Hiring and Firing Right at Your Medical Practice

Busy physicians have a tendency to hire fast and fire slow. Faced with a busy office and harried staff, they settle for a warm body and lose sight of the ultimate goal: A high performing employee who is a good fit for the practice. And they tolerate poor staff performance because the staff member is doing at least some work. The result is a high rate of turnover that is expensive in every way. There are better ways to handle hiring and firing.

Hire Slow
Most practices are naturally inclined to fill vacancies as soon as possible. Before you rush to hire, consider these two apparently counterintuitive truths:

• Bad help is worse than no help.

• Even the best new help is a temporary drag on experienced staff.

Given the tendency to short-circuit the hiring process, it’s crucial to make sure your practice has a well-defined hiring approach. Here are some tips:

1. Decide what education, training, experience, and skills are required and write them down. These are objective measures and the threshold for consideration. Committing them to paper allows a staff member other than the final decision-maker to screen candidates, and it provides a consistent standard for initial evaluation.

2. Identify the important intangibles and record them. These are the critical attributes for success in the practice, and they are subjective measures. How important are collegiality, commitment, communication skills, patience, high-energy, etc.? The list will vary from one practice to another. The evaluation of a candidate as to these characteristics should be carried out by the final-decision maker. It cannot be delegated to a screener.

3. Interview potentially successful candidates. Assuming a good screening process, interviews are about only the intangibles. A common pitfall is that this evaluation can be too influenced by a personal connection. For example, a physician was once in the process of hiring a physician assistant, and asked me to sit in on the interviews. She really liked a particular candidate and wanted to hire her - even though the candidate did not meet the intangible criteria. It took some talking to convince the physician that either the criteria originally set forth was wrong, or this candidate would not be a good hire. It is another example that instincts can lead us astray, and discipline can rescue.

4. Make sure that interviewees spend some time interacting with other staff. This is critical. Ask anyone the candidate dealt with before the interview how she behaved. Folks tend to be on their best behavior for the decision maker, but they are not necessarily so careful with those who do not seem to be in a position to do them any good. Once a candidate has passed muster with the decision maker, ask other staff to visit the candidate briefly. If existing staff asserts a bad vibe, keep looking.

5. Allow the candidate to try out the job. A four-hour period on a typical day will provide a lot of information to the practice and the candidate. Either or both may decide not to move forward.

6. Institute an initial or probationary period. Provide ample support to the new hire in terms of training and observation. Be ready to answer questions and point out shortcomings. The objective is to help the new hire become high performing and long tenured, for the benefit of the practice and the employee.

Fire Fast
When an employee is underperforming, the instinct is to complain but not rock the boat too much. The devil you know is better than the devil you don't know, and you may not have the documentation to support a firing. Consider, however, the damage to productivity, patient satisfaction, quality of care, and quality of life for the provider and other staff. Patients and high performing employees will self-select out of a practice that tolerates poor performance. Here are some tips to ensure firing is handled appropriately:

1. Document specific performance criteria for staff members, including disciplinary steps. Well-defined criteria give the office and the employees a static definition of desired performance. Employees know what is expected and can be fairly held accountable.

2. Counsel on unsatisfactory performance and document infractions. New employees will make numerous mistakes due to lack of knowledge or understanding. Those are opportunities to teach and clarify. Infractions are the willful disregard of defined standards. Document those, in case more than counseling is necessary.

3. Dismiss. When it becomes clear that an employee is not going to perform at least satisfactorily, cut your losses. It is the best thing for the problem employee, other employees, your patients, and yourself. Having clear, well-documented standards and a clear disciplinary process avoids most problems associated with an involuntary termination.

Hiring staff is an investment in your practice. Following a disciplined process and taking it slow significantly increase the probability of a good return on that investment. Firing fast is only fair to all the stakeholders, and it has a positive effect on morale and productivity.