We've all had interactions where logic and reason have nothing to do with the issue at hand. A physician has one perspective and another physician has an opposing view. The conflict could delay a decision or create divisions among staff. Whatever the issue, managing physicians need to intercede or facilitate a break in the impasse.
Is there ego involved? Probably, but before we place blame, remember that physicians are trained to be independent decision-makers. We wouldn't want doctors telling patients who are sitting on the exam table to come back in 2 weeks after a committee determined whether it was appropriate to prescribe antibiotics.
In comparison, administrative decisions often require consensus-building, which can take time. This too is foreign to physicians, who issue orders and people make it so, like Captain Jean-Luc Picard on the television series "Star Trek."
Tricks of the trade
Practice management is unique in the sense that professionals in this field manage other professionals, who are usually owners of the business and also billable workers.
To start down the path of managing up, put aside your own ego. Yes, you too have a sense of self-importance that may get in the way. Success requires you to put the physician's needs at the center of the picture. In other words, if you have physicians who need to have the last word, let them have it. But ensure that their words take the practice in a direction you have prescribed.
Try to dialogue
When an issue arises, talk to a physician one-on-one; ask what his or her concerns are and how you can allay them.
If you recognize that a physician is unlikely to change, focus on understanding his or her style to help mitigate the situation. For example, I worked with one group that had a physician who behaved badly when he became frustrated. In addition to bringing staff to tears, we feared that his yelling and negative behavior would prompt staff to quit. The other partners preferred to avoid confronting him, but when the group sat down to discuss the problem during a meeting, he agreed that his behavior was inappropriate. Unfortunately, it kept happening.
It wasn't until a managing partner stood up to him -- literally stood up -- that he stopped behaving in an abusive manner. Sometimes a conversation has to take place from a position of power to have a real impact. In this case, standing face-to-face (in private) rather than sitting across a desk or conference room table helped raise the importance of the issue, and solve the problem. The managing partner also gave the physician an alternative to vent his frustration.
Instead of verbally attacking employees, she told the physician that he was free to vent his frustration to her, even to the point of picking up the phone and spewing unmentionables. He never took her up on that offer.
Try subtle changes
In another two-doctor practice, a new physician was uncomfortable asking his partner for a change that would help with patient flow. The partner had managed the staff to facilitate optimal workflow for her patients by usurping the shared (and infrequently used) procedure room as a fourth exam room, even on busy days. Meanwhile the newer physician was limited to two exam rooms, which resulted in increasing patient wait times even on days when the partner wasn't in the office.
An easy solution was to provide a third exam room for the new physician. This was accomplished when the office manager asked the staff to start rooming patients in the procedure room on days when the partner was not in the office. That rooming process became routine on days when both physicians were in the office, which created a more equitable arrangement: three exam rooms for each physician.
Management strives to make the job of physicians easier. It is not unusual to have physicians with special needs or problematic conduct. It's our job, as managers, to develop skills to support them, and often that means dealing with egos -- our own as well as others.