Laurie Morgan, MBA is a partner and senior consultant for 

. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book 

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business

Laurie Morgan

In the course of my work helping practices become more efficient and profitable, I do a fair bit of physician recruiting. I frequently write about job-seeking for physicians, too, and when I begin my research for a new piece on physician career planning, one thing always stands out: It’s not hard—not at all!—to get physicians talking about how much they’ve regretted some of their career choices.

Physicians tell me they want to help their younger colleagues avoid the same pain. Often, their regrets boil down to a mismatch of expectations versus reality. This is pain that could have been avoided with better information.

In a field where candidates have already been through some of the toughest intellectual screens around just to get their M.D. or D.O. credential, “better” talent isn’t mainly about who ranks higher on objective measures. It’s about who matches up best with your organization.

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Your ideal candidate isn’t just someone with impeccable credentials, it’s someone who will stay with your organization, help shape its future, enhance its reputation, and earn back the costs of their recruitment many times over. A physician with an outstanding C.V. who leaves your practice as soon as they can—and who is unhappy for most of the time they were with you—represents a huge cost, both in actual dollars spent and in the missed opportunity to bring on someone more compatible.

Yet even though the mismatches are costly, practices and integrated systems don’t always do enough to make sure the fit is good. Perhaps they believe that this is up to the physician candidate to decide. The employer, however, bears much of the cost, and is in a better position to ensure the candidate has the information needed to make a smart decision.

Here are two dimensions for which physicians often tell me their expectations were out of line with the reality of the jobs they accepted:

Some practices spend little time describing their culture when hiring, perhaps because they don’t appreciate how important it is. Culture can also be difficult to define. If you haven’t thought about yours (i.e., you haven’t thought about what the experience of working in your practice is like, compared with others), it’s useful to give it some thought.

For example, if your practice values productivity highly, 

 that it is a place where people who want to earn more by working harder will earn more. Like-minded physicians will be delighted to know that you support their financial focus! Aim to attract those sorts of people, instead of hoping a physician whose attitude differs will eventually come around.

Similarly, if your practice prizes collaboration, mentoring, etc., make that clear from the start. You want physicians who wish to be more independent to disqualify themselves.

There are many of these kinds of cultural dimensions that are not inherently good or bad but will be good or bad to a candidate if they don’t match that candidate’s work style and preferences.

Sometimes, culture is not discussed in recruiting because either the need to hire is urgent or the recruiter is aware of some toxicity and unable to do anything about it. In either case, concealing what it’s really like to work in your practice in order to fill a job quickly can be penny wise and pound foolish. And if the reason for being less transparent is fear that the environment in your organization will scare candidates away, remember that this type of truth usually comes out. It’s easy for unhappy employees to share their experiences online with the entire world anonymously. Once that happens, your recruiting costs will increase. It also can be much harder to reverse a negative online reputation once established. Though obviously difficult, it’s best to address underlying issues first, rather than hoping new employees won’t notice what you already know is a problem.

Another source of job dissatisfaction physicians frequently cite is opaqueness of compensation plans. Some doctors even describe their experiences as “bait and switch,” especially when their compensation plans are based on productivity metrics the physicians didn’t understand or that rely on factors physicians don’t believe they control.

This problem often starts with a recruiter who doesn’t understand enough about productivity calculations to answer candidates’ specific questions. Terms like “RVU” and “net collections” that are relatively straightforward once you understand their meaning can be intimidating when you don’t.

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Preparing either the recruiter or the hiring managers to explain compensation plans in detail can go a long way to minimize these misunderstandings. Young physicians, especially, may be reluctant to admit that they don’t fully understand how they will be paid. Be proactive and avoid a potential problem by preparing detailed information.

In addition, plan for and make clear the support you will give to the physician to help them meet volume goals when they do their part. Will you be willing, for example, to add clinical staff support if the physician demonstrates they’ll be more productive? How will you market the new physician? Will he or she start work with patients already assigned, or do you expect new physicians to market themselves (and will they have guidance if so)? What kinds of reports and metrics will the physician have to monitor their own production?

It’s also worth noting that some physicians shy away from jobs with productivity plans altogether, even when they can earn more, if they don’t understand how the plan works. Being clearer about compensation helps you attract more candidates who might work out well in your practice and gives you a much better chance of retaining physicians you eventually hire.

MBA is a partner and senior consultant for 

. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book 

People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice 

business as well as the Management Rx series of e-books, and blogs at 

Articles

Two dimensions in which physician expectations were out of line with the reality of the job.

Attracting better talent with greater transparency

When we talk marketing, we usually discuss proactive steps to attract patients—things like advertising, social media interactions, updating your website, encouraging reviews, and strengthening referral connections. But if we look at marketing more broadly and holistically, I think there’s an opportunity to get more bang for the buck on those efforts—and improve our businesses at the same time.

The legendary business guru Peter Drucker famously opined that marketing is the responsibility of every manager in an organization. His point was that marketing is about understanding the customer’s point of view. Everyone who comes in contact with a customer contributes (positively or negatively) to the customer experience and the business brand.

At first, this idea might seem like an imperfect fit for medicine. It’s undeniable that people become patients because of very specific medical needs, and how well those are met is your practice’s top priority—and your patients’ top priority, too. Other aspects of the patient experience should take a back seat—shouldn’t they?

When medical care is needed, it’s more important than almost anything else a patient can purchase. But this is not the only situation in which a person might need to rely on others to solve a crucial problem. Things can go wrong with the delivery of other essential services, and we can learn from those examples.

Internet service, for example, is something most businesses require. Maybe you’re fully pleased with yours—but then there’s a weird problem with your bill. It doesn’t take too many minutes of navigating an automated “assistant” or arguing with a rep about whether you actually were notified of a price increase to raise your blood pressure—and to make the excellent coverage and reliability of the network seem less impressive.

Or what about when you bring your car in for a repair and you’re upsold on extra work? Maybe you go ahead for safety’s sake, but then after you leave the shop, it bugs you that you weren’t quite clear on why the additional services or maintenance were needed. You’re glad to have your car back and working properly, yet also a bit bothered. Were you pressured into buying something you didn’t need?

These feelings of being unable to understand costs or why additional services are necessary can easily happen to your patients, too. They feelings can be amplified, even, because needing healthcare makes patients feel vulnerable. If you’re not actively counteracting the confusion, they can erode your patients trust.

I had a relevant experience of my own recently. I switched dental plans and needed to find a new dentist. An acquaintance referred me to a dentist who had a soothing and intelligent demeanor. From the start, though, I found the dentist’s office practices so inefficient and outmoded, a seed of doubt was sown in my mind. For example, it was all but impossible to get through to the office by phone, and nothing was done electronically—no portal, and even referrals and prescriptions were still hand-written. If you had a question or needed an appointment, you just had to wait and hope you got a call back—usually not until the evening or the next day. Most frustrating, the dentist’s website had a link for “appointment scheduling,” but when you clicked on the link, it displayed a page that said “call the office”—where, of course, no one would be available to answer your call.

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On the strength of the referral, I went ahead—but when the dentist spoke with me about the importance of doing certain procedures in a “more modern” (more expensive) way, it gave me pause. Was this dentist—whose office practices were stuck in the 1990s—really offering me the most advanced technical option in 2020?

Curious, I dug into the dentist’s online reviews. I learned that other patients had reactions like mine. Most of the reviewers gave high ratings, but included complaints about office processes in the text. Some gave middling ratings, and explained that the dentist was lovely, but dealing with the office was a hassle.

When administrative issues affect your practice brand, it can be hard to know how to respond. There’s no magic wand to immediately upgrade your administrative systems, but there are actions you can take.

Promote what you have—not what you don’t.

 At the heart of many negative impressions is a mismatch between the actual patient experience and expectations. If you aren’t the most technologically advanced practice in town, focus on other (important) aspects of your practice culture in your promotions. And if you do things “old school” because you think that’s better for patients, tell them. For example, I met a physician who still keeps paper charts because she believes it better protects the privacy of her patients (many of whom are HIV patients). When she explains why she has no portal or electronic records, some patients are still disappointed—but they know what to expect and can see her decision in a context that shows the doctor truly cares.

 Many physicians and practice managers tell me they don’t pay attention to reviews. While this can be good for sanity, it’s useful to remember that critical reviews often focus on administrative issues. If you’re unsure whether patients are dissatisfied with office processes (or if you’re assuming everything’s fine without knowing for sure), reviews can help you get a more accurate read quickly. And a well-constructed patient survey can help you dig deeper.

 Sometimes, you can’t fix the actual problems—at least not completely. Billing confusion, for example, stems largely from insurance methods you had no hand in creating. You likely can do more to help patients know what to expect, however. Be sure your staff is trained to help patients estimate costs and know what comes next in the billing process. And be sure your written materials (e.g., on your website) explain insurance terms that often confuse your patients, such as what’s covered as a preventive service and what isn’t.

Practices also often tell me that offering technology that patients want, like online bill pay and scheduling, is just too difficult. But practice management technology continues to improve, and your vendors may be able to help you transition more smoothly than you fear. (Consider how quickly most practices launched telemedicine in recent months—when many had assumed it was an insurmountable hurdle.) Check in regularly with your vendor contacts to learn what additional features you can offer to add convenience for patients and make your practice run better.

Promote the heck out of your improvements!

 When you make changes that address patient preferences, be aggressive about getting the word out. Remember that you probably aren’t reaching many people if it doesn’t feel as if you’re “over-communicating.” Don’t be afraid to feature “news” about administrative upgrades multiple times in your newsletter, on your website, on social media, and in person in your office.




. Her consulting focuses on practice management effectiveness and practice profitability. She is the author of the book People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice business as well as the Management Rx series of e-books, and blogs at 

There’s no magic wand to immediately upgrade your administrative systems, but there are actions you can take.

The Patient Experience, Marketing, and Your Practice Brand

An email from the MGMA delivered an exciting tidbit into my mailbox this morning.

, which analyzes financial and operational excellence. It asked readers to guess which organizational effort was correlated with an extra $85,000 in annual revenue per physician. The choices were trimming waste, reducing headcount, or launching an employee appreciation program.

It didn’t surprise me that the answer was the employee appreciation program. But it also won’t surprise me if you guessed one of the other two options. In my experience, many physician-owners and practice executives assume staff is a cost they should always look to minimize. This notion is something my partners and I are always trying to combat.

While there is, of course, an expense associated with staff, your employees are also essential to generating revenue. That’s why I argue it’s better to think of your team as an investment—and consider the revenue and profit they contribute to your business, not just the cost.

Here are just a few examples of how focusing primarily on minimizing the out-of-pocket cost of front office staff to bolster profit can have an unintended opposite effect:

Many practices we’ve worked with are more troubled by front desk staff having occasional downtime than by what might not get done timely when staff are overloaded. For example, a common hidden cost is lost business when phones aren’t answered. If your practice is not the only option a new patient is considering, they may call another office and book with them if they get voicemail when they call yours.



It doesn’t take many lost new-patient opportunities to exceed the cost of an additional staff member. Even just based on the initial missed visit, a single new patient per day offsets much of the cost of a staff member—but the actual revenue potential of a new patient is likely much higher in terms of lifetime value and referrals.

Many practices are reluctant to have enough phone/scheduling support to enable insurance eligibility verification at the time of booking, instead waiting to verify a day or two before the appointment (or worse, not at all). But this may mean that appointments need to be cancelled too late to offer the slot to a different patient—a deadweight loss for your practice and any other patient who wanted to be seen.

Similarly, if mistakes in demographic information make their way through the billing process, they create extra re-work and delays in getting paid. (And this extra work and delay is actually the best-case scenario—in which the patient is actively insured under a plan you’re contracted with. If it turns out the patient isn’t covered, you lose both the billing time and, likely, the revenue.)



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Practices that focus on minimizing staff may leave themselves vulnerable to spikes in demand, the exit of an employee, or a bug that sweeps through the office. Being slightly short-handed versus your norm shouldn’t put your practice into a high-pressure situation, but if you’ve cut your headcount to the bone, this can easily occur. You may have been patting yourself on the back for keeping costs as low as possible, but if your employees feel overly stressed by their workload, especially if they’re dealing with impatient or angry patients to boot, you’ll likely have higher turnover than you should—and the costs of it can quickly exceed the profitability gains you thought you were getting.

So how does all this connect with the MGMA finding? The presence of an employee appreciation program suggests that a different mindset about staff, one that seems “softer,” yet can pay off with the bottom-line impact practice owners and managers are looking for. Staff who feel recognized may work harder, be more creative, take more initiative, and be less likely to leave—all ways in which they boost your revenue and profitability. So, while it may seem counter-intuitive, investing more in staff, not less, may actually be a more reliable path to a more profitable practice.

More staff may actually be a more reliable path to a more profitable practice.

Protecting your investment in staff resources

Practices have begun to resume services and 

, especially patients who’ve put it off because of anxiety about COVID-19. While ensuring (and communicating about) patient safety naturally takes center stage, the revenue side of practice management needs extra attention, too. Patients may hesitate to visit your office not just because of fear of infection, but because of financial concerns.

Some patients face uncertainty about their job security. Some may have already suffered a job loss (and even a corresponding loss of insurance). For patients who are struggling financially, or are simply anxious about money, anything but urgent health concerns may be pushed to the back burner—even though this might increase the risk of more dangerous problems down the road.

Of course, practice managers and physician owners also have their own financial concerns to contend with. Generating and capturing revenue is crucial to ensure employees can be retained and the bottom line remains healthy, especially as government supports expire.

The high cost-sharing many patients face may seem like a formidable obstacle when patients are already nervous. But there are ways you can shore up your practice’s financial picture and collect more effectively from patients—without jeopardizing your patient relationships. In fact, with the right efforts, your practice may be able to improve both your financial picture and the patient experience.

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One way practices can help reassure patients is by helping them get a handle on their costs. Often, the out-of-pocket owed is less than patients fear. Even when it will be more than they hoped, patients will be better served by a 

straightforward and honest conversation about costs

Providing accurate information depends on staff training and technology. Be sure your schedulers are aware of how to access an up-to-date estimate of costs from your patients’ health plans. Proper training, including role-playing, can help staff become more comfortable with broaching financial terms.

Sharing this information with patients at the time of scheduling also provides an opportunity to 

 to process payments after services are provided. Storing a credit card (in a PCI-compliant fashion, with a maximum charge amount authorized by the patient) eliminates the need for the patient to hand over their card at the front desk—one less physical point of contact for patients to worry about. At the same time, knowing you can charge the account automatically, even if the payments must be spread out over a few months, helps ensure you’ll be paid in full.

Sometimes, patients may avoid care out of fear of costs when copays and deductibles don’t even apply. Make sure staff knows which services are typically covered as preventive, with no cost-sharing, or as follow-up visits included with a globally billed service.

Be sure you’re current on payer policies

AHIP (America’s Health Insurance Plans, the trade group for health plans) recently shared 

 its members have made to help patients and providers cope with the pandemic. While some responses are common across most plans, such as waiving copays for coronavirus testing, individual plans in your area may offer unexpected extra concessions. For example, some plans are waiving copays for regular office visits or telemedicine. Knowing about cost-savings like these can be handy when trying to coax wary patients to book an overdue visit.

Waiving copays or discounting cash services that apply towards deductibles may be a violation of your contract, but it can’t hurt to check in with payers to be sure you can’t offer some flexibility to cash-strapped patients. In some cases, payers may be willing to allow such discounts (just be sure to get that confirmed in writing before proceeding).

You may also find that some of your patients will have swapped their employer plan for an ACA marketplace one if they’ve been laid off. Make sure your staff asks each patient what their current health plan is, and that it’s clear which networks your practice is part of. (Marketplace plans offered by large payers may or may not be part of your contract with them. Knowledgeable staff can help avoid unpleasant denied-claim surprises for both your practice and your patients.)

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A surefire way to put your patient receivables at higher risk of non-payment is to bill your patients months after they visited your office. If the bill arrives long after services are rendered, your patient may have forgotten it was coming and believe it to be in error. That sets the stage for disagreement, unpleasant interactions, and extra handling and collection costs (at best), or even non-payment.

Ensuring your patient statements are delivered promptly starts with 

billing patient insurance quickly and accurately

. With some payers short-staffed due to the pandemic, it’s even more important to get claims right the first time. It may be much harder to get assistance by phone or email.

Many practice management systems have rolled out more advanced claim scrubbing tools in recent years. Much more of the billing process can be automated than ever before. Make sure your billing team is up-to-date on all the billing features of your system and prepared to take advantage of them to get bills submitted and paid as quickly as possible. And make sure all clinicians understand that it’s more important than ever to complete documentation and sign notes so that claims can be generated within a day or two of services being provided.

For patients who are struggling financially, or are simply anxious about money, anything but urgent health concerns may be pushed to the back burner.