By the Numbers

The benefits of the physician-administrator dyadic leadership model

Here are seven tips to help establish an effective dyadic partnership.

“The ‘dyad’ is a partnership where an administrative leader is paired with a physician leader. An effective dyad is frequently referred to as a ‘work marriage’ — the two partners balance each others’ skills and weaknesses and work as a cohesive team toward a common goal.”

– The Advisory Board Company

A majority of ophthalmic practices today pursue in reality — if not in name — a so-called “dyadic leadership” model. This model has the following chief features, whether the practice is small or large, and whether the practice has intentionally set up a dyadic approach by design or has organically arrived at this model inadvertently:

  • A physician-owner is nominated, with a greater or lesser degree of formality, as the managing partner, president or chairman of the
    practice.
  • This physician works closely with the administrator. Each has written, board-approved roles, and each stays in their own “lanes.”
  • Both halves of the dyad work as hard on their relationship as they do on the practice, with frequent meetings and discussions that are deep enough to affirm that both parties are mostly on the same page, while respecting small differences.
  •  A successful co-managing relationship between the MD leader and lay administrator has much in common with effective parenting:
        •    Shared values and standards;
        •    Shared vision for future priorities;
        •    Speaking publicly with a single voice;
        •    Consistency and reliability and predictable follow-through;
        •    No disagreements in front of the “children”;
        •    Seen as a unified force commanding respect; and
        •    Not allowing the “children” to play “mom” against “dad.”

As effective as this approach to practice leadership is, many practices have still not jumped on the dyadic band­wagon. Or they are incompletely on board with the concept.

We often see the results of this in client practices. In some settings — even some quite large practices — there is no managing partner, and the administrator is obliged to run a circuit from partner to partner to get things done.

In some settings, the MD and lay administrator are competitive rather than collaborative. They unduly poach responsibilities and authorities from each others’ territories.

In other settings, we do not see outright conflict, but rather a relinquishment of responsibility: the managing partner who is more figurehead than leader, or the administrator who has given up managing, saying, “What’s the point? My doctor is going to want to do it his way, anyway.”

Here are seven ideas to help you improve an existing dyadic leadership structure or establish a high-functioning dyadic leadership model where none presently exists.

1. The MD leader should be formally authorized to lead by the board. The managing partner position should have a written job description and a small honorarium (in the range of $1,500 to $5,000 per month, depending on the size of the practice). There should be a formal vote for the managing partner, and a term of 2 years is best, with no term limits; a talented individual can be voted in for successive terms. A shorter term makes the new managing partner an immediate lame duck with little authority. Do not make the mistake of having every partner take a turn at being managing partner; run this critical aspect of your company as a meritocracy. The managing partner’s performance should be formally reviewed by the board annually or more often in the event of poor performance. Managing partners should be subject to mid-term removal.

2. MD leaders need to put in the time. In the average ±$5 million private practice, it is typical for the managing partner to spend about 8 hours a week at the job. Most new managing partners fear that this will steal time from their work as an ophthalmologist and will result in a pay cut — this fear is unfounded. Empirically, we have only seen managing partners increase their income by being more engaged with the details of the practice and finding ways to compress and increase the efficiency of their clinical life.

3. Administrators need to be comfortable sharing information and power. At the outset of launching a dyadic leadership model, and perhaps voting in for the first time a managing partner, there can be a multi-month settling in period. The new managing partner can be over-grasping and start taking on some of the administrator’s authorities. The administrator can understandably, almost unconsciously, withhold information from the managing partner in an effort to retain control. Any emerging conflict within the dyad that cannot be reduced directly by the MD-administrator pair needs to be addressed by the board. In a few cases, a new administrator or a different managing partner is indicated.

4. Because the underlying relationship and trust between the administrator and managing partner are so critical, wise boards take administrator sentiments into consideration when selecting a new managing partner. Although the administrator may not have a formal vote in the boardroom, it is best to hear the administrator’s views of who on the board they think they could work with most effectively.

5. There has to be a good temperamental fit been the MD leader and the administrator. They have to like and respect each other’s expertise and role. In ideal settings, the administrator learns just as much about medicine and surgery as the managing partner learns about business.

6. There has to be a written strategic plan. Whether you are a doctor-leader or an administrator, it is hard to lead or manage effectively if the company does not have a board-approved business plan. This plan, which can be as short and informal as a few pages in less challenging or less ambitious settings, should discuss the 3- to 10-year intended future of the company and nominate the desired growth rate, service area, service mix, provider mix, relations with other market participants and succession details. The plan should be updated annually.

7. The managing partner needs to be a member of the practice’s management committee. What is a management committee? In most settings, this group, led by the administrator, includes the managing partner, the administrator and all of the department heads (technical services, billing, reception/call center/records, optical, ASC director, etc). In the strongest practices, this group meets biweekly and is chiefly responsible for collaborating to assure that operations are polished and projects are completed.

An effective dyadic partnership between doctor and administrator does not arise overnight. As our colleague, consultant Craig Piso, PhD, puts it, “Dyadic leadership is excruciatingly simple and intuitive in principle. But it is sometimes subtle and frustratingly slow to emerge when applied in your own practice, even with the best intent. You’ll know you’re getting better at it when the following signs emerge in your own practice:

“The ‘dyad’ is a partnership where an administrative leader is paired with a physician leader. An effective dyad is frequently referred to as a ‘work marriage’ — the two partners balance each others’ skills and weaknesses and work as a cohesive team toward a common goal.”

– The Advisory Board Company

A majority of ophthalmic practices today pursue in reality — if not in name — a so-called “dyadic leadership” model. This model has the following chief features, whether the practice is small or large, and whether the practice has intentionally set up a dyadic approach by design or has organically arrived at this model inadvertently:

  • A physician-owner is nominated, with a greater or lesser degree of formality, as the managing partner, president or chairman of the
    practice.
  • This physician works closely with the administrator. Each has written, board-approved roles, and each stays in their own “lanes.”
  • Both halves of the dyad work as hard on their relationship as they do on the practice, with frequent meetings and discussions that are deep enough to affirm that both parties are mostly on the same page, while respecting small differences.
  •  A successful co-managing relationship between the MD leader and lay administrator has much in common with effective parenting:
        •    Shared values and standards;
        •    Shared vision for future priorities;
        •    Speaking publicly with a single voice;
        •    Consistency and reliability and predictable follow-through;
        •    No disagreements in front of the “children”;
        •    Seen as a unified force commanding respect; and
        •    Not allowing the “children” to play “mom” against “dad.”

As effective as this approach to practice leadership is, many practices have still not jumped on the dyadic band­wagon. Or they are incompletely on board with the concept.

We often see the results of this in client practices. In some settings — even some quite large practices — there is no managing partner, and the administrator is obliged to run a circuit from partner to partner to get things done.

In some settings, the MD and lay administrator are competitive rather than collaborative. They unduly poach responsibilities and authorities from each others’ territories.

In other settings, we do not see outright conflict, but rather a relinquishment of responsibility: the managing partner who is more figurehead than leader, or the administrator who has given up managing, saying, “What’s the point? My doctor is going to want to do it his way, anyway.”

Here are seven ideas to help you improve an existing dyadic leadership structure or establish a high-functioning dyadic leadership model where none presently exists.

1. The MD leader should be formally authorized to lead by the board. The managing partner position should have a written job description and a small honorarium (in the range of $1,500 to $5,000 per month, depending on the size of the practice). There should be a formal vote for the managing partner, and a term of 2 years is best, with no term limits; a talented individual can be voted in for successive terms. A shorter term makes the new managing partner an immediate lame duck with little authority. Do not make the mistake of having every partner take a turn at being managing partner; run this critical aspect of your company as a meritocracy. The managing partner’s performance should be formally reviewed by the board annually or more often in the event of poor performance. Managing partners should be subject to mid-term removal.

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2. MD leaders need to put in the time. In the average ±$5 million private practice, it is typical for the managing partner to spend about 8 hours a week at the job. Most new managing partners fear that this will steal time from their work as an ophthalmologist and will result in a pay cut — this fear is unfounded. Empirically, we have only seen managing partners increase their income by being more engaged with the details of the practice and finding ways to compress and increase the efficiency of their clinical life.

3. Administrators need to be comfortable sharing information and power. At the outset of launching a dyadic leadership model, and perhaps voting in for the first time a managing partner, there can be a multi-month settling in period. The new managing partner can be over-grasping and start taking on some of the administrator’s authorities. The administrator can understandably, almost unconsciously, withhold information from the managing partner in an effort to retain control. Any emerging conflict within the dyad that cannot be reduced directly by the MD-administrator pair needs to be addressed by the board. In a few cases, a new administrator or a different managing partner is indicated.

4. Because the underlying relationship and trust between the administrator and managing partner are so critical, wise boards take administrator sentiments into consideration when selecting a new managing partner. Although the administrator may not have a formal vote in the boardroom, it is best to hear the administrator’s views of who on the board they think they could work with most effectively.

5. There has to be a good temperamental fit been the MD leader and the administrator. They have to like and respect each other’s expertise and role. In ideal settings, the administrator learns just as much about medicine and surgery as the managing partner learns about business.

6. There has to be a written strategic plan. Whether you are a doctor-leader or an administrator, it is hard to lead or manage effectively if the company does not have a board-approved business plan. This plan, which can be as short and informal as a few pages in less challenging or less ambitious settings, should discuss the 3- to 10-year intended future of the company and nominate the desired growth rate, service area, service mix, provider mix, relations with other market participants and succession details. The plan should be updated annually.

7. The managing partner needs to be a member of the practice’s management committee. What is a management committee? In most settings, this group, led by the administrator, includes the managing partner, the administrator and all of the department heads (technical services, billing, reception/call center/records, optical, ASC director, etc). In the strongest practices, this group meets biweekly and is chiefly responsible for collaborating to assure that operations are polished and projects are completed.

PAGE BREAK

An effective dyadic partnership between doctor and administrator does not arise overnight. As our colleague, consultant Craig Piso, PhD, puts it, “Dyadic leadership is excruciatingly simple and intuitive in principle. But it is sometimes subtle and frustratingly slow to emerge when applied in your own practice, even with the best intent. You’ll know you’re getting better at it when the following signs emerge in your own practice: