Polite and friendly, pediatrician Carol Reynolds isn't your typical angry-at-the-system doctor. But get her talking about the challenge of dealing with insurance payers, and her congeniality turns to frustration.

"It's so burdensome and labor-intensive," says Reynolds, the medical director of Potomac Physicians, a multispecialty primary care group with 10 practices in the Baltimore area. "I don't know why insurers seemingly work so hard not to pay doctors. There is so much that has to be done and every payer seems to want it done in a different way."

She struggles with other practice management hurdles, too, from staffing to scheduling to finding room for all those paper charts that occupy every available inch of her office in Woodlawn, Md.
And Reynolds is hardly alone.

So common and pervasive, in fact, are certain challenges to running an efficient medical office that when Physicians Practice asked its readers to name their five biggest headaches, the response was overwhelming. And while opinions were not without variation — some of you cited certain clinical challenges, for instance, and one of you complained about lax security at the prison where you work — a clear consensus emerged.

Most respondents focused on a handful of complaints that seem to plague almost every practice, regardless of size, specialty, or location.

In no particular order, they are: staffing issues, scheduling problems, the headaches of dealing with payers, the challenge of reviewing new technology, and the overwhelming documentation required to get paid — and to cover one's posterior in an over-regulated and litigious world.

Why should anyone want to compile such a list of problems? The dual goals were to remind practices that they are not alone, and — more importantly — to offer some creative suggestions for clearing their biggest hurdles.

On the latter point, there is good news: there are ways to deal with every item on the list — perhaps not to eliminate any entirely, but to manage each one at least a little more easily.

Challenge: Staffing

The difficulty of finding, managing, and retaining good administrative staff was one of the most common challenges identified by physicians.

Daniel Laury, a solo OB/GYN in Medfield, Ore., says employees today are not properly motivated.

"Basically, there's a work-ethic issue," complains Laury. "I know every generation says this, but ... the drive to do well just isn't there anymore. And that's what other doctors tell me, as well."

The complaint by middle-aged and older physicians that younger colleagues and staff don't want to work very hard is a common one. And indeed there are generational differences when it comes to attitudes toward work, says practice management expert Elizabeth Woodcock, MBA, FACMPE, CPC.

But what prior generations may perceive as laziness is for many younger people just a different set of priorities, she says. Younger doctors and staff tend to work to live, not the other way around; they work as hard building satisfying personal lives as previous generations did building their careers.

Between clinical and nonclinical staff, this gap can seem wider, because administrative jobs in medical practices can be tedious and low-paying. In other words, to many of your staff it's just a job.