Is your office manager a tyrant?

"The staff was scared of her, but whenever they complained to the lead doctor, he sided with the manager," says Sharon Rentze, a former practice management consultant who now oversees several occupational medicine clinics in and around St. Louis. "She had been there for 25 years and had an excellent handle on paperwork and the accounts receivable. However, turnover was constant. The practice was losing half its employees each year."

There is a high price to pay for tolerating tyrants who scare off staffers. It costs a practice thousands of dollars to recruit and train new employees, and that is not counting decreased productivity. And when employees are terrorized by a voice down the hall, patient care can suffer, too. After all, hostility and rudeness have a way of filtering down to the exam room.

In this pecking order, many rank-and-file workers make ideal targets for sharp beaks, says Namie. "They tend to be more empathic, more sensitive. And they usually don't challenge the status quo." Instead, they might react by limiting their encounters with the manager-coming in late and leaving early, using all of their sick days, or skipping office social functions-none of which is good for morale, or your bottom line.

Clearly, it behooves physicians to understand what conditions breed tyrannical managers, and how to cultivate civil, yet effective ones instead. We interviewed experts like Rentze and Namie to help you take the bully by the horns.

Signs of a problem

Remember the manager who roared from her office? Public reprimands of employees also signal despotism, says Diane Cate, a practice management consultant in Santa Rosa, CA. "You need to do that behind closed doors. Otherwise, it is humiliating." You should also pay attention whenever you hear the manager use insulting words like "stupid," "dumb," or "idiotic" in conversations with subordinates.

It would be unfair to chalk up all heavy-handed management to a mean streak, however. Experts say that most managers given to authoritarianism are well-meaning, but unprepared for the job by dint of disposition and training. Frequently they are longtime billing personnel, good with numbers, and especially good with money, and therefore prized by physicians, says management consultant Judy Bee in La Jolla, CA. However, they are often not as good at people skills-listening to others, resolving conflicts, promoting teamwork, doling out praise, tactfully delivering criticism. "Promoting from the front desk creates the opposite problem-weak financial skills, strong people skills," says Bee.