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    Tina D'Amico
    Tina D'Amico, MHA, CMPE

    Practice administrators approaching the end of their full-time work cycle should be planning for succession. To be most efficient, this planning must begin years in advance to provide the best possible outcome for the success and continuity of the practice.

    Trust and respect

    Succession planning starts and ends with the physician/administrator (P/A) team, a dynamic that is one of the most valuable tools a practice can have. In a mid-sized practice (6-20 providers), where multiple partners/owners can bring diverse opinions and suggestions, waiting for approval on every decision can be counterintuitive to running an efficient and effective practice. Therefore, the partners must trust and respect who they chose as the managing partner, and the managing partner must trust and respect the administrator’s opinions. This balance is necessary for effective decision-making, relying on each other’s expertise and judgment. Open, honest, complete discussions should be a daily occurrence.

    Succession planning should be a comfortable topic for the P/A team to broach. While strategic planning may not occur as often, practice growth decisions should always consider each staffing change. Questions that should be regularly discussed include:

    • What is our provider/staff ratio?
    • Do we need additional help? 
    • Should we add a physician or an advanced practice provider (APP)?
    • If a provider becomes unexpectedly ill, how and when will we plan for a replacement? 

    When a topic is raised by the partners/owners, the administrator should feel comfortable in their thought processes and be prepared to facilitate a productive discussion. Discussions as personal and as difficult as these are always built on trust and respect.

    Planning should be continuous

    Traditional strategic planning should occur every two to three years, while succession planning should be a constant consideration. The primary focus should be protecting the organization’s current and future success, which requires solid management and office protocols.

    Midsized practices often have a limited staffing budget, unable to support several layers of management. Consequently, practice administrators often have minimal layers of management between themselves and the staff, taking on heavy HR responsibilities — or no management at all. In these cases, it’s best to exemplify the work ethics, dedication and commitment of the partners/owners of the organization, serving as a model for all staff members and managers.

    Partners should openly share their plans for retirement, cutting back on office hours or changing their on-call schedule, regardless of how vague or distant these plans may be. The administrator should feel confident and comfortable sharing plans without fear of retribution. These discussions can be informal, flexible and are not commitments. They should be included on the agenda for the annual partner meeting.

    Succession planning is an ongoing duty that affects every role in the practice. Administrators should review the staff roster, examine each job description and identify “hidden jobs” that staff members perform. These tasks often go unnoticed and unaddressed during vacations or extended leaves and illness, leading to missed calls, improperly recorded callbacks and unprocessed faxes or scans. The worst time to discover these gaps is during such absences.

    Planning succession for the administrator role

    If possible, consider the second-in-command for the administrator role. While this is not always feasible, the next assistant administrator should be selected based on their capabilities and enthusiasm for their current role, in addition to training and education. They might lack experience initially, but this will likely improve over time. It is key to select someone with ability and potential, even at the early stages of their career.

    When training the next administrator, slowly integrate job duties and responsibilities, teach protocols for unlikely scenarios, and have them problem-solve “what-if” scenarios. Encourage them to join local and state management organizations or committees to gain experience. Include them in meetings even if their input isn’t required. The goal is comprehensive knowledge, and allowing access is the key to future success.

    In many practices, employees are happy and have longevity. If you have long-term employees, celebrate your achievement. However, high turnover rates need to be addressed and monitored. If turnover is consistent, examine job duties to determine if the issue is selecting the wrong employees or if the requirements for the position are too demanding.

    Post-COVID employees prioritize work-life balance. Carefully examine job duties and consider any changes in day-to-day activities. Review your organizational chart and ask employees how they are doing in their roles. Do they like their jobs? What can be done to make their work more interesting?

    Case study: Importance of backup staff and maximizing productivity in an OB/GYN practice

    In our practice, the need for backup staff became apparent when a young medical assistant fell ill with a serious medical condition. This assistant, known for her diligence and dislike of idleness, often asked for extra work and was assigned several important but occasional tasks. Unfortunately, she required a complicated surgery and did not survive. Following her passing, it was challenging to identify and redistribute the numerous tasks she had taken on.

    To address this issue, we scheduled workflow reviews for each staff member. While job descriptions were generally clear and being adhered to, the review revealed several unexpected details. For example, one employee, who tracked her daily steps, took an extra lap around the office near the fax machine and took it upon herself to distribute paperwork to the appropriate person to avoid delays. Another employee arriving early each day because she drove her neighbor to work, waited in the parking lot for 30 minutes before starting her shift. We realized we could utilize this time by adding a new job duty to her schedule.

    To avoid “administrative medical errors,” which can delay clinical diagnoses, thoroughly review each staff member’s job description. Understand the specific duties of front-desk staff, sonographers, medical assistants, scan techs, billing staff, administration, and payroll and human resources. Ensuring these roles function seamlessly daily is crucial, even when a staff member is absent.

    The key takeaway here is identifying the backup staff member for each role. No job function should be performed by only one staff member; every role needs a backup, including the administrator’s. Practice makes perfect! Regularly practice having backup staff perform their respective tasks to ensure readiness. For example, backup staff should practice payroll processing and scheduling duties, such as creating patient schedules, entering templates into the EHR, monitoring schedules and handling cancellations, recalls and routine stats. These tasks should never depend on just one person.


    Succession planning is an ongoing process and a significant time commitment. Planning and protocols must adapt to reality; we can’t predict the next big change for a key staff member or when the next pandemic will disrupt the best planning. Robert Burns said, “the best laid plans of mice and men often go awry,” and we administrators believe “the only constant in medicine is change.” Therefore, succession planning is not only necessary but also one of the administrator’s most important goals.

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