But in a way that's good news, because while there isn't much you can do about someone's poor work ethic (short of firing him), you can strive to make your workplace more fun and interesting. And you can challenge your employees in ways that will keep them engaged, while benefiting them and your practice in the long run.

Reynolds says she sympathizes with her administrative staff.
"The jobs have a certain degree of monotony associated with them," she says, "but they are absolutely critical functions. We have to make sure that we all do what we can in terms of engaging the group. Make sure you give them the appropriate training, answer all their questions, and try to find ways to inject in their day some other things that kind of generate a little more interest and keep them going."

For instance, charge-posting has to be done perfectly, Reynolds says, yet the process of typing numbers into a computer all day is tedious, and therefore prone to error. How to resolve that?

Potomac Physicians involves its charge-posters in its claims appeals process, "so they have a fuller picture of the whole situation," says Reynolds. "It gives them a sense that they're really bringing something to the practice."

By cross-training its front-desk staff to perform in other areas of the practice, it adds variety to staff members' days, builds their professional credentials, and gives the practice some flexibility. The results have been solid, says Reynolds.

"Statistics I've read suggest that practices have an annual turnover rate of 20 percent to 25 percent at most front desks or medical record operations," she says. "We've been lucky; at our practice, turnover is around 12 percent, and we're really happy with that. Again, our efforts are to try to make the job a little more interesting. We train all of our front-desk people at all of our offices to have the ability to make appointments, register people as they come in, manage the medical records area, get the physicians' claims into our business office — they all have the ability to do that. They all have primary functions in one area or the other, but if they want to, they can move around — or if we have an urgent issue, we ask them."

From time to time, you can also try to make the workplace more fun by having inexpensive office events, like summertime ice cream socials. Involve patients, too.

Of course, the principles of basic employee management always apply. "Don't tolerate employees who are not pulling their workload or being a team player," advises Woodcock.

You should hold staff to productivity standards that you develop for specific job functions in your practice. Consider offering monetary or other types of incentives to staff who meet and exceed your standards.

Of course, knowing what you need is one thing; knowing whether employees are meeting your expectations is another. Sometimes neither the employer nor the employee knows for sure whether the staff member is doing a good job. You need to know what the employee's actual productivity is, and that information is difficult to glean without a good practice management system.

Speaking of which ...

Challenge: Purchasing technology

When the doctors at Arizona Oncology Services, a 20-physician radiation oncology group based in Phoenix, realized they couldn't determine how well they were doing financially with a new brain cancer procedure without performing weeks of research to run several reports, they knew it was time for a new practice management system.

But how to find the right one? That job was handed to Joshua Mentzer, the practice's chief technology officer, who sorted through systems offered by more than 100 vendors before paring the list to 30, and then to three.

Eventually, the group settled on the NextGen Enterprise Practice Management system.