About This Series
Have you been pondering striking out on your own, making the leap from employed associate to practice owner? Or are you just starting out in practice, and wondering if it’s worth going even deeper into debt to start your own venture rather than getting “a job”?

Whatever your situation, Physicians Practice is here to help with our comprehensive six-part guide to starting a medical practice. In addition to the pre-opening day planning advice you may have seen in other such guides, we’ll delve deeper into the key milestones you’ll need to meet for success long after you cut the ribbon.

You may have heard that hiring staff is one of the later tasks to be completed in the run up to opening your doors. But ideally, that process should begin much further in advance — think months rather than weeks — and be inextricably linked to the raison d’être of your business.

“Starting a practice is a great chance to build your team from the start,” notes Northbrook, Ill.-based management consultant Donna Weinstock. “If you can convey an attitude of what you’re looking for, what your mission statement would be, and have the staff participate in building on it, they feel not just loyalty but also have a stake in [the practice] in terms of wanting it to succeed.”

Lay the groundwork

Your team won’t gel — or indeed even begin to function as a cohesive group — unless everyone has a common vision of where you (and they) are headed. Start by returning to some of the questions you hopefully asked yourself early on: How do I want my business to look and feel? What do I want from my practice five years down the road? Ten years? Where do I hope to be 12 months from now?

You shouldn’t have to change your values to align with job candidates. You may have to think creatively and be flexible about who performs what task, but conceding to a decision that represents a fundamental philosophical shift — or simply straying too far from your preferred path — isn’t a good idea in the long term.

West Virginia dermatologist Beth R. Santmyire-Rosenberger feels fortunate to have figured this out early in the life of her two-year-old practice. “I think you need to develop your personal mission statement and stick with it no matter what you have to do to achieve your goals,” she says. “It is important to know yourself, your ethics, and your values.”

Then, with the help of standard examples readily available online (a basic search will produce plenty of options), you’ll be ready to craft the essential underpinnings. In addition to a formal mission statement for your practice, you’ll need job descriptions and a handbook for employees. “So you’re prepared and are able to hire the right person,” says Weinstock. “Know who you want and what you want.” Too many practices, she says, make the mistake of thinking, “We’ll write a manual later,” or, “We’re too small an office to need policies and procedures.”

Get a running start with a sample handbook (from a site like AllBusiness.com, HRIT.com, or TemplateZone.com), then consult an attorney experienced in labor law. Yes, sorry, you need a lawyer: Information laid out in the manual could later be used to back up an employee’s claim of wrongful termination. Even a simple statement could be misconstrued. For the same reasons, you’ll also want to include a disclaimer stating that the book does not constitute an employment contract.

Make sure job descriptions, meanwhile, are oriented toward the results you expect rather than just static lists of responsibilities. A group called the Job Results Management Institute, whose founders have authored several books on job descriptions and employee performance, suggests on its Web site the following example for a medical assistant:

“Job purpose: Helps patients
By arranging examining room instruments, supplies, and equipment; greeting patients; confirming purpose of visit or treatment …”

Under the list of “essential functions” for this employee fall generalized tasks — the results the MA is expected to achieve — followed by the steps they’ll take to accomplish them. This MA will prepare patients for their visits “by directing and/or accompanying patients to the examining room; providing examination gowns and drapes,” and so on.

A document crafted in this deliberate fashion helps staff understand where they fit into the practice’s mission, and makes crystal clear their contribution to it. The MA above, for instance, is told that he is expected to generate revenues by recording billing data and answering payer inquiries.

Refer back to the job description when conducting all subsequent employee reviews, updating it when circumstances require a change in the duties assigned to a particular position. And although it sounds like nothing more than a cover-your-duff move, add “and other duties as assigned” to the list, and let employees know that their jobs will change over time. A staff member who continually uses the job description or other documents to back up a “that’s not my responsibility” stance is someone you — and your patients — don’t want working in your practice.

Experience counts

First on the list of the folks you do want in your practice should be someone who can ensure that operations run smoothly, allowing you to focus on your patients. According to Sheri Poe Bernard, vice president of member relations at the American Academy of Professional Coders, a certified coder may be the best fit for this role, at least initially.