The first time I heard this comment occurred as a radiologist asked me to step in as the practice administrator. The group had been searching for “the best man for the job” and wasn’t experiencing stellar success. On the other hand, I had worked as their business development director and most recently, ran the billing office several days a week as the former practice manager worked with the hospital on special projects (and was then hired by the hospital).
“How hard can it be, Kroken? You front the practice and go to some meetings.” Since my typical career choices were made on the basis of “more guts than brains,” I accepted. And like many new practice managers, I was questioning the wisdom of that decision after only a few months.
Granted, being a practice manager does not involve life and death decisions of the kind faced by radiologists many times each day. However, the nature of the position–and the stress levels involved–represent a formidable challenge and no matter what your educational level or even experience in other industries, you are most likely not prepared. This is reinforced repeatedly as I find myself talking to managers (including radiologists who have just been given practice oversight responsibilities) through the transition–and some truly talented managers have not made it!
The business of radiology is complex, ever-changing and rapidly evolving. Experience is valuable as long as it doesn’t become stagnant. Last year’s knowledge may (or may not) be valid today and after 19 years in the radiology saddle, I still work on my skills and knowledge every day.
Some (and only some) of the issues:
1. You are working in a highly regulated industry. There are more than 100,000 Medicare regulations alone and in terms of compliance (or violations), ignorance of the law is no excuse. You have a “know or should have known” expectation that governs the actions of everyone in the group, from physicians to the newest charge entry person. The marketing concepts that make sense in virtually any other business situation are illegal in radiology. Ditto for aggressive contracting and pricing. And in a hospital-based group if you make a billing error (”abuse”), you probably did so 8,000 times before you discovered it.
2. In addition, you have the usual issues related to personnel management in terms of compliance with the Americans with Disabilities Act (ADA), the Fair Labor Standards Act (FSLA), state employment regulations and more—much more. OK, so you only deal with these on a daily basis with virtually every employee interaction and they are behind the scenes, usually surfacing later as something like an EEOC suit following termination.
3. Revenue–that’s a biggie. As long as physicians make at least as much as they did the previous year (providing it was a good year), preferably more, you are doing a good job. If they make less, you are not–and it doesn’t matter if the reasons are out of your control. (That may not seem fair and it’s a major stressor for managers, but it is the absolute Darwinian reality of the business). If the group hires too many new physicians, purchases too much new equipment, changes the bonus structure, loses a contract or Medicare rates tank for the year–oh, well. It’s your job to make it work.
4. The infinite challenge of reporting to highly intelligent bosses. On one hand radiologists are delightful to work with. They are bright, well-educated and for the most part, open to new ideas. On the other hand, each partner expects to have his/her issues prioritized and there are always several people in any group with fairly extensive lists of priorities. And they seem to call within 5 minutes of each other. It’s not that any single question, concern, idea or analysis is unduly complex or demanding it itself, it’s just that the cumulative effect can become overwhelming. As a matter of fact, this is where new managers seem to struggle–or break under the strain.
In total, the entire administrative challenge is more often one of volume rather than the complexity. There are definitely intellectually demanding projects, but the trick is to complete them accurately while dealing with interruptions at 30-second intervals. Granted, if you aren’t spending a portion of your day keeping up with regulatory and reimbursement changes you will probably be severely bitten in the butt at some point–but the art form lies in developing the ability to juggle projects and requests without dropping anything. (God forbid you make a math error on anything–but that’s another story). As a colleague so eloquently stated, “It’s like being pecked to death by baby ducks.”
So here you are. You started on an analysis of contract rates (by payor and modality) at 8:00 with the goal of being done before a 9:00 meeting–plenty of time. And then–the imaging center manager needs you to call an irate referring physician office, you receive a call from the recruitment chair to get out an offer to a new physician immediately, find out there is a problem with the hospital downloads that has been going on for more than a week, are asked by a physician to verify what is being paid for a certain procedure because it takes a long time to read and he isn’t sure if we should continue to do them if we aren’t being paid enough, the hospital radiology manager calls to complain the physicians aren’t signing their reports in a timely manner and by the way, Dr. X is being rude to the ultrasound techs and refusing to read cases, you counsel a manager who wants to fire an employee that she does not have sufficient documentation to do so–and handle a few dozen other miscellaneous phone calls and “quick questions.”
It’s 2:30, the analysis isn’t yet complete, you realize you haven’t eaten lunch yet and one of the physicians calls during a slow afternoon in the reading room to ask, ”So what’s going on in the business office today?”
You unsuccessfully try to remember what the heck has happened since you arrived at work, but it’s a blur–so you just say, “The usual stuff.”
How hard can it be?