The Great Practice Makeover: Skilled Part-Timers Needed

Kristin Murphy*, administrator of an anesthesia group, has a common complaint: “I’m having trouble recruiting intelligent people who can work independently for part-time work,” she says. “And when I finally get them trained, they leave as soon as a full-time position is offered to them. How do you find quality individuals who just want part-time work?”

A familiar conundrum, but one that’s potentially devastating to a practice’s productivity, particularly when the staff in question handle your billing. Murphy has been filling the gaps with college students, whom she praises as fast learners, as well as with previous employees willing to work a few hours here and there. But the college kids are usually onto the next thing after a semester or two, and former employees are not reliable long-term, which is not too surprising. They had their reasons, after all, for leaving in the first place.

All of this leaves Murphy spending precious time and energy training an endless string of new hires - and the practice’s cash flow on shaky ground - as everyone focuses only on meeting the next deadline. “It’s starting to burn out myself and the other gal who has been here a long time, having to constantly train people,” says Murphy. “It puts you behind on your own work.”

She says the practice can’t afford to hire a full-time biller, and indeed, it doesn’t currently have enough work for another one anyway. But making the search for admin help even more challenging is the fact that even part-time candidates increasingly want benefits, too, such as health insurance coverage - essentially impossible to offer for this practice. “Since we are a very small company, our benefit costs are astronomical,” says Murphy. “We have dropped group healthcare coverage and put employees on individual plans.”

All the options

Murphy feels she’s done her due diligence in terms of staffing analysis - she’s convinced that what she needs is part-time help - and maintains that her “current employees are working their patooties off!” Still, she wonders whether she’s overlooking anything that would help her retain quality part-timers, which is certainly possible. How to find out?

When you’re faced with a situation as seemingly intractable as Murphy’s, start by questioning your underlying assumptions. In this case, that might mean determining whether the workload really doesn’t merit an additional FTE, and whether the folks you already have are working efficiently and at full capacity. Conversely, in light of the current complexities inherent in the reimbursement environment, it’s also worth analyzing whether a college student, no matter how bright, could actually be costing more than he saves. A top-notch billing pro could potentially bring more dollars in the door, which would cover that person’s salary and then some.

Bringing in an additional FTE really might be justified if this new billing person proactively corrects issues on the front end. For Murphy that could even mean working with the facilities where her docs have privileges to improve, over time, the information coming into the practice. After all, says Murphy, “The part-timers are not there to fix their [own] mistakes,” and they don’t necessarily have a sufficient personal investment in the practice to consider their work a career. If she ends up correcting the same errors over and over - a snowballing time-waster if ever there was one - even the quickest short-termer becomes a liability.

Possibly, the next step could be to entertain ways to take on more work to better justify an additional FTE (and then more realistically be able to offer the benefits in the first place). The physicians at this southwestern U.S. practice tell Murphy they’ve never enjoyed such profitability as they now have with her leading the administration. “We have a fabulous collection rate because we appeal so many denials,” she says. And, she says, the docs are thrilled with the staff’s ability to keep current with changing carrier rules. Idea: Perhaps it’s time to bring that expertise to a wider audience and seek economies of scale by taking on billing or other services for outside physicians.

Or go polar opposite and outsource your billing. Consider a revenue cycle management vendor that would provide regular reporting. If you don’t like the idea of forking over a flat fee, consider an RCM company that charges using a percentage scale - if they don’t perform, you don’t pay.

Offloading non-revenue-producing administrative work to a professional employer organization is another possibility. PEOs undertake a host of HR functions, usually for larger practices, but the value for Murphy could come primarily in the form of access to benefit programs. Expect to pay a fee or a proportion equaling about 4 percent of payroll for these services. Although it would mean giving up at least some control of staffing, that cost could be worth it to a practice like Murphy’s, which can’t find affordable health coverage for its employees and has trouble locating worthy job candidates.

Rocks to overturn

Providing an attractive work environment certainly helps draw candidates. This practice offers perks such as flexible hours and dress for those in clerical positions. And, she points out, plenty of the previous part-timers do end up wanting to come back at some point, even if only for short periods or, say, around holiday spending season.

Perhaps Murphy could establish a more formal coverage network comprising these alums, a sort of extended job-sharing arrangement that would provide them a bit of increased financial stability. In exchange for being more regularly available, these folks might receive a slightly higher hourly rate, reflective of Murphy’s reduced training burden.

Murphy plans to expand her applicant pool to more specifically include older folks as well. “We’ve advertised at the schools, Mother’s day out, churches, daycares as well,” she says. But the practice is located in an affluent area where women in their child-raising/parent-caretaking years - the group you might typically look to for such roles - tend to pursue either charity work or leisure activities to fill their spare time. “My applicants come from farther away, and as such really want full-time in order to make it worth the trip.”

The specialty of anesthesiology presents some unique challenges. Obviously, one is the inability to capitalize on an often-fruitful recruiting avenue - the practice’s own patients.

On the other hand, relocating the office to a neighborhood with a larger applicant pool (and lower overhead?) could be an option, as patient-facing activities all take place in off-site facilities anyway.

Certainly, traditional advertising isn’t out of the question to find well-qualified folks, although word of mouth may ultimately prove most productive. For starters, ask local IM practices to keep their eyes peeled. Murphy might also look to retail and other service businesses in her immediate vicinity. And think creatively - even store greeters might have a lead for you. Approach one who’s on the ball and impresses you, and say you’re looking for someone with a personality like hers. Perhaps you can offer the attraction of a better work environment … Upon hearing this suggestion, Murphy’s understandably a little skeptical: “Oh, don’t tell me my next biller is going to come from Wal-Mart!” But you never know, do you?

*Name has been changed.

Laurie Hyland Robertson is senior editor, projects, for Physicians Practice. E-mail her at Laurie.Robertson@cmpmedica.com, or join the online discussion atforum.physicianspractice.com, where we’re talking about how you find reliable part-time employees.

This article originally appeared in the January 2009 issue of Physicians Practice.