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Identity crisis
Monday January 21, 2013

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Resources for clinic managers

Society for Human Resource Management
The world’s largest association devoted to human resource management

Private Practice Section of APTA
Shares advocacy, education and ideas among PT business owners

Physical Therapist in Private Practice
Group for PTs in private practice to share information

Online collection of free sample business plans

Network of independent rehabilitation providers

Physical Therapy Business Alliance
Advocacy organization of physical therapy businesses

Advice from physical therapy marketing consultant

CMS forms
Access to reimbursement forms from the Centers for Medicare & Medicaid Services


Days start early and end late for physical therapists who also are responsible for managing their clinics. Neil Masters, PT, MS, of Axis Sports Medicine in Avon, Colo., called the dual duties “very challenging.”

Masters carries a nearly full caseload and relies on staff to follow processes and procedures. He tries to determine employees’ strengths and goals and builds on them. “Organization is the No. 1 thing,” said Masters, who tends to administrative duties before and after patient care. He reviews the prior day’s activities and developments in the morning, then makes a list of items for the staff to accomplish on that day, such as handling insurance claims or other tasks.

He also sets time aside in the middle of the day to deal with the unexpected. “As a manager, my job is not only to tell people what to do, but also to help structure what needs to be done and let them take care of those things they do best,” said Masters, adding the business must keep employees happy to keep patients happy.

Ronald Scott, PT, MBA, EdD, JD, assistant professor, The University of Texas Health Science Center at San Antonio, and co-author of the book “Physical Therapy Management,” said in the case of PT-run clinics, the manager knows what clinicians face and will have more empathy. “They also are more satisfied, because they are treating patients,” Scott said. “It’s a way of breaking the monotony of managing.”

However, Scott said handling both duties takes time. “You should have the expectation that you will have a very long day,” he said.

Samuel H. Esterson, PT, MA, MBA, DScPT, founder and owner of Esterson & Associates in Baltimore and author of “Starting and Managing Your Own Physical Therapy Practice,” agreed about the rewards of handling both roles and cautioned that PTs who focus solely on the business and not on treating patients risk losing touch with the full scope of the practice and the big picture. “I personally find my role as a clinician/manager to be motivating to my staff, as they see me shoulder-to-shoulder with them, sharing their successes and their challenges,” he said.

Tannus Quatre, PT
Falling into the managerial role

PTs typically go to school with the desire to treat patients, not picturing paperwork or administrative duties. But that’s a direction their careers could take them. “You exceed expectations on a clinical level or show some leadership, then ownership sets sights on you, to put you into a management position, so you can influence others,” said Tannus Quatre, PT, MBA, principal with Vantage Clinical Solutions in Bend, Ore.

Alternatively, PTs with entrepreneurial aspirations often launch their own private practices. “Clinicians who choose to open their own practices inherently have a dream and drive to create something new and perhaps innovative,” Esterson said. “This internal fire motivates them to do both management and clinical care.”

While venues may differ, balancing both roles is a common challenge, said Michael Weinper, PT, DPT, MPH, president, CEO and founder of PTPN, a network of independent rehabilitation providers. Success requires multitasking, flexibility and knowing when to say no, he said. Emergencies, such as a medical situation, will require the manager’s attention, but interruptions for billing or other questions may need to wait. In larger practices, an office manager may handle those issues. “Patient care comes first,” Weinper said. “Patient care generates revenue; without the revenue, you don’t need a manager.”

Managers must learn to delegate but supervise, and policies should be in place for staff to handle most situations. However, managing requires being prepared for the unexpected. “You better be a good juggler,” Weinper said. “At the same time, you have to keep in mind your primary [focus] is your patients.”

“Before you have human resources in place, you have to be highly organized and willing to work extremely hard,” Quatre said. He suggested PT managers assess their own strengths and capitalize on them, then compensate for weaknesses.

Michael Weinper, PT
Outside expertise

Masters opened his own practice 10 years ago, which he operated for eight years. He left to join a hospital clinic, then moved to a group practice with other PTs. He determined what he did well and outsourced tasks such as payroll and billing in his private practice, but at his current clinic, support staff handles those responsibilities. In fact, he said, economic pressures and market dynamics are what pushed him into a larger practice better able to manage costs associated with those functions.

“You are usually bootstrapping it when you start,” Quatre said. “When you start to scale up, hit a critical mass and can afford to bring someone in, it’s a fallacy to think you can effectively hire someone to take all of the administrative duties off your plate.” In this situation, the new employee is at risk of mismanaging the practice because he or she does not share the same vested interest as the owner.

When hiring another manager, Esterson advised recruiting a someone who shares the PT’s vision, goals and work ethic.

Another option is contracting the services of a manager who oversees multiple practices part time or as a consultant, Weinper said. “Practices need to consider joining forces, lowering their costs and sharing resources,” he said. “I see more of a role for shared management between practices.”

Samuel H. Esterson, PT
Preparing for both roles

“[Management] can become a dilemma if you don’t have the passion or knowledge,” said Weinper, who returned to school for a doctorate with an emphasis in administration. “If you are going to be a manager, you need to know what you are doing.”

Scott suggested clinicians pursue additional management education, perhaps undertaking an accessible transitional doctorate of physical therapy program with a strong management component. Additional academic coursework can better prepare leaders to budget, monitor finances, forecast the need to add PTs, hire the best candidates and other tasks, he said.

“You want to stay sharp,” Quatre said, advising PTs to treat their management skills as they would their clinical knowledge — to keep learning and retooling.

A mentor may prove helpful, said Quatre, who said he found about five mentors within the healthcare organization where he worked to help him learn the management ropes. That included the CEO.

“I got so many gems,” he said. “I had experience by proxy to use as I charted my own course.”

PT managers can turn to organization board members or advisers, such as accountants and lawyers. They also can join professional associations to find opportunities to consult with experts (see sidebar).

“When you are going to be an administrator, you better know what you are doing, or it can get away from you quickly,” Weinper said.

Debra Wood is a freelance writer.

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Monday January 21, 2013
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