Thoughts on doctors and management styles

[SoundofMusic]

So, the doctor that owns our practice and has been there for 30 years, and is essentially "my boss" has a hard and fast rule for all staff that all issues regarding the practice must be addressed first with the practice manager and not directly with him -- like, ever, at all.

I can understand how this makes sense for routine matters, but as an NP in the practice, I feel this is just stifling. I don't feel like I can go to him and talk, about much. Sometimes I just want guidance, reassurance, or just to shoot the breeze in general -- or get feedback on my performance. He's a great one minute manager -- offers praise if you've handled a singular issue well, and is always thanking us for picking up extra shifts, or whatever. But in almost two years I have not received a performance eval of any kind.

So, is this a normal thing or is my doc just a big wimp/jerk/avoidant type personality who doesn't want to deal with conflict or to have conversations. I just don't feel like I can knock on his door and just talk .... we have to go through the practice manager . . . who can at times also act as his attack dog as well. I also don't feel like I'm being developed much as an employee.

They're all nice enough to work with, but I find this sort of management style strange and have nothing to compare it to as this is my first time working alongside md's in practice on a daily basis. Any thoughts or comments on how it is done in your practice?

Sometimes I really feel he just doesn't care ....which is also sad/disturbing.

[djmatte, ADN, MSN, RN, NP]

My first thought is "how young are you?"

I'm not going to validate or invalidate how you "feel"about your job or your feelings of value as an employee, but I find it strange that you are inclined to label this management style as that of a "wimp/jerk/avoidant type". In the end he's your boss and not your friend. He expects you to work in your provider role autonomously (especially with two years at their practice) and not need coddling or reassurance.

But past that, raise your concerns with the practice manager as you've already articulated there is a chain of command. Feedback and regular evaluations are a good thing, but don't need to be provided by your primary employer. My director of operations does mine despite the practice being owned by two doctors and him being from a business background. They both give passing praise and go about the business of running the company.

[traumaRUs, MSN, APRN]

Is he available for clinically relevant questions? If so, then I would say he has fulfilled his goal. I am in a very large practice - we go to our lead NP for routine matters, then to the director of operations (nurse) and then if needed to the practice manager. I go to my docs for clinically relevant questions.

The docs own the practice but the practice manager was hired for her business acumen and we all in a non-clinical way answer to her.

As to evaluations - yes we get them yearly and its an official type of eval - determines our pay raise to a certain extent.

[Jules A, MSN]

I'm fortunate to work on a small team where the physicians treat the three NPs like colleagues and friends. We rarely deal with administration but if that wasn't the way it went as long as I was being paid well and able to ask a question on occasion I'd be ok with that. I have several physicians who I consider personal friends but have worked at other jobs with some who aren't interested in being anything more than co-workers or employer/employee which is fine with me.

[Oldmahubbard]

I work for a very large company. Our medical director expects the practice manager to handle absolutely everything. He is a busy man to put it mildly, mostly wheeling and dealing. Traveling. The entrepreneurial type. It's a business to him, and if he is holding my hand, he isn't making money. This is my impression. He does a good job medically, but it's a business.

If a clinical conundrum comes up, he expects me to refer to ethics committee or inpatient. Or come to a consensus with the administrator. I am in psych, so there is not always an easy answer for everything. He expects me to be able to handle it, and I can.

We have occasional evening meetings, ie pharmaceutical sponsored, where practice issues are discussed. The meetings are rarely mandatory and often they are an hour away, so attendance is never 100%. Earlier this year, an NP in our group committed suicide. The issue was briefly discussed, with encouragement to seek help and the EAP is available 24/7. I thought it was appropriate. The employee had personal problems unrelated to his employment.

More recently, I was aware of a medical NP in a LTC facility who flatly refused to work with a Psych NP, new to the practice. I have been a mentor to the new Psych NP, so I knew all the ugly details. At the next meeting, some vague announcement was made about being professional with other colleagues, but I can assure you the offender was never confronted as she should have been.

So, no, I don't find this to be unusual or avoidant. Not at all. One of the great perks of being high on the totem pole is not having to deal with "stupid" questions, or interpersonal friction.

[Jules A, MSN]

More recently, I was aware of a medical NP in a LTC facility who flatly refused to work with a Psych NP, new to the practice. I have been a mentor to the new Psych NP, so I knew all the ugly details. At the next meeting, some vague announcement was made about being professional with other colleagues, but I can assure you the offender was never confronted as she should have been.

Sorry for the hijack, OP, but I'm curious about this and it might be worthy of a new thread. I'm assuming the new psych NP was problematic? "ugly details". If so, I'm wondering why it was turned back on the NP who refused to work with them as unprofessional rather than addressing a known problem employee? I have a low tolerance for having to do more work to support a chronically weak, for whatever reason, team member although I found that more often as a floor RN than a NP.

[Oldmahubbard]

Sorry for the hijack, OP, but I'm curious about this and it might be worthy of a new thread. I'm assuming the new psych NP was problematic? "ugly details". If so, I'm wondering why it was turned back on the NP who refused to work with them as unprofessional rather than addressing a known problem employee? I have a low tolerance for having to do more work to support a chronically weak, for whatever reason, team member although I found that more often as a floor RN than a NP.

The two NPs had never met before. The Psych NP was new to the company and relatively new to the profession. This is at a LTC facility where chronically mentally ill people usually end up in my state due to closing of long term psych beds. In the 400 bed facility, there were some 380 people on psychotropics. All of it having been managed for decades by PCP's and you can imagine the mess. Wrong dx, no labs, horrible polypharm. The medical NP simply rejected her outright. I suspect she was worried about making her numbers because we are paid by productivity.The facility medical director sent an email saying " we all should get along" but wouldn't confront the NP.

[Neats, BSN]

Everything I read sounds like you want your hand held at times. Maybe it is because you have not had an evaluation in several years and this might be some of the etiology of your concerns of where you stand.

I would go to the office manager and ask them if they do annual reviews (the practice manager may have a portion-non clinical) if they do not do evaluations then I would do this for myself

1. Start 3 SMART Goals annually

2. Review those SMART goals once every 3 months via using a journal that you write in at least once weekly. If you feel comfortable share those with your friends/peers for feedback.

Being an high level Administrator for 20 years I know how hard it is to keep the communication line open and some high level employees are not that great at speaking to others. Sometimes anything you say can be felt as something else maybe this person just does not have the skills to be culturally sensitive and feels it is better to say nothing at all. There were facilities I went into where you had to make appointments to see me and I always had a witness I did clear concise communication and to follow the chain of command, the military is like that, you dare not approach an officer if you are enlisted it is fraternization.

Again the best thing you can do for yourself is to develop yourself in a way that you become invaluable in their eyes.

[SoundofMusic]

Thanks for the responses. In regard to wanting my hand held .... I'm not sure that's entirely fair. As a person who has always worked in past corporate PR and also large hospital system eonvirnments, I am used to professional annual evaluations. I'm also used to seeing leaders lead and to being advanced and developed as an employee.

I'm new to the single owner medical practice environment and I just don't know what the norms are. As a military spouse having picked up a bit on leadership styles, I find it strange how this is done and thought doctors would have more to do with the development of their employees ..... but I guess this isn't how it works. It's all different from what I'm used to, so I was actually just trying to learn.

[Oldmahubbard]

I don't think at all that you are wanting your hand held. You would like a little more contact with the boss, and it isn't going to happen. He just isn't into it. He is busy and doesn't want to be even a little bit of a pal.

My boss is the same. They don't really care, as long as we show up at work and don't do anything illegal or blatantly unethical.

Overall, I am paid very well, and I am pretty sure in my boss's mind, that is thanks enough.

I do think you have the right to request a performance evaluation, but bear in mind it is just a bull crap piece of paper.

If they ever want to get rid of you, it will mean nothing at all.

I would be curious to know what type of issues make the practice manager act an as attack dog?

If anything serious, that really should come from him.

If it is just complaints about paperwork not being done fast enough, blah blah blah, anyone can recite those mantras.

But I think your situation is nothing unusual.

Maybe be grateful? They leave you alone.

[traumaRUs, MSN, APRN]

Thanks for the responses. In regard to wanting my hand held .... I'm not sure that's entirely fair. As a person who has always worked in past corporate PR and also large hospital system eonvirnments, I am used to professional annual evaluations. I'm also used to seeing leaders lead and to being advanced and developed as an employee.

I'm new to the single owner medical practice environment and I just don't know what the norms are. As a military spouse having picked up a bit on leadership styles, I find it strange how this is done and thought doctors would have more to do with the development of their employees ..... but I guess this isn't how it works. It's all different from what I'm used to, so I was actually just trying to learn.

You get it! You are trying to learn but the docs are just not meeting your goals. I too am a vet as well as later a military spouse and I'm an experienced APRN. So, is there a team atmosphere among the other APRNs? For my practice (which is large) we are a team and do what we need to support our team. Usually one of us can come up with the answer to clinically relevant questions which helps to further develop our newer members.

Best wishes....

[FullGlass, BSN, MSN, NP]

This doctor's management style is called "laissez faire," which means he doesn't do much in the way of management. If you need clinical guidance or someone to discuss clinical issues with, then tell him that and ask for him set aside a regular time for you to discuss clinical cases with him.

Here is more info on management styles:

4 Management Styles to Strive For, And 4 to Avoid