The Intake

Insights for those starting, managing, and growing independent healthcare practices

Practice Pulse: How to choose a practice administrator

In this Practice Pulse post, Dr. Sutton covers what to look out for in a practice administrator — and why it’s one of the most vital decisions a practice can make.

This post is a part of the Practice Pulse series
How to choose a practice administrator graphic

Tips for success

    • Search locally, regionally, and nationally.

    • Your best candidate will resemble a project manager who is an expert in planning and execution and understands numeracy.

    • Find the right person who will take charge immediately so the physicians can step out of the way and practice medicine.

    • The interview process should take place in phases of familiarity and hard questions.

    • Practices should only consider those with high marks on the candidate final exam.

The Practice Pulse is a monthly column written by Dr. Drew Sutton, a board-certified ENT physician with over 20 years of experience of managing an independent practice. He covers topics about patient care, leadership, practice management, and more.

One of the vital decisions that a medical practice faces is choosing a practice administrator — the person who will oversee the business and operational side of a practice. The selection process is often based on a mix of personality, insight, and how good the candidate is at selling themselves. It should be more than that.

Judging who may be the right fit for your practice may not be as straightforward as asking around town about who has the best reputation — and then trying to steal them away to work for your practice. On paper, candidates may turn out to act differently on the job.

Recruiting the ideal candidate for the practice is personal, and above all, non-scientific. The best person may seem great at the onset, handling the expected, and then later lose effectiveness because of the unexpected. 

At one point, our practice was faced with the challenge of a sudden influx of Spanish-speaking patients. Our practice administrator was at a loss as to how to handle it. Her solutions did not match her promises.

There are many online guides and suggestions, but few offer a physician’s perspective. After almost 30 years of experience, working with practice administrators with varying degrees of competency, and struggling to keep up with the changing healthcare market I found that choosing a practice administrator means creating an alliance with someone who desires to be equally invested in the practice as the owners. 

In this guide, there will be a review of some key elements, minimum requirements, and tips on how to pick the best administrator for your practice.

Where does a practice find an administrator?

The first place is to ask around locally. These are leaders in the community who already know the local talent and business atmosphere. They may lend insight into local trends in healthcare.

But don’t feel obligated to stop there even if there are candidates with advanced degrees such as Masters in Healthcare Administration (MHA), Masters in Business Administration (MBA), Masters in Public Health (MPH), or Master of Public Administration (MPA). Post your job opening regionally and nationally on sites such as mgma.com or Linkedin

If the practice is a specialty, don’t forget to include American Academy resources in that particular field of medicine. My experience is that all practices look or should look to mimic or improve on what others are doing in other locations. Some national organizations have groups of administrators who trade ideas and have suggestions, too.

Even if your practice administrator is not discovered through a national organization, encourage your new potential hire to participate or even to become a leader locally, regionally, and nationally. In my practice, this visibility brought more patients and revenue to our practice.

The practice administrator who won the gold star in my career encouraged me to become involved in leadership in medical societies. The combination of both the practice administrator’s and my reputation improved our practice overall, allowing the practice to attract new physicians and advanced practice providers (APPs).

Optimize Operations

Think of your next practice administrator as a project manager 

Anyone can plant, only the best can foresee what the landscape will likely look like in the future.

Of course, the practice wants someone to perform site analysis, site inventory, and site planning while managing everyday operations. But what a practice needs is someone who will solve problems, create sustainable designs, and ensure all the best practices follow appropriate laws and regulations. 

What a practice needs is someone who will solve problems, create sustainable designs, and ensure all the best practices follow appropriate laws and regulations. ”

The best person to choose will develop new or improved theories, and create functional methods to improve the practice. This methodology will involve research and continual monitoring. Think about asking the potential candidate how they would accomplish these goals.

A point that is often overlooked in choosing a practice administrator is the fact that they will be the practice leader overseeing the staff, but they should not be subordinate to the physician owners. They should be colleagues.

In our practice, we devised creative ways for our practice administrator to become an integral part of the practice, short of outright ownership. We offered her the title of CEO and defined her role as a fiduciary so that when the practice did better, she did better. Practices should make these types of decisions on an individual basis.

How should a practice interview a prospective practice administrator?

Find the right person who will take charge immediately so the physicians can step out of the way and practice medicine.

Physicians don’t like drama in their offices. They especially don’t like trying to fix issues out of their comfort zone or losing revenue. Most are focused on improving their lives and the lives of their patients and staff. 

Finding an administrator who possesses a great work ethic and seems to have all the right education and experience may still not be enough. Physicians know this firsthand during their training. 

Some people can look great on paper, but when it comes to action, even the best people can fall short in action. This is hard to predict. Consider possible red flags before hiring such as:

  • Lack of clarity or consistency in answering questions
  • Giving the impression that the administrator's job should be something different than what the physicians think it should be–a lack of connection.
  • Inappropriate questions or comments, particularly about patients or staff.
  • Resistance to change, especially if constantly comparing your practice to a previous one
  • Demands or ultimatums such as “I need to know if you will hire me right away or I will need 6 months to decide,” “I have a lot of other offers,” “I want practice ownership and voting rights,” or “I will need to reschedule our next interview for 3 weeks.”

The interview process should be led by the practice, not the physicians

Whether the candidate is local or must travel from afar, the interview process should be the same. The physicians should not make the mistake of interviewing the candidates alone. They should always invite someone else from the practice to join them to meet the new person, even for informal meetings.

The day before: get-to-know-you time

The practice should familiarize itself with the candidate. The best way to do this is to invite the candidate to lunch or dinner the day before the interview. This is true even if the candidate does not have to travel to the practice from out of town.

It is important that no one pressures the candidate during this time or asks the tough questions. Save that for the next day.

The venue for this pre-interview should be nearby, not at one of the practice locations. Again, the idea is to make the person relax and become comfortable. 

Keep in mind that first impressions matter and can go both ways. If the practice — or the prospective administrator — doesn’t see what it likes at first glance, chances are it will not work out. 

Interview day

The candidate should meet all of the staff, if possible. This aspect of due diligence cannot be overemphasized. Everyone in the practice should have a say; everyone’s impression is important. 

One of the top red flags to look out for is if the candidate spends too much time with the physicians or nurses and ignores other staff. That person is already ignoring their central role: the practice’s well-being.

The candidate should be allowed to tour not only the physical office(s) but also the internal workings of the practice. That means like a new car buyer, they should be allowed to look under the hood, kick the tires, and take the practice for a test drive. Interviewing someone on a busy clinic day may bring insight as to what is going on in the practice, or it can prove to be a detractor.Every individual practice should choose what works best.

The candidate should be given disclosures of financial performance, practice demographics, workflows, and payment history. A lot can be determined by physician and nurse schedules and procedure protocols, so make sure everything is available.

Aside from looking for inquisitiveness, the practice should see the person as an excellent communicator with good arbitration skills. A lot can be learned from the person’s energy and enthusiasm. Also, the person should be able to talk about how they multitask, handle the unexpected, and look at the big picture.

Questions and curveballs

Depending on the needs and concerns of the practice, every candidate should be given a litany of questions that are relevant to the current situation of the practice. These questions should be sprinkled out throughout the day, but they are not the Candidate Final Exam which will be described below.

The following are examples of questions that are not meant to be complete, but rather a starting point for discussion. The interview should last for several hours and resemble a typical workday.

General questions:

Why do you want the job? 

Why are you best suited for this practice?

Quality of care:

How do you define, evaluate, and monitor the quality of care in a medical practice?

How does patient satisfaction relate to quality of care?

Education:

What is your view on patient education and how can it be improved?

What are your views on provider and staff education? How would you create a learning environment?

Patient and staff experience:

What are your favorite methods of communication with staff, patients, and providers?

What steps would you use to improve the practice’s overall atmosphere for patients and staff?

How would you minimize patient wait time in this practice?

How do you prefer to handle patient complaints?

Patient and staff acquisition, retention, and scheduling:

How would you market the practice?

How would you improve the practice’s patient volume?

How have you helped practices attract new physicians, nurse practitioners, and physician assistants?

What are your strategies for workload distribution and provider scheduling?

What are your hiring strategies for staff?

Finance and law:

What is your financial background in managing a medical practice?

How comfortable are you with creating financial statements and communicating with practice accountants and lawyers?

Describe the experience you have with managing contracts, vendor relationships, and supply inventory.

How do you stay up to date with healthcare regulations and laws, specific to this practice’s specialty?

How versed are you in HIPAA compliance and OSHA regulations?

Problem-solving:

Can you offer a past example of a disagreement among the staff and/or providers and how you handled the situation? 

Provide an example of a prior emergency or crisis. What did you do and what could have been done differently?

Technology:

What is your experience with electronic health records (EHR) and practice management software? If the practice uses a different system than what you are used to, how will you get up to speed?

What is your view on new technology and software being introduced? Provide a recent example and how you handled it.

Leadership:

What kind of a leader do you see yourself as?

What are your strengths and weaknesses?

Don’t be afraid to throw curveball questions. The idea here is to gauge a response, not so much of an opinion.

  • What are the top leading causes of death in the United States? (Heart disease, cancer, COVID-19, accidents, and stroke are in the top 5) 
  • What is your opinion of the bombardment of television advertisements dealing with pharmaceuticals? 
  • What is your opinion of the recent healthcare worker strike involving Kaiser Permanente? 

Avoid controversial topics such as politics.

Download the report

Get a sense of numeracy, not math

Another elusive quality to find in a prospective candidate is known as numeracy. This means how the person can demonstrate an understanding of math in practice.

Raw math skills are not enough. Anyone can add, subtract, multiply, and divide, or even use a spreadsheet. While there is no requirement for theoretical calculus, the practice should try to find someone who can: 

  • Understand and apply reasoning with the application of numerical concepts
    • Have the ability to recognize the importance of medical practice numbers in contextual settings. An example is the number of patients seen and how that number impacts the financial health of the practice. Sometimes, more patients do not translate into more revenue.
  • Measuring the efficiency of a provider’s or staff member’s time and resources
  • Judging the numerical magnitude of expenses, investments, and income opportunities
  • Subitizing. This is the art of estimation of amounts. It is how certain numbers in the practice may mean more than others. Only the rare few can squeeze the last drop of juice out of the orange. For example, don’t be afraid to ask the potential candidate for real-life experiences on how they were able to estimate numbers for certain medical procedures.

Candidate final exam: one question

What is their vision for the practice in 6 months, 1 year, and 5 years?

The best candidates will have plenty to say. The worst candidates will not. It is that simple.

The practice needs someone who will know that strategies for improvement do not always fit into existing plans. It needs to hear that there are ways to see more patients, increase patient satisfaction, and at the same time, make more money. 

The practice needs someone who will know that strategies for improvement do not always fit into existing plans. It needs to hear that there are ways to see more patients, increase patient satisfaction, and at the same time, make more money. ”

The new administrator should be able to elucidate goals to give the practice a competitive edge. If the candidate has nothing at this point, then it is likely that they will not come up with anything anytime soon.

Next, the practice should hear about detailed plans to achieve these goals. Granted, some of these ideas may seem like dreams, but dreams are the foundation of progress. An independent medical practice must have a visionary, not just a leader.

Grading the candidate final exam

The greater detail that is offered, the better. Those prospective candidates who come up with a dozen or more reasonable ideas will score the highest. 

Points are deducted for:

  • A candidate who offers too few or nonsensical recommendations, or states that they won’t be able to finish the final exam until they are working in the position. The latter is almost always a signal to pass on that particular candidate. 
  • Negative talking points or comparisons to a prior practice, hospital, or healthcare setting. A practice needs only positives.
  • A lack of people skills.

Finding the right practice administrator is worth it

The grading of potential practice administrators on the final exam can be daunting, especially if none of the current candidates score highly. The idea is for the practice to keep looking until there is a good fit. Don’t give up.

The most successful independent practices have the best practice administrators. Finding the right person is worth the time and effort.

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Reviewed by

Drew Sutton

Dr. Drew Sutton is a board-certified ENT physician. He has vast experience in treating all aspects of ENT, with particular interests in disorders of the ear and nasal and sinus disease. During his career, he started and managed an independent, single-specialty medical practice in a large metropolitan area.

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