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Fifty Posts Later: Thanks to My Readers!

I’ve completed 50 posts since I launched this blog in July, and now is a great time to pause and send out some thanks.  I appreciate the help and support of many colleagues and friends, and sincerely thank the readers who are subscribed to my blog via email or RSS.

I love to hear from you – leave a comment or email your ideas, questions, or suggestions for information, resources or topics.  I’m listening!


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Learn This: MP3 Players (Do You Like Good Music?)

This is the first of what I hope will be many posts from my talented technical consultant, Abraham Whaley.  I’ve asked Abe to demystify the technology that is intuitive if you’re under age 30, but Greek to those of us slightly over that age.  I can’t repeat enough that I think it’s important for managers to stay current on technology to stay fresh, stay marketable, and be able to translate world technology into technology for your practice.

Abraham welcomes your questions and comments.

Do you like good music?

How do you listen to it?

It seems every few years the electronics companies come up with a faster, cheaper, better-sounding something, and they begin anew the job of convincing us that it’s the ultimate in sonic enjoyment.

But seriously, what is all the MP3 fuss about?

MP3 is a file format. MP3 files have “.mp3” at the end, so your favorite song looks like “yourfavoritesong.mp3” on your computer. Just like “.doc” means a Microsoft Word document, and “.exe” is an executable program file, “.mp3” is a sound file- i.e. music. MP3 files are a way to “compress” sound files. Compression is a common computer technique, where something is packed into a smaller space than in originally fit into in order to make it easier to use, and send to other people. Maybe you’ve downloaded or created “.zip” or “.rar” files for sending over the Internet. MP3 is just a way to make it easier and faster to send sounds to each other.

In order to make the sound file smaller, the programs that compress them find pieces of the sound data that people never hear, or can barely notice, and removes them. For the most part, this doesn’t affect the sound quality- although some sound mavens people heartily disagree!  And since most MP3 files tend to be between 5 and 10 megabytes, they’re pretty quick and easy to send in emails, download, and transfer from a computer to a music player.


What can I do with MP3s?


Listen to them! Any part of your life that would be enhanced with a little music can be enhanced with MP3s. First you’ll need something to play your MP3 files. That means either a piece of software that can turn the MP3 file into sound, or a hardware device with that software already on it (ie. an iPod).

The most popular choices for MP3 listening software are iTunes and Winamp.  iTunes is the Apple software that comes with the purchase of an iPod- but you can download it regardless and use it for free anyways. Since so many iPods have been sold (more than 150,000,000 as of this March, FYI), iTunes has become the standard in MP3 software for many people. If you’re thinking about buying an iPod, downloading and trying out iTunes is a great way to try the software before you buy the hardware that goes with it. iTunes also allows you easy access to the iTunes Store, where you can buy MP3s of music, audiobooks, and free, Internet radio shows that update and download automatically. Winamp has been around longer, and is a smaller, lighter program- but is still packed with a ton of features.

Also, both software programs allow you to “burn” CDs. Since every song is an individual .mp3 file, you can very easily make custom CDs that have only the songs you want, in the order you want. This was perhaps the most exciting development for me when I discovered MP3s- that I could make my own CDs to listen to in the car or at friends’ houses.


Where can I get MP3s?


First of all, you can make them! Both iTunes and Winamp allow you to (cool slang alert!) “rip” CDs to MP3. “Ripping” is just taking music on a CD and having the computer compress the sounds into MP3 files. Once this is done, the music stays on your computer and you can now play the music on your computer without the CD. You’ve probably just realized another pretty nice use for MP3 files- they can be used to back up your music collection. “Ripping” CDs is completely legal if you own the CD already, or are ripping music that is in the public domain.

Amazon has pricing comparable to the iTunes store, but made headlines by offering “DRM free” MP3 files. DRM (Digital Rights Management) is a way to stop people from sharing MP3s with each other by making them so they only play on certain devices, at certain times etc…But since Amazon offered files without the restrictions, their downloads can be a lot easier to use and enjoy. Apple does offer some, but not all downloads are DRM-free. Buying my first MP3 from Amazon was a delightfully quick experience. I didn’t even have an account with Amazon and in less than five minutes I was enjoying “Wily” by the British reggae band “Greyhound”. Amazon recommends you use their small download manager program, but once you download the program, it’s easy to keep track of the songs you downloaded.

Other services, like Rhapsody and the infamous, but now totally legal and legitimate Napster offer subscription-based programs. For a monthly fee, you can access and download music on your computer, on other people’s computers over the Internet, and onto some, but not all portable music players. The catch is that you aren’t buying the music, you’re paying for the right to access it. So if you decide to cancel your subscription, the music you downloaded doesn’t work anymore.

Additionally, many websites offer free, legal MP3s to download. iTunes usually has a free MP3 of the week, and websites like CNET’s have plenty of free music that aspiring artists and hopeful record labels have released to get you excited about new songs and albums.


What if I want to take my music wherever I go?


So, you’ve downloaded an MP3 software program, ripped a few CDs (making sure to use the word “rip” to impress your kids), and even found some free MP3s online that you really like. Maybe you even organized some songs you like to regularly listen to into a “playlist” so you can hear your James Brown in the morning to get going and your Jackson Browne in the afternoon to relax. Sadly, you can’t take your laptop on a nice jog and shouldn’t browse the web while driving to work.

It’s time we liberated those MP3s from your computer! This is where a portable, hardware MP3 player comes in. There are a lot of choices to be made for those in the market, so here’s how to cut through the mumbo-jumbo.

First, the numbers. The two main things that a portable MP3 has that set it apart are its storage capacity and its extra features. Most everything else is negligible. Storage capacity is just that- how much music and sound you can store on the player.  Storage on players is measured in gigabytes. Now, if we assume for simplicity that most MP3 files are about 5mb (megabytes), we can get a picture of how much storage you need. A gigabyte of storage is roughly 200 songs. So, how many songs do you think you’ll put on a portable player? Are you going to listen to the same music over and over? Probably not. If you have 20 albums that you like to hear, and that’s it, a few gigabytes will be just fine. But if you are always on the hunt for new sounds, you’re going to want a lot more storage. Also keep in mind what else will be on the player- if you want to download movies, then those are much larger files. How about keeping photos on your player? Do you subscribe to any podcasts? The best way to figure out how much storage you need in a player is to start downloading and listening to MP3s so you can get a feel for how you’ll use one, and what you need.

Then there are the extra features. MP3 players are almost like digital pocketknives these days, and you should know ahead of time which tools you want if you’re looking to buy. For example, Apple now makes an iPod that is also a cellular phone (the ubiquitous iPhone), as well as an iPod that can surf the web, and send email but isn’t a cellphone (the iPod Touch). Microsoft’s entry into the market is called the Zune. The Zune has a larger screen, with a more detailed user interface, and some interesting features like the ability to share MP3s between Zune users. If you have a song on your Zune, you can “beam” it to another Zune close by so they can play it too. This feature has a major drawback though- beamed Zune songs are only good for three plays over three days. My neighbor has a Zune, and he loves it. Also, some MP3 players are really more like portable televisions that can also play albums. Examples of these are the Archos 5, and the Cowan O2.

Lastly, if you’re a little overwhelmed by all these choices, I would suggest CNET’s MP3 Player Finder. CNET’s site will ask you some questions, and make some suggestions as to what might suit your needs.


There’s more out there than MP3s!


Don’t limit yourself to just MP3 downloads either. There are a ton of ways to listen to music online, and a ton of different startups trying to “solve” online music. Although I own an iPod, and love finding new MP3s, I also regularly listen to custom radio stations on Pandora, search for songs on Songza and Seeqpod, and I’ve heard great things about MOG, Imeem, and Last.FM.  Plus, almost every new college-rock band and aspiring singer has a Myspace page, usually with music to listen to.

On a cautionary note: beware of getting something for nothing. One doesn’t have to look very hard to find illegal MP3s for download. The ethics of copyright law in the digital age entail more discussion than this column has room for, but suffice it to say, the laws regarding copyright are quite real. Do you know anyone whom has had the FBI knock on their door for stealing music? I do. It wasn’t fun for him.

Also, many of the websites that offer these illegal MP3s also offer other things – viruses, spyware, and things your mother wouldn’t approve of on a healthy computer. Be careful, use common sense, and if something seems too good to be true, it probably is. Except of course, the goodies at =).

To Recap:

  1. Music is good.
  2. Download free MP3 software.
  3. Download free or not-free MP3s or load your own CDs onto your computer using the software.
  4. Make your own CDs or playlists with your favorite songs. (Great holiday gifts!)
  5. To take it with you, purchase a MP3 player after assessing your style and your needs, and load your music onto the player. 1 gig storage = 200 songs.
  6. Don’t steal.  Your Mama would know.

Have fun out there!


Posted in: Learn This: Technology Answers

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Standard Operating Procedure: How To Make A Bank Deposit

The Bank Deposit Slip

I am writing this post in response to seeing a lot of questions recently about making deposits.  (If you are looking for information about making personal bank deposits, go to the top of the page and click on the Lexicon and look for “Bank Deposits.”)  Even if you know how to make a deposit, you could copy this post into a word document and with a few changes, use it for a protocol for your office.  So, here goes:

  1. Make sure all mail and checks that you receive are for your practice.  It’s easier and less costly to return it to the sender if you catch the mistake on the front end, instead of refunding it after it has been deposited in error.
  2. Open the mail and separate the checks into four piles: (a) all insurance and other non-patient checks, (b) all patient checks, (c) all correspondence from insurance companies without checks, such as denials, “no-pays”, and requests for additional information, and (d) patient credit card payments..  Run two adding machine tapes each on the insurance check pile and the patient check pile to get an accurate total.
  3. Some practices receive checks for medical records, depositions, honorariums, call pay, etc. and handle these monies outside of the standard deposit protocol.  Other practices handle them as a part of the process and post everything to a patient account or a dummy account specifically for non-service related revenue.  Either way is fine if it works for your practice.
  4. Give the credit card payments to the person in your office who processes credit cards, and have them add these payments to your other credit card payments from over the counter.  Once the credit card payments are successfully processed, give them to the billing clerk to post to the patient account on the computer.  Be sure to always post patient payments ASAP (over the counter and mail) so patients don’t inadvertently receive a bill from the practice that does not reflect their recent payment.
  5. Give the insurance company correspondence to a billing clerk to process after stamping the date on each first page.
  6. If your office is big enough, split the duties between three people of (a) opening the mail and running two matching adding machine totals on the checks, (b) preparing the deposit and running a third matching tape total, and (c) posting the checks.  Make sure all adding machines are set to count the number of items and that item numbers match on all tapes.
  7. Paperclip each check to its documentation.  Recycle the envelopes.  Some detailed people keep the envelopes with the patient checks until matching the address on the check and on the envelope and on the statement stub in case the patient has moved.
  8. Stamp today’s date on the paperwork and EOBs (Explanation of Benefits) that accompany the insurance checks. Give the EOBs and one tape to a billing clerk to post.
  9. There are two schools of thought at this point.  One school believes that no check should be deposited without first posting it to the patient’s account in the computer.  A second school (to which I belong) believes that the money should go right into the bank, and post the payments to the accounts within 2 business days.
  10. Some offices have the technology to scan all deposits and all EOBs, and some offices will choose to photocopy checks to use as reference documents.  Some banks offer online images of deposited checks.  Refer to my post on lockboxes and remote deposits for other options.
  11. Separate all insurance checks from their EOBs and stamp the back of the check (on the correct end) with your bank deposit information.  Separate the patient checks from the statement stubs and stamp the back of the checks with your bank deposit information. Give the statement stubs to a billing clerk to post the patient payments, checking first that the information on the stub and the check match, including the amount paid.
  12. Deposit slips are carbonless and each deposit uses a set of two slips: one goes to the bank and one stays in the book.  Look in the back of the book for the piece of cardboard that you use to slide behind the two slips to keep the writing from bleeding through.
  13. Date the deposit slip.  If you happened to have received cash in the mail, add the total of the cash where indicated on the slip.  Run a third adding machine tape for the insurance checks and the patient checks, verifying the correct amounts, and fill in a total for each category (I do not recommend you list each check separately!), totaling at the bottom of the page, and filling in the number of items.  Most deposit slips also have a place to fill in the total on one side of the deposit slip.
  14. Most banks charge by the number of deposits, so it is typical to make one large deposit, regardless of the number of checks in the deposit.  Tear the top copy of the deposit slip off, put it on top of the checks, paperclip or rubber band the stack together and take it to the bank.
  15. Once you’ve made the deposit, bring the receipt back and tape it on the back of the deposit slip copy in the deposit book.  Enter the amount of the deposit into your accounting system (Quickbooks, Peachtree, Great Plains, etc.)
  16. Rest until tomorrow’s mail arrives

Note: smaller or larger offices may use a simplified or a more sophistocated version of this process.  Feel free to comment and let me know how you do it!

Posted in: Day-to-Day Operations, Finance

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Monday Special: Podcasts for Medical Practice Managers

Do you listen to podcasts?  They’re little stories for grownups; small blocks of info that you can listen to while you’re doing almost anything.  I remember story time in elementary school so well.  The classroom lights would be off, and we would put our heads down on our desks.  I remember one nun had the most beautiful reading voice; I would wait all day for storytime.

Podcasts are one way you can feed yourself information or ideas, get continuing education credits, or just relax while someone reads to you.  Some people listen to podcasts as they’re falling asleep, and others listen while they’re exercising.  Even though the podcasts I’m describing here are for professional enlightenment, you can find podcasts on just about any topic you choose.

Here are a few podcast sites for healthcare managers, and one for managers in general.  You can listen by clicking on the website, or if you want to listen away from your computer, you can load it onto your iPod or other MP3 player.

SoundPractice has podcasts abstracted from The Journal of Medical Practice Management (both available from Greenbranch Publishing) as well as interviews with “health leaders and interesting people involved in the American health care system.”

Manager Tools just won Best Business Podcast Award for the third year in a row.  The producers of the podcasts recommend new listeners start with Manager Basics that cover core principles that underly the Manager Tools philosophy.   A comment from the producer was, “…healthcare management is the hardest management job in the world”¦if Manager Tools works there (and it does, say our healthcare clients), it will work anywhere.”

P.S. I checked the MGMA/ACMPE  website to see if continuing education credits are available for podcasts, but it wasn’t clear.  If anyone knows, would you leave a comment and let me know?

Posted in: Learn This: Technology Answers

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Are New Consumer Satisfaction Measurements Needed for NCQA Health Plan Ratings?

From today’s US News & World Report:

This is the fourth year that U.S. News and the National Committee for Quality Assurance, managed care’s major accrediting and standards-setting body, have teamed up to rank healthcare plans. We release the rankings during open-enrollment season, when millions of Americans prepare to select their healthcare coverage for the next year.

How were plans rated?

The rankings … show how well plans do at preventing and treating illness and providing consumer services to members.

How is consumer service defined?

(Measures) …included members’ opinions about the ease of making appointments and getting care, doctors’ ability to communicate effectively, and satisfaction with claims handling.

I find these measures particularly interesting as only “satisfaction with claims handling” is a measure of the plan.  “Making appointments” and “doctors’ ability to communicate effectively” are services provided by the participating physician, unless the physicians are employed by the plan.  I would like to see measurements of plans be more along the lines of:

  • clarity of plan details communicated to subscribers and physicians;
  • ability of plan agents to communicate with consumers and physician offices about routine issues and priority issues;
  • ability of the plan to provide the physician office (preferably electronically) with pre-authorizations and pre-notifications for services, procedures, surgeries, and implants in a timely and efficient manner.  These functions, which are very critical to getting patients needed services in a timely and efficient manner, are not usually considered to be a part of the claims handling process.
  • ability of the physician offices to obtain (electronic) information on individual plan benefits by subscriber or beneficiary OR electronic adjudication of the patient’s visit that day;
  • ability of the payer to provide the physician office with info for giving patients real quotes on tests, therapies, procedures and surgeries so that patients can make informed decisions about the cost of their care prior to having a service.

I know that to measure this, the plans would have to collect data from the physician offices (and some do), and publish this (none do that I know of.)  Kudos to any plans doing this (and write to me and tell me if they/you are) because it acknowledges that the physicians are stakeholders and are a critical part in satisfying consumers.

Medical Group Management Association (MGMA) recently sponsored a survey ..” to assess group practice professionals’ attitudes concerning payers in all 50 states.”  Members who participated will receive a copy of the survey for responses from their state.

More on NCQA:



NCQA is a private, non-profit organization whose mission is to improve health care quality. The organization measures and reports on various aspects of performance and offers a range of accreditation and certification programs for different entities and individual physicians. Visit them online at

Posted in: Medicare & Reimbursement

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Spotted! Amazing Customer Service Experience at Walgreen’s

Today I had to run to the drugstore to get a bunch of cough drops and cold medicine and some microwave chicken noodle soup for my husband, who has a nasty cold.  I ran in, grabbed a bunch of stuff and juggled it in my arms (not taking the basket as always because I’m only getting a few things) and unloaded at the cash register.  Not only did the cashier search through the Walgreen’s circular because she was sure there was a coupon for something I was buying, but another Walgreen’s employee came up to me, took a handful of coupons from her smock, and found two more for items I had on the counter.  Between them, the two clerks saved me almost $3.00!

Neither one of the clerks had to help me in the way they did.  I had no expectation that I would get to use coupons because I was in a hurry to get in, get out, get back home to ditch the stuff for my husband, and head back out to work.  These Walgreen’s ladies thrilled and delighted me by offering me more than 10% off my bill, and I felt they wanted me to get the discount.  If Walgreen’s instructs employees to help customers this way, they are brilliant.  If the Walgreen’s in my neighborhood has a manager that promotes customer service, I commend him or her.  If these ladies are the creators of this customer service ethic, I bow to their excellence.

What could be better than a customer service surprise?  Something you didn’t require, or expect, but certainly appreciate.  What could you do to create this in your practice?

  • Validate parking on a special day (election day, the practice’s anniversary, veterans day, etc.) for a location where patients usually have to pay to park.
  • Provide information on local pharmacies so patients can easily find the closest pharmacy to your office, or find a pharmacy that delivers.  This could go hand-in-hand with helping patients to find the pharmacy with the lowest price for their prescription (see my post on getting started.)
  • Send new patients an email thanking them for coming to your practice and making sure they know how to get back in touch with the practice if they have any questions or concerns.  Most practices may not be ready to open this door, but I suggest you be one of the first and set the pace for your competitors.
  • I suggest you take down the signs saying “no cellphones”, and recognize that patients are trying to multitask and get things done in exactly the same way that we are.  Invite loud cell phone talkers to step outside and give them a pager to call them when you’re ready for them.  Meet patients on their terms.
  • What are your ideas?

Posted in: Amazing Customer Service

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Monday Special: Use BNET and CNET to Find Information on Business, Management and Healthcare

BNET is Business Network and CNET is Computing Network and both sites are owned by CBS.

BNET is a great one-stop shop for information on business and management, and now the site has a category for healthcare described as:

…daily industry news coverage and insights for managers and executives, focusing on the major health care providers, hospitals and facilities, insurance companies, and medical device manufacturers. In addition to detailed company profiles, we bring you critical analysis on new alliances and partnerships, new products, health care cost control, partnerships and alliances, management and board changes, and a host of other important business issues.

That may be a bit much to consume on a daily basis, but don’t forget, information is a buffet, and you don’t have to eat everything!

Here are a few BNET goodies you might like to check out:

Marketing Secrets from Campaign ’08 (if you are in a competitive market, read this and think about your maketing!)

Finding Opportunity in Upheaval (if everyone at your practice is stressed and cranky, it’s a perfect time for you to think differently. Patients need healthcare – what are you going to do about it?)

And don’t forget to check out BNET’s Business Library and Videos (including “Motivating a Stressed-Out Staff” during an economic downturn – very solid advice – I give it 5 stars!)

CNET is all about cell phones, computers, audio, video, etc., and has the latest on gadgets, including reviews and prices.  It’s also a great site to find software to download.  This site might not be as appealing as BNET, unless you’re as geeky as I am, and the longer I write this blog, the geekier I get.  One of my favorites on CNET is Tips & Forums.

And just in case you are geeky, check out Woot, the site I check daily for great geeky deals.

Posted in: Learn This: Technology Answers

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Top Takeaways of MGMA 2008 – FierceLive Webinar With Yours Truly

I just participated in my first webinar and really enjoyed discussing the 2008 MGMA Annual Conference with colleague Marshall Maglothin and Editor-in-Chief Anne Zieger.  Click here to register with FierceHealthcare and launch the webinar.  My part starts at about 16 minutes.

Let me know what you thought about the conference.

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Monday Special: Resources for Managers Who Think Outside the Proverbial Box

Another week, another barrage of interesting and helpful items on the web.  I hope you enjoy today’s selections!

Getting Warmed Up: Employees Walk While They Work (Call it innovation in the staff wellness/insurance premium reduction program arena.)

This next resource comes with a “R” rating, because it gives you the word of the day and it covers everything!  If you want to know what current lingo means, this is the place to find it.  Remember, I warned you!

Have you ever thought about having volunteers at your facility?  Volunteers might be just be what you need! Read about volunteers here.

And now for something green, read this article to learn about saving paper, toner, shredding service, time and trees!

I’m off to the MGMA meeting in San Diego, then off for a few days of vacation with hubby where we will attempt to “unplug” from all things electronic.  When there’s no Monday Special next week, think of me somewhere with blue water and very expensive roaming charges.

Posted in: Learn This: Technology Answers

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How Does One Become A Medical Practice Manager?

Is my job similar to being the Commissioner of Baseball?

Am I the Commissioner of Baseball?

Most people who ask what I do have never heard of managing medical practices.  Many people say “I didn’t know there was a job like that.”  Medical Group Management Association’s (MGMA) definition of medical group practice and medical practice management is helpful:

Medical group practice is defined as three or more physicians engaged in the practice of medicine as a legal entity sharing business management, facilities, records and personnel. This includes single- and multispecialty physician offices, ambulatory surgery and diagnostic imaging centers, hospital-based practices and academic practices. (Medical Practice Managers) … are part of a large and growing field that requires broad knowledge, skills and experience for long-term success. And the decisions they make directly affect nearly every aspect of a practice’s operations, from financial performance to patient care.

The next question many people ask is “How do you learn to do that?”  People who do what I do come from lots of different professional backgrounds.

It has been a fairly recent development that there are undergraduate and graduate programs for this field.  Many physicians who are business-minded have pursued degrees that allow them to manage their own practices while practicing medicine, or enter the healthcare management field and leave active clinical practice.  According to a recent Times article, there are 49 schools that currently offer a dual MD/MBA degree.

Here a few ways other than formal healthcare management training that medical managers enter the field.

Nursing/Clinical: I have known some excellent medical practice managers who have four-year nursing degrees, but I don’t know a lot of them.  It seems that most nurses want to be nursing, not managing, and that they became nurses to care for patients in a hands-on way.  I have observed that some managers with nursing backgrounds are instant fixers, and have trouble taking the contemplative route to problem-solving.

Management Experience: There is no question that private practices are coming late to the business party and that experienced managers bring a lot to the field.  It can be hard, however, to jump into managing a practice with no former healthcare experience because so much is so different.  The owners of the business (the docs) are also the ones producing the revenue.  As my husband says, the job is very much like being the Commissioner of Baseball.

MBAs: Having a MBA brings a lot of tools and resources to the table, but is not the be-all and end-all, especially when it comes to people-management.  The best managers in any field truly like and value people, have time for people, are collaborative with people, and care about people.  Can this be learned?  I don’t know.  Probably not genuinely.

Technology: Managers who understand and embrace technology will have the advantage over every other manager.  Healthcare and technology are becoming more and more wedded.  Every priority technology function that healthcare managers have to outsource is an aspect of the practice that is somewhat out of their control.  Think practice management systems, EMR, phones, PACS, email, knowledge management, lab interface, hospital interface, patient communication, etc.

Up through the ranks: Managers who have come up through the ranks have a big plus in their favor and a big minus.  The plus is that they understand healthcare, the nitty-gritty functions of the practice, have experience relating to administrative and clinical staff, and know how to network.  The minus is that they are usually undervalued due to the lack of formal education, and may also undervalue themselves for the same reason.

In the end, it’s not where a person comes from that makes the biggest difference, it’s who they are and what they’ve made of their career.  Anyone can enter the field of healthcare management, but I do suggest  these three prerequisites:

  1. Compassion for patients (compassion for all people)
  2. A desire to continuously learn; if you stand still you’ll get moldy
  3. A sense of humor.

For information on organizations that award credentials click here.

Here’s an interesting history of the field of medical practice management.

Photo credit: Mary Pat Whaley

Posted in: A Career in Practice Management, Leadership

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