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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What Saves Money, Time and Is Green All Over?


An article authored by Kurt Cagle, online editor for O’Reilly Media, does a great job exploring telework which he defines as

employees and contract workers performing their work out of the office – from home, from distributed work centers, from coffee-shops, indeed, from wherever those workers may happen to be at the time.

Probably the job most commonly performed off site for medical practices is transcription, with billing a close second.  More recently I’ve heard of triage nurses and registrars teleworking and if you  think about it, any job that can currently be filled by outsourcing (appointment reminders, appointment scheduling, switchboard, etc.) could be performed by your own employees offsite.

If you’re like me, you may have considered teleworkers for your practice, but worried about managing off site employees and keeping them bonded to the team.  Cagle discusses the ever-growing list of technologies available to stay connected, but does not underestimate other problems historically associated with telework.

Telework requires a certain degree of self-starting and responsibility. Ironically, a number of studies, including one performed by Sun in 2007 showed that one of the older stereotypes of teleworkers as people who would tend to do a little work then skip to some other activity, watch TV or surf the web actually proved to be something of a myth – for the most part most teleworkers actually tend to put in longer days working than they would in the office …


Other benefits of teleworking for employees:

  • Savings on gas, parking and wardrobe
  • Ability to self-schedule
  • Gain personal time eliminating commute
  • Customized workspace for each person: temperature, light, sound
  • Reduction of the carbon footprint

Other benefits of teleworking for employers:

  • Saves on expensive medical office square footage
  • Fewer distractions could increase productivity
  • Allows practice to grow without physical expansion
  • Expands employee pool – employees can live anywhere
  • Reduction of the carbon footprint


Read the entire article here.


Posted in: Human Resources, Innovation, Memes

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Google Health’s Newest Version Makes Personal Health Records Accessible to Visually Impaired Users


Google Health announced today that the newest version of its patient-managed medical record is accessible to visually-impaired users.  Using voice prompts and auditory icons, users of assistive technology are now able to open Google Health profiles and populate them with their own medical information including vitals, conditions, medications, allergies, procedures, test results and immunizations.

Assistive technology such as screen readers, which translate  text into speech or text into Braille, offer computer access to the blind, visually impaired and illiterate.

Writing about the launch of Google Health’s newest enhancement, Google Blogger and Research Scientist T.V. Raman, notes that

“Google Health gives me a single unified web interface to manage all of my health-related information. Kudos to the Google Health and GWT teams for creating an extremely useful and usable solution!”

T.V. Raman is also the author of Emacspeak, a speech interface available free on the Internet that allows visually-impaired users to access computer applications, including video gaming.  T.V. Raman, himself a visually-impaired user, discusses the software requirements to use the Google Health.

“Note that the accessibility support in Google Health requires support from both the browser as well as the adaptive technology in use. At present, we recommend Firefox 3.0 with screenreaders that support ARIA, alternatively, you can also use Fire Vox, the self-voicing extension to Firefox 3.0.”

In addition to improving accessibility for users, Google Health continues to seek relationships with innovators in healthcare, including those developing applications for disease management, secure messaging, and research.

Look at Google Health here.

Posted in: Innovation

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Monday Special: A Resource for Increasing Everyone’s Basic Computer Knowledge


Have you ever discovered a new software shortcut you can use that improves your efficiency?  Or someone is working with you and shows you a faster way to do something?  What a great moment and a great feeling of success that is – it’s almost like winning a prize!

Sometimes I’ll be working with Excel and just KNOW there’s an easier way to do something, but don’t have the time, the energy, or the patience to find out what it is.  Not that going to Help is that hard or time-consuming, but it’s a mindset that I will find out some other time how to do it faster.  That “other time” never comes.

We’re getting ready to have Brown Bag Training classes (30 minutes, during lunch, staff bring their lunch, not mandatory) at my practice to bring staff up to speed on some basics.  I’m sure we’ll give them some great tips, and I’m sure we’ll learn a lot too.  The point is to get everyone together and build our group knowledge by sharing what everyone knows.

In preparing our handouts for the classes, we’ll use the great article by David Pogue, a tech writer for the NY Times.  The article has 1228 comments full of tips from readers!  Here a few to whet your appetite:

  • You can enlarge the text on almost any Web page. In Windows, press Ctrl and the plus or minus keys (for bigger or smaller fonts); on the Mac, it’s the Command key and plus or minus.
  • Instead of the painstaking task of highlighting a whole document or web page with the mouse cursor, hit Control + A to select all.
  • You can tap the Space bar to scroll down on a Web page one screenful. Add the Shift key to scroll back up.
  • If you are having a problem in Windows and need to ask somebody for advice, try this: in Windows, use the Print-Screen button on your keyboard to take a picture of what’s on your computer screen. You can then paste that (CTRL-V) into a Microsoft Word document. Double click on it in Word and you will get options to crop it and resize it. Then email it.  Showing somebody the problem you are having is a lot easier than trying to describe it.

What’s your favorite tip or trick?

Posted in: Learn This: Technology Answers

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Nuance Releases Version 10 of Dragon Medical Speech Recognition Software


David Williams has a podcast/transcripted interview with Nuance Communications’ Keith Belton on the new release of Dragon Medical.  Here’s the pertinent information straight from the interview:

  • allows physicians to navigate their EMR via speech command and to dictate anywhere in the EMR
  • 20 percent more accurate out of the box than Dragon Medical 9
  • first industrial strength version that allows a chief information officer to install it and deploy it enterprise-wide across hospitals and clinics
  • medical vocabularies that cover almost 80 specialties
  • listens to the speech of non-native speakers and automatically loads one of eight region-specific language accent models
  • new medical abbreviations wizard that presents a list of common specialty abbreviations and follows the Joint Commission guidelines on approved and unapproved expansions of abbreviations
  • can create text-based macros and text-based templates with personal variability

The list price of version 10 of Dragon Medical is $1599 per physician.  The 18% annual maintenance fee includes upgrades.  Here’s the original release notice from the Nuance website.

There remains a huge controversy over the fact that Dragon Naturally Speaking Version 10 (different from the Dragon Medical product) no longer works with EMR packages.  At about $200, Version 9 of Dragon Naturally Speaking was the choice of many physicians using EMR.

Posted in: Electronic Medical Records, Innovation

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What a Patient Said to Me When He Found Out I Manage a Physician Practice


He said, “I’m looking for a doctor that uses email.”  He said he would not use a doctor that doesn’t use email because he doesn’t have the time to fool around on the phone when he needs an appointment or has a question.  Of course, in the practice, we don’t have time to fool around on the phone either, and we’d LOVE to do everything via email, but this is something that seems hard to implement.


  1. Everyone (including me) is uncertain about privacy and HIPAA when communicating with patients electronically.
  2. Everyone (including me) worries about the liability issues related to electronic communication with patients.  How do you index it on the EMR?  Do you print it out if you’re using paper charts?
  3. Systems that are designed to facilitate email with patients seem limited and restricted as to specific uses like making appointments.
  4. Managers worry that email opens the door to patient communication falling through the cracks when we/they are already working very hard to keep that from happening.
  5. Most wonder if it is worth adopting technology early when it’s expensive and untried.
  6. Most wonder how many patients would really communicate electronically if given the chance.

If you could design a safe, low-risk system to communicate electronically with your patients, what would be the uses for this system? What are your communication logjams? Are you aware of or using any systems that have cracked the electronic communication conundrum?

Here’s another article on doctors using email: Why Doctors Don’t Email Patients.

Photo by Andi Berger/

Posted in: Innovation

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Monday Special: A Resource for Your Most Valuable Resource – You


What have you done for your career lately?  Are you comfortable in your current job?  Are you happy?  Happy with your income?  Happy with your level of challenge?  What would you do if you lost your job tomorrow?

Do yourself a favor and invest a little time in your future.

At WordCamp recently, Lorelle VonFossen said “You need to think about having a digital presence.”

I suggest that signing up with LinkedIn (free) and building your online presence is a good start.  LinkedIn could be called the business version of FaceBook although many people use FaceBook as their business networking tool.  The general consensus is that for business LinkedIn is probably the most-used (25 million people) and best-known of the social networking websites.  Social networking uses the theory that we’re all connected to each other through those we know and that every other person on the Earth is connected by six other people, thus the term you’ve heard “six degrees of separation.”  You use these connections to network and meet people, ask and answer questions, and possibly, find jobs.

There’s a lot to completing your LinkedIn online profile, but you don’t have to do at all at one time.  I think my LinkedIn profile is about 75% complete and I’ve been working on it for a couple of months.  Take your time, do it right, then start to look into joining some LinkedIn groups to see what people are talking about.  The trick is not to get hundreds of people in your network (unless you’re a recruiter), but to build authentic relationships with people you think well of.

If you’re not sure what social networking can do for you, check out these articles:

Jobseekers are Beginning to Favor Social Networking Over Online Career Sites to Find Jobs

The Social Network as a Career Safety Net

Posted in: A Career in Practice Management, Leadership, Memes

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Monday Special: One Big Gift Box with One Big Resource Website for Healthcare Managers


Okay, this is a big one!  This one website is like a big gift box that has another box inside and another box inside, and so on.  The site has links to over 800 of the top English-language health blogs.  You can search on site names or search on content.  There are clinical blogs, research blogs, hospital blogs, and management blogs. You can find information, opinions, news, webcasts, and podcasts. You can find lawyers, doctors, nurses and patients.  And pretty soon, you’ll be able to find me!

Happy hunting, and let me know what you find.

Posted in: Learn This: Technology Answers

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Field Trip: Camping, Blogging, Twittering, Vlogging!


My husband and I are away this weekend attending blogging camp.  No, we’re not at a logging camp, we’re at blogging camp.  If you remember, hubby and I both launched blogs in July (you’re reading mine right now,) so we’re newbies trying to learn more and meet others who are blogging.  My passion is taking interesting ideas from other worlds and applying them to mine.  Here are a few things I’m taking away:

  • I just joined Twitter.  This means I can communicate with others and they know what I’m doing and I can find out what they are doing via text messages.  As I explore this more I’ll write about it.  I’d like to use Twitter at MGMA in San Diego in October.  If anyone out there is going to MGMA and using Twitter, please get in touch with me by leaving a comment, or emailing me at
  • Some who know me will say I am obsessed with toilet paper dispensers and hand towel dispensers and they would be correct.  My theory is: If you’re not paying attention to the tissue and hand towel dispensers (the little things) in your practice, you probably aren’t paying attention to the big things.  More on this topic later as I am building out a new site for my practice and will write about making design and fixture choices in the future.  Anyway, the conference we’re attending is being held at CubeSpace which is a very cool place where folks can come and use workstations and technology.  The bathroom here has a very cool hand towel dispenser (picture above) that you work with your forearm!  I will be checking it out for my new office.
  • Backchannels are the new intranets.  I am working on a knowledge management tool for my practice to help document important information that tends to be lost when staff leave the practice.  I got some different ideas about accomplishing this goal from camp.
  • The camp presentations were also streamed live and I learned a little about vlogging (video blogging.)  The last time I thought about making an orientation video I was told it would probably cost $10,000!  With some practice, I think my staff and I can make “videos” for just about any topic.  We can do video tours of our facilities for our website, we can film our meetings for absent staff, we can do narrated PowerPoint presentations.

Whew.  So much technology, so much fun!

Posted in: Innovation, Social Media

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Online Surveys Help You Find Out What Everyone is Thinking


I am about to use SurveyMonkey again.  The first time I used SurveyMonkey was to ask the staff questions about benefits.  I knew that we were facing some big health insurance premium increases and I wanted to know what employees’ priorities were.  SurveyMonkey walked me through the process of designing a simple survey (10 questions) and compiled the results for me.

I presented the results of the survey at my first quarterly staff meeting and discussed what my challenges were in trying to meet the needs of the employees and the needs of the organization in choosing a health plan.  The use of the survey tool and my discussion of the results let the staff know that their feedback counts.

Now, we’re designing a new office and I am soliciting information (not anonymous this time) about what people value in a workspace and what their needs are for technology and comfort.  Feedback from the staff is that they like being asked what they think and enjoy the surveys.  Feedback from me is that SurveyMonkey is easy to use and at $20.00 per month for unlimited surveys, it’s a tool that delivers the value.

Here are some other ways you might use surveys:

  • Put a survey on your practice website.
  • Put a survey on a computer monitor or tablet in your reception area.
  • Send a survey to patients via email.
  • Ask the staff or docs at referring physician practices to complete a quick survey about the service you provide to their patients.
  • If you’ve sent patients for tests, therapy or surgery, have them complete a survey about their experiences.
  • Have a computer for surveys at health fairs asking visitors to participate for a chance to win a prize.
  • Add a link on all marketing materials to a community survey.

What are your survey ideas?

Photo credit: Dmitry Maslov |

Posted in: Innovation

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