Don’t discount the value of non-clinical staff

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 for 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, setting the cost guidline based on the lower end of salary ranges found on websites or paid by their peers.

Hiring these staff members has often been treated with a “not my responsibility” approach. The typical path seems to be hire an administrator first (a subject of a future article) and then leave 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 owners usually set the standards for, and are involved in, the hiring of the people who are the “face” of the business. The owners usually want to be part of selecting those who are the first to interact with prospective customers, be it on the phone or in person.  

This generally is not so with most small medical practices. Since small practices often lack a mission statement, there’s no directive that sets the tone for the practice and guides the conversation about how to best handle patients and their families. As a result, a practice can end up with some terrible social media rating 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?  Here are 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, all business approach. 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 and has to engender the trust of all, while fully understanding and developing your business concept. Make sure he/she understands billing and collecting. See if he/she has had any conflict resolution training. Prepare a list of “what if” questions that address some tough subjects, especially angry patients, to ask at the interview. Check references!

3. Be as specific as possible with the administrator regarding the qualifications for personnel they will be soliciting. When the administrator has 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 your problems. 

4. 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.

5. Remember there’s a huge income and education disparity between you and staff personnel so try not to be intimidating. Once hired, all of your employees 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.

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, because 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 doctors don’t make time for the employees except at the holiday 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, rather than screaming at the staff. Chaos ensued, as you would imagine. 

Every practice is different. So there’s no exact model about how to evaluate staff personality in the design of your practice. It’s going to take some time, and some work.

But it has a huge impact on your medical business, maybe even 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!