Sigrid Schreiner's working-class parents in southern Germany didn't take stock in higher education, especially for girls. Her mother, a seamstress, and father, who restored churches, diverted her from the college track when she was in the fourth grade.
But that early discouragement didn't stop Ms. Schreiner, who came to the United States at age 19, joined the U.S. Army and put herself through college. She now oversees a four-surgeon practice, Cascade Vascular Associates, and its affiliate, Cascade Vascular Diagnostics, in Tacoma, Wash., practices that generate $2.4 million in annual revenues. On the side, she is president of Schreiner & Associates consulting firm in Federal Way, Wash.
She boasts of quadrupling her income to more than $100,000 since 1989, when she earned a master's degree in health services administration from the University of Washington in Seattle.
In October, Ms. Schreiner, 36, will assume the presidency of the 351-member Assembly of Surgical Group Practice Administrators of the Medical Group Management Association. She also represents medical groups on the Washington State Medical Association Medicare Liaison Committee.
Her parents believed people with college degrees didn't work, Ms. Schreiner said. But Ms. Schreiner's success is in large part the product of hard work, ambition and vision. By her estimate, she works 70 hours a week.
Ms. Schreiner doesn't mind the hours, or the company. "I like working with physicians," said Ms. Schreiner, who would have been one herself if it hadn't been for her marginal English skills at the time she took the medical college admission test. "They're smart. You always have to be two steps ahead of them."
Ms. Schreiner understands how physicians think, said Barbara Gottas, director of physician support services at the Franciscan Health System in Tacoma, who has had a working relationship with Ms. Schreiner for five years.
"Sometimes physicians bring ideas to the table that are not necessarily based in fact. Rather than arguing with them, she either has the facts at her fingertips or researches it and brings the facts back to the group," Ms. Gottas said.
Ms. Schreiner also has a way with staff. When Tacoma ophthalmologist Richard Bowe, M.D., called Ms. Schreiner several months ago to streamline his office in preparation for state healthcare reform, he knew changes could demoralize his staff. But it turned out just the opposite. Ms. Schreiner clarified job descriptions, established chains of command, and in the process even won over an office administrator whose job was changed to bookkeeper, he said.
"It must have been very threatening to the employees when she came in," Dr. Bowe said. "Yet in talking with them afterward they all really like her. The morale is better than it's ever been."
She also established a marketing program for a new surgical procedure and rearranged his schedule so he could see patients sooner. That helped increase profits, he said.
Ms. Schreiner abhors chauvinism, and the fact that female medical group administrators commonly earn 30% less than men, according to an MGMA survey. Her own $100,000-plus salary includes her consulting income, she said. "I'm known to be a very assertive person, and the physicians here take that very well. I think that women often don't ask for it," she said.
Don't be among those who demand to speak to a doctor when they don't like one of Ms. Schreiner's business decisions. "They're dead in the water," she said. "I'm the one who runs this practice. Period."
It hasn't always been that way. Her first position out of graduate school was a "nightmare job" running a Seattle clinic of five doctors who, she said, weren't ready to relinquish authority-even, she said, over the color of toilet paper. She said she lasted 10 months-longer than any of the previous administrators.
Ms. Schreiner wants to move to a larger organization, but she'd like to continue working with physicians. She said they are wrongly viewed as greedy. "I'm not saying physicians should get everything they ask for," she said, "but I feel you need to deal with them in an honest way. You shouldn't trick them."