When an office manager quits, spend the first two days on access to payroll, banking, the practice software, insurance portals and vendor accounts. After that, list every task they handled, give each one to a named person for the next month, and hire for the role the practice needs now rather than a copy of the old one.
The news usually arrives midweek, and by Friday you've found out how much of the business lived in one person's head. It happens in good practices with good managers, and a month is enough time to come out of it better organized than before.
What needs to happen in the first 48 hours?
Access comes first, because it's the one thing that can stop money moving or lock you out of your own systems. The team announcement and the job posting can wait a day.
If your manager is working out their notice, go through the list together. If not, your most senior front-desk person can usually fill in most of it. Your employment attorney should guide the separation itself, including final pay, since the rules vary by state.
Access checklist
- Payroll provider, with you as an admin and a clear plan for the next payroll
- Online banking, merchant accounts and the deposit routine
- An owner-level admin login to the practice management software
- Clearinghouse and insurance carrier portals
- Supply, lab and vendor accounts, noting any auto-ship or auto-pay
- Phone system, voicemail, website, domain and practice email
- Alarm codes, keys, the safe and petty cash
- HR files, licenses and credentialing paperwork
- This month's due dates for payroll, lease and loan payments, insurance renewals and anything your CPA tracks
Once you hold admin access yourself, change the shared passwords and close their logins on the last day. Handled as routine, it doesn't need to feel personal to anyone.
Who covers the work while the practice hires?
Trying to absorb it all yourself between patients rarely lasts more than a week. A better approach is to split the work up and put a name on every line. Their calendar and sent email will show what they did daily, weekly and monthly, and you'll likely find a few jobs nobody knew they were doing.
| Task | Covered by | How often | Back-up |
|---|---|---|---|
| Morning huddle and schedule review | Lead assistant | Daily | Owner |
| Confirmations and filling openings | Front desk | Daily | Hygiene coordinator |
| Collecting at checkout and posting payments | Front desk | Daily | Owner reviews the day sheet |
| Deposits and reconciling the day | Owner or trusted senior staff | Daily | CPA or bookkeeper checks monthly |
| Insurance verification | Front desk | Daily | Billing vendor, if you use one |
| Claims and insurance follow-up | Billing team or vendor | Weekly | Owner gets a short status |
| Payroll hours and time-off approval | Owner | Each pay period | Payroll provider support |
| Supply and lab orders | Lead assistant | Weekly | Front desk |
| Vendor calls, bills and renewals | Owner | Weekly | Hold anything that can wait |
Hand the table out at a short team meeting. Extra work goes down much easier when people know exactly what's theirs and roughly when it ends.
What does the 30-day plan look like?
Week 1. Steady the practice. Finish the access list and tell the team what's happening and who's covering what. Patients shouldn't notice any change, so protect the schedule.
Week 2. Write the job description. Build it from the coverage table, around the real day. It's a good moment to ask whether the old role still fits. Some practices find they need a manager who also presents treatment; others do better with a strong front-desk lead and outside help on the business side.
Week 3. Hire. Post the role with a short scorecard of must-haves and nice-to-haves. After a phone screen, a working interview with a real task, such as walking through your aging report or untangling a messy schedule day, tells you far more than a conversation. Check references properly.
Week 4. Hand off and document. If your manager is still there, ask them to record the routines only they knew, like month-end steps, payroll prep and vendor contacts. Those notes become your first SOPs, and they shape the new hire's first 90 days with a named trainer.
A 20-minute check-in on the same day each week keeps the month on track.
- Payroll, deposits and bills went out on time
- Nothing on the coverage table is slipping
- Hiring moved forward this week
- One more routine got written down
Is it better to hire a replacement or outsource office management?
That depends on the size of the practice and how much of the business side you want to carry personally.
A full-time office manager makes sense when there's enough daily work to fill the role and you have time to supervise and develop that person. A strong hire is worth a few extra weeks of searching, because a rushed one often means repeating this process within the year.
Outsourced, or fractional, practice management suits a practice that's too busy for the owner to run alone but doesn't need a full-time administrator. It also helps when you'd like the systems built before the next hire starts. In that setup a fractional manager handles the business routines and the numbers, and a front-desk lead runs the day.
Plenty of practices use both in sequence. Outside help keeps the business side steady during the gap, helps hire and train the new manager, and then steps back.
How can the next departure go more smoothly?
Keep an access list showing every system, its admin and its back-up, and look it over each quarter. You'll want to hold owner-level admin on payroll, banking and the practice software at all times, whoever manages the office.
Monthly and quarterly tasks are the ones that vanish when someone leaves, so they're worth writing up first. Cross-training helps too, as long as the second person has actually done the task and not just watched it. Regular one-on-ones with your office manager matter as well, because burnout tends to show up there long before a resignation letter does.
Good office managers generally welcome all of this. Being the only person who knows the passwords is a lot to carry.
If your office manager has just left, or you sense it coming, we'd be glad to help you keep things steady and find the right person. Our Partner retainer is designed for practices going through turnover, and we also run office manager hires as a fixed-fee project. A complimentary 30-minute First Look is an easy place to start. Molar + Margin is based in South Florida and works with practices remotely across the U.S., and you can reach us at jana@molarandmargin.com or 561-685-4859.