Your Guide to Firing Medical Practice Staff

Dismissing a team member, either for poor performance or financial reasons, is emotionally wrenching for all. In the best case scenario, it creates ill will for the terminated employee and anxiety for the staff members left behind. In the worst case, it can result in a patient mutiny, morale crisis, or legal claims.

To protect your practice and maintain a productive work environment, Ricki Roer, an attorney with Wilson Elser Moskowitz Edelman & Dicker in White Plains, N.Y., says leadership is imperative every step of the way. "The bottom line is that the physician owners are going to be the ones named in any lawsuits, so they must take full responsibility for the work environment they create, including termination sessions," she says. "Making sure that the employer is properly protected and fully assessing the decision to terminate is one of the great challenges for any employer, but it's even more so for physician owners because often their concentration is not in business or in creating a human resources apparatus within their business organization."

Here's how to fire a staff member the right way.

STEP 1: CONSIDER THE LEGAL ISSUES

Before a physician should even consider firing an employee, Roer says, they should carefully weigh whether a "legitimate business reason" exists for doing so - the standard defense against wrongful termination claims. Specifically, review the employee's file to determine whether he ever complained about unfair work practices, or indicated he was in need of accommodations related to religion or disability. Were such requests granted? Look, too, at the employee's written evaluation history. "Were they given wonderful rave reviews or top raises every year and does that in any way conflict with your stated reasons for articulating a legitimate business reason?" she says.

Consider, too, whether other employees who are "similarly situated," a legal term meaning those with a similar performance record, were treated differently, which could open the door to discrimination claims. And take note of whether the employee you are looking to fire falls into a protected employment category based on race, religion, gender, or age. Does any pattern of terminations within those categories exist, or appear to exist?

Most who work for physician practices are considered "at will" employees, says Roer. Thus, they can quit at any time without reason, and their employer may fire them without cause as well. Keep in mind, however, that the courts may consider any employee manuals you use or procedural processes for disciplinary action to be an "implied" contract, which could limit your ability to fire staff members at will.

Beyond exposure to claims of wrongful termination and discrimination, physicians are also uniquely vulnerable to legal accusations of false claims by disgruntled former employees. "This is an area where we've seen a huge increase," says Roer. "Ensure your practice does not in any way violate any of the guidelines for proper billing, because if there is a situation of any concern about compliance that opens the door to a disgruntled employee bringing up these issues and helping the government pursue a case." Whistleblowers are financially motivated to come forward, she says, because they get "a piece of the pie."

STEP 2: PREPARE FOR THE PROCESS

Once the decision to fire an employee is made, and all your legal bases are covered, the physician owner must decide who delivers the news. In larger practices, that may be the human resources supervisor or the employee's immediate supervisor. But a second manager, or the physician, should always be present to witness what was (and more importantly, was not) said. The physician owner should also ensure that all keys, phones, and laptops belonging to the office are turned over before the employee leaves, and that computer passwords to any software programs are immediately changed.

Throughout the termination process, it is important to show the employee the respect he deserves, both because it's the right thing to do and because it minimizes ill will, says Michael Munger, a family physician in Overland Park, Kan., and a director of the American Academy of Family Physicians. "It's important to do this privately, without a lot of bystanders," says Munger, noting it will cause less embarrassment to break the news when the fewest staff members are present - either at lunch, or at the end of the day. "Take them to a separate room and give the employee as much dignity as you can." Some HR experts suggest terminating staff early in the work week rather than on a Friday, giving them an opportunity to send out resumes right away rather than pondering their unemployment over the weekend. Either way, the employee's last day should be the same day she is terminated. Whatever is owed to her for the remaining pay period, or per her contract, must be paid in full, but you don't want an angry employee kicking around the office for the next two weeks.

STEP 3: REASSURE THE REMAINING STAFF

After the employee has left the office, the physician's role becomes central. "As the leader of the office, the physician owner needs to be the one communicating with the staff," says Munger. Don't let the news trickle out if you hope to manage morale.

Be sure, too, to address your staff personally rather than sending out an e-mail. "In a very straightforward way, tell them that this person is no longer part of our team, without divulging a lot of details, and immediately set to work planning for those job functions that need to be handled until their replacement is hired."

Take time specifically to address the concerns of your staff members. Be sure they understand that their own jobs are secure and that every effort was made to retain the staff member who was just let go. "Anytime a fellow coworker is no longer there that can lead to worry for their own job," says Munger. "In a doctor's office, you work together as a team so it affects everyone. It's really important to talk through their concerns and help develop an action plan together for how we're going to get the work covered."

There's no easy way to terminate an employee. By managing the process professionally and treating your staff member with dignity, however, you can minimize potential aftershocks. "The more attention and detail physician owners invest in a well-run professional work environment that is compliant and knowledgeable of all its obligations and duties, the better protected they are," says Roer. "That is a great investment of time as well as dollars."

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

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