The Physician-Administrator Leadership Team

By: Patricia (Pat) Kroken, FACMPE, CRA, FRBMA
Originally Published in RBMA Bulletin May/June 2023

Radiologists and the administrators who handle the business side of the medical practice come from different worlds but can represent highly effective leadership teams.  A functional team involves a balance of talents, skills and expertise, with the radiologist offering critical insight in terms of the physician perspective, knowledge of industry trends in the development of new technology and how best to communicate information to his or her largely fact-based colleagues.  The administrator provides a different skill set often including complex project management, relationship development, organizational development and communications.     

Different Worlds

It’s worth mentioning early in the game that physicians and administrators come from different worlds.  While it may seem obvious, it impacts how each of us makes decisions and can also influence the style and content of communications.  Our physician counterparts make hundreds of decisions each day as they interpret cases and quickly move on to the next problem to be identified.  An incorrect decision can be life threatening and the radiologist relies on fact-based training to come to conclusions. 

The administrator is often dealing with ongoing issues, which could involve layers of subsequent decisions and multiple people working for months to complete a project.  Or she addresses a complex employment problem that involves seeking outside expertise and maintaining extensive documentation.  To that degree, they share an inherent legal risk associated with their actions. 

The scientific background of the physician implies presenting them with factual information when seeking decisions and the speed with which they must normally work emphasizes getting to the point quickly.  A CEO with whom I previously worked summarized this approach as “Don’t tell me about the labor, show me the baby!”  In other words, don’t spend time presenting the history and nuances of the situation, but lay out key facts and what is needed in a decision.  If additional materials are required for historical perspective, provide them upon request or as supplemental information if you are presenting the case in writing.  This will of course vary with the situation since compliance and/or employment issues may initially require more background information but it is a good rule of thumb when informing both physicians and upper management folks.  Get to the point—and quickly. 

 For the manager/administrator this implies taking the time to think through the situation, organize information and the ability to succinctly communicate what needs to happen.

Common Characteristics of the Successful Administrator

In many organizations, physician leadership positions rotate every few years and the administrator provides continuity and stability for the larger leadership team.  A commonality found among successful administrators includes strong basic skills in communications, project management, relationship building, oversight of functional areas and analysis.  Many of these positions were historically filled by highly competent technologists but physician groups have also sought expertise in billing/collections, legal/compliance issues, employment law and financial/operational performance. 

Large practices may employ specialists in organizational areas with a Chief Executive Officer supported by managers in human resources, accounting, facility operations, marketing and more.  In a smaller group the administrator is expected to wear multiple hats and may be heavily involved in all functional areas. 

One key characteristic of success is “no surprises” for the radiologist counterpart so effective and timely communications are essential.  This doesn’t mean you can’t take some time to distill a difficult situation before explaining it because initial hysterical reactions should be minimized.  The key rule is to ensure your physician leader doesn’t first hear of a volatile situation in a board meeting or when meeting with the hospital administrator—or from someone other than you if it involves the group.  You get the idea.

In the Beginning

What’s the most effective way to work together?  Since administrators regularly work in an environment of meetings and follow-up, they can take the lead to establish a work style based on the personality of the radiologist leader.  For example, I used to work with two very different clients.  One of them was focused and fact-based.  She needed a formal agenda, made decisions quickly and meetings were short and efficient.  The other valued interpersonal relationships, needed to chat first over coffee, was informal and interrupted frequently by her staff so the same number of decision points could easily take twice as long.  I learned to schedule accordingly, mainly so I wouldn’t get stressed trying to hurry the second client along.  The important message is that I adapted to their styles and didn’t try to force everyone into the same structure.

It’s also good to recognize style to the degree some people are good at making decisions on the fly (the hallway meeting) and others must have a focused time to discuss things.  (You often find this out the hard way, by going ahead with an affirmative hallway discussion to find out your counterpart doesn’t even remember that happening).  The complexity and/or risk of the situation will help define the meeting format. 

Establishing Trust

Establishing trust between members of the physician/administrator team is essential to both the effectiveness and enjoyment of working together.  It starts with “no surprises” and keeping your physician counterpart informed of critical issues that arise.  The goal is not to have unpleasant news emerge at the group’s board meeting or a meeting with hospital administration if you knew about it and just hadn’t communicated yet.  (There will be enough incidents you didn’t know about).  Examples: 

  • A terminated employee has filed a discrimination suit with the Equal Employment Opportunity Commission (EEOC).
  • You received a letter from the Office of Inspector General requesting records related to a pending investigation.
  • Hospital administration is talking about opening a Request for Proposal (RFP) and you hear the rumor before it is officially announced.
  • The radiology department head tells you one of the group’s physicians is being brought up for disciplinary action.

When alarming news happens, will you be Chicken Little or can you calmly present the situation?  How you handle yourself in a crisis will communicate much about your ability to lead.  It’s OK to not have a complete answer to the first two bullet points if you say, “I’m talking with our attorney and will let you know what needs to happen next.”  For the second two bullets, there’s a decent chance the physician leader would have heard about the situations first—and that may serve as a good reminder to keep you informed.  In any case, each situation involves “next steps” before a resolution can be determined but waiting for the next formal meeting to discuss them is not advised.

A successful leadership team must also have a “got your back” mentality.  It means you should always tell the truth but also not sell out your partner when someone is seeking a person to blame.  Deflect first, gather information and keep your physician partner informed.

In Summary

Working as part of a physician/administrator team is demanding but can also be professionally satisfying.  Some of my best (and worst) days happened while working as a team and it was always a challenge dealing with different leadership personalities, both when things were going well and when it all hit the fan.  As a friend once said, “It’s all part of life’s rich pageant.”   

Patricia Kroken, MSN Healthcare Solutions Director of Education and Corporate Communications

FACMPE, CRA, FRBMA

Prior to joining MSN Healthcare Solutions as Director of Education and Corporate Communications, Pat Kroken had nearly 30 years of experience in radiology management as both a practice manager and consultant to radiology groups, billing companies, software vendors and hospital radiology departments.

Pat has had more than 200 articles published, is a regular contributor to the Radiology Business Management Association (RBMA) Bulletin and a frequent speaker on practice management topics. She served two terms as President of the RBMA, is Editorial Advisor for the national RBMA publication, The Bulletin, and represented the “business side of radiology” as RBMA Liaison to the Radiological Society of North America (RSNA) Associated Sciences Consortium for 7 years. 

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