9 rookie mistakes new practice managers make

The best biller in the office gets promoted on a Friday. By Monday morning she is managing the same people she ate lunch with the week before, refereeing time-off disputes and answering to three physician owners, all without a single day of management training.

That path is the rule, not the exception. A March 2025 MGMA Stat poll found that most medical groups center leadership development on people already in manager roles or higher, which means the training tends to arrive after the promotion, not before it. New managers are left to learn on live payroll, live schedules and live personalities, and the margin for error is thin: MGMA's May 2026 polling shows staff turnover has stabilized but not improved, with roughly three in 10 groups reporting more churn this year than last. Much of that churn runs directly through the manager's desk.

The encouraging news for anyone new to the chair, or anyone coaching someone who is, is that first-year management mistakes are remarkably predictable. Predictable means avoidable. Here are nine of the most common, and what to do instead.