“You have to wear so many hats,” says Jimmy Norman, practice administrator at University Orthopeadic Clinic (UOC) in Tuscaloosa. He has run five practices in his 22-year career. “No job is too small that you may find yourself a part of as a practice administrator.”

Norman has cleaned toilets and kept out-of-line patients at bay while security was called. “I never thought I’d be a bodyguard,” he says.

“I never thought I’d be cleaning the gutters,” says Jim Carson, practice administrator at Southside Pain Specialists in Birmingham. A leaky roof called for temporary patching while roofers were enroute. “I never thought I’d be setting an IT network either.”

Practice managers run the business side of medical practices. From equipment purchase, IT, pension plans, billing, inventory and staffing to building upkeep, marketing and planning for the growth of the practice, they are the go-to person. Any situation that arises that impacts the flow of work at a practice, then it’s the administrator who gets the call and takes the action.

Now, with the healthcare landscape constantly shifting, administrators are burning out. Carson has known four people who moved on to other careers, mostly in healthcare. Norman knows of a dozen or so who have opted out. “The interesting part,” he says, “is several of those ended up coming back to practice management because there were problems and issues in those other lines of work too. The grass wasn’t always greener.”

Last year, Karen Roden called it quits after 19 years as a practice administrator. “When meaningful use came around two years ago, I already had a full-time job,” she says. But the small general surgery practice meant limited resources on which to off-load the numerous demands of proving meaningful use to earn EMR incentives. “I felt like I was caught in a vise with reimbursements declining and not able to control expenses. In my opinion, I could never win.”

The constantly increasing demands on practice managers call for an entrepreneurial spirit, says Norman. “You have to be an agent of change; you have to embrace that,” he says. Job satisfaction has to derive from things like tweaking billing to gain revenue or reducing transcription costs through EMR usage to offset decreasing reimbursements. “That’s the kind of thing that keeps me invigorated and passionate about my career,” Norman says. “You need to feel as if this practice is yours and nothing is too beneath you to be handled.”

Roden says her burn out came from feeling ownership all the time. “I couldn’t turn it off. Unless you can turn off that feeling of responsibility, then the job is probably not a good fit.” She is relishing her new career as a credentialist at a healthcare system that employs 200 physicians. But she says if there was a practice administrator job within the healthcare system, she would be interested. “The difference is there is support in place for things like [human resources] and IT.”

The administrators say human resources top their list of stress points. “Our hardest role is hiring good talent and keeping it,” says Carson, who oversees 23 employees and four physicians. Norman says most healthcare applicants don’t realize how fast paced the environment is at a practice. “It’s customer service but at break-neck speed. It’s like drinking out of a fire hose.”

Tied with HR as the greatest stress point sits government regulations. “Every time we turn around, there are new hurdles that lead to high jumps and then pole vaults,” Norman says. “These days, you can get penalized for doing the same job you’ve been doing for the same physicians your whole career.”

Ten years ago, practices did procedures, billed, and got paid. “Now there’s so much more to it. You have to cross your T’s and dot your I’s before you even see the patient,” Carson says.

To relieve stress within the practice, building relationships goes a long way. Last spring, Norman volunteered for the dunking booth at the employee appreciation event. “The doctors brought their chairs over to the booth to watch and laugh. It was fun, until I realized everyone had lined up to take a shot,” he says.

Carson takes his staff bowling and plays golf with his physicians. “It takes your relationship to a different stage because you know each other on a personal level. It lets you find common ground,” Carson says. Those connections make one-on-one talks easier when things are not so rosy, such as when a physician’s production has declined.

Finding support from other practice administrators is the most powerful destresser. “Get advice, because you’re not in the boat alone,” Norman says. “Reaching out to a group is one of the best things you can do.”

The Birmingham MGMA and the Alabama MGMA meet regularly. “Surround yourself with colleagues in the same game,” Norman says, but don’t just sit and listen to the program. “The best conversation isn’t happening in the conference room, it’s outside the door.”

Carson says his renewal comes from getting letters saying what a difference the practice made to someone and then passing that along to the physicians and staff. “And it’s a lot of fun to see the practice grow and generate more revenue. Then I get to tell everyone that those numbers mean we’re doing this the right way, we’re growing, and you’re all going to benefit from that.”