Leadership Attributes and Management Qualities

As a practice owner, you should be asking yourself the following questions objectively:

  • Am I a good leader?
  • Do I run from conflict?
  • Am I able to motivate my staff?
  • Is my office harmonious or is it filled with conflict?
  • Does my staff “own” their jobs, or do they just punch in and out?
  • Do I ever feel that my staff is “holding me hostage”?
  • Am I running my practice? …or is my practice running me?

Did you answer any of those questions favorably? If you’re like the average practice owner, the answer is no. That’s because, like most doctors, you were not trained in leadership and executive skills. Consequently, you will often find yourself in management situations in which you lack certainty about what to do. Insufficient leadership could easily result in poor staff performance, unhappy patients, needless stress and lost income.

Maxim: The Morale of the Staff Is Based Upon Their Individual and Office Production.

Believe it or not, most staff members want to do a good job. They want to improve and they like being acknowledged for a job well done. When one produces a good product, it’s a reflection of his competence. Demonstration of competence raises anyone’s morale. As a leader, you have the opportunity to foster an environment that can bring about ever-increasing competence and morale.

So, how does one become a good leader? Is leadership a personality trait with which only a few are blessed? No! Leadership skills are taught and, with practice, can be put successfully into daily use.

The first quality a good leader has to have is the ability to confront situations, i.e., to face up to them. If you are the type of owner who runs and hides from conflict and staff problems, then you need some improvement in this area. First, decide that you are going to face up to the problem. Simply take a moment and make the decision; this is very helpful.

Next, grab someone — a friend, your spouse or a colleague — and roleplay the problem. Have that person play the part of the troublesome individual, hitting you hard with backtalk, new problems, can’t-be-dones, etc. Be sure to do the drill until you find that you are more confident and even feel somewhat excited to try out your new skills and presentation. You will be surprised at how easily the situation will resolve once you do this. Keep in mind that your staff can’t and won’t follow if you don’t lead.

It is very important for you to maintain excellent communication with your staff and to provide demonstrable leadership.

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How to Write a Mission Statement

The owner of a veterinary practice recently asked us about how a mission statement should be written, what it should focus on and what the final objective should be. This example is for this particular veterinary practice, but all of the concepts we will cover apply equally to any other private healthcare practice.

Their current mission statement is below:

“To honor our patients, (our) Animal Hospital ensures that each client is confident in the care they are receiving for their animal companion, comfortable with all aspects of the hospital and staff, as well as engaged in all areas of their pet’s health and wellbeing.”

The idea of this mission statement is good. My only concern with it is that it is somewhat limited. Here’s what I mean.

The effectiveness of a mission statement is that it creates the goal towards which the practice strives. The goal, once stated, is what is called an ideal scene, meaning what the practice would look like to the practice owners if it was functioning at an ideal level. This ideal scene is then compared to the existing scene. The differences are the corrections that need to be undertaken.

Let’s use your mission statement as an example. Let’s say when you compare this mission statement, this ideal scene, with the existing scene you find what’s missing is that the clients aren’t as engaged in all areas of their pet’s health and wellbeing as you would like. Let’s say too many of them view their pets as a bit disposable. This can be a problem in more rural areas where pet owners often feel that if something is wrong with the pet, rather than fix it, they’ll have the pet put down and get a new pet….in other words, the pet is viewed as discretionary or disposable.

So, how does this missing ingredient to the mission statement affect the doctors? The doctors have to compromise their treatment of the patients to align with the clients’ wishes. While it’s a bit optimistic to think that all clients will do everything that is best for the pet and not take their pocketbook into account, when the pendulum swings too much in that direction, the doctor’s work satisfaction declines. I’ve seen this really crush the morale of the doctor. So, assuming this was indeed a true mission statement, now we have the existing scene not lining up with the ideal scene and the result is the doctors are not happy.

To see how to resolve this issue in your practice read the final half of this article by filling out this form.


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How to Properly Correct Employees

It would be wonderful if employees never make mistakes and always do a perfect job. But we’re all human; on-the-job errors are part and parcel of working in a practice. That begs this question: What do you do when a staff member messes up and how do you correct him?

Here are some suggestions on how to properly correct your staff:

As part of this overall process, you must have written job descriptions and office policies that clearly delineate which tasks a person is responsible for on his/her job and the overall working guidelines for the office, respectively. The reason that proper, written job descriptions and office policies are so important is that you should use them as part of your correction procedure. Unfortunately, very few practice owners have them in place.

For starters, if you need to correct a staff member, make sure you review any specific disciplinary policies that you have issued, so that your actions are consistent with them. For example, if your policy states that proven theft results in an automatic discharge, you would not utilize a gradient approach to termination by merely reprimanding someone guilty of stealing.

Typically, the first step in correcting a staff member is to direct his attention to the specific item he violated, as delineated in his job description or in your written policies, indicating the appropriate action that he failed to take or the inappropriate action that he did take. Direct the staff member to reread the policy and/or job description. Ensure that he understands it and clear up any confusions or misunderstandings. This corrective action is usually sufficient to handle the first offense.

If the staff member commits a second offense involving the same issue, the office manager or practice owner should review the situation with the staff member and have him sign a copy of the policy or procedure that covers what was violated, as an attestation that he understands it and agrees to abide by it. We then recommend that you put a copy of the signed document in the staff member’s personnel file and give him a copy to put in his staff binder. One may consider that this constitutes a warning.

To learn how to apply these policies in specific situations, such as;  How many warnings should be issued? What if the employee is an excellent producer? Read the final half of this article by filling out this form.


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Resolving Negativity in the Office

Some time ago, I read this article in the Wall Street Journal – which discussed dealing with feuding employees. There is good information in this article on feuding employees, and anyone having staff-conflict issues should check it out. Since dealing with staff bickering and personality conflicts can be a major source of stress in an office, knowing how to deal with it can be extremely useful.

As the Wall Street Journal article points out, when you let employee situations linger too long, bad things happen, and you can end up losing not only the problem employee but other good employees as well. So, when you encounter two or more employees feuding, our recommendation for you is to find out as quickly as possible who seems to be instigating the problem, as well as determine which of the two employees is the most productive, and to quickly nip it in the bud.

Normally, when a feud is going on, other staff members have either been involved or have observed it in one form or another. It usually bothers them as well, even if they are not directly involved. What we recommended to practice owners is to interview these peripheral staff and get a more neutral opinion of what’s going on and who is really causing the problem. Also, interview the staff involved and get their respective sides of the story. From this you should be able to find out who the real problem employee is.

ACT FAST! The longer you let something like this linger, the greater the odds that you will lose not only the problem employee, but the good employee and possibly other staff members who are sick of being involved in that type of work environment. If you act swiftly on such matters, you will keep your employees happy.

There’s another very important point: the longer this kind of thing is allowed to continue in your office, the more likely it is that other staff members will start to feel that their workplace is not safe. They will also feel that the owner is not in control of the office and that they may want to find a better environment to work in. You could end up losing a really good employee because you didn’t confront the problem and act swiftly and appropriately.

Having the right office policy and job descriptions in place to govern acceptable and unacceptable behavior in the workplace will give you an important foundation to stand on when handling this kind of situation. Lack of such policy can make the workplace less than harmonious. And don’t forget to document, document, document the non-optimum issues in writing and what was done to handle the people involved. Without documentation, you can open yourself up to potential legal issues.

The “staff infection” is a term that I came up with long ago to discuss the effects that a negative employee can have on a team and how fast it can spread. Similar to how the “Staphylococcus Infection” is dangerous to the body.

The “staff infection” starts in various ways, such as with a staff member that often rolls his or her eyes at staff meetings. This staff member engages in rumormongering and can be counted on to “stir the pot” in the office. This can be the idle staff member or the person who always seems to be busy but gets nothing done. You get the idea. This is the employee that you are “just not sure about.”

What would you think of a doctor that did not practice good sepsis control and permitted Staphylococcus germs to fester in or on his or her equipment? It simply does not make sense, does it? Nobody would do that. Preventing any sort of infection in a patient is more than second nature to any doctor. What would your opinion be of a doctor that was aware that his or her patient had an obvious staph infection but did nothing about it? Enough said.

How do you handle the “Staff Infection”? Read the final half of this article by filling out this form.


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Looking Toward the Future: 10 Steps You Must Do Before Selling Your Practice

In the course of your career, you might decide to sell your practice. There are ten important aspects of your practice that you should consider NOW, so that when the time arrives, you will have developed a truly marketable practice.


Professional respect has value. Do you have good relationships with other professionals in your community? You should. If so, are those relationships so strong that you can transfer them to a new owner?

For example, if you have several professionals who continually refer patients/clients to you, you would want to ensure that those referral sources will continue to send patients/clients to the new owner. Otherwise, the buyer might want to discount the practice price by the amount that would be lost from not getting referrals from just those few sources.

Most professionals will continue to refer to the practice after your departure, as long as they are assured that those clients/patients they refer will receive the same good care that you currently provide them. It is also important for your referral sources to know that the new owner will reciprocate with referrals to them (assuming that is the type of relationship you currently have).

Keeping up with and then transferring these relationships will help your patients/clients too. That maintains continuity and quality of care for them, which will help them to always think well of you.


Everyone is inclined to pay more for something if it looks attractive. The same principle applies to buying a practice. If your facilities are pleasing to the eye, you might be able to command a higher price. While a clean carpet is only just that, it might demonstrate to the buyer that every aspect of your facility and practice is probably well maintained.

Well-maintained, state-of-the-art equipment also speaks well of you. It says that you have a growing practice that is keeping in step with technology.


The best indicator of the value of a practice is its cash flow. Your successor will want assurance that he is acquiring a reliable income stream. Now is the time to concentrate on reactivation of old patients/clients, increasing your marketing budget to attract new patients/clients, setting goals for the staff and moving the practice toward maximum productivity.


Part of selling a practice requires that you develop and present an accurate picture of what you have accomplished. You will want to be able to disclose good financial figures. Plan to have at least five years’ worth of good financials because the buyer wants predictability. Have an outside professional prepare “compiled statements.” That adds credibility. The practice buyer will find that well-maintained, accurate accounting records help with forward planning. Additionally, good records can even help you explain a slump period.


Very few practice owners supply the buying owner with a transition plan. If you were to do that, you will be far ahead of other owners who want to sell their practices. You should develop a plan because it not only can increase the worth of your practice, it can make life easier for everyone. Put the transition plan in writing, then review and outline all the systems and how they work. The marketing plan, referral sources, management policies and accounting systems should all be put down in narrative form.

Indicate a time frame in which the practice will be transferred to the new owner. That will give him an idea of how long he will have to learn the ropes. Don’t expect to make the deal and run with the money. An adequate time frame to transfer a practice in which you will be working side-by-side with the new owner, will range from 30 to 120 days, depending on the size and complexity of the practice.

Part of an effective, valuable transition plan can involve a good loan package. It shows that you have put together a transition plan that is easily understood by a third party. It indicates that you have a good relationship with the bank. That can enhance the value of your practice, since the banker knows that the systems will remain in place and generate cash flow to repay any loans.

Fill out the form to the right to continue reading “10 Steps You Must Do Before Selling Your Practice – Part II”(highly recommended). Scroll to top


Fill out the form to continue reading this article 10 Steps You Must Do Before Selling Your Practice – Part II (highly recommended).

Did You Hire the Wrong Person?

A recent survey conducted with practice owners across the US revealed that the number-one management problem they have is personnel issues. Among the problems mentioned by hundreds of owners surveyed were:

  • Procuring qualified personnel,
  • Getting employees to perform competently once hired,
  • An inability to hold staff members accountable for their work,
  • Turnover and handling disputes among employees.

Correctly isolating and debugging non-optimum practice situations is a skill that every doctor finds he needs. Oftentimes, a manager who is seeking solutions overlooks some administrative fundamentals which, left undetected, cause a problem to appear larger or more complex than it really is. Moreover, failing to discover the real source of a problem leads to poor decision-making. In the case of managing employees, this type of failure is not only frustrating, it’s expensive.

The real work begins after the hiring process ends, for each employee must be well trained for his/her position in the practice. Lacking thorough training, an employee will not perform to the expected standard. That will inevitably lead to either the employee quitting or the doctor firing him/her.

There is an exact technology for finding and hiring good staff members. Assuming the hiring techniques are sound, the most devastating managerial mistakes are made during the training period. During that time, an unskilled manager might make assumptions that lead to incorrect reasons for poor performance, and those conclusions, in turn, lead to bad decisions regarding personnel. All too often, a suitable person who is both willing and trainable fails to receive the information needed to do the job. As a result, turnover occurs and doctors and office managers spend their time dealing with personnel problems rather than treating or servicing patients.

Written job descriptions are a must for each position in a practice. More importantly, those descriptions need to include fundamental data that are often omitted because the manager assumes that the employee already knows what is needed from him. Common sense, or common knowledge, to one person may not be so to another. Verbal instructions are much less effective than thoroughly written job manuals.

Every job description in an office should include the seven following sections:

  1. The responsibilities that the person holding the job position has to the patients,
  2. A general description of the position, which includes its purpose,
  3. A statistic that quantifies, and thus objectively measures, the production of the position,
  4. A list of specific duties that one in the position is expected to perform,

What are the final three sections that a job description should contain and the four things to examine when employee problems arise? Read the final half of this article by filling out this form.


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A Functioning Office Manager

Your Key to Success

The primary function of the office manager is to accomplish the goals and purposes of the practice as determined by the owner of the practice. The OM should assist the owner in developing policies that forward the purpose of the business as a whole. It is the OM’s job to see to it that all members of the group are fully contributing to the expansion of the practice, and that a high level of communication exists between the group and the owner.

The OM should run the day to day activities of the office and keep the daily distractions off of the owner/doctor’s plate. This would be accomplished by ensuring that the OM, first of all, was trained in the handling of staff and felt comfortable with the hiring, training and correction of all staff members.

The OM should be a person who understands the importance of communication and the power that open communication can generate within any group. The OM should energetically lead the group toward accomplishment of the established goals. The OM should be someone with good communication abilities and someone who can really care for the staff.

The OM would ensure that all internal communication systems are strongly in place and operational, and that the staff is taking responsibility for keeping all unnecessary “traffic” from and within their own posts to a minimum.

To affect the above, the OM should have a strong working understanding of the management tools such as statistical management, the establishment of a communication system that really works for the office, written communications, job descriptions for each position, written policies for the practice, and personnel management.

The OM is in charge of seeing to it that all areas in the practice are running smoothly and producing the desired products of each respective area. This would require her/him to have an understanding of organizational structure and function. They would ensure that all functions in the organization were being firmly held by someone and that they were trained in the skilled handling of their assigned posts.

The OM should have a very strong working knowledge of statistics and their use in strengthening the practice. The OM would be in charge of posting statistics and going over those statistics with the staff in the staff meeting to determine the appropriate steps to take in order to improve, maintain, or increase practice production statistics.

It is the OM’s responsibility to obtain compliance from all staff in regard to the owner/doctor’s wishes and any program or project steps that are being worked on.

The OM would be responsible for the hiring and firing of personnel and for conducting performance evaluations on a regular basis with all staff.

The OM is responsible for the preparing and implementation of programs that would take the group through the needed steps toward the accomplishment of company plans.

Fill out the form to read the rest of this article which includes: 5 key objectives of an OM, the results the OM must obtain for the practice and how to select an OM (highly recommended). Scroll to top


Fill out the form to read the rest of this article which includes: 5 key objectives of an OM, the results the OM must obtain for the practice and how to select an OM (highly recommended).

Optimize Your Marketing

In today’s economic climate a great deal can be said for the benefits of marketing effectively. There are many mediums for marketing a practice – referrals from existing patients/clients are normally the best and most cost effective means of getting new patients/clients. External marketing, such as the Internet, business directories, new resident mailings, bus benches, and even the local newspaper, radio and TV, has worked for some. Some form of one or more of these has proven to be successful in various markets, but not all of them are effective in all markets. Given all this, it is vitally important to know how your new patients/clients are finding out about you, and based on this, you should focus your marketing dollars in the most effective areas.

This brings up the topic of this Hot Tip.

Somewhere on your new patient/client form there should be a little line that says, “How did you find out about our practice?” If you don’t have this line on your new patient/client form, you should institute it right away. Some offices have little check boxes that mention their various marketing activities, and others just offer a blank line to be filled in. However you do it, the purpose of this is for your new patients/clients to tell you which of your marketing tools have been most effective. This is vital information for your promotional and marketing activities, only as long as you do something with it. Unfortunately, many doctors don’t use this information properly.

In fact, the last poll taken in our online journal “The Practice Solutions Magazine”, showed that 54% of those responding said that they “did nothing” with the information that they got from this question on their forms. At the same time, our current poll shows 43% stating that they are increasing the amount of marketing they are doing currently. The poll data seems to support that “marketing for new patients/clients” is important to practice owners but the importance of tracking effectiveness of marketing seems to be missing.

Let’s take up effectiveness of marketing as a running theme and discover how it might be used. A simple starting point would be to actually use the data you have already gathered by doing a quick breakdown of where your new patients/clients came from for the past 6 to 12 months. Assign your front desk person the task of reviewing the files of all your new patients/clients and tabulate their responses to the question concerning what brought them to your office. Once the tabulation is done, have this staff member provide you with a summary of this information – i.e. “45% came from referrals, 20% came from new resident mailings, 10% from Yellow Pages ad, etc.” Use the results from this summary and locate the area(s) that seem to be providing you with the most new patients/clients. Do not be surprised if “referred by a friend or relative” shows up as the number one item – in fact you should be surprised if it doesn’t.

At this point, inspect your marketing budget. How much do you spend to make sure people know how to find your practice? How much are you spending on ads and how many new patients/clients came from that? What kind of materials do you have to stimulate referrals? Examine each area that you are spending your marketing dollars on and what your return is on those dollars. While taking into account the cost effectiveness of each activity, you’ll want to invest more heavily in the area(s) that are giving you the most return. For example, if “referrals” is your number one draw, and the local radio ad is not producing much, how can you shift your advertising dollars into more support activities for referrals? As an example, creating a “Refer a friend or family member” card might be one way to start.

To summarize:

  1. have a means to know where your new patients/clients are coming from;
  2. don’t ignore this data – tabulate and evaluate the information;
  3. invest your marketing budget in the most effective areas based upon the data you gather;
  4. regularly re-assess this information and adjust your marketing plans and investments accordingly.

If you do the above regularly and religiously, you’ll find a steady increase of new patients/clients coming in your door. The first priority is always to strengthen the area that is working best, before looking to add additional avenues.

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We offer any practice owner the opportunity to receive one of the below gifts in exchange for a 15 minute, anonymous phone survey (at the date and time of your choice) that will assist upcoming publications by The Practice Solution Magazine. As always, we are very grateful for your help in making our publications better.

  • Phone Consultation (1 hour) on a management topic of your choice. Subjects include: staff management, hiring, marketing, financial issues, how to set fees, increasing net profit etc.
  • Comprehensive website marketing analysis.
  • Job Description Pack – Practice Owners (Valued at $129 – for an additional 15 minutes phone survey)
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Recruiting New Employees

Who, what, when, where and how:

It is a 100% certainty that with any practice you will need new employees at some point in time, either to replace employees who leave or to help the practice grow. Where do you find the type of people you want to work with, people that you can trust and who will want to see your practice succeed?

Posting on the Internet and in the Newspaper:

The most obvious resources to use in recruiting new personnel are the internet and the newspaper. Before we discuss the ad itself, let’s take a look at some basics. The best place to place your want ad is going to be online. There are several websites that you can use to find a qualified employee, such as Careerbuilder.com, Indeed.com, Monster.com, Glassdoor.com, and Craigslist.com.

Never lower your standards when looking for a staff member. Keep your standards high and remember that you not only want a top quality person, but you deserve that person! Your practice growth depends upon people who are bright, energetic, sensitive, intelligent and outgoing. Be willing to compete for that type of person.

Also, realize that the type of person you are looking for may not be actively looking for new jobs. Some of the most qualified individuals already have jobs, but they may be looking for a change. These individuals may seem like “cold prospects,” but they actually do skim through the want-ads just to see what is out there. So, it is very important to develop an advertisement that will attract the person you are looking for.

For newspapers, Sunday is definitely the best time to run your ad. Even though newspaper sales have been declining in recent years, it isn’t out of the question to use it as a means of finding new hires. Running an ad on both Sunday and Monday would be the most successful combination because people who are looking will look through Sunday’s paper and continue “looking” at least through Monday’s paper. Do not waste your valuable ad dollars by advertising right before a major holiday, as people are less likely to read the classifieds. They are too involved with other matters, and will usually look after the holidays.

Part two of this article will go over tips on how you develop your ad and how to use hiring agencies.

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Fill out the form to continue reading this article Recruiting New Employees – Part II (highly recommended).

The Do’s and Don’ts of Bonus Plans

The subject of bonus plans has bewildered practice owners for quite a long time. The theory—create an incentive for staff to do exemplary work—generally makes sense. The difficulty is in the implementation. When you tread into the realm of bonus plans, you are entering a minefield. If you construct a bonus plan correctly it can be a very useful tool for you, the executive. But when done incorrectly (and for every right way there are countless wrong ways) it will blow up in your face and create a terrible work environment; your staff will be livid. And when the dust settles, you, the besieged practice owner, will be likewise incensed, as you will feel unfairly attacked when all you were trying to do was to find a way to pay your team more.

Why does this all go so wrong?

First, let’s look at this from the staff member’s perspective. No matter how the bonus system is structured, it’s essentially all about money. While the old adage, “Never discuss politics or religion at the dinner table” is sage advice, neither of those subjects provokes as much emotional reaction as when you tamper with someone’s pay.

Consider how salaries and wages are set up. It’s fundamentally based on exchange. A staff member is hired to do a certain job. Money is given in exchange for that work. Anyone who has ever held a job understands that basic concept. He knows that if he were to consistently do poor work, he will be dismissed. Consequently, most personnel strive to do a good job. In return they expect remuneration and they expect it to be consistent. If an owner constantly changes the pay scale, the staff would understandably be upset. In other words, agreements are in place that are a matter of routine: work ‘x’ number of hours and get paid ‘y’ amount. When and how much a person will be paid then becomes predictable and dependable. There is nothing arbitrary or capricious about it.

Predictability is the Key

So, this brings us to one of the basic problems with many bonus systems: bonus plans are neither predictable nor dependable to most staff members. Here’s an example: In many practices, bonuses are doled out on a whim; the owner feels that this month’s production was better than usual, so he wants to share his good fortune with his staff by distributing some of the profits to them. They obviously like this and want to experience such generosity again. The next time monthly production is exceptionally high, there would understandably be an expectation of a similar bonus. And when it doesn’t materialize, resentment ensues.

What has been violated is “predictability.” To earn their basic check, staff members know they need to show up and do good work. This will predictably lead to a paycheck. However, with the bonus, there is no such predictability. The practice had a similarly good month but the staff was not rewarded as before. Now they resent the owner and view him as a cheapskate; the owner, in turn, is left wishing he had never doled out a bonus in the first place. So, what started out as a generous act on the owner’s part has now become the source of dissatisfaction on everyone’s part.

Nevertheless, the owner, who still perceives some benefit to the implementation of a bonus plan, makes adjustments and sets up an actual bonus structure: If the practice does ‘x’ amount of production, the staff will get ‘y’ amount of money in the form of a bonus. So now there is predictability.

But upon closer inspection, we see that predictability still eludes the staff. For if production consistently increases, so will the expenses associated with obtaining it. Consequently, the owner must increase the amount of production required (‘x + 5’, for example) to earn the same ‘y’ bonus. And the unintended result is that the staff loses predictability again. From their point of view, just when they started making consistent bonuses, the owner suddenly changed the rules and moved the goal line further away, making it more unlikely that a bonus will be earned. And their concern is that even if they were to somehow achieve the new production goal, the owner would again change the rules. And he’d be viewed as a cheapskate once more.

Lack of Control = No Bonus

 In addition to the problem of predictability, there is the issue of control. Oftentimes the team can work hard to achieve a production goal, only to see the practice fall short of the named target. In that event, they will become frustrated, as the carrot (incentive) has been dangled in front of them, but they don’t know what they can do to make sure the practice reaches its target. In other words, they don’t know what to control that would help to achieve the stated goal. They work hard, perhaps work through lunch or take less breaks, and pay close attention to their workmanship. Those are all efforts on their part to control something that can be controlled: their time and quality of work. But when that still doesn’t result in the practice reaching the targeted level of production, staff morale will most assuredly plummet. They will feel as though they are just a cog in an enormous machine wherein their individual efforts can’t affect the overall income of the practice. And when they reach that conclusion, they will cease making the extra effort and then for sure the intended goal will never be attained.

This dilemma of staff feeling that they aren’t able to effectively contribute and resultantly help to control the income level of the practice is one of the most common problems in virtually every practice I’ve analyzed. In most cases, I traced back the source of this predicament to the owner not knowing how to identify all the parts of a practice that affect income. By the way, did you know that in a solo-doctor practice there can be up to 12 or even 15 such areas? In a multiple-doctor practice there are more than that! Once those areas have been identified, the owner must place a staff member in charge of each area and develop a statistic to monitor it and then teach the staff member how to control the area so as to keep the stat at the appropriate range. The owner who can accomplish that is the owner who can control his or her own economic destiny.

Bonus Plan Inequity

Let’s return to the subject of bonus plans. In addition to the problem of the staff’s inability to effectively control the attainment of targeted income goals, there is also the sense of inequity or unfairness that most bonus systems create. The majority of bonus systems are set up to take a certain amount of money and divide it among the staff, generally in proportion to the number of hours they work. But in most practices, you’ll find a few superstars who do the majority of the extra work required to reach the target. They are the ones who talk to patients about referring friends and family when the other staff members are reticent. And they are the ones who are more productive than their co-workers on an hourly basis. But when those superstars see everyone being rewarded equally, despite the obvious differences in the quality and quantity of the work being done, resentment emerges. Consequently, they stop putting forth the extra effort. After all, why should they work so much more diligently if they will be paid the same bonus as those who don’t make the extra effort? And, of course, the irony is that when the superstars start cutting back on their efforts, the goal won’t be achieved and NO ONE gets a bonus!

Profit-Based Bonus Plans

Poorly crafted bonus plans also create problems, mainly financial, for owners. Bonuses are supposed to be calculated and paid on profit, i.e., the money a practice makes after accounting for all expenses (often referred to as the make-or-break point or overhead). If a bonus system starts to pay out before profits are achieved, then the owner has effectively taken a pay cut.

Based on analysis of many thousands of practices, we can conclude with certainty that most owners don’t know how to correctly figure out their make/break point. One of the reasons for this is that those owners don’t take into account the non-monthly expenses when calculating overhead. Examples of such expenses are repairs to equipment, equipment replacement, money set aside for reserves or for staff training, etc. Since those aren’t bills the owner deals with on a recurring monthly basis, it’s easy for them to be excluded from the make/break point calculation. But they are expenses and will eventually have to be paid. Therefore, in most practices, the make/break point is actually higher than what the owner believes it to be. Consequently, the bonuses levels can be tied to income goals that don’t correctly take into account the actual profit being made.

Summary of the Situation

These are the main reasons bonus systems can fail to function well:

  1. lack of predictability for the staff
  2. the staff’s perceived inability to proactively control the production or income that would achieve the bonus
  3. bonus distribution that is not based on level of contribution
  4. bonus levels set incorrectly.

While other factors might cause bonus programs to be problematic for the practice, those listed above are some of the biggest culprits. And the result of that is the opposite of a win/win scenario. The team is unhappy and perceives the owner to be a cheapskate. On the other hand, the owner is resentful, shocked or even furious that his or her efforts to help the staff make more money are not just unappreciated, they are attacked. What a mess!

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