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Managing Staff in a Bad Economy


The worsening economy is taking its toll even on the best practices.

The worsening economy is taking its toll even on the best practices. With the national unemployment rate at 9.7 percent, it’s not unexpected that your staff members might get a little concerned about the security of their jobs. Especially when your new patient count is down and there are pot holes in what use to be a crammed appointment schedule.

Staff costs account for as much as 30 percent of practice overhead in some specialties, so it makes sense that physicians will start to look for ways to shave a little off this expense when revenue takes a dip. At the same time, when you start tightening your practice’s belt, it’s predictable that staff members will begin to feel insecure about their future.

Before your staff starts talking among themselves and second guessing actions you might take, have an honest conversation with them about both your concerns and intentions. If production is down or costs are creeping up it’s time to talk about it.

You may need to tell staff members that overtime is unavailable and raises are on hold for now, but that doesn’t mean you can’t give them a little hope for the future. Brainstorm on what solutions might be viable. Ask for their suggestions on how to beef up revenue and cut expenses. Here are just a few ideas to get the discussion going:

  • Are there ways to increase collections at the time of visit? Suggest that the billing staff help receptionists understand how to review patient accounts and ask for balances owed when the patients check in.

  • Are staff members making sure patients come in for their follow-up appointments? Nurses can be more adamant about stressing to patients the importance of follow-up appointments, while the front desk can help patients schedule their next appointment before they leave the office. Even if a patient says she needs to check her calendar first, suggest she schedule a tentative appointment and call to reschedule later if there is a conflict. This increases the patient’s commitment.

  • Is there more you can do to make sure patients don’t miss their appointments? Emphasize the importance of keeping appointments and ask staff not to let patients off the hook when they fail to show up. Call all no-shows and let them know that the doctor is concerned about their absence, and if possible make another appointment for them. Some practices tell patients they’ll get a pass on the first two missed appointments, but after that they will be charged a missed appointment fee. Of course, this only works if the doctor starts on time and stays on time, maintaining mutual respect for appointments.

  • Where can the practice cut down on expenses? You might be surprised at the cost-saving ideas that your staff comes up with. They may see waste that management and physicians don’t. For example, using both sides of the paper to make copies is good for both the environment and your wallet. Or consider purchasing energy-efficient window coverings that reduce heating and cooling costs. Cost-saving strategies are limited only by your practice’s creativity.

  • And finally, one of the toughest questions of all: Are any staff members willing to reduce their hours temporarily? For some staff this might be a viable option. After all, if an employee can leave work at 3:00 p.m. instead of 5:00 p.m. she may lose two hours pay but save far more by eliminating after-school child care. You can also emphasize that losing a day’s pay is better than being laid off.

In a bad economy, the most important thing is to communicate honestly with your staff. Help them feel a sense of control by having them participate in the solutions that will help your practice stay afloat during difficult times.

Judy Capkois a healthcare consultant and author of the popular books "Secrets of the Best Run Practices" and "Take Back Time." Based in Thousand Oaks, Calif., she is a national speaker on healthcare topics. She can be reached at 805 499 9203 or judy@capko.com.

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