How to Hire a Practice Manager and What to Look For

Before you hire someone to run your practice, get clear on what they’ll own and what you’re actually willing to let them lead.

You’re answering staffing questions between patients, handling post-clinic complaints, and making operational decisions that keep finding their way back to your desk. Hiring a practice manager starts to sound like the obvious solution.

But before you post the opening, ask yourself: are you looking for someone to keep the office moving, or someone to lead the operation?

Those responsibilities can overlap, especially in a small practice, but they aren’t interchangeable. Someone can excel at coordinating schedules and handling daily tasks without being prepared to manage performance, interpret financial reports, or lead team-wide change.

The goal isn’t to find someone who promises to take every problem off your plate. It’s to hire someone whose capabilities match the role, then give them the authority and support to succeed.

Define the job before you start looking for the person

“Run the practice” is not a clear job description.

Before you interview anyone, decide what this manager will actually own. Will they supervise administrative staff, coordinate operations across multiple locations, oversee billing performance, manage a budget, or help implement a growth plan? Who will support them with human resources, compliance, information technology, and clinical questions?

Medical practice management spans a broad range of responsibilities. MGMA’s competency framework includes operations, financial management, human resources, governance, risk and compliance, and healthcare delivery. That breadth is a useful reminder to define your particular role rather than assume every applicant has done all of it.¹

Write down the three most important outcomes you need this person to work toward during their first six months. Perhaps you need a consistent staff accountability process, better oversight of referral follow-up, and a reliable monthly operating review. Those priorities matter more than a job description filled with phrases like “self-starter” and “wears many hats.”

Then check whether the position is realistic. A manager who spends most of the day covering the front desk won’t have time for staff development and process improvement. If you need someone to lead a complex turnaround, oversee several locations, and develop business strategy, reconsider whether the experience level and compensation you’ve budgeted match the work.

Your posting should explain the reporting relationship, team and location scope, major responsibilities, required capabilities, available support, and compensation range. Give applicants enough information to understand what they’re considering.

Look beyond the title on the résumé

A previous practice manager title should start a conversation, not end your evaluation.

Ask what the candidate actually managed. How many people reported to them? Which decisions could they make independently? What financial information did they review? What support did they have from a larger organization? What did they change personally, and what did someone else handle?

A candidate who succeeded with a regional director, centralized billing team, and dedicated human resources department may still be a strong choice for an independent practice. You simply need to understand how they would work with a different support structure.

Apply the same scrutiny to specialty experience. Knowing your specialty can help, but it doesn’t show someone can lead a team. Conversely, a candidate from another outpatient setting may bring relevant leadership skills while needing time to learn your workflows.

Consider education and credentials alongside demonstrated capability. The Bureau of Labor Statistics notes that educational requirements for medical and health services managers vary, and that experience may sometimes substitute for education.² Decide which qualifications your role genuinely requires and which are preferences.

Internal candidates deserve a fair evaluation, too. Don’t overlook someone who has already demonstrated judgment and leadership. But don’t promote your most dependable employee simply because they’ve been there longest. Evaluate whether they’re ready to manage people, including former peers, and plan how you’ll support that transition.

Assess the capabilities that matter in the work

For a small or mid-sized outpatient practice, I’d build the evaluation around five areas. These aren’t a substitute for a role-specific hiring assessment; they’re a way to make the conversation more substantive.

First, look for someone who can lead people without avoiding accountability. Ask about a time they addressed a recurring performance problem. Listen for how they clarified expectations, understood the employee’s perspective, provided appropriate support, and followed through. “I get along with everyone” doesn’t tell you how they handle a difficult conversation. Neither does “I don’t tolerate excuses.”

Second, look for operational thinking. Ask them to describe a recurring problem they helped prevent, not just an emergency they handled. You want to understand whether they examine handoffs, workload, training, and unclear responsibilities before concluding that people simply need to work harder. Someone who always solves the problem personally may be dependable, but ask whether they also build processes that work when they aren’t there.

Third, assess financial fluency appropriate to the role. A practice manager doesn’t have to be your accountant, but they should be able to discuss the reports and business drivers they’re expected to oversee. Ask which measures they reviewed in a previous role, what they learned from them, and what action followed. Listen for an ability to connect operational decisions with financial consequences, not just repeat financial terminology.

Fourth, explore how they understand patient experience. Give them a recurring complaint and ask how they would investigate it. Would they focus only on apologizing, or also examine why the problem keeps happening? Look for someone who can connect the patient’s experience across scheduling, arrival, the clinical team, checkout, follow-up, and billing rather than treating every complaint as an isolated staff issue.

Finally, look for judgment and appropriate boundaries. Ask what they do when a concern exceeds their expertise or decision-making authority. A credible manager should be comfortable seeking qualified help with clinical, employment, privacy, or compliance matters. “I’d need to verify that before acting” can demonstrate better judgment than a confident answer without a sound basis.

Together, these conversations should give you evidence of how the candidate works, not just whether they know the right language.

Use the interview to gather evidence, not just establish rapport

It’s natural to prefer a candidate you enjoy talking with. But a comfortable conversation isn’t enough to support the hiring decision.

Use a structured interview with the same core, job-related questions and consistent evaluation criteria for candidates. Define what a strong answer should demonstrate before the interviews begin, and have interviewers record their assessments before discussing the applicants together. This follows the structured approach described by the U.S. Office of Personnel Management.³
Ask questions that require specific examples. “Tell me about a time you disagreed with a physician owner about an operational decision” can reveal how someone handles influence and professional disagreement. “Walk me through a process improvement you led” can reveal whether they understand the problem, their contribution, and the result.

Follow up when an answer stays general. What did the candidate personally do? Who else was involved? What resistance did they encounter? How did they know the change helped? What would they do differently?

Include a question about a decision that didn’t work out. You’re looking for ownership and reflection, not an applicant who claims to have made no mistakes.

Also examine what you mean by “culture fit.” Translate it into observable behavior. If your Culture of Care is grounded in accountability, compassion, collaboration, and empathy, ask for examples of those values in difficult situations. Don’t let “fit” become shorthand for someone who feels familiar or is unlikely to challenge you.

Give finalists a realistic, limited work sample

A conversation tells you how a candidate describes their work. A well-designed work sample lets you observe it in action.

Choose an exercise that reflects an important responsibility and assesses a skill the person needs when entering the role, not knowledge you intend to teach after hiring. OPM’s guidance makes that distinction explicit.⁴
For example, you could give finalists a brief, fictional practice scenario: completed visits are steady, collections have declined, overtime has increased, and patients are complaining about unanswered calls. Ask them what they would investigate, what additional information they need, and how they would present an initial recommendation to the physician owner.

The point isn’t to see whether they guess a hidden answer. You’re looking at how they distinguish facts from assumptions, prioritize questions, and avoid jumping to a solution before understanding the problem.

Keep the exercise brief, explain what you’re evaluating, and use fictional information rather than patient records or confidential employee material. Don’t turn the interview into a request for free consulting work on your actual practice.

Use consistent scoring, arrange appropriate accommodations, and have qualified human resources or employment counsel review your selection process. Employment assessments need to be job-related and used in a nondiscriminatory way.⁵

Check references against the work you need done

Reference checks should help you examine the candidate’s examples, not simply confirm that someone liked them.

With the candidate’s permission, speak with people who directly observed relevant work. Ask about the responsibilities the candidate held, how they handled disagreement, whether they followed through, and where they needed support. Use a consistent set of job-related questions; OPM recommends adding structure to reference checking rather than relying on informal impressions.⁶

If the candidate described a particular improvement, ask about their role in it. If your position requires substantial independence, ask what decisions they handled without extensive direction.

Don’t contact a current employer without explicit permission. And don’t interpret an employer’s limited reference policy as evidence against the candidate. Use what you can verify alongside the interview and work sample, rather than allowing one enthusiastic or vague reference to decide the outcome.

Be honest about the partnership you’re offering

The candidate isn’t the only person being evaluated. They also need to understand how you’ll work together.

Discuss decision-making authority before the offer. What can the manager approve? Which matters require consultation? How will disagreements be resolved? When multiple physician owners are involved, who provides direction when their priorities conflict?

Be candid about the challenges. If staff turnover, unresolved conflict, inconsistent expectations, or an upcoming expansion will shape the job, say so. A candidate can’t make an informed decision about a role if you withhold its most important demands.

Then consider your own readiness to delegate. A manager can’t establish consistent expectations if staff can routinely bypass them and obtain a different answer from the owner. Nor should they be expected to enforce standards that leadership repeatedly undermines.

You can’t hire someone to lead and then require them to seek permission for every meaningful decision.

Physician owners can delegate day-to-day operational management without abandoning their responsibility for direction, resources, clinical leadership, and oversight. The working relationship needs both.

Plan the support before the first day

The hiring process shouldn’t end with an offer letter and a start date.
Build an onboarding plan that gives the manager access to the people, information, and systems they need. Introduce them to key vendors and advisers, explain existing commitments, and make their responsibilities clear to staff.

A practical first-90-day plan might start with understanding the team and establishing a baseline, then move into an agreed improvement priority, and finally review progress and remaining barriers. Address urgent concerns promptly, but don’t expect a new manager to redesign the practice before they understand it.

Schedule regular owner-manager meetings. Use that time for priorities, decisions, risks, and feedback, not just a list of urgent problems.
When an experienced operations leader isn’t available internally, consider appropriate coaching, mentorship, or external operational support. Match the support to the need: leadership coaching isn’t a substitute for technical expertise or executive-level operational oversight.

Development should make the manager more capable, not indefinitely compensate for an impossible job.

Hire a leader, not a permanent workaround

The right practice manager isn’t necessarily the candidate with the longest résumé, the most confident interview, or the strongest promise that they can “handle everything.”

Look for evidence that they can lead people, understand the operation, use information thoughtfully, communicate with physicians, and follow through. Be equally clear about the environment you’re asking them to lead.

A strong hire begins with a well-defined role and a careful selection process. What happens afterward depends on whether the practice gives that person a genuine opportunity to succeed.