When the Physician's Spouse is Employed at Your Practice

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It can be a great thing for a physician's spouse to work in her practice. It can also be a disaster. What makes the difference? The short answer is clear boundaries for everyone in the practice, especially the two spouses.

Whether a physician is considering employing his spouse, or the spouse is already working in the practice, here are some tips to keep things professional, positive, and productive.

Establish authority. Regardless of the spouse's position in the practice, establish clear lines regarding what the spouse is - and is not - authorized to do. Determine:

• The limits of the spouse's decision-making authority.
• Whether the spouse can make independent decisions about non-medical office equipment and services.
• Whether the spouse is authorized to counsel and correct staff performance and if that authority is limited to specific areas.
• Whether the spouse will perform staff reviews and recommend or decide changes in compensation.
• Whether the spouse can approve or deny requests for time off.

There is no single right answer for any of these considerations. What's key is that the answers are documented, and that everyone in the office knows, acknowledges, and abides by the guidelines.

If clear lines of authority are not established, staff can end up being pulled in different directions by the physician and spouse. They will not know who has the final say and responsibility for anything.

Establish clear responsibilities. Establish and document the spouse's responsibilities including specific tasks, key deliverables, time frames for delivery, and work schedule.

If the spouse lacks the knowledge or skills to perform an assigned task, establish a plan for her to acquire this expertise and develop a plan for the interim. 

The spouse's rules and responsibilities may differ from other staff. It is fine, for instance, if all employees have to be in the office between 7:30 a.m. and 5:00 p.m. Monday through Friday, and the spouse's workday is 10:00 a.m. to 2:00 p.m. Tuesday and Wednesday. The key is to establish rules and ensure they are consistently observed.

An often-overlooked problem is the spouse being in the office more time than the responsibilities require. There is hardly anything worse than an extra body in an office with nothing official to do. That person wants to visit, ask lots of questions and make suggestions. It degrades both staff satisfaction and productivity.

Establish boundaries. The spouse must have an explicit job description and he must approach work in the office as a job. He must focus on the business of the practice while at work, honor his commitments, and perform to the same standards as other staff members.

That also means that personal issues between the physician and spouse have little or no place in the office. The spouse's special relationship to the physician should be, as much as possible, not part of the dynamic. At the same time, it is imperative that staff be consistently aware that the spouse is not just one of the guys and can be expected to communicate staff conversations to the physician.

Staff must be willing to accept the spouse as a coworker or supervisor. The staff may be resistant because they perceive the spouse lacks necessary skills and knowledge. The resistance can also come from staff resentment at the spouse's intrusion into a long-standing relationship between the staff and the physician.

It is particularly difficult for staff when the spouse's behavior is offensive to them or to patients. Staff, or a staff member, must first make a judgment as to whether the physician is aware of the issue. If the physician is probably not aware of the problem, one very well prepared staff member must approach the physician privately to clearly and gently describe the problem in a factual, non-judgmental manner. Specific examples of problems are essential. Once staff knows the physician is aware of the problem and choosing not to act, their only option is to live with the situation or leave the practice. Complaining and sabotage are never appropriate options.

It is up to the physician to address all of these issues directly.   A physician who abdicates this responsibility does a great disservice to his spouse, his staff, and his patients.