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‘Why won’t my manager lead?’


Three keys to managing a successful practice as a leader


There is a major difference between a manager and a leader. In most cases, the differentiation is easy. The manager/administrator runs the office and the business, and the leader runs the staff.


Putting It In View By Dianna E. Graves, COMT, BS Ed

Routinely, wherever I travel throughout the country, I am asked the same questions by frustrated technicians: “What can I do when my manager won’t be the boss? What should I do when he or she won’t stand up and lead?”

When I talk with managers about this, I hear: “My staff doesn’t listen to me and goes around me to the doctor if I tell them ‘No.’”

The doctor says: “I hate being involved in the day-to-day running of the office, . . . but I feel I have to keep my hand in it because communication is poor.”

I would love to say that this does not happen at my own office. While I have spent 30 years of my career helping put patients into glasses, I have never been a fan of wearing my own pair of rose-colored glasses.

There is a major difference between a manager and a leader. In most cases, the differentiation is easy. The manager/administrator runs the office and the business, and the leader runs the staff.

Is it possible to be a manager and a leader? And which one are you? Which one do you want/need to be? When you break it down, there are times you need to be the leader and then there are times when you should expect others to step up and take the lead. The rest of the time you should be managing the business part of the practice.

The key to managing a successful practice can be listed as follows:

  • Ensure the staff is aware of the goal of the group and works together to achieve that goal.

In most practices, the doctors are partners and they own the business. They delineate the goal-the standards of the practice and empower the administration to manage the staff and organize the day-to-day operations of the business.

While most practices have an administrator/manager, the exact role is often poorly defined to the staff. Most technical staff feels the administration is responsible for paying/ordering new equipment, handling business office/billing issues (the financial bottom line) and managing the business growth of the practice. Although the manager probably was the hiring individual, when you ask staff who the boss is most will answer that it is the doctor.

  • Most managers are not medical staff. So while they may be able (via taking classes and studying) to talk the talk, they haven’t really walked the walk regarding patient care.

Technicians are highly independent people who often take charge of patient or clinical issues, even when no one has officially given them the power to do so. They will deal with patient conflicts, patient concerns, and medical-care issues usually quite well. But, when forced to deal with interpersonal issues (technician versus technician), financial issues, and/or interdepartmental issues (front desk versus technical staff), they often think of these areas as not their problem. They often will dump these problems back on the manager because they are unpleasant chores to handle.

If the administrator/manager is an absent manager-one that sticks to his or her office in the administrative area and rarely ventures into the clinic-then someone from the technical staff will eventually step into that leader role. Even if the administrator/manager has delineated an individual who he or she wants as a leader, the one that will grab the reins is usually the technician that is the “protected” one (i.e., the doctor’s favorite). The technicians will follow this person, not because they want to, but because they need to survive and no one wants to go against the “favorite” one.

  • Most managers won’t go up against the “favorite” one either. And, believe me, the staff would like the manager to do so.

This is when the technicians ask me how to make their managers see the issues and step in to lead.

While I earlier said that the technicians don’t always enjoy seeing the manager in clinic because that is their world, interpersonal issues are not their forte. They need a manager involved to keep the playing field fair. By stepping in and managing these situations fairly, the manager is also being a leader.

When I discuss this concept with managers, they say: ”I have tried to talk with the doctor about the issues, but he doesn’t see them. He is afraid she’ll quit and she’s his best technician, so he says to back off. He’ll take care of it, but never does.”

Most doctors I know honestly don’t realize the mixed messages that they send, and the chaos it creates for managers.

All the doctors know is how they want their day to run, which technician makes the day run smoothly, and that they hate controversy. Yet, the mixed messages stir controversy and discord throughout the day behind the scenes.

The favorite one will use his or her protected role to his or her benefit and gain; the un-favorites are angry because they feel (and are) left out; the manager is frustrated because his or her hands are tied and he or she looks ineffectual. The bottom line here is that the manager is usually fearful of rocking the boat as well.

Comedian Jeff Foxworthy has a great routine of one-liners (“You might be a redneck if . . . .”). Trying using this same thought process in ophthalmology (or any field) to determine whether one is a manager or a leader:


  • You might be a manager (and not a leader) if you walk into the back of the clinic area and someone stops you because it is a patient-care staff area only.
  • You might be a manager (and not a leader) if a technician complains to you about the favorite one leaving as soon as his or her doctor is done while everyone else stays until closing. You tell the informing technician that medicine involves being a team player and you don’t appreciate staff tattling on each other to stir up trouble.
  • You might be a manager (and not a leader) if the staff at the telephone appointment center, which is located on the other end of the clinic, knows about the dust up between technician A and technician B-but you are trying to recall what technician B looks like.

So, how does one morph from manager into leader? Reverse everything from scenarios 1, 2, and 3.

You can’t lead from the back of the pack. You need to be the one who is going to step up and, unfortunately, get your nose bloody every once in awhile. And when you step up, get on the bucking bronco of inter-office politics, and get thrown off-get back on the horse.

Your staff is waiting for you to grab the reins.


Dianna E. Graves, COMT, BS Ed, 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. She can be reached at dgraves@stpauleye.com.




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