One of the biggest time management challenges physical therapy practice owners face is the ongoing need to continue functioning as a clinician. In a service industry like physical therapy, the manager is simply too valuable as a producer to allow them to disengage from the production side of the business. This creates a particularly difficult challenge as we try to work ‘on’ our business, while still needing to work ‘in’ our business.

A timeless HBR article titled Management Time: Who’s Got the Monkey? first published in 1974 is perhaps one of the best articles ever written on the subject. One key to keep day to day demands from taking over our ‘management time’ is making sure ‘the monkey stays where it belongs’. Holding your subordinates accountable for solving their own problems is a key skill in the delegation leadership style.

The powerful imagery in this article I have found to be extremely helpful, particularly when trying to make time to manage and lead while still living in the whirlwind of day to day clinical practice. Picture each patient on a schedule as a monkey (no offense intended). If you are the clinic director or owner, with several staff therapists working for you… where should most of the monkeys be? Keeping the right balance of workload between directors and staff therapists is both important and challenging. This is made more difficult when the director also happens to be:

1)a more experienced clinician

2)perceived by patients to be the ‘expert’

3)because of these things maintains higher visits/new patient or ‘durations’

In other words the tendency will be for the owner or director to have an easier time maintaining a full case load than a less experienced staff therapist.

In other professional fields, such as within a law firm, this tendency of the ‘senior partner’ to be more sought after is usually balanced by increasing rates. While I have seen this work in some cash practices, it isn’t likely to be useful in a typical private practice where rates are set primarily by contractual discounts to insurance providers.

Perhaps the most useful piece of advice in this area comes from the delegation rule of thumb often attributed to John Maxwell: ‘if somebody else can do the task 80% as well as you can - you should be letting them do it’.

Over time this practice is the key to leveraging your time and energy to maximize your impact. Don’t fall prey to the easy route of taking on the larger caseload… instead spend that time developing your staff therapists. Work to eliminate the real or imagined disparity between the director and and the staff therapists, with the end goal that patients prefer to see them over you.