A Physician's Role in Dismissing Staff

Have you ever been part of letting a staff member go? Most physicians stay far away from that aspect of running a practice. It is uncomfortable for many of us and we simply do not have the training or the interest to become involved. But let me convince you that there is value in being present for staff terminations.

Most practices have an administrator or office manager. Hopefully you have one with the appropriate level of skills and education to support your needs. Any practice administrator should be fully versed in proper HR management, including staff termination proceedings. For instance, our practice has a policy that termination is the next step after the staff member receives two official written warnings.

Just to be clear, staff termination should take no more than 15 minutes. It is imperative to not get emotionally involved in the process, and while you can be empathetic, don't get sucked into a lengthy counseling session.

You might wonder, "Why should physicians even get involved if the administrator is capable of a termination procedure?" Here are three important reasons:

1. You don't really have to do the termination yourself; after all, you have an administrator. Let him do all the talking because he knows what can and more importantly can't legally be said.

2. Be present as a witness to help give your administrator the authority he needs to do his job. The staff member will know that the physician owner is in complete agreement with the administrator's decision and that it is final. That way, the terminated employee won't come running to you to seek clemency afterwards.

3. This is a learning opportunity for the physician. Remember the old adage "See one, do one, teach one"? You own a business and you should be aware of all aspects of the business, both medical and administration duties. It doesn't mean that you will be performing this duty on a regular basis, but you should know how it is accomplished. For example, you clearly know how to draw blood, but you don't do it as a regular duty in the practice.

Witnessing your first staff termination will be difficult and quite possibly uncomfortable. It is never pleasant but neither is delivering bad news to a patient. Take your clinical bedside manner into the situation. Be dispassionate and maintain your professional demeanor. Most staff members have a great respect for the physicians and if you are present during the termination, the staff member will know that the termination is final and non-negotiable.

A few years ago, we had a triage nurse that we kept on way too long because of personal disasters in her life, and because we felt really sorry for her. She had been making a series of small mistakes that we kept excusing. Finally she directly contradicted a provider's medical recommendation for a sonogram, in writing, on the same note. I was present during her termination, sitting silently as the administrator discussed the situation with her. She gave a few excuses, fumbled around for things to say, started crying, and then looked at me and said "Really?" All I had to say was, "Really!" She stood up, threw the papers at the administrator, and stormed out of the room to clean out her desk.

Staff terminations are difficult, but remember, as the physician owner you are responsible for the greater good of your practice. Letting a poorly performing staff member go will strengthen the overall quality of your practice.

Rebecca Fox, MD,is the co-owner of a pediatric practice in Northern Virginia, a member of the Physicians Practice Physician Advisory Board, and a contributor to Physicians Practice's blog,Practice Notes.

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This article originally appeared in the June 2015 issue of Physicians Practice.