I am often asked, “How do you know when a practice needs a practice manager?” My answer is simple – every practice needs a practice manager. The real question is, “What type of manager do you need?” There are three categories of practice managers: Office Manager, Practice Manager, and Hospital Administrator.

Office Manager 

An office manager is basically a head receptionist who has been given additional management responsibilities. Your office manager might help you with accounts receivable or inventory control. This person will be very limited in their management responsibilities and normally has little training in business.

Practice Manager 

The practice manager functions between the office manager and a hospital administrator. This individual may or may not being doing this job on a full-time basis. They spend at least half of their working time in management and have had some training in practice management. The practice manager is normally in transition from an office manager to a hospital administrator.

Hospital Administrator

The hospital administrator is responsible for all areas of hospital management, including (from a management perspective) the oversight of associate veterinarians. In fact, this is the major definitional difference between a practice manager and a hospital administrator. The hospital administrator would be responsible for ensuring that associate doctors charge for their services, adhere to their work schedule, and get all their work done. The hospital administrator would not oversee the medical and surgical competences of the associates unless the hospital administrator is also a veterinarian. Instead, this responsibility would fall to the owner or the board of directors of the hospital.

How do you know what type of manager your practice needs?

One key to determining what type of manager your practice needs is to determine what you can afford. Three percent to four percent of your gross revenue should be spent on management. This sum of money represents what you should spend on all aspects of management. So, if you have an office manager and a hospital administrator, or if the owner is spending time on management, this 3% – 4% of gross needs to cover everyone involved in the practice’s management activities.

Normally, office managers earn $1.00 or $2.00 more per hour than your lead receptionist. Practice managers are paid in the range of $45,000 – $55,000 and hospital administrators will make $80,000 or more per year, plus benefits. So calculate 3% – 4% of your gross revenue and you will have a good idea of what type of manager you need to have in your practice.

Once you have figured out what type of manager you need, the next step is to determine what this individual will do in your hospital. I suggest developing a job description for your manager. You can purchase job descriptions or create your own.

Here are examples of these job descriptions:

These,as well as Phased Training Programs and Evaluation forms are available as part of our Management Tools for Veterinary Practices package.

I have hired many managers over the years for a variety of veterinary practices. As I stated earlier, an office manager is basically your lead receptionist who taking on some additional management responsibilities. This position does not require a great deal of management training. However, a practice manager will certainly need to be trained and experienced in management. Most people want to hire someone with veterinary experience and this may indeed be a plus, but it is not necessarily a requirement of the position. I have hired many practice managers who had been managers of medical offices or small businesses. Management is management and about 60% of the manager’s job will be personnel management. So, hiring someone who has excellent training in human resources and who has successfully managed a small or medium sized office may work out really well for you. It is nice if they have veterinary experience, but it is not always necessary.

When hiring a hospital administrator, you will want them to have veterinary experience and a great deal of competency. Hopefully, you already know that there are individuals in our profession who are Certified Veterinary Practice Managers. CVPM, as it is known in our field, is a certification process that I and several other people developed many years ago under the auspices of the Veterinary Hospital Managers Association. We originally designed this certification to be similar to the process accountants go through to become a Certified Public Accountant. When the CVPM designation was initially offered, applicants had to complete a very detailed application process and then, if they were qualified, they would sit for both an oral and written exam. The certification process has now become standardized and the oral exam has been eliminated, but applicants still must undergo an extensive application process and written exam. To successfully pass the exam, you must have competency in many different areas of practice management. CVPM’s must complete yearly continuing education requirements and are held to a very high standard. If you hire a CVPM, you can be assured that you are hiring an exceptionally competent veterinary practice manager. For more information about CVPM’s, go to VHMA.org.

You’ve got to LET GO!

Now you know what type of manager you need and, hopefully, you have hired this person, developed their job description, and made sure they have adequate training to do the job. The next step is that you, the practice owner, must let go! This is the hardest part for many veterinarians.

When consulting with veterinary practices, I often recommend that they hire a practice manager. My firm will even interview and hire that individual for the practice and help to train them. That part is almost easy compared to the next step – getting the practice owner to let go of the reins and allow the manager to do their job. I certainly understand how this can be difficult. In smaller practices, the owner may be used to personally handling all the management activities, but now they need to let go and let their manager do their job.

The key to making this transition a success is defining what the manager will do and setting up internal controls. While there are horror stories about practice owners who hired a practice manager and turned that person loose in their hospital only to find that the manager embezzled from them or created havoc among the team members, there are many more success stories. Those are the ones where a manager is hired, the practice is managed better than before, and the owner can take some time off, develop other areas of the practice, or just enjoy an enhanced quality of life.

Again, the key is to incorporate internal controls. Delegation is not abdication. Let me give you an example: You should review bank statements at the end of the month and review the financial reports from your veterinary software program and your accounts payable system. Only you, the owner, should be able to write off accounts. You should also monitor your aged accounts receivable each month. Remember, it is still your practice. You must keep a finger on the pulse of your practice and know what is going on in it. There are many checks and balances you can put into place to make sure things are going well and that your manager is effective.

Hiring or developing a manager in your practice may be one of the best things you ever do, if done correctly. Most veterinarians were not trained to be managers and, frankly, I think most would prefer not to have to deal with the management of their practice. I can’t count the times I have heard, “I went to school to be a veterinarian, not a manager.”

Other than learning how to let go and using appropriate internal controls, the other obstacle to effectively developing a manager is lack of training. Many practice owners promote receptionists, technicians or veterinary assistants to the position of practice manager without any training whatsoever! Does it make sense to have an individual who might not even have a college degree managing a million or multi-million dollar practice? They may be nice and may have been with you for a long time, but that does not make them a manager. Many types of training are available. I am sure there is a school or university in your area that provides education in this area. About 25 years ago I developed the VMC School of Veterinary Practice Management. This was back in the day when there really wasn’t any other place to get true veterinary practice management training. This school is a one-week, intensive training program designed to teach practical practice management. Having been an Administrator myself for over ten years, I know what is required to be an effective manager and I designed a school around this. Classes are kept small (under 20 students) and the material taught is both comprehensive and practical. We also provide six months of follow-up, so students can contact any of the instructors if they need help with management issues in their practice. We have taught hundreds of managers.

So, do you wish to improve the quality of practice management in your practice? Do you want to spend more time doing medicine or surgery than paperwork? Do you hope to spend more time with your family and friends? Then maybe you should consider developing a manager within your practice.

Mark Opperman, CVPM
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