More Opinions on Practice Management

The decision to add laser procedures to your current practice can be daunting yet exciting. Realistically, this is unlike Field of Dreams, as patients do not materialize just because you have a new laser. Certain questions are important to answer in making this decision.

Read more

The largest asset on your balance sheet is almost certainly, believe it or not, accounts receivable. Collecting balances due has always been a problem for physicians.

Read more

The word "volunteer" is unusual in that it may be used as a noun, verb, or adjective. As a noun, it identifies a person who performs a service of his or her own free will, and, importantly, as a verb, it means to do charitable or helpful work without pay.

Read more

Film is dead, it has gone the way of the daguerreotype and calotype. As DVDs have replaced VHS, digital cameras have replaced film cameras and for pretty much the same reason; digital cameras are easier to use.

Read more

Opinions on Practice Management

Neal Bhatia, MD

Office Politics in Private Practice: Cases and Conundrums

Neal Bhatia

Friday, June 07, 2013


The daily challenges faced in a private practice are varied and can permeate all areas of the business; left unchecked, they can quickly spiral out of control, affecting the stability of the working environment and eventually the entire business, so it is vital to identify potential pitfalls before they happen.

Common challenges often develop from differences between individuals or a collective of individuals representing a certain group of workers; for example, physicians and front-office staff or front- and back-office staff, or even between staff groups. Office politics is therefore far-reaching and, if left unchecked, may manifest as derailment to the routine staff dynamics (lunchroom separation; perceived inequality of working hours), separation between individual staff or employee groups, the formation of toxic employees and poor staff morale. On top of these, there are also private issues to contend with, particularly when there is a considerable personal interest in the practice such as family monetary investment or partnership with a spouse. The fact that, in the US, over 50% of marriages end in divorce is a particularly sobering thought to consider in the latter case.

To help address some of these aspects, we will focus on three cases that were chosen to help you tackle some of the day-to-day problems that can expect to be encountered when setting up your own practice. The following cases were compiled from real-life experiences that were kindly provided by friends and colleagues.

Cases and Conundrums

Case 1

"Two employees managing the front desk are clock-watchers, always the first to leave at 11:59 am for lunch and 4:59 pm for the end of the day, no matter what is happening, leaving the other employees stuck with their work."

  1. How is this cycle broken?
  2. What is the breaking point for termination, even for a good employee?
  3. What is the role of the non-partner physician?

There are multiple issues that could be contributing to this: 1) policy on overtime; 2) teamwork; 3) personal attitudes of staff.

  1. Policy on overtime: In this case, it is difficult to ascertain a perpetrator with respect to flouting of the rules if they are operating legitimately within them. Hence, if the member(s) of staff are contracted to set hours and there is no incentive to stay longer (overtime payment), then there is no reason to expect them to
  2. Teamwork: There appears to be a lack of acknowledgment of colleagues' workload and/or inclination to help
  3. Personal attitudes of staff: Personalities may preclude them from being altruistic

In answer to the questions outlined above:

  1. The cycle could be broken by offering incentives (overtime) or conveying the importance of teamwork (helping out other colleagues)
  2. There may be no grounds for termination of employment if these are set hours
  3. If they are not doing anything illegal, then the role of the non-physician partner is limited, and if the attitudes of the members of staff have been tolerated and are firmly established, then this is likely to be difficult to change

Answer adapted from information provided by Dr Allan Wirtzer.

Case 2

"The new MA in the office is amazing and does the work of three, she is efficient and energetic, and the patients love her. However, she calls in sick every other Friday. Everyone in the office knows she is not sick, but feels trapped."

  1. How should this be addressed?
  2. What can be done to break the pattern?
  3. How should morale be restored?

Issues to address here include: i) unacceptable absence having a detrimental effect on the business; ii) the employee's personal wellbeing

In answer to the questions outlined above:

  1. This should be addressed privately with the individual, making sure that her positive contribution is acknowledged, but highlighting that her level of absence is of detriment to the business
  2. Notify her that missed days are unacceptable or, even better, change her schedule and eliminate Fridays
  3. There is a need to identify any occupational issues that the member of staff may be experiencing, e.g. issues with the nature of work or other members of staff; honesty is key in order to establish whether morale can be restored

Answer adapted from information provided by Dr Allan Wirtzer.

Case 3

"A marginal employee spends a good part of her day on social media. After hours, she has been posting information about her day at work, including information about her employer, the practice, and specifically other employees that she has had disagreements or issues with. Eventually, the posts start occurring during the working day, and the other employees are hearing about it from outside sources. The reputation of the practice and the employees are now being compromised as she airs her 'dirty laundry'."

  1. What is the course of action here to protect the employees and the practice?
  2. What are the consequences of her actions? What if she calls this 'freedom of speech'?
  3. How can this be prevented?

There are three issues to contend with here: i) there may be a legal issue about posting inappropriate information about others online; ii) the reputation of the practice may be being compromised; iii) the general distraction of using social media may compromise the quality of work, further damaging the reputation of the practice.

  1. The course of action should be swift, open and honest, and in this case, should act as a deterrent for others
  2. This can be prevented by establishing some ground rules regarding social media, including the use of mobile telephones, i.e. restricting/monitoring the amount of time spent on social networking sites, restricting/limiting what internet sites can be visited; and all staff should be made aware of the rules to be fair and effective

Answer adapted from information provided by Dr Allan Wirtzer and Dr Jo Herzog.


The pitfalls associated with office politics, although not always avoidable, can be dealt with effectively if the necessary tactics are executed in a timely manner. Resolving a situation requires tact and honesty, especially where employees are involved directly and, to this end, communication is key. It is better to over-communicate with your staff - particularly when dealing with issues such as pay-freezes, layoffs, longer hours or budget cuts. Discuss these as a team and involve them in the changes. In other words, weather the storm; sometimes things happen and the best policy here is honesty. The table below summarizes some of the common problems and standard measures that might be considered in a private practice as part of a solution:


Staff problem


Clock-watching/staff leaving despite work not being finished

Determine how impactful this is on their peers and on the business; if need be, incentivize staff to go over and above designated scheduled hours and/or workload; assess if staff are not fulfilling adequate workload, in which case, consider local disciplinary action

Poor personal attitude of staff members

Gauge if there are reasons behind negative attitude by speaking directly to staff; if their attitude is impacting on other staff members, consider redistribution of the member of staff in question or seek disciplinary action

Unacceptable levels of absence

Identify reasons for absence by talking directly to member of staff and establish a solution directly

Use of social media during work

Blanket ban or limiting use of social media during working hours; establish a clear disciplinary line with all members of staff

Inappropriate comments made on social networking sites

Gain evidence of comments and ascertain how serious/damaging these are to individuals and company; if necessary, seek legal advice before any disciplinary action or termination is implemented as the comments may be a National Labor Relations Board (NLRB) protected activity


In situations where disciplinary action is required, make it swift, fair but impactful, and chastise discretely. As the owner or partner in the practice, you should establish a clear hierarchy to facilitate this process when appropriate. However, if you are working in a larger institution, some of these solutions may be difficult to implement or hampered by what seems like additional bureaucracy or resistance from co-workers. In these situations, be prepared to make your case to your peers and present a clear and logical rationale behind your solution. Remember that communication with your peers is as important as communication with your staff, so be receptive to any advice that they have to offer.

Finally, poor morale poisons the office function, hindering growth and ultimately compromising patient care. It is not always expensive to reform morale, and success will be rewarded with a happier working environment, less errors and greater productivity. Remember, as the physician and leader of the team, take a top-down approach: enthusiasm is as contagious as poison, so check your own attitude first.