light on what sort of leader they would be, and how they might handle difficult choices and situations as your manager.
If there are specific qualitative characteristics you’re looking for, says Mull, you can simply ask candidates to tell you about a time when they displayed that characteristic. “For example, ‘tell me about a time when you had to negotiate. Tell me about a time when you had to mediate a conflict. Tell me about a time when you had to deal with a highly-charged emotional situation at work,” he says. When listening to their answers, Mull adds, ask yourself, “Did their response demonstrate the skills, knowledge or behaviors you are looking for? If that situation occurred in the new job, is their response appropriate?”
Mull also notes that, rather than listening for a specific response, you should read between the lines to understand the motivation behind a candidate’s answer. “For example, if a candidate says that the first thing [she] did when confronted with a patient who was angry and shouting was move them to a private office where they could speak one-on-one, I could infer that she was concerned about the other people in the waiting room—even if the candidate doesn’t say that,” he explains.
Red Flags and Warning Signs
Just as there are important skills and characteristics you want to look for when screening candidates, there are some red flags you want to look out for, as well. These warning signs can help you spot potential weaknesses and weed out problem candidates before they make it to the offer stage.
When a candidate speaks negatively about the doctors or staff they worked with in a previous job, that’s a huge red flag, Ryan says—especially if the candidate was in a managerial position. “If they were attracting people who were catty, immature and unprofessional, I think that says a lot about the management,” she explains. They should’ve been able to spot those characteristics in people during the hiring process, or deal with those problems once they became evident.
Asking about salary over the phone is another red flag for Ryan. Salary questions aren’t appropriate, she says, until the candidate has seen the office, met the staff and understood exactly what the position will entail—because a great medical office job isn’t primarily about the money. Asking about the hours at any point in the interview process is also a bad sign. “[That means] they just don’t understand that the hours are whatever they need to be,” Ryan says.
Ferkovic warns against candidates who give too many “I” answers. “If the answers are all, ‘I did this’ or ‘I made this happen,’ [you] need to probe more to see if they can delegate,” he says. Team dynamics are integral to any medical office, and your manager must be a team player who is capable of assigning the right tasks to the right people so that the practice can operate efficiently.
Mull notes that a lack of awareness for the human element of the office manager position is another major warning sign. “If the candidate seems to view the role simply as managing processes… if they share no experience, interest or awareness that the job will require ‘people skills’… I would be concerned,” he says.
Putting Candidates to the Test
Administering a test to office manager candidates can be an effective screening tool, says Mull. The material covered on the assessment will depend upon the particular needs of your practice and the specific knowledge or experience you want to ascertain in applicants.
“Some are used to ascertain personality preferences to evaluate cultural fit; others assess intelligence, service skills and even ethics,” Mull says. “I’ve seen scenario-based questions, math equations, picture puzzles and even vocabulary quizzes.”
White notes that a sample test would be especially worth considering “if there were specific issues confronting the practice… or a new level of expertise in their practice was needed.” Such an assessment could help ensure that you hire the right person to handle the strategic, long-term issues that are affecting your practice and goals you want to achieve.
Administering a test can be an effective way to screen internal candidates as well as external ones. Some practices may want to promote internally to fill an office manager position—but they must ensure that internal candidates have the knowledge and skill required. White cautions that a track record of success in a lower-level position isn’t necessarily a predictor of a candidate’s success in a managerial role.
Trust Your Instincts
Ryan says that while her practice gave tests to clinical job applicants, for the office manager position, she came to rely on a much less quantitative type of assessment: gut instinct. After hiring two office managers based on good-looking resumes who ended up not working out, Ryan says she learned to trust her own impressions more than just what she saw on paper.
“It was more their experience, where they came from and… their personality,” she says. “A positive attitude is just so important, and you can sense that when you’re in the room with someone more than you can really qualify it.”
Finding the right office manager isn’t easy—but you can make the process simpler and more effective. Before you begin screening candidates, decide what sort of education and experience is necessary for the role. During the interview process, look and listen for the qualities and characteristics that are important for success at your practice, and be on alert for red flags and warning signs. Administer a test if you want to check for specific skills or knowledge—and when in doubt, go with your gut.
By following these guidelines, you can hire the right medical office manager for your primary care practice.