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Three Ways to Deal with Toxic Medical Practice Staff


The key to dealing with problem medical practice employees who question your decisions is moving quickly to fix the behavior. Here's what I recommend.

Did you ever manage a staff but not really manage a staff? Do you have issues among staff members but are not certain what to do? Do you find yourself speaking to staff only to have them look at you like you are Charlie Brown's teacher? How about shouting into a canyon only to hear your echo return? Sounds a bit like work doesn't it? Unfortunately many physicians and practice managers experience these problems.

If you are one of them, the problem might be that you don’t take the difficult steps and make the difficult decisions that are required of a strong practice leader. While it's never appealing to confront staff members about poor performance, or to let repeat poor performers go, failing to do so could do some serious damage to your practice. 

If you wait too long to address poor performance, your good employees may leave because the work environment will become intolerable to them. Even if it doesn't come to that, the undermining of your authority by the poor performer may permanently damage your authority.

After all, if you are willing to let a staff member continually perform poorly, do you think others will continue to maintain their faith in you? Probably not. Their esteem for you as a doctor/leader will likely plummet, and, in turn, their productivity and motivation will plummet as well.

The key to dealing with problem medical practice employees is moving quickly to fix the behavior.  Here's what I recommend:

1. Use formal write-ups. Document it when employees demonstrate poor performance. Include what happened and when. If you do not have a poor performance documentation template, I recommend the book "101 Sample Write-Ups for Documenting Employee Performance Problems." This is a great resource when you need to document everything from substandard work quality to absenteeism to e-mail misuse.

2. Don't shy away from the issue. When you detect a performance problem, intervene early. Think of it this way, the reason why there are issues is because over 80 percent of the time, the issue is not addressed or corrected. So correct it.

Counsel the employee and try to determine the cause of the poor performance. Look for issues such as lack of training, motivation, burnout, or some other cause (e.g., personal tragedy or conflicts with coworkers).

I definitely suggest a one-on-one meeting to help the staff member understand that there is an issue and it must be immediately corrected. Provide a neutral setting and rather than constantly berating the staff member, explain what you need him to do differently, and then provide the opportunity for him to provide suggestions for how he can improve. 

3. Implement a plan. Provide the employee with the opportunity to demonstrate acceptable performance after discussing his performance problems with him. Write down this "opportunity to improve" and establish a timeframe by which his performance should improve. If performance does not improve, you may reassign, demote, or remove the employee following a prescribed set of rules established by law.

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