Spouses at Work

Question: Our little clinic is fighting high overhead. So the wife of one of my physician partners offered to come in and work the front desk for free. We let our part-time receptionist go and are saving money. The problem? Now all the spouses want to help. I'm grateful for the help but feel uncomfortable about it. For one thing, the spouse already working here knows she is a volunteer and doesn't come in if she has an important conflict. It's just not a real job, and she, rightly I guess, treats it that way. But how can I handle this issue with my partners? Can I work with one wife but not the others? How do I say no?

Answer: Wow. This is an unusual problem. Setting aside the other spouses' desire to help, the first thing you must do is establish the employment status of the one already working for you. That's because her working for free could be a violation of the federal Fair Labor Standards Act (FLSA), which states you must pay employees at least a minimum wage. However, according to our human resources expert Bob Vidal, the FLSA does not apply if the wife is truly a volunteer, or if she is considered an owner, which she may be (by virtue of her marriage) if your practice is set up as a limited liability company. Still, Vidal says that "if there is a question about her status then prepare a letter stating that the individual has a volunteer status not eligible for pay or benefits."

Now, as to the question of dealing with the other spouses: I think your first step needs to be to clearly articulate to your partners the problem with this set-up. It's great that everyone is so supportive of the practice, but it is a management nightmare. Your office manager can't possibly manage the spouses as you would any other employee, and neither can the physicians. Give them some examples. Here's a real one that another practice wrote me about - the manager had reason to believe that the physician's wife was stealing money. How could the manager confront her without also insulting her husband - the manager's boss? But even something as simple as expecting employees to show up on time and to follow specific protocols becomes an issue if they are spouses. You simply have no recourse if a wife decides not to come in - other than to ask another staff person to cover for her. It's hard to run a business that way. Too many cooks and no responsibility.

Then, quickly point out the more positive roles these women can play. I have to guess that their backgrounds gave them skills beyond those needed by a receptionist. Are they trained in marketing? Technology?

Match their skill sets with projects for the office. They might shop out EMRs, set up an auction to benefit low-income patients, do business planning, or research billing and collection workflow in medical practices and offer suggestions for improving yours. They'd have their own project-specific, pre-set budget, responsibilities, and timeline. They could present ideas that the physician partners approve or change - they don't "report" to the manager. And, the beauty of it is that instead of saving the practice $13,000 a year in receptionist costs, they could save you hundreds of thousands in high-level consulting fees.

In short, change the terms of the conflict.