Today’s medical practice is complex. You strive to deliver quality, compassionate care to your patients. But there are legal and compliance requirements—CMS, malpractice, Stark, HIPAA. You’re accountable for institutional performance metrics. Payor and network contracts must be negotiated and renegotiated. Then there are the functions inherent in managing a business—operations, budgets, space allocation, personnel management. You address the increased workload by adding more staff. Meanwhile, reimbursements are declining. 

One person can’t do it all. In the successful medical practice, it takes two. Two highly trained professionals—the physician and the practice administrator—must work in concert, utilizing their individual skills and talents. By complementing each other’s strengths and weaknesses, this team can lead the practice to excellence and advance patient care. But it takes the right players and the right attitudes. As with any successful partnership, there must be give and take. 

Over the last eight years, we’ve worked together to significantly grow our patient visits, improve our collections/expenses ratio, reduce employee turnover and increase patient satisfaction. Here’s the formula we’ve discovered for creating a sound partnership.

For the Physician

What the Physician Should Look for in an Administrator
  • Motivation
  • Integrity
  • Humility
  • Record of accomplishments
  • Flexibility
  • Tact
  • Diplomacy 

Drop the ego and be ready to share. There are four critical steps the physician must take for paired leadership to be successful:

1) Prepare yourself. Make a conscious decision that you are ready to share the leadership of the practice.

2) Drop the ego. You’ve worked hard to grow this practice. You’ve spent long days in clinic and longer nights sifting through paperwork. But you’ll have to admit that you can’t do everything yourself and do it well. 

3) Swallow your pride. Be ready to be challenged. Be willing to listen. When you hire someone who can help share the administrative load, you are also hiring someone with opinions about how to do things and a set of skills and expertise that you probably don’t have. 

4) Share the good and the bad. If you share leadership responsibility, you’ll have to share the recognition that comes with success, as well as the ownership of failure when some decisions don’t work out as anticipated.

Remember, finding the right partner is a two-way street. The physician should desire a paired leadership model—and should be searching for a candidate that can fulfill the qualifications of this role.

But the practice administrator candidate should also have a corresponding list of criteria for evaluating the physician leader. It is essential that the interview process be structured in a way that will bring these specialized capabilities to light for each party.

For the Practice Administrator

What the Administrator Should Look for in a Physician 
  • Humility/ego balance
  • Motivation
  • Integrity
  • Communication/listening skills
  • Collaboration
  • Flexibility
  • Patience
  • Vision 
Find a physician who can let go. The first quality you’ll want to look for in a physician doesn’t always reveal itself in the first several meetings—a good balance between humility and ego. Many physicians can’t let go of leadership responsibilities for fear of appearing less than capable to medical staff. While a good shot of ego is necessary for success, finding the right balance between the two is what will make or break the partnership.

Paired Leadership in Action

There are no rigid guidelines for how paired leadership should work. As situations arise that require decisions, a style or “dance” will emerge that is right for the two of you. But there are some factors that are critical to your success as paired leaders.

Build your relationship on trust and respect. The keys to that include:
  • Communicate and listen effectively. Take the time to listen—really listen—to what the other person is saying. Learn how to disagree with each other and communicate with respect.
  • Be candid. Express your honest opinion and don’t hold anything back. Give the other person room to express his or her opinion fully and openly.
  • Show mutual respect. Respect is something that has to be earned through repeated actions. Each leader should respect the other’s opinions and show that respect in front of other staff members. You should each know the other’s “got your back.”
  • Share a leadership style. Paired leadership works best when both of you embrace a non-controlling leadership style rather than an autocratic one. An open-door policy smoothes information flow.
  • Respect the other’s skills. Both of you are experts in your respective fields—respect what the other has to offer. You each have something to teach, and you each have something to learn. 
  • Recognize the line between business and personal. For paired leadership to work, you should support, but not get involved with, the other’s personal matters. 
More Practical Tips

Our experience has shown us a simple equation about paired leadership: Share the work, share the pain and you will share the success. Here are some further ideas that will help forge your partnership:
  • Define roles clearly. Who reports to whom? Who works on what and when? Establish the frequency of formal and informal interactions.
  • Collaborate on decision making. Consult with each other and discuss difficult decisions. Listen and communicate, but don’t be afraid to challenge each other.
  • Share goal setting. Set a dedicated time aside for planning and weekly updates. Be open to each other’s ideas—no idea is a bad idea.
  • Develop a strategic plan. Your strategic plan should be a written document that is shared with the larger group through mission-specific meetings. Allow for input and feedback from staff. 
  • Have the difficult conversations. Don’t ask your partner to do the dirty work if it’s within your area of responsibility. Prepare each other by role-playing and acting as devil’s advocate.
  • Empower each other. Know when it’s OK to act on your own and when you need to circle back around for consultation. Your job is to make each other look good and to let the other know that you’ve got his back.
  • Don’t hold each other back. Support each other when opportunities for growth present themselves. Challenge each other and get outside the comfort zone.
The results will be a growing practice with better income and better outcomes. By creating a culture of collaboration, you’ll attract the best physicians and realize less staff turnover. You’ll improve the patient experience, resulting in higher satisfaction. But most important: You’ll enjoy the rewards.  REVIEW

Dr. Sternberg is the assistant vice chancellor for adult health affairs and associate dean for clinical affairs at Vanderbilt School of Medicine, and the G.W. Hale professor and chair at Vanderbilt Eye Institute.

Mr. Carlson is the department administrator at Vanderbilt Eye Institute.