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What to do when the clinic has taken you hostage


A dysfunctional clinic environment may mean the power lies with employees instead of the administration. Be aware of common complaints so the power of the practice  can be taken back.

Putting It in View

“Hostage: One that is involuntarily controlled by an outside influence”


GravesOne of the joys of teaching at the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS) or American Academy of Ophthalmology (AAO) is having the opportunity to meet so many other managers and administrators and talk with them about what is happening in their offices.

I am always able to glean ideas from them that I can bring back to potentially help improve what we are doing in our office. 

Sometimes, the conversations are uplifting and humorous. Other times, they are very serious and complex, regarding changes to insurances, billing, meaningful use, or how their physicians are handling governmental mandates. Then, there are the discussions that hit home-discussions about staff, hiring/firing practices, and the overall health of the clinic.

Each year the conversations seem to have a theme, whether that be relationships in the clinic that are damaging teamwork, ethical dilemmas regarding salaries, discipline and human resource issues, or, how groups staff the clinics. Do they have individual technicians for each physician or do all the technicians see all the patients for every physician regardless of which physician the patient is coming to see?

This year’s overwhelming discussion was different from past years, but every time someone asked to speak to me after a class, the discussion had a similar, desperate tone.

“Help me! My office is holding me hostage!” said multiple managers, physicians, and even one chief executive officer. The stories ran the gambit of salary issues, the inability to find qualified staff, and issues with administrators running amok. Lastly, the topic turned to “scary techs.”

Do you ever have that sinking feeling in the pit of your stomach that your clinic, or you in particular, might be in line to being held hostage?

Have you thought about it?

And if you are sure you are not being held hostage at this time, do you know what the signs and symptoms are? And can it be turned around before it happens to you?

3 common complaints


3 common complaints

Complaint #1: "I always thought they worked for me-but I now think I am the one working for them."

One day, after I was done teaching and relaxing in the sun at lunch, I visited a physician and his office manager. They stated because of the area they live in, they could not find qualified people to work in their general ophthalmology clinic.

Because of the lack of qualified people, they were in the routine of taking in anybody who applied and then train them in-house and “on the fly.” When the new hires began to develop skills, they started paying them more and more to keep them with the group.

It did not take long for the staff to see this. Soon their intensity levels began to go down exponentially as their salaries went up. The physicians made sure they stayed happy by giving bonuses and salary bumps occasionally. Staff soon realized that the physicians would not be able to get anyone to replace them. So they demanded more and more money-as well as other perks.

Eventually, the teeter-totter of power swung into the employees’ favor. The physicians are being held hostage by undisciplinable (they threaten to leave if poor behavior is called out), overpriced staff who will only give them a marginal day’s work.

They wanted help and ideas from me, but when I gave them the solution I would use-and have used in the past-the practice manager had to catch a fainting physician.

I told them to fire the one that was the “ring leader” in order to send a message to the rest of the group that no one was irreplaceable.

Yes, I know-this is cutting your nose off to spite your face, but a message needs to be sent that even though it will be very hard to replace that person, no one is sacred. The reason employees are there is to work for the group-not the other way around.

Complaint #2: “This really is my practice-I just let you work here!”

A different physician spoke to me about her office administrator after a class I had just given called “Scary Tech.”

The class is about how an outstanding technician with excellent skills, giant work ethic, and loyalty to the practice to a fault, could ever be thought of as scary.

These are the monster technicians or administrators who have managed to cull their power into such a position that even the physician worries about having to go up against them because they are so integral to the practice.

These employees are often quick to launch, “passionate” in how they treat others (“my way or the highway”), are unapproachable in their work habits so no one can match up to them, and consider themselves the “silent partners” who are actually on a peer level with the physician.

This physician found herself tip-toeing around the administrator because she did not want to make the administrator mad and did not “want her wrath coming down on me, and couldn’t afford to have her leave the group.” The administrator had been with the group 25 years, and was felt by all to be irreplaceable. They just needed to know how to survive working with her!

When I asked the physician, “Who thinks they are irreplaceable?” she said, “That’s what they tell us all the time.”

I advised her that when she got back, she needed to sit down with the other partners and have a serious discussion regarding the administrator and whether this is the person they want to manage their business.

When I emphasized the administrator was working at the pleasure of the physician, she smiled and asked how much it would cost to have me come and tell that to her!

Complaint 3: 'Pet' technicians


Complaint #3: “The physician won’t let me cross-train anyone to work with him. He only wants his technician. When he is out, he lets the technician take time off too. He has created a monster that I am not allowed to discipline, do reviews, or set the schedule for. Then, he asks me why morale is so low!”

This administrator had the saddest demeanor I had seen in a while. She had a clinic under assault from the physician’s pet technician.

The technician was a tyrant, lazy, and turfed anything she didn’t want to do on her fellow co-workers. They had no clue what his patient protocols were because she never told them, and if she did have them help her, he was not as pleasant to them as he was to his technician.

The administrator explained that her group had lost four good technicians in the past year for this reason, as revealed in their exit interviews.

I advised her to go back to her room and write down the good and the bad of life at her clinic. Then, write down where the physician’s behavior and the technician’s behavior fit into the good and bad.

Afterward, I instructed her to sit down with the physician, discuss the issues regarding staff leaving, poor workplace/staff morale, and how these behaviors were making for a poor clinic workplace. Advise him that you need to have this technician in the same flock as the others.

If he says no, then she would need to decide if she wanted to be an ineffective manager at this clinic any further. If her answer was no-and it was-there would be plenty of places that would want her to come and manage their group.

3 lessons learned


Lessons learned

What did I learn from these conversations?

  • I am never teaching that class again!

  • These issues are consistent, and they are everywhere. They affect us all, and affect the staff we manage.

  • Believe it or not, very often the physicians are not even aware of their behavior, and when it is brought up to them, they have been known to change.

Give it a try. At this stage of the game, what do you have to lose? Silent suffering isn’t going to change anything. Your job is to “manage” the clinic and the staff (including the physicians). If the staff is running you, it is similar to the dog and wagging tail analogy:

"Why does the dog wag its tail?
Because a dog is smarter than its tail.
If the tail were smarter, it would wag the dog."
From the 1997 movie "Wag the Dog"

I’d rather be the dog! Hit the problems head on-and get wagging!


Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Dianna Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.

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