Frugal And Foolish??

Over the years I’ve assembled many, many budgets for physician practices.  Some of these were done for banks and financing, some as a footprint for new partners, some for one and three year plans for benchmarking growth and a variety of revenue and cost line items.   
In assembling budget costs, I’ve always been surprised at the attitude taken toward the cost of front and back office staff.  Most physicians have wanted to allocate the minimum amount of money for these crucial employees, taking the lower end of salary ranges as stated on various websites or as paid by their peers as the cost guideline.
Hiring these people has often been treated as a “not my responsibility” as the practice takes shape or reshapes itself to accommodate new physicians.  The typical path seems to be hiring an administrator first (a subject of a future article) and then leaving it up to him/her to assemble the non-clinical staff.  And usually this is done with little input from the physicians.
In every other small business I can think of the owner usually sets the standards for, and is involved in the hiring of the people who are the “face” of his business.  They usually want to be part of selecting those who are the first to interact with their prospective customers, be it on the phone or in person.  They spend an extra amount of time with these people.
Not generally so with most small medical practices.  Since there’s no mission statement involved in most there’s no directive that sets the tone and starts the conversation about how to best handle patients and their families at the initial point of contact and beyond and what impression they want the practice to make on the public. In my experience if find most docs rarely get together with the key staff to discuss how they want their practice to present to customers, vendors, other physicians, etc. 
So between a lack of a directive in hiring parameters, going cheap, and little involvement in who ends up being hired you can end up with some terrible social media scoring and negative comments that last forever on the internet.
So how do you assemble and direct a front office (and back office, who frequently deals with patient problems more than anything else) that will project the practice image you envision?  A few steps to get you started:

1. Develop a general concept of how you want the practice to “show” to the public and your patients.   You might want friendly, smiling faces.  Or a very professional approach, all business.  But figure out what you want (usually a reflection of how you interact in the exam room) and put it down on paper.  If you have examples from other practices, note these.  Better, visit them and see for yourself.
2. Hire an administrator with experience, and don’t err on the cheap side.  This person will be running everything for you. They have to engender the trust of all, while fully understanding and developing your business concept.  Then find the other people to do the same.  Check references!!!  Make sure they understand billing and collecting.  See if they’ve had any conflict resolution training.  Prepare a list of “what if” questions that address some tough subjects, especially angry patients and ask them at the interviews.
3. Be as specific as possible with the administrator regarding the qualifications for personnel they will be soliciting.  When they have narrowed the lists down, for each specific job, sit in on the final meetings.  Ask questions, first as the doctor, then take off your lab coat and be a patient, looking for answers with their problems.
4. Remember, there’s a huge income and education disparity between you and staff personnel so try not to be intimidating.  Once hired, your employees (all of them) need to feel like they are going to be both valued and, this is important, respected for what they bring to the practice, i.e., the respect they bring is “owned”.  Most medical practices follow a rule that employees  “earn” respect—but there’s too much at stake for that approach and it implies hiring people who do not bring the level of experience or work expertise you need to be successful from day one.
5. Don’t be cheap.  Really good employees are hard to find.  An extra $1.00 per hour for a strong, experienced employee may be worth thousands.
6. Meet weekly with the administrator and develop a reporting format that covers basic financial and operational matters, as well as patient comments on staff, staff interaction/problems, etc.  Don’t avoid the small stuff, at first, because at the beginning you’re building the structure of your practice and how the employees need to fit within it.
7. And once you’re up and running, make sure you remember to interface with them.  I’ve seen too many practices where the docs don’t make time for the employees except at the Christmas party, and that’s not enough.
8. Finally, make sure you meet with your partners and have a frank conversation about the way staff issues will be handled.  I worked with an OB years ago who was part of a group and a terror with the staff.  None of her partners had the nerve to tell her she needed to stop, and direct her problems to the administrator, NOT scream at the staff.  Chaos ensued, as you would imagine.

Every practice is different.  The way patients and families need to be treated in a pediatrics office is very different from that dealing with cancer of the pancreas.  So  there’s no exact model about how to evaluate staff personality in the design of your practice.
But it has a huge impact on your medical business.  Maybe equal to the clinical relationship you want to develop.  It’s a high priority on the front end, and will continue to be every day.  Don’t overlook it!  –Tom Ellis