In small practices, there’s one person doing everything on the administrative side. The office manager. They answer the phones, they schedule, they bill, they order supplies, they talk to the insurance companies, they run the front desk, and somehow, everything remains.
It’s a fantastic system until it’s not. Then the practice expands. More patients. More employees. More moving parts – and suddenly, that one person who handles it all is overworked with no one else to step in and share the burden.
And that’s where the practice faces a problem that no one warned them about: their office manager is now a choke point.
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The Role Where Good Intentions Lead to Overwork
When a practice is small, the office manager position is demanding but manageable. One person can reasonably be in charge of scheduling for one or two providers, manage the administrative needs of a decently sized patient base, and maintain relationships with a smaller employee roster.
But once offices add more providers to the mix, have larger patient caps or expanded need offerings – office manager responsibilities increase tenfold without anyone realizing. They don’t only do what they did before; they do it at a higher volume. They add in getting used to new employees, new policies, nuanced systems that didn’t exist before when things were simple.
The worst part is that no one ever sits down and assumes that one person can effectively handle everything – and then some – to accommodate growth. But everyone assumes that the office manager will keep on operating like there was never a change at all.
The Bridge Between Busy and Overwhelmed
There’s a point where busy becomes overwhelmed – and it’s a sad reality when practices don’t recognize the warning signs until things start falling apart.
The office manager starts working extended hours. They’re slow to respond to employee inquiries. Things that used to be turned around quickly take days. Minor issues that would have been resolved get blown up because there simply isn’t enough bandwidth.
Employees start taking their admin questions straight to the physician – the entire purpose of having an office manager cut out – and patients are frustrated with longer call back times. Increased errors happen on billing – things that haven’t been checked twice – and now, the office manager appears overwhelmed, irritable, and beyond stressed instead of their usual welcome, calm presence.
This doesn’t mean a bad office manager. It means an office manager who’s been given an impossible job. This is when practices start looking for solutions – like bringing on a Virtual Medical Assistant Company – to assist their office manager by absorbing daily, time-consuming responsibilities (phone coverage, digital scheduling assistance, insurance verification) – relieving some of the pressure without having to have multiple new full-time hires.
The Worst Decision A Practice Owner Has to Make
And this is when the uncomfortable decision has to happen. The office manager who was treasured as part of the success story in the beginning can no longer thrive as the only person doing everything any longer.
Either hire an assistant office manager or an influx of administrative support to take some responsibilities off their plate – where it’d be more money on payroll for something unjust; or accept that not everything is going to be as good as before; accept that things might slide a little bit; no harm/no foul; or guilt the office manager into working harder and being disappointed that things aren’t good enough and turning their frown upside down – which only destroys relationships and ends up with the office manager resigning anyway.
None of this feels like an ideal solution – and that’s why a lot of practices avoid making any decision at all.
Where Inefficiency is Unacceptable
What needs to happen is that a growing practice needs additional administrative support – and that’s it. The question is not if there should be more assistance – it’s how to give additional support when it makes sense financially and operationally.
When practices promote their office manager to help lessen trivial day-to-day operations or hire an additional person to come on board for good – with someone else handling training on pivoted needs who can handle common inquiries without asking for assistance all day either from an overworked administrator but knows better than to ask the physician who’s busy – then small talk goes a long way.
Alternatively, practices split their needs and specialize them for someone for billing specifically (especially if it’s someone who has internal experience from another practice) or scheduling or pure administrative gain.
At this point in time, it’s not about who’s to blame for being a bad fit – it’s about where the structure’s been failing all along. No small practice with good intentions with high-quality office managers is going to suddenly have someone who’s so competent at handling 20 patients a day and now suddenly incapable of managing 50 – or 30 – at 50% capacity just because they’ve reached administrative popularity.
The Cost of Waiting Too Long
Practices who wait too long pay for it in many ways.
When the office manager burns out and quits, so does years of institutional knowledge that’s buried in their exodus instead of paying for months at a time for someone who’s inexperienced to come up to speed while chaos reigns throughout the rest of the practice. Or even worse – they can’t find anyone willing to tolerate such impossible standards so now the position lies vacant for extended periods where those once-growing positives become dreaded negatives instead.
Issues compounded operationally behind the scenes; billing fell behind; patient satisfaction dropped; employee morale suffered as if there was no one truly managing their inquiries; physician work sunk as they did more administrative work instead of focusing solely on patient care.
The money saved by not adding additional administrative support got reinvested into inefficient processes instead – but no one wants that false economy at best.
The Final Signals You’ve Waited Too Long
And for practices who live with blinders on – sometimes they don’t realize there’s an issue with their office manager until it’s far too late – and this means:
When they’re working 50-60 hours per week but still nothing’s getting done (and getting added onto) and someone’s deflective upon other administrative concerns because they’re doing their best but it’s still not good enough – staff become frustrated because they can’t get answers, themselves, let alone support every time they ask a question or need help; and finally, the physician gets pulled into administrative fires at least 3-5 times throughout each day.
At this point – not adding at least one more person who may side split things but instead – requires practice-wide restructuring as to how different administrative functions are sorted and split isn’t like biting the bullet if only it was challenged beforehand.
How to Avoid The Problem
If practices had their way – there’s no need for this to become critical; when a practice grows – it’s best to build in support growth before the breaking point occurs.
This doesn’t mean everyone has to staff up full-time for every function – as cash flow won’t make sense – but it does make sense in having functional discussions about what happens when there’s an increased volume.
Maybe it’s part-time task help; maybe it’s technology functions that cover certain automated tasks; maybe it’s remote outsources where people don’t physically need to be in any building.
But assuming that good people will work harder just because they’re good people isn’t viable – it builds resentment – and that’s no solution either.
What Works
What works? Practices who do it differently:
- When they monitor what’s going on to avoid job stress levels – not merely if things are getting accomplished – but if it seems like a person is drowning as cautionary signs
- When they’re willing to invest in administrative needs before urgency becomes critical
- When there are good signs about growing before anything optional gets taken into account – they treat those thoughts as necessities.
They recognize that their office manager who knows how things work from day one is invaluable – not something that can keep going longer without benefiting anyone in higher cash flow – it’s just good business sense.
The Office Manager Problem is Predictable
It’s predictable – but every growing practice will eventually find itself facing it. The ones that thrive are those who see it coming down the pipeline and combat it before their essential middle person cracks under undoable pressure.