For many practice managers, attaining likeability alongside respect is a struggle, says Diane Brennan, MBA, CMPE, ACC, leadership coach and consultant at Brennan Associates in Tucson, AZ. And too often, managers and administrators are so concerned with being liked by their employees that they hesitate to make decisions to avoid any conflict. “You can’t do that. You need to step into the manager role confidently,” Brennan says.

For this leadership-themed issue of TDO, we spoke with Diane M. Kellogg, EdD, associate professor of management at Bentley College in Waltham, MA, and a faculty partner with the Center for Leading Organizations, a management development consulting firm in Concord, MA. Practice managers, stay tuned. This is one class you won’t want to miss. TDO: Not all practice managers go to business school. For many, the office is their classroom, and they become managers after years of mastering various positions within the office and working their way up through the ranks. What do you view as the top challenges for people who evolve into leadership roles rather than seek them outright?

When he saw firsthand the magnitude of the destruction brought down on New Orleans by Hurricane Katrina in August 2005, and when he considered the mountain-high obstacles that would have to be overcome to reopen his practice, urologist Neil Baum, MD, says he thought about retiring from the solo practice he’d started in 1978. “That definitely crossed my mind, until my wife pointed out that I had nothing to retire to, that I wasn’t ready to re-tire,” Baum says. Instead of retiring, Baum chose to be inspiring. “I came back and saw a city that really needed doctors. Here is something I can do to help. So, it was what I felt was a civic responsibility in addition to my own personal desire to get back to work again.”

New payment policy guidelines issued by CMS will have a vital effect on how critical care services should be documented and billed. To understand how critical care differs from other E/M codes, providers should study the newly revised CMS policy MM5993. CPT defines critical care as the direct delivery of services by a physician for a critically ill or injured patient. These services must encompass treatment of “vital organ failure”—such as failure of the central nervous, circulatory, renal, hepatic, metabolic, or respiratory systems—and “prevention of further life-threatening deterioration in the patient’s condition.”

For many physicians, taking the stand in a malpractice case can be a traumatizing experience. But for expert witnesses, that task can be intellectually motivating, professionally stimulating, and financially rewarding—as long as it is handled correctly. Expert witness physicians are hired by law firms to examine the facts of a medical malpractice case and give their unbiased opinion in depositions, reports, and court.

Separately managed accounts (SMA), with their benefits of tax efficiency, customization, and transparency, have attracted an increasing number of high-net-worth investors in recent years. Particularly since the tech bubble burst, more physicians seem to appreciate that prudently managing asset growth and preserving assets involves integrating cash flow management and tax planning into their investment portfolios. SMA portfolios, which allow for customization and ownership of individual securities, are tailor-made to provide such services. They allow for greater flexibility to construct truly person-alized investment strategies. For example, if an individual wants to avoid sin stocks such as cigarette manufacturers or defense companies, they can be left out of the portfolio. If the individual thinks sinning means winning, then he or she can put them back in.

“Give all you can, rather than get all you can.” That’s the short definition of servant leadership, or professional stewardship. As physicians, this mantra is a solid fit with the care you provide to patients every day—but have you thought about how you can apply the philosophy to your role as a physician leader? Consider the following definition: “Servant leaders are committed to making independent contributions to society. They view professional duties as a life mission. They work in environments that encourage individuals to learn and contribute,” Patricia L. Brewster, MHA, FACMPE, CEO of Southern Orthopaedic Specialists, LLC, in Atlanta and past chair of the American College of Medical Practice Executives, writes in her award-winning paper1 on the subject. “Altruistic? Yes,” Brewster tells PPS. “But it can be done and must be done.”

Although some private practices might think of business strategy in immediate terms, it is important to think about the long-term goals, or governance, of the organization. Not doing so could prove disastrous to a practice’s future business, experts say. One of the first things a private practice should do is understand the difference between governance and management. “What you are asking governance to do is to set a strategy that will factor in to the next 10 years, and it will also shape your organization,” says Michael Dugan, vice president of Health Directions, LLC, a Chicago-based healthcare strategy and operations consulting firm. “The management of that is the actual follow-through. I guess you can say governance is what you want the organization to be, and management is how you want the organization to get there.” Governance, in other words, is providing direction toward the goals or mission of the business, whereas management is implementing that direction.