Human Resources: Love in the Afternoon

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Jeanne Distretti, administrator for an OB/GYN practice in Memphis, once worked in a medical office in which a married physician was simultaneously dating two staff members - one a married nurse and the other a married medical assistant.

Imagine what their staff meetings were like.

Romance is in bloom in many medical practices. What does that have to do with practice management? Plenty.

Romantic entanglements between physicians and staff members (and, typically, we are still talking about male physicians and female staff members) are a distraction from an office's normal work flow and can be devastating to the professional relationships within a group. It would be one thing if the only people affected by such relationships were those directly involved in it. But in reality, workplace romances breed gossip, jealousy, and bitterness throughout the office.

And that's the best-case scenario. The worst cases often involve legal action.

Physician-staff affairs "go one way or the other," says Owen Dahl, practice administrator with Northwest Cancer Center in Houston, who has seen it all during his 35 years in the industry.

Perhaps the relationship goes well and leads to marriage. That may sound like the triumph of true love, but in the workplace it's often just the beginning of sticky complications. Other staffers may think the newlywed employee slept her way into her job. Even if that's not the case, it is correct for them to assume that as the physician's wife, she now wields an unfair advantage over them.

"You just can't fight through the feeling of favoritism. You can't battle the perception. People just won't buy it," says Nick Fabrizio, a consultant with the Medical Group Management Association, a practicing administrator, and an assistant professor in the Department of Family Medicine at SUNY Upstate Medical University. Fabrizio says the "favoritism dynamic" can get worse if the new spouse lands a promotion or takes on the role of de facto practice manager, essentially overseeing her former colleagues.

Much better, then, if the relationship just fizzles out, right? Not necessarily. After a breakup, it's unlikely that the physician and staffer will work well together. And when the tension gets so thick it becomes clear that someone has to go, guess who will be sent packing? Not the physician. The practice's employee inevitably gets the short end of the stick, and the group can only hope she doesn't ask for a giant severance package or sue for sexual harassment.

Love happens

If your office has not yet been disrupted by a workplace romance, chances are it will be. Forty percent of employees in all industries say they have dated someone with whom they've worked, according to research conducted this year by the Society for Human Resource Management and CareerJournal.com.

In a study last year released by Vault, a popular online career information source, 58 percent of the employees surveyed said they had been involved in an office romance - that's up from 46 percent two years ago. When asked whether an office romance was currently occurring between coworkers at their respective workplaces, 43 percent of survey respondents said yes.

But how accurately do those numbers from corporate America reflect what's going on in medical practices?

It's difficult to say for sure, since practice-specific data don't exist on this subject. But the culture in medical offices tends to be far more laid-back than the corporate culture typical of other types of businesses, which may suggest that the hanky-panky rate in your office is even higher. On the other hand, these surveys reveal relationships between equal-status colleagues as well as the far more dangerous (from the business's point of view) supervisor-underling affair. The former may be more common than the latter in corporate America, but in medical practices the boss-underling affair is probably more widespread. The fact remains that most private practice physicians are men, with women comprising most of the staff.

Plus, unlike the typical boss/employee relationship in most industries, in medical offices, " staff revere the physician. It's a form of flattery if he finds them sexually attractive," says Laura Murphy, an attorney who handles sexual harassment cases with Sunstein, Murphy & Associates in West Chester, Pa. "I know practices in which doctors fornicate in the broom closet with the techs."

Certainly, there's plenty of anecdotal evidence regarding the prevalence of love affairs within medical offices - not that any one wants to go on record about it. Consider these tales from a human resources listserv for medical managers:

• A fling between a staff member and a senior physician ended badly. Counsel advised the practice to offer a $100,000 severance package to the staff member to ward off a sexual harassment claim.

• Employees in another office became violent because one was jealous that the other was dating a doctor. The relationship ended after the dating employee became pregnant.

• A physician was cheating on his wife with the office receptionist. A jealous nurse called the wife. The wife asked the physician partners to intervene. (How would you like to be in the middle of that?)

• Another doctor divorced his wife and started living with his nurse. Gossip ran rampant in the small town where the clinic was based, hurting business until the practice let the physician go.

It just happens. People spend long hours getting to know one another in medical practices. And it's no small factor that coworkers are, frankly, convenient to date. When reporter Amanda Robb attended a matchmaking seminar to research a story for Oprah Winfrey's magazine O, she discovered that men and women have different nonnegotiables - traits that a potential mate absolutely must (or cannot) possess. Women commonly demand educated nonsmokers. And men? Their most common nonnegotiable is geographic proximity. "Apparently, a shocking number of guys won't travel more than a half hour for love," Robb reports.

So there you have it: Male physicians who are obviously educated and for the most part don't smoke, and female staffers who often idolize physicians and who are, well, there.

Whose business is it?

It should be clear from these stories that if Cupid does visit your office, the outcome isn't likely to be all lollipops and roses. There is surely a strong temptation to ignore a partner who dallies with his nurse after hours. After all, it's none of your business, right?

Wrong.

Office romances kill productivity and pave the way for a steady stream of staff complaints. Here's how consultant Judy Capko describes what typically happens: "You see a flirtation start and, of course, the staff starts to notice it right away. Usually, the staffer involved starts to flaunt it - that she has a special relationship with the physician. It becomes the scuttlebutt. It puts a partiality into how that staff member is treated. It impacts her work performance and the performance of others. It can fester and become something quite ugly."

It might also end up costing you money. "I have seen situations in which the employee leaves, but only with a hefty severance package," says Dahl. Hopefully, that cash comes only from the pocket of the Romeo, but don't count on it.

Capko had a client practice in which a workplace affair went south and the departing employee wanted cash. She ended up suing for sexual harassment and the physician simply paid her off to the tune of $50,000 to $80,000, as Capko recalls. But it didn't end there. When another staff member wanted to change her hours and the practice refused, she also filed for sexual harassment. "She knew she could get away with it," Capko says. The physician decided to fight back. "He won the case, but it cost him a fortune."

The truth is, someone who happily agrees to a consensual relationship will have a hard time winning a sexual harassment case, but it hardly matters. "These suits often come up where the woman feels not responded to or jilted," says Murphy.

And then, "Even if you win, you don't win," says Capko, referring to the legal fees and months of distraction such an incident can cost. "If someone decides to make it ugly, it will be ugly." And consider the damage done to the reputation of both the physician involved and the rest of the group. Losing your credibility in such a way can cost you your patient base.

Take control

What to do? Workplace policies forbidding relationships seem rather beside the point. Who's going to hand the employee handbook to the couple in the broom closet?

Besides, are office romances always inappropriate? "Sometimes work is where you'll find your soul mate or spouse," admits Fabrizio. "But at that point someone has just got to make a decision to leave the organization. I'm not saying people shouldn't fall in love at their workplace. It's what you do next that matters."

Although it's true that millions of people find true love at work, personal romantic relationships between physicians and staff members can't be condoned because doctors are intrinsically in a position of authority over their employees.

And we're talking here only of genuine, consensual office romances, not about situations in which a physician actually does engage in sexual harassment, which certainly happens. There need not be a personal relationship for a physician to behave inappropriately. And sometimes harassment occurs during the course of what started out as a consensual relationship, usually after the woman breaks it off. As Capko points out, a physician willing to risk dating an employee may be willing to cross other boundaries as well.

Your policy should state that if a relationship starts - whether it's an open secret or a public affair - one of the people involved must leave the office. If the couple can't agree which one it will be, the practice's leaders should decide, says Fabrizio. "I personally and professionally don't think it's appropriate" for the couple to stay, he adds.

The idea is to intervene in consensual relationships before things get ugly. Make it clear in your employee policy handbook that dating employees must decide which of them will leave; the practice will step in only if they refuse to make a choice.

Of course, this strategy makes sense only for consensual relationships. And even then, it's not perfect. It may force the practice to fire someone - probably the female staff member. But it's better than nothing.

Capko urges physician leaders to take action as soon as they hear about a relationship: "Nip it in the bud. Bring it to a physician meeting. Say it's not OK, and ask the offending physician to ask his romantic partner to take another job." She also suggests doing what you can to limit the time male physicians and female staff members spend alone before and after regular hours. "Physicians and nurses especially work closely anyway," she points out. Time spent alone might push a good working relationship beyond acceptable boundaries.

At the very least, understanding the possible outcomes of office romances will put you a few steps ahead of a potential crisis. Why sit back and wait for it to happen?

Pamela L. Moore, PhD, is senior editor, practice management, for Physicians Practice. She has been writing for physicians on practice management topics for eight years, and she is a recognized speaker and commentator on healthcare management. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the November/December 2006 issue of Physicians Practice.