Managing Difficult Medical Practice Employees

January 27, 2012

Tips for transforming immature staff members into great employees

You hired a 40-something billing manager, hoping for the wisdom, experience, and temperament often associated with age. What you got was a control freak, who verbally blasts coworkers for the slightest infractions. Emotionally immature workers, who react inappropriately under pressure, can upset the balance of any organization. But the problem may be more pronounced at medical practices where managers often cultivate a zero-mistake culture, but fail to confront counterproductive behavior head-on, says David Schlactus, chief executive officer of Hope Orthopedics of Oregon in Salem, Ore. "The problem most managers have with these employees is that we all avoid conflict like the plague," he says. "Therefore, the difficult employee is allowed to bully their way through an office because after all, who wants to deal with them?"

What it looks like

Emotional immaturity is loosely defined as the inability to accept responsibility for one's own actions. Those who exhibit such character traits often feel victimized, give excuses for their unprofessional behavior, and lack the ability to disagree with, but still respect, another person's point of view.

They all deal poorly with stress, but emotionally adolescent individuals may express their frustration differently depending on their personality type, says Sherry Buffington, a psychologist and chief executive of NaviCore International, a human resources consulting firm in Dallas. And the higher up the chain of command these employees climb, the harder it is for your practice to deal effectively with them.

According to Buffington, dominant and aggressive employees with low emotional intelligence have proportionately lower patience when things don't go as planned. "They have high expectations and low tolerance for many things, including their underlings, their peers, even systems and processes," says Buffington, who co-developed a personality assessment tool called the Core Multidimensional Awareness Profile (MAP), which helps organizations identify and develop high performance employees. "There tends to be an expectation as to how things ought to be, and when they are not that way, their response is quick and emotional as opposed to a thinking response."

These individuals may erupt in anger, snap at subordinates, or push for results at the expense of morale. They also often fail to compromise with coworkers and rules. "They get louder and get in the middle of things and become disruptive," says Buffington, noting their need for perfection is a breeding ground for bottlenecks.

The more submissive personalities who exhibit emotional immaturity, she notes, tend to swing the other direction. "Their agenda is to get along with everyone, so they become indecisive and servile and start putting themselves on the back burner," says Buffington. "They won't speak up or let you know where they stand for fear of offending someone." Thus, these employees can be less difficult to work with, but are unproductive and contribute little to the team.

How to deal

From a leadership perspective, says Buffington, the best way to intervene regardless of personality type, is to try to identify the source of the problem. Is your employee bored? Does she feel underappreciated? Is he doing the job of two full-time workers and going home exhausted every day? You'll never know unless you ask. "Most organizations look at the wrong thing," says Buffington. "They see someone who is emotionally immature and think that person needs more training and more skills. They should be focusing on interest." The highest performers in any office, she notes, consistently have both high skills and high interest in their positions.

Ask the employee, as well, what he believes his core areas of strength are, which can help you determine how his talents can be better utilized within your organization, says Buffington. The employee's current role may be at odds with his personality, creating avoidable stress. A people person, for example, will never thrive in a position in which they're stuck behind a computer all day. Likewise, a worker with little propensity for details will have low job satisfaction in a data entry or bookkeeping position, and be more likely to make costly mistakes, she says.

During the meeting, discuss what you can do to increase the employee's job satisfaction. If the problem is boredom, find out what job responsibilities she would prefer and start by cross training her in that area for use as a backup when the regular staff member is out sick or on vacation, Buffington says.

Understand, don't condone

If the employee is overworked, find out how you can lighten some of his load. But never let bad behavior slide, says Teresa Martinez, office manager of four-physician practice Houston Family Practice in Houston. Address problems promptly and professionally. "There should be a verbal warning in which you let them know that if the behavior continues it will go into their file," says Martinez. "Do it privately in your office, but do it right away." Failure to address inappropriate behavior, she adds, sends a message to the rest of the team that it's either acceptable in your practice or that leadership doesn't care. Neither message is productive. "If I make it OK for you, the other employees will think it's OK for them," says Martinez. You should also define the discipline process, and be prepared to follow through. "You have to give them adequate warnings, but be prepared to let them go" after the appropriate channels have been exhausted, she says. "You can't hold onto someone and keep trying to fix them when it affects the rest of the office."

Sheila Margolis, president of the Workplace Culture Institute, adds that managers who are dealing with such employees should avoid feeding the problem. "If they have a tantrum, do not provide an emotional response," she says. "Often, you can empathize with the person by asking questions and listening for feedback as to why the person is upset or angry. Taking time to calmly understand the person can be a way to rationally deal with the individual." Managers should also coach these employees to express their feelings in a more professional manner, and discuss the impact it has on others, she says.

Emotionally immature workers not only create headaches for your practice, but waste valuable resources by turning the focus away from customer service and productivity. By dealing with the matter promptly, however, and removing barriers to job satisfaction, you can help turn problem employees into productive members of your team.

In Summary

Emotionally immature staffers can have a negative effect on your whole practice. Ideally, managers should address problems as soon as they occur. Effective strategies include:

• Addressing behavioral problems privately and quickly.
• Keeping reactions unemotional.
• Explaining how bad behavior negatively impacts coworkers and patients.
• Asking about employees' interests and shuffling responsibilities to increase job satisfaction.

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on,, and She can be reached via

This article originally appeared in the February 2012 issue of Physicians Practice.