A Physician’s Start-Up Guide: Staffing Your Practice

In our previous discussions we’ve introduced debt and practice financing basics, real estate purchases and issues to consider when buying an existing medical practice. This week, in the fourth installment of our physicians practice start-up series, we’ll address the foundational issues on what is both your practice’s single largest asset and its greatest liability: employees.

Any practice of scale has a chain of command that delegates essential functions and work flow on both patient care and front-office business, theoretically leaving the physicians as free as possible to attend to the ever increasing demands of patient care. Unfortunately this chain is fragile, very human, and is dependent on the training, work habits, and interactions of a wide variety of people you can’t possibly supervise at all times. It has been my experience in working with businesses all over the country (and some top-notch employment attorneys we’ve tapped to solve specific problems) that starting an employment relationship the right way is one of the single most important factors in a businesses’ success with staffing. The topic of employment law and management can fill books and constitute entire post graduate degrees; here’s a more manageable start.

Have the Basics in Place and Perfect
It's so important to have a top-notch, professionally drafted employment manual and policies.

We are consistently presented with issues arising from omissions or ambiguities in the employment manuals of medical practices. Even successful practices often have policy manuals that are outdated, incomplete, or based on another state’s law, often because they have been passed along by another doctor. This investment will define rights and obligations for both you and the employee and is your internal compliance guide. Just follow the rules.

Get EPLI Coverage
We’ve covered this issue before in detail, but it bears repeating. Your medical malpractice and general liability insurance umbrellas almost never cover the costs of defending a lawsuit. Like all other forms of liability insurance I advise that you get Employment Practices Liability Insurance (EPLI) coverage as the first line of defense against employment-related lawsuits. This is one of the mostly likely and serious legal exposures your practice faces and even the costs of a successful defense could be devastating to a practice.

Have Well-Defined Job Descriptions and a Specific Training Plan
Many issues between employers and employees arise because expectations are not met, In some cases that’s because they were never adequately defined, but that’s part of your job. The majority of workers, in spite of the strong warning tones I’ve taken here and in our previous articles on this issue, want to please you and want to be good at their jobs. The beginning of your relationship sets the tone and speaks volumes about how seriously you value them and the functions they perform for you. Take the job and all associated tasks seriously and so will they.

Make Hiring the Best Part of Your Budget and Business Plan
Hiring better-trained, more-experienced employees costs more, but it also increases the overall productivity of the office and frees you up to focus on the income-producing act of patient care. Consider hiring fewer, but more valuable and skilled, employees on the front end of your practice formation: It’s easier to add fill-in, extra, non-essential, or replicable support and admin staff once your core team is place and can help train and utilize them. 

Create a Culture of Accountability From Day One
It’s natural for employers to want to create an atmosphere of congeniality and happy workplace. Unfortunately many physicians have not had specific human relations or management training and the line between “friend” and “boss” gets blurred all too often. This “buddy” approach almost always backfires when you need to enforce rules or make tough decisions as you are no longer their employer or supervisor providing instruction but a friend doing something personal to them.

It is your responsibility to make sure that things are being done and being done well, so establish regular reviews and goals and make people stick to them. Have and actually use (not just a book on a shelf) a specific discipline plan and learn to fire without fear when required. Not every choice you make in hiring is going to be right. That’s OK, but you owe it to your practice and to the person you hire to provide the guidance and structure they need to excel up to the point they prove they can’t or won’t deliver what you need.

Find out more about Ike Devji, JD, and our other Practice Notes bloggers.