The Administrator’s Desk: Move Up or Out?

September 1, 2008

You’ve been the backbone of your practice for years, but your compensation hasn’t changed much. Do you have to move out to move up?


There you are, coming in early, managing the staff, averting financial disasters at every turn, and all you’ve seen by way of recognition is an extra pile of paperwork. No pat on the back. No pay raise.

But before you start humming Dolly Parton’s “9 to 5” on your morning commute or quit in a fiery rage, try these five strategies to command the respect (and the paycheck) you deserve. Hey, if you see no signs of improvement, you can always take your talent on the road.

“You don’t always have to move out to move up,” says Richard Hansen, vice president/managing principal for the Medical Group Management Association’s Health Care Consulting Group. “Part of it is the relationship you develop all year long with your physicians. The idea is to communicate with them regularly to avoid suddenly feeling that you have to leave.”

Know your benchmarks

According to Hansen, competent practice administrators should expect a pay raise every year. “It should be based on merit, rather than the cost of living, and some years it might not be much - it depends on how well the practice has performed,” he says. “But I believe that if you as an administrator helped the practice succeed then you should share in the reward. Even if it’s not much, they need to respect what you contribute.”

How do you know if you’re underpaid or on par? Compare your income against national benchmarks. The Professional Association of Health Care Office Management publishes an annual compensation survey that highlights how much administrators are paid in base salary and bonuses based on years of experience, type of practice, and region of the country. Likewise, MGMA publishes a management compensation report, which highlights average compensation by various types of practice administrators, years in the field, and degree.

Insist on a review

You should also keep tabs throughout the year of what you’ve accomplished. “You need to be able to show [the physician shareholders] in bullet point form that because of you, for example, they have fewer days in accounts receivable,” Hansen says. “Make it short and sweet, but show them what you’re doing because the physicians don’t always understand the time and complexity required to accomplish some of your goals. They’re focused on clinical issues - as they should be.”

Anne Cordes, PAHCOM’s executive director, agrees: “It’s the administrator’s job to focus on business and it doesn’t hurt to put yourself right up there with accounts receivable in terms of things the physicians need to focus on,” she says, noting administrators should insist on a review every year and keep it as business-like as possible. “Highlight your achievements and how they have benefited the practice,” she says. “Show them how you have made a difference.”

When you meet for your review, Cordes also urges administrators not to sell themselves short. “There is a tendency among office managers to undervalue what they know and what they contribute and that may have to do with the fact that physicians aren’t as focused on the manager’s contributions,” she says. Don’t be afraid to ask for the salary you believe you deserve (without being confrontational) and back up your request with a summary of your accomplishments.

Set goals together

One reason you may not be getting the respect - or salary - you deserve, is that your goals are different from those of your physician shareholders. While you’re focused on reducing days in accounts receivable, they may be looking to implement an electronic medical record. Hansen said all administrators should have a written job description outlining the expectations for their position. Likewise, it’s a good idea to identify two or three goals for the organization at the start of each year. “You should set these goals and consider how they will filter down through the organization,” he says. “Ask yourself how does this play out in billing, at the front desk? That way everyone knows what the goals are and agrees on a [direction for the business.] Unless people know where they’re going, they can’t evaluate where they are.”

Most practices hold monthly meetings to discuss their progress and any staff issues that might arise. This is an opportune time to keep leadership apprised of any accomplishments you and your staff have realized. “You can’t over communicate with physicians,” says Hansen. “It shouldn’t be done to the point of tediousness, but be sure you tell them at the next meeting when the staff does something right and say, ‘Hey, let’s have a pizza party or bring in bagels in the morning to reward them,’” advises Hansen. “It’s a nice way to reward the staff and it shows how many of your goals they’re accomplishing with you leading the charge.”

Moving on

If, after meeting with the physician shareholders, you feel your request for fair pay is falling on deaf ears, or you’re not getting the respect you deserve, it may be time to call it quits. Renie Galford, for example, recently left her job at the seven-physician practice where she was the administrator for 13 years, taking a pay cut to become assistant manager at Orthopedic Associates in Fishersville, Va. “I was putting in 75 to 90 hours a week. I was exhausted. I had no time for my personal life and after talking with the physicians I saw no change coming,” she says, noting her salary and benefits were highly competitive. “For me, I had to make a change.”

Another sign that it’s time to move on? When your values are not coinciding with the senior management’s philosophy. Joan Rissmiller, who left her general surgery practice in April after 15 years, learned that lesson first-hand. “You’ll know when it’s time to move on,” she says. “The senior managing partner who I had worked with closely had left and his replacement did everything behind closed doors. There were never any meetings between the corporate partners and myself. It was an entirely different environment. I became very dormant in my position.”

While Rissmiller says she had expected to stay at her former practice until she retired, her decision to leave was ultimately the right choice. “It took me a long time to take the leap and I had a lot of sleepless nights,” says Rissmiller, now the administrator for Colon-Rectal Surgery Associates in Allentown, Pa. “But after six months in my new job, I received a bonus that I’ve never had in my life and now I have a staff of 18. It’s nice knowing you’re challenged and appreciated. I literally just moved across the street and the grass really is greener over here.”

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for 12 years. Her work has appeared on CNNMoney.com, Bankrate.com, and Healthy Family magazine. She can be reached via editor@physicianspractice.com.

This article originally appeared in the September 2008 issue of Physicians Practice.