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Great Medical Employees Are Vital


The ability to hire and manage top-notch staff is an important skill that doctors have no training for.

A doctor office’s staff and its image are critical. Patients have a difficult time measuring quality of care, along with the rest of us, so they, and we, rely on proxy measures. This includes word of mouth, online sources, the appearance of the office and doctor, and, critically, the mien of the office staff. In addition to appearance, the staff's competence and attitude are vital to a doctor's success, let alone the welfare of the patient.

And the ability to hire and manage top-notch staff is another in the long litany of important skills that doctors have no training for. The obverse is even more important: preventing, identifying and rooting out the bad apple.

There is research that tells us that just one slacker or bad apple in your group can bring down performance by 30% to 40%. And the negative interactions that these folks can produce have five times the impact of any positive interactions. That's just the way our psychology operates. Similarly, a healthy marriage or relationship can be assessed by a ratio of at least 5:1 positive to negative interactions. A lower ratio is a warning sign in each of these settings, aka as the "Bad is Stronger than the Good" effect.

So how can you, as a prospective employer without any human resources training, sort out your applicants? Doctors tend to fall back on the usual suspects of looking at a resume for experience and training, but that doesn't tell you much of what you really need to know. Even references are iffy, for those surprisingly few of us who actually follow through with this additional key to rooting out a dud. It's also regrettably true that references have learned to be leery of potential legal trouble and are often cagey. Unfortunately even a prospect's brilliant interview or appearance can easily disguise a person's laziness, incompetence or nastiness in day to day.

You can ask what an employee wants, needs and fears, but you usually don't find out those keys to a personality until much later through experience. Much better, many experts say, is to bring the prospective hire in for a day or two of paid work.

Not only do you get a quick demonstration of skills, but also, even more vitally, of personality and character and how they handle various situations in real time. I learned the hard way, with various misadventures, to do my homework with references, asking primarily about personality and character. I can teach anyone to run an EKG, for example, but not necessarily how to reassure the patient having one.

And in a working test you get to see how the newbie relates to the staff and to the patients. Technical and interpersonal deficiencies can become known even in this abbreviated time. Sometimes having the staff cross-interview helps with rooting out the occasional rutabaga or beginning to build a relationship with a good fit.

Hiring right is doubly important because it can be very difficult to remove a bad match later. Even "at will" employees now have a profusion of legal rights that require documented, specific warnings and time lines. Better to put all that effort in at the front. Many doctors don't, hiding their lack of preparedness under a gruff "I'm too busy," or "My office manager will handle it." Maybe they will and maybe they won't, but ultimately, even in a large group setting, the responsibility for your assistant's performance is your ultimate responsibility.

When I had sold my practice to be able to spend more time teaching — to maintain my street cred — I joined a large, multispecialty group that could accommodate my part-time needs. Hiring my assistant was remote from me in some other department in some other building, but I inserted myself in the process from the get-go. I realized the vital importance of this position to my success, especially being connected to the staff and patients only part time. As a result I got a gem and all constituencies were the better for it: me, her, the group, the other staff and, most importantly, the patients. And we worked as a team to ensure good communication and continuity.

Assuming that you have hired well, it is just as important to develop a successful culture that does not tolerate bad actors. That is to say, an environment where certain behaviors are unacceptable, with policies put into place to prevent and halt them. Specifically, demeaning colleagues and putting personal needs ahead of others come to mind. A culture of complaint too, common enough in medicine, can be corrosive if not kept light-hearted and infrequent. And how does whining help anything?

I once heard a bit of wisdom about getting along in a fast-moving, interconnected group such as you often see in medical settings. First, "Respect each other's space." Second, "Respect each other's differences." Third, "Be very clear with each other." Just as in most other areas of human interplay, communication is the key to better results and a happier workplace, which often are co-dependent.

In an increasingly complex medical marketplace, with closer to the edge margins, even having an "OK" staff is not good enough. And being busy, it's easy to become complacent. So try this: Ask around and visit a few recommended colleagues’ offices until you strike upon that one situation where the clouds part, the sun shines through and the music starts. You'll know it when you see it.

Study them, ask questions and then go back to your office. Do some homework to better understand what you have seen. Then you'll know if you have an office policy problem or just a bad apple that needs culling.

As I rant on about through this series, everything you need to practice good medicine, and have a rewarding life along the way, does not, unfortunately, come from your medical training. More's the pity, but thank goodness for resources (such as PMD) where we can at least learn to play catch-up football.

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice