Outpatient clinics are called ambulatory care practices because they are designed for people to come in and walk out the same day. They may be owned by a private organization, a physicians group, an insurance company or a larger health care system. While the ownership may vary, the internal organizational structure of outpatient clinics is generally the same, typically resembling a small business.


While patients may actually see a nurse practitioner or physician’s assistant when they visit an outpatient clinic, the ultimate supervision comes from a physician who serves as the clinic’s medical director. The doctor oversees the treatment and diagnoses of patients and signs off on decisions made by the PA or nurse practitioner. The medical director may report to a board of directors, an insurance company team of executives or a governmental executive director, but plays the most integral role within the actual clinic.


Day-to-day management of outpatient clinics varies, but typically, there are three primary positions who report to the medical director: the office manager, the PAs and nurse practitioners, and the accountant. The office manager usually oversees the nursing and administrative staffs, which also may include ancillary service providers such as lab and X-ray technicians. In a small physician-owned clinic, the accountant may be an outside contractor who comes in weekly or monthly to do the books. In a county-run clinic or one that operates under a larger health care umbrella, the accountant is a staff member of the governing body. PAs and nurse practitioners report directly to the medical director.


A head of nursing reports to the office manager and also oversees the medical staff that includes other nurses, certified nursing assistants and medical technicians, lab and x-ray technicians, and orderlies. If the clinic provides outside services to a jail or prison, treatment center or nursing facility, that staff also reports to the head nurse. The head nurse usually sees patients, but may spend more time in a supervisory role in a larger clinic setting, setting schedules and providing assistance where needed.


Administrative duties include those performed in the patient reception area. Medical coders and the billing department also fall under the administrative supervisor who may also be the office manager in a small clinic. Housekeeping and maintenance workers also fall under the supervision of the administrative supervisor, who reports directly to the office manager in a large facility. Human resources professionals who handle staff benefits and keep up with certifications and staff license renewals may report to the administrative supervisor or directly to the office manager. In a small clinic, the office manager oversees personnel issues.