It was nearly 20 years ago, but Nancy Becker remembers the incident well. She was working as a medical practice manager when she received a phone call inquiring about a job opening. She knew the caller. It was a woman she had personally fired for poor performance from another practice. Becker was incredulous that this woman was inquiring about a job from the very person who had let her go three years earlier.

But the caller was insistent, saying she had “turned her life around.” Becker, now a practice management consultant in Westchester, Penn., agreed to interview her, and she says that when the woman walked through the door, “I would not have recognized her. She dressed better, looked great, and had a good attitude.”

The woman told Becker that when she dismissed her three years ago, “it was a personal wake-up call.” She changed her attitude, went back to school, and earned her GED and associate’s degree. She actually thanked Becker for being the catalyst for the positive changes she had made. Becker rehired her, and says the woman was an exemplary employee who stayed with the practice for five years, leaving only when Becker encouraged her to apply for an office manager’s opening at a nearby practice, a job that she landed and in which she enjoyed a long tenure.

Of course, not all termination stories have such happy endings. Indeed, it’s a task that no manager relishes.

An unsavory task

Bob Levoy, author of the recently published book, “222 Secrets of Hiring, Managing, and Retaining Great Employees in Healthcare Practices,” says dismissing employees is “management’s most unpleasant task.” Because of the awkward confrontation that terminating an employee entails, Levoy says that many administrators cannot bring themselves to do it, and so they “put up with” poor performers for prolonged periods of time. Doing so can affect an entire practice, says Levoy.

“Nothing makes employees as discouraged and resentful as having to work alongside people who don’t pull their own weight. Employees who are not performing up to par are expensive in terms of payroll, and even worse, are in danger of alienating or perhaps even endangering patients,” says Levoy. “If one person is permitted to behave inappropriately, eventually other people will feel that they have that ‘privilege.’”

Levoy says there is “no way to make firing someone a pleasant task. You can only minimize the pain and hostility.” Still, when dealing with a poor performer who won’t or can’t improve, dismissal is for the best. Levoy recalls a physician who finally worked up the courage to fire his longtime bookkeeper after attending one of his seminars. “He said it was without doubt the hardest, most painful thing he’d ever done,” the author recalls. “But he also said it was the best thing for his staff, his patients, and himself. It was hard for him to recognize the negative impact that [the bookkeeper] had on the practice until she left.”

Deborah Martin-Norcross, a Princeton, N.J.-based attorney who specializes in employment law, agrees that physicians tend to avoid confrontation more than most other professionals. Avoiding communication with a troublesome or underperforming employee until termination seems the only option is always a bad idea, says Martin-Norcross. You should always give such a staffer a chance to correct poor performance or inappropriate behavior, and that means you have to be clear about your expectations.

“The employee who’s been the recipient of good communication about their performance, their match in the job, or whatever the issue is,” says Martin-Norcross, “at least will believe that they haven’t been run out. And in my experience that lessens the likelihood that they will come after their employers and file a lawsuit or discrimination charges.”

Thomas Weida, medical director of the University Physician Group at Fishburn Road in Hershey, Penn., says that he doesn’t fire employees, “they fire themselves.” He says that when managers work with underperforming employees to help them identify and correct underlying problems, they should recognize that they are dealing with human beings who may have issues outside the workplace that affect their behavior. “But,” says Weida, “at some point they have to work those issues out for themselves.” 

How to get fired

Employees get fired for reasons that most commonly have to do with underperformance, an inability to adapt to a practice’s culture, excessive absenteeism or tardiness, inappropriate behavior with other staff or patients, and — perhaps the most egregious — patient confidentiality breaches.

Only that the last infraction is sometimes serious enough to get an employee fired on the spot. Most of the time employees are dismissed due to ongoing problems that are not corrected. In these cases, managers unanimously agree that continually documenting their communication with the employee is paramount.

“It’s not just a case of saying, ‘You’re out of here,’” says Rick Jamison, the national director of Practice Solutions Consulting in Saskatoon, Saskatchewan, in Canada. “Employees should not be denied the opportunity to improve and be given the tools they need to do so.” Such tools may include training or personal mentoring, which can be effective for an employee determined to improve or may serve as a wake-up call for others who know they’ve been slacking.