Enhancing Practice Performance

Peer to supervisor promotion

Tips for finding the right candidate for a managerial position and helping that person succeed in the new role.

The majority of U.S. ophthalmic practices are small, with a handful of providers. For practices at this scale, a typical organizational chart includes one doctor-leader, one administrator and two or three supervisors.

The number of mid-level managers or working supervisors (and what kind) your practice needs depends on several variables:

  • How departmentalized is the practice?
  • Are there ASC or optical ancillaries?
  • How many locations are present?
  • How fast is the practice growing?
  • How hands-on or delegating is the administrator?
  • Are the physician-owners involved with business management?

Your practice’s leaders — administrators, middle managers and supervisors — often begin their careers as entry-level billers, techs or receptionists. With hard work and an aptitude for managing others, they climb their way up the ladder.

But sometimes the rungs can break.

Some new managers, after hard work and effort to advance, are held back from their full leadership potential because they find it difficult to shift from being a peer to being “the boss.”

Here are the factors you need to consider when employees are promoted to managers.


In most practices, great potential leaders hide in plain sight. It’s not unusual for a client to say, “We really don’t have any of the techs who would make an acceptable department supervisor.” But, when we interview the techs individually, one or two great candidates inevitably surface. What do we look for?

At the top of the list is the candidate’s competency in the core skills of his/her current position AND that his/her peers respect the candidate for being among the most skilled in the department. This doesn’t necessarily align with tenure — some excellent supervisors who are selected are by no means the most senior in their department.

Also, be open-minded and creative when it comes to considering internal candidates. Candidates with a strong desire and ambition to succeed, as long as they have some of the skills you need, may surprise you. (For more, see “Desirable traits”)


In the best of situations, you may have two equally qualified members of a department to pick from. How do you choose? One approach is to let the two finalists decide between themselves who the next department head should be. The person who wants it the most will almost always be selected and, with proper leadership, often ends up being the most effective. (You never want to draft unwilling department members to head departments, no matter how skilled they may be at their core job.)

If you are still stuck deciding between two internal candidates, you can test the waters by giving each finalist an assignment or task to test their fitness, such as:

  • Leading a departmental brainstorming session
  • Participating in an interdepartmental task force
  • Presenting an educational segment at a staff meeting


The fear of failure and being demoted back to a non-supervisory-employee status can cloud the judgment of potential candidates and may cause them to decline the opportunity. You can offer the new position in an “acting capacity,” which makes it easier for them to retreat. All the same, make sure your final candidate is not accepting the position offered simply to make the administrator or doctors happy.


Another common struggle that can emerge when you make a rank-and-file member of a department the department lead: adjusting from being a peer to being a boss.

It generally takes at least 12 months for co-workers to shake the jealousy and go through “testing” the new manager. This common testing of the new manager’s authority is typically not undertaken by all members of the department, but only by a few people — co-workers who had become personal friends or were already nominally competitive with the new manager back when they were peers.

Occasionally, new managers find themselves having to terminate a staffer who just can’t accept the change and is too much of a pot-stirrer to keep employed.


Workplace relationships, even in the absence of the natural friendships that arise, are tricky. But working relationships are harmed when rank-and-file department members remain personally friendly when one of them is promoted. One of the hardest things for a new up-through-the-ranks manager to do is to revise old friendships, and create a bit of professional distance between worker and boss.

Desirable traits

When looking for employees to promote to managers, several traits should be visible, including the following:

  • Prioritization, organization and time management
  • A collaborative spirit (not a glory hog)
  • Proactive
  • Good at building work relationships
  • A natural, persistent problem solver
  • Expresses appreciation to others
  • Accepts blame, when appropriate
  • Strong, comfortable communicator
  • Someone you will feel comfortable taking into your confidence and discussing sensitive matters with
  • Already acts as an informal leader among peers in their department
  • Makes potentially unpopular suggestions for the good of the patients or practice
  • Contributes toward productivity — likes to keep working when others rest
  • Accomplishes more with less
  • Speaks up and advocates for the department appropriately

As hard as it is to do, every HR professional’s wisdom is applicable in situations like this: managers should avoid being friends with work subordinates.

So what does the new manager do about their old friends?

The common advice to provide is to be friendly, warm, caring, supportive and have fun together … but not friends. Workers and their bosses can go to an after-work happy hour to be social, but the boss should make it a habit to leave after the first drink and not be around when everyone else lets their hair down. Managers should avoid being in any photos that will be posted to social media, especially as a protection to themselves and the practice. Should something go awry, this will eliminate the perception that it was a company-approved function or management’s responsibility.

As difficult as it may be, managers need to “unfriend” their employees on Facebook and other social media sites and stop getting together outside of work. Boundaries between supervisors and employees need to be established and followed. If they want to be successful and professional managers, stepping back from friendships is painful but also the best policy. True friends, those who want the best for the manager, will understand the transition is necessary. OM