Who does the nurse manager report to?

Two people, honestly. Solid line to the practice administrator for employment, scheduling and pay; dotted line to the medical director for clinical supervision. Draw both. A chart with only one line hides a relationship that regulators and malpractice insurers will ask about.

Where does the compliance officer go?

Under the practice administrator for day-to-day work, with a dotted line to the owner, managing partner or board. The officer needs a route around the administrator, because some of what compliance flags is the administrator's.

How do you show physician owners on the chart?

As providers, under the medical director, like everyone who sees patients. Ownership isn't a reporting line. If it matters to the reader, note 'Partner' in the title.

Does a hospital org chart look the same?

Same two lines, more layers. A hospital adds a CEO at the top, a chief medical officer above the medical directors, a chief nursing officer above the nurse managers, and a COO for operations; departments (radiology, lab, pharmacy) each get a director. Start from this chart and add the layer you need.

Medical practice org chart example

A physician-owned group practice with two lines under one roof: the clinical line, where providers answer to a medical director, and the business line, where everything from the front desk to billing answers to a practice administrator. Where the two meet — nursing — is a dotted line.

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Fennelbrook Medical Group · 20 people · an invented company, drawn by the layout engine. Clinical staff under the medical director, operations under the practice administrator. The nurse manager is employed by operations but clinically answers to the medical director; compliance keeps a dotted line to the managing partner.

How a medical practice is usually structured

Almost every medical practice, from a three-provider clinic to a hospital, has the same two lines. Clinical: physicians, nurse practitioners and physician assistants, who report to a medical director for credentialing, quality and clinical decisions. Business: front office, billing, IT, compliance and HR, which report to a practice administrator (in a hospital, a COO). At the top, in a physician-owned group, sits a managing partner; in a corporate-owned practice, a regional director.

Nursing is where the lines cross. Nurses and medical assistants are employed and scheduled by the practice — solid line to the administrator through a nurse manager — but their clinical work is supervised by providers. That is a dotted line to the medical director, and it's not optional: clinical supervision is a legal relationship, and the chart should show who holds it.

Compliance and privacy report to the administrator day to day, with a dotted line to the top, because the officer sometimes has to say no to the administrator. Billing is its own department the moment the practice has more than one biller, because revenue cycle is a specialism and the person who codes shouldn't also be the person who books.

What's particular here

Clinical supervision is a separate line
Who a medical assistant is employed by and who supervises them clinically are different questions with different answers. Draw employment as the solid line and supervision as the dotted one.
Owners are also employees
Partners see patients and hold shares. On the chart they appear where they work — as providers under the medical director — and the partnership itself sits above the chart, like a board.
The front desk is the widest team
One front office manager can run six to ten patient services reps across check-in, check-out and phones. Stack them; a row of receptionists says nothing a list doesn’t.
Hospitals add a layer, not a shape
A hospital's chart is this one with a CEO, a CMO over the medical directors, a CNO over the nurse managers and a COO over everything else. Same two lines, bigger boxes.

Typical titles by level

The vocabulary these charts use, from the top down. Titles vary by country and by company; the levels don't.

Level	Titles you'll see
Leadership	Managing Partner or Practice Owner, Medical Director, Practice Administrator (CEO or COO in larger groups), Chief Nursing Officer (hospitals)
Providers	Physician, Nurse Practitioner, Physician Assistant, Locum (as a contractor)
Managers	Nurse Manager, Front Office Manager, Billing (Revenue Cycle) Manager, Clinical Supervisor, Lab Supervisor, Compliance & Privacy Officer, Practice Manager (per site)
Staff	Registered Nurse, Licensed Practical Nurse, Medical Assistant, Patient Services Representative, Scheduler, Referral Coordinator, Billing Specialist, Medical Coder, Lab Technician, EHR & IT Coordinator

Where these charts go wrong

The practice chart goes wrong when the nurse manager is drawn with one line (whichever is chosen, someone is now technically unsupervised), when partners are left off because 'they're owners', when compliance reports to billing, and when the practice administrator has fourteen direct reports because nobody wanted to promote a front office manager.

Questions people ask

Who does the nurse manager report to?: Two people, honestly. Solid line to the practice administrator for employment, scheduling and pay; dotted line to the medical director for clinical supervision. Draw both. A chart with only one line hides a relationship that regulators and malpractice insurers will ask about.
Where does the compliance officer go?: Under the practice administrator for day-to-day work, with a dotted line to the owner, managing partner or board. The officer needs a route around the administrator, because some of what compliance flags is the administrator's.
How do you show physician owners on the chart?: As providers, under the medical director, like everyone who sees patients. Ownership isn't a reporting line. If it matters to the reader, note 'Partner' in the title.
Does a hospital org chart look the same?: Same two lines, more layers. A hospital adds a CEO at the top, a chief medical officer above the medical directors, a chief nursing officer above the nurse managers, and a COO for operations; departments (radiology, lab, pharmacy) each get a director. Start from this chart and add the layer you need.

Other industries

Or start from a structure — functional, divisional, matrix or flat — or from your own spreadsheet.

Make it yours

Download the spreadsheet, replace the names, import it — the chart redraws itself. Or start empty and drag people until it's true. Building is free at any size.

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