If your grandfather or great-grandfather was a physician, you probably have lots of family stories about him making house calls in his automobile or on horseback, and occasionally receiving a bushel of corn or a cured ham as payment from a family who was short on cash. But that was a simpler time, before HMOs and PPOs and MRIs and JCAHO and HIPAA and countless other acronyms that have so complicated the medical landscape they've made the day-to-day management of physician practices a career specialty of its own. The national Medical Group Management Association (MGMA) has some 20,000 members across the United States in fields ranging from anesthesiology to urology, as well as its own accrediting organization, the American College of Medical Practice Executives (ACMPE). The job description of a physician practice manager is not an easy one to pin down. "When my kids ask me what I do at work all day, I don't even know where to begin," Bill Cockrell, FAMCPE, said with a laugh. He's administrator of Cardiovascular Associates, a 28-doctor practice with headquarters in Birmingham and clinics around the state. "Basically, a practice manager is responsible for everything from billing to human resources, and from purchasing to regulatory compliance. In other words, just about any nonclinical aspect of the practice." In general, practice groups of fewer than 25 don't have quite as many regulatory hurdles to navigate as his organization does, Cockrell explained. "Plus, overall, there are just more elements involved. More employees, more doctors, more square footage, and so on." Besides the normal administrative functions, practice managers also play a psychological and motivational role in their organizations, according to Mike Ingram, outgoing president of the Birmingham MGMA chapter and administrator of the Mitral Valve Prolapse Center of Alabama. "As employee leaders, we have to help set the standard for employee performance and how we treat coworkers and the public," Ingram said. "But of course, that's on top of such obvious tasks as paying the bills, invoicing, managing payroll, and interacting with insurance companies. And some days I'm also emergency plumber and electrician, janitor, social worker, and what-have-you. "The main difference I see in working with a smaller practice such as ours (four physicians) is that I have a somewhat closer relationship with the details of employee benefits, and so on." Debi Waldrup, practice manager for the seven physicians of Pulmonary Associates of the Southeast, PC, agreed: "I wear so many hats it's hard to know where to start," said Waldrup. "But my main job is leading the staff, and making sure things run smoothly. As medicine has gotten more specialized, with certifications in so many more fields such as coding medical records, it's gotten harder to find trained staff. So a large part of what I do is finding and hiring good people." Waldrup also serves as secretary and treasurer of the Alabama MGMA. Helen Combs, practice manager of the Alabama Allergy & Asthma Center, moved to Birmingham from New York. She said her colleagues in different regions face pretty much the same challenges, with the exception of occasional variations from state to state in such areas as labor laws and payer mixes. "Our biggest overall problem right now is that reimbursement is stagnant and expenses keep increasing," Combs said. "As a result, there's a huge initiative to become even more focused on customer service. We're trying to be friendly and personal while automating some of our office functions, so it's a very tough balancing act to pull off. But we're all having to do more with less, in order to compete." Combs gives especially high marks to the Medical Group Management Association for supporting practice managers with resources and ideas for doing their jobs better. Likewise, Mike Ingram credits MGMA with helping smooth out the transition to one of his industry's biggest challenges of recent years, the introduction of the Health Insurance Portability and Accountability Act (HIPAA) and its myriad regulations and requirements. "When HIPAA was first announced, it was a really scary word for everybody," Ingram recalled. "But fortunately we learned enough about it in advance that we could prepare well. And with MGMA providing insight, training, and helpful hints along the way, I'd say it's gone a lot more smoothly than most of us would ever have imagined. "Of course, it's not finalized yet, and every year there's one more twist. But in general, I look back on it the same way I do the Y2K scare. You think, 'Gosh, was all that worrying really necessary?' And that's a good position to be in." November 2006