Q: Dear Doctor, I have been in practice on my own in a suburb of Philadelphia for almost 9 years. I have basically always been in control of managing the practice and my employees. Recently, the woman who does my billing and collections suggested that from her experience in managing other offices and in working in my practice for 3 months that she feels that she could add to the success of the practice by taking an additional role of office manager in my practice. I am ready to try this and see if I am able to give the control over to her so that I would regain my focus as doctor. My question is one of salary. I have paid her $14/hour for billing and collections. She is requesting that I offer her a certain salary on which to negotiate. I would like to know how other docs around the country are compensating their "office managers." I would like your input and advice about setting up this new position and how incentives and bonuses may also be considered to make her even more interested in participating in the growth of the practice. I appreciate your time and assistance in helping me with this challenge. A: This answer was sent by Dr. Kevin W. Ross a mentor on my webpage. His e-mail address is: KRoss777@aol.com Hi... Tough question... obviously, the person needs to be "earning their keep". She needs to generate more revenue than what you are paying her. the cost of that will depend on the area of the country and what is reasonable. New York will be different than Kansas for pay. She has only been there 3 months... does she understand chiropractic and what you do? is she also under active care with you? does she work well with the other employees that have been there longer? will it create more harmony or more strife? What is she wanting to do in the role?... manage the other office staff and make sure all you do is adjust? If so you have to trust her implicitly... she could quickly ruin a practice if she was motivated to do so... What feedback mechanism do you propose? once a day meetings? once a week? Will she help in new patient acquisition? The position is nice to have if you need it. Personally in my office we see about 65-75 people per day, almost all cash (except for PI cases) they pay our full fee and we give them a HICFA form to submit to be reimbursed directly... We only lost one patient in transitioning and they would have been gone soon anyway... Everyone else understands... I say this to tell you that we do this with myself and one office staff... That is it. It reduced overhead and made life VERY easy... If you are interested in this I would be glad to provide you the letters we sent out to introduce the change.. It was a big step but EVERYONE understands (it is common in medical offices as well) and takes you out of the middle man and you don't have to "accept what the insurance pays as payment in full" because you are paid in full. We lowered our office fee to do this and people can afford maintenance care as well... If you need an office manager then hire her with specific expectations. Give her a percent of new growth each month. When you hit production goals (to be set by you) then give a bonus. For example when we collect more than $3000 in a week I pay Lorie a $100 bonus. What do you expect and what would be reasonable for you to pay in your area? It is easier to slack off on a salary position... have vacation days CLEARLY set out and who will do her job when she is gone? Don't loose touch with the front because if she leaves then you are left hanging... keep it as simple as possible but anticipate ahead of time all the things that could go wrong and account for them ahead of time in writing. Hope this helps... Dr. Kevin W. Ross Creator of The Psoas Video DrRoss@RechargeYourLife.com