Many plastic surgery offices have a practice manager who provides administrative and business leadership for the practice. When a performance issue surfaces with your practice manager, it is usually difficult for some physicians to address the issue effectively.

A common problem is giving performance feedback to a manager who is valued in many ways but is causing trouble is other areas. Typically, the practice manager is valued for his or her technical or operational skill. Sometimes, this person might have been brought into the practice to introduce new processes, making it doubly challenging to address a problem or concern.


Schedule a meeting of up to 2 hours with the practice manager, roughly 1 week in advance. It may be challenging to find the time for this meeting, so you may need to commit to meeting after office hours.

When you first speak to the practice manager to arrange this meeting, do not go into great detail. Instead, say you want to discuss his or her performance and career goals. You want the practice manager to start thinking beyond immediate practice issues to larger career issues.

In your own preparation, give some quality thought to this initial meeting.

The first step is for you to be clear on your vision of how you want the practice to operate. You need to be ready to clearly articulate that vision.

Giving feedback and counseling to a distressed employee is never an easy process and should not be done on the fly, so write down the major points you want your practice manager to consider.

For example, what does the manager do that looks like good leadership? How does his or her behavior develop a shared direction, challenge processes in a productive manner, motivate others, and create a culture that supports the practice’s business purpose? Describe specific behaviors.

Conversely, ask yourself which of his or her behaviors does not translate into good leadership? That is, what behaviors create confusion, miscommunication, needless frustration, or mistrust? Elaborate on these problem areas.

You may want to seek out professional support from a practice-management consultant and have that consultant with you at the initial meeting.


Review the purpose of the meeting and clarify any misconceptions. Ask the practice manager what she would like to get out of the meeting. Express your desire to help the manager succeed in your practice. Share your vision of how you want to see the practice operating in the future.

Next, ask the manager about his or her long-term career goals. Link his or her performance with career goals. Provide specific feedback about the observable behaviors you listed during your preparation. Begin with those behaviors that demonstrate good leadership, and tie those behaviors to both your vision for the practice and her career goals.

Review your perception of the behaviors that do not espouse quality leadership. Clearly state how those behaviors do not support your vision of how you want the practice to operate.

State the ways in which your support of the practice manager will be crucial in her reaching personal career goals at the practice. Offer recommendations, or suggest projects in which your support is important to the practice manager.

Ask the manager to respond to your comments, and check to ensure that she understands what behaviors support her career goals and what behaviors do not.

Discuss the changes you deem necessary to occur to have your support. Ensure that she understands what she must change to gain your support in reaching her goals.

The practice manager can “be right” by discounting your feedback and continuing on her present course. She can also choose to “be successful” and change over to a new set of leadership actions. There is no “in between” option.

See also “Taking the Guesswork Out of Hiring a Practice Manager” by Cheryl Whitman in the September 2008 issue of PSP.

When your manager has a clear understanding, ask that she meet with you (and/or your consultant) again in a week or so. Discuss plans for addressing your concerns or for addressing her questions.


At that next meeting, review the practice manager’s plan and negotiate as needed. You must follow through on your genuine offer to support the manager, via format coaching and consultations with a practice-management firm.

Using this plan, you can measure her response to your concerns and gauge how well she improves within the time frame you established with her.

Gary R. Casselman, PhD, and Timothy C. Daughtry, PhD, are with CCG Inc, a leadership and organization firm. They can be reached at .