It almost always starts out the same way. A practice (usually a small one) loses its manager, or has its first financial troubles and realizes it really needs a professional manager, and one partner says innocently enough, “What about my wife?  She’s got an amazing corporate background, and is getting bored at home with the kids.  She could work for a few months part-time, get us turned around, and then we could hire someone permanently.”

It sounds like a perfect solution.  After all, aren’t the partners’ spouses goals the same as the partners?  Who can we trust more than one of our wives (or husbands)?  Besides, it’s only temporary ….

After those few months, the miracle replacement manager who could be as loyal/smart/affordable as the partner’s wife has, predictably, failed to materialize. And everyone is so grateful for the “magic” the temporary manager has pulled off — it seems like she has literally saved the practice from bankruptcy! — why would we want to replace her?

Years go by.  The manager amasses more and more control over the business side of the practice. Maybe she seems a little insulted when you ask about the status of a particular account, or why a particular vendor has been getting paid so much. Then, little by little, some of the partner discussions that used to guide financial decisions stop happening.  The manager, after all, is “almost like a partner” anyway.  No one feels comfortable confronting or curtailing the manager — their dear partner’s husband (or wife) — so problems fester.  The manager wants more pay — argues it’s “market rate” — who will be willing to contest this?  The festering worsens.  The manager’s productivity analysis seems to always favor her husband at bonus time.  Resentment is growing, bottled up.  Is the practice earning all the revenue it should?  Are payer contracts negotiated to best advantage? Nobody knows, and nobody feels comfortable asking.

And what if the practice has new financial problems a few years down the road?  Where is our heroine now?  She’s doing her best to appear neutral and professional, while simultaneously doing everything she can to protect her household income.  She’s not an unbiased, professional manager who can readily put the needs of the entire practice first — she is a person who is undeniably biased towards defending her own needs first.  Most important, she’s not an employee you can freely ask to defend her performance and her decisions — she’s family, so you feel like you have to take whatever you get, regardless of cost.

Your partner’s spouse isn’t, and won’t be, an unbiased advocate for you or your practice.  Physician owners: don’t hire a partner’s spouse to do the work of a professional manager.  Do so, and odds are you and your partners will one day face an uncomfortable conversation that might be years overdue — and might ruin your relationships and your practice.  If you’re thinking this sounds unduly cynical, unfortunately, we’ve seen it happen far too many times to too many good doctors.  And all of the pain and financial loss that resulted could have been avoided simply by hiring a professional manager whose accountability to all of the partners would have simply been a clear condition of employment.

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