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Introduction

A team that shares your values and vision can contribute significantly to your success. Whether you are starting your own practice, or are a partner in a pre-existing practice, personnel decisions are inevitable. But how do you approach deciding when to hire new staff members, and finding the right fit for your team?

Team Setup

Bringing in a new employee is a significant decision because of the expense involved in training. Before making the decision, it is important to think seriously about how many team members you will need to run an efficient practice that provides safe and effective patient care. Most practices have, at minimum, a staff manager; staff to provide clinical and billing support; and a receptionist who can handle schedules, check-ins, and answer the phone. Depending on the size of your practice, you may be able to hire staff to fulfill more than one role to allow for greater flexibility, or choose to outsource specific roles, such as billing. Many businesses use a S.W.O.T. analysis as a first step to determine whether or not to invest in hiring a new staff member. You ideally want to hire new staff only when they will significantly impact elements of your S.W.O.T. assessment.

S.W.O.T. is an acronym that stands for “Strengths, Weaknesses, Opportunities and Threats.” (See graphic). As demonstrated in Fig. 38.1, the analysis considers both factors that are intrinsic to the company (top row) and external factors that impact business success (bottom row).

Fig. 38.1
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An example of a S.W.O.T analysis for a private practice

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Strengths

Assets of your current practice could include staff expertise, clinic location and reputation, or providing cost-effective services.

Weaknesses

Practice weaknesses could include insufficient appointments (e.g., if there are limited staff), outdated technology, or inefficiency.

Opportunities

These are external factors that can be exploited to help your practice succeed. For example, offering services that your competitors do not offer, increasing your patient base in a community through outreach, or the closure of a rival practice.

Threats

Although threats are external factors over which you may not have control, understanding and being aware of them within your business plan is helpful. For example, threats could include increased local competition or an unexpected pandemic that changes market demand for nonurgent appointments and services.

The goal of the S.W.O.T. exercise in this context is to analyze systematically whether a new employee would either contribute to your strengths or detract from your weaknesses. For example, hiring a staff manager with experience might decrease demand on the physician’s time for administrative tasks, allowing them to focus more on clinical care, which in turn could improve revenue.

The Hiring Process

Once you have made the decision to hire a new staff member, your goal should be to make sure that you attract the right applicants: those who understand and share your values. A shared vision, along with a positive work environment, creates a cohesive atmosphere which helps maintain staff retention.

The best way to find new staff is through personal connections and networking. However, advertisements for staff can be placed with a recruiter or on multiple job sites (such as Ziprecruiter, Indeed, or Linkedin). Especially if you are looking to hire additional physicians, you may need to reach out to local residencies or advertise through the American Academy of Pediatrics (Pedjobs).

During the screening and interview process, determining the applicant’s personality and passions is crucial, and far more important than their skill set. Assess their work ethic and values. If they will fit in and are motivated, specific skills can be taught. In contrast, a toxic personality in the work environment is extremely challenging for all team members, and sometimes even the patients. Once an initial pool of applicants is identified, invest time in thoughtful discussions with their references, and in thorough background checks.

A candidate who understands their own value will most likely negotiate salary and other benefits. Compensating a qualified candidate well means that they will hopefully not continue to look for a better offer. Additionally, benefits do not have to be limited to financial compensation. Especially in a clinic setting, offering flexibility in terms of hours, discounts for medical care for family members, or educational benefits such as CME can be very attractive.

After Hiring New Staff

Once you have made the decision to hire a candidate, discuss the contract with an employment attorney to ensure all paperwork is appropriately completed. Many practices also begin with a training or initiation period to ensure that new staff are able to perform skills adequately and fit well into the clinic culture. During and after this period, make a plan for frequent and formal performance reviews to help remediate issues and provide feedback. Ideally, feedback should be positive and concrete, reviewing both strengths and specific areas for improvement. These performance reviews must be documented.

When Things Do Not Work Out

Terminating an employee is unfortunate, but at times necessary. Sometimes staff that you hire turn out to not be a good fit or are unable to learn necessary skills. Written evaluations with a documented time and date, along with the employee signatures, can be helpful to indicate that you have provided opportunity for remediation and can minimize accusations of wrongful termination. This is, of course, assuming the employee has not done something egregious that requires immediate dismissal.

If, despite remediation attempts, you decide an employee needs to be terminated, your first step should be to consult with your employment attorney. Depending on the size of the practice, either you or your manager may be responsible for having the discussion with the employee. Termination should occur in private, and as professionally as possible. It may be advisable to have at least one witness during the conversation.

After a termination, other staff members may need reassurance about their own job security. Communication is an essential part of running a practice; although you do not need to provide details regarding the termination, having thoughtful discussions about how to move forward and reassign work can help the team recover and remain as cohesive as possible.

Practice Roles

The number of staff working in your practice will partly be determined by revenue, the types of services offered, and, of course, patient volume. The following is a brief discussion about the roles and responsibilities of a clinic manager; this person can tremendously influence practice success. More information on other roles and their responsibilities can be found in the resources at the end of the chapter.

Clinic Manager

Your manager will be a very visible, outward-facing, representation of your business. Ideally, you want to hire someone for this position who is passionate about your business strategy and vision for the practice and who has the leadership skills to implement that vision without your close oversight.

Clinic managers need excellent interpersonal skills. They will interact with patients, staff at all levels, and physicians and will be involved in not just the administrative elements of running your practice but also perhaps hiring or firing additional staff. An individual who is open to learning new skills and adapting to ongoing challenges (such as technological advancement or public health crises) is critical. Of course, they also need to be detail-oriented and ideally have some managerial or business experience.

Summary

As an employer, you are ultimately responsible for your clinic culture. Your expectations and manner set the tone. Patients are able to sense when employees are happy and feel supported in their jobs. Happy employees take initiative and think outside the box to help strengthen your business. And employees are happiest when they feel valued and envision themselves with a future at the company. A thoughtful approach to the hiring process can go a long way to putting together a team that works together effectively and passionately.

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Resources