In the continuing series on my conversations with c-suite leaders in hospitals, this blog will address errors I see some hospitals commit when employing physicians in clinical offices.

I keep hearing that physicians are “difficult.” Engaging physicians in leadership is a frequent concern. Engaging physicians in general is also a frequent concern.

Medical practice is one of the few businesses where the major earner (the person who brings in the dough) is on the front lines. Most businesses have tiers, and the higher paid employees supervise lower employees who actually do the work, while the higher paid employees supervise those workers.

Medical practice is different in that the person responsible for doing the work (seeing and generating charges for patient care) and, thus, generating the revenue, is also typically one of, if not the highest paid employee. The normal hierarchy of rank and salary equals distance from the front line is not true here.

Here are three serious errors that hospitals commit, even unwittingly, that put a wedge between them and the physicians they employ, stand in the way of engagement, and guarantee that their employed physicians will be “difficult.”

Mistake #1: Treating a physician like a line employee

Hospitals may defer the “management” of physicians to the HR department, because they are, after all, more employees among the hundreds of employees in the hospital. HR departments are often also bound by an internal ethic that all employees are the same in their eyes.

So processes that every employee goes through, like orientation, filling out forms, and such mundane tasks necessary to accomplish employment are the same for physicians as every other employee. It’s laudatory to try to do that.

But you’ll start a tiny ripple of resentment when physicians are run through the same process without a tiny bit of recognition that they are a bit different than other employees. Give them a bit of recognition, treat them like the money generator they are, and you’ll go a long way.

Mistake #2: Taking authority away from physicians to have a say in the operations of their office

Now, there are a lot of physicians who choose to be employed because they just want to see patients, and leave all the daily details of running the office to other people. But for physicians who have been used to running a practice, it’s a huge change to suddenly have little or no input to the management of the office (if that’s how you employ your physicians). And there are some little things that may mean a lot.

Yes, sometimes the physicians accept a lot because “that’s the way it is now.” But then you find yourself wondering why there is an edge of resentment when you want something from them.

In the back of their minds is the following thought: “You didn’t ask me about something that involved my daily work life, but now you want me to help you answer a question YOU need an answer to?”

I’ve been in offices where the docs had no input as to vendors. They might say: “I used to get XYZ done for much less than they pay now, and they yell at me for the expenses we’re incurring!”

I’ve been in offices where the physicians had no opportunity to even interview or meet prospective hires for their office. This is fine if the physician doesn’t care, but I haven’t met any that didn’t.

Prospective hires, whether a maintenance/cleaning position or an office manager, should meet and be interviewed by the physicians (if they want to), but you need to at least ask.

And, in my view, prospective employees should interview the physicians as well. Personality conflicts, styles, and interpersonal interaction mean a lot when you’re working long days seeing patients, under a lot of pressure. Incompatibility should be caught early, not after the hire.

Mistake #3: Treating medical office receptionists as an entry level position

OK, this is a pet peeve of mine, but I’ve heard it multiple places. The person answering the phones, greeting and registering patients in a medical office is a critical position. That is especially true in primary care, where a relationship should develop between the front desk and every patient.

If you have this as an entry level position in a hospital, turnover will be high, and your office will never run smoothly. That will ripple back to the clinical areas, where you’ll fail to understand why chaos reigns.

Physicians will often assume you know how disconnected they feel. And feeling disconnected will lead to that feeling you see that “they don’t trust me,” or, “I can’t get them to work with us.”

If you aren’t making the connections they want, or at least asking regularly, you’ll lose them quickly.

Physicians, what other things do hospitals do that disengage you?

Hospital folks, are you really engaging your physicians on a daily basis? Do you wonder why they won’t come to meetings?