PRACTICE POINTERS

Hiring—and keeping—good clerical staff

Does your office have a revolving door? Here's expert advice for stopping it.

By Talia S. Krohn

Before completing medical school, internist Jeffrey M. Kagan of Newington, CT, worked as a physician assistant and was responsible for hiring employees. Kagan recalls how "the doctor used to have me hire inexperienced people and pay minimum wage. Invariably they'd leave after a year or two to seek similar work. Now that they were experienced, they could get much more money. I used to spend a lot of time interviewing for new employees."

Sound familiar? The problem of hiring and keeping good nonclinical people has been around for as long as examination tables or stethoscopes, but it's getting worse. Due to the need for greater specialization among nonclinical staff, the growing number of government and managed care regulations to keep track of, as well as the new emphasis on "customer service," it's increasingly difficult to find competent and qualified employees.

But it is possible. Jeffrey Kagan does it, now that he has his own practice. Here's how you can do the same.

The best approaches to finding good applicants

The first step is to recruit the right candidates. Where to begin? Practice management experts agree that it's especially effective to place ads in print media, such as your local newspaper. Give a brief job description and a post office box number where candidates can mail their resumes. Omit your phone number and address, to keep calls and envelopes from flooding your office.

Office manager Deanna Perzan of NovaCare Rehabilitation in Baltimore, who's an area representative for the Professional Association of Health Care Office Managers, also recommends advertising in professional association newsletters and local clinical journals.

Another way to lure good office employees to your practice is to post help-wanted ads in the right locations. Practice management expert Judy Bee of Practice Performance Group in Long Beach, CA, suggests placing ads on hospital bulletin boards and intranet sites, where they'll be spotted by people who may be looking to trade in the chaos of the hospital setting for private practice employment. Consultant Michael Brown of Health Care Economics in Indianapolis recommends posting ads on bulletin boards at local business schools or medical assistant schools.

What about advertising on the Internet or your practice's Web site? Most doctors and practice management experts say No. Internet job postings often attract masses of people, most of whom lack the training and qualifications necessary for the job. Similarly, an ad on your Web site can attract employment-seeking patients, who tend to be unsuitable for the job, yet difficult to turn away.

Narrow the field with these tips

Let your ad run until you've accumulated at least five promising applicants after eliminating any who clearly lack basic qualifications, such as a high school diploma.

Next, have your office manager or trusted assistant conduct phone interviews. Make clear what you're looking for in an applicant, and how you want the interviews conducted. This should narrow the pool of candidates to no more than three, whom you can then interview in person. Review each resume thoroughly, then spend at least 30 minutes with each applicant.

David L. Sharp, a family physician from Houghton Lake, MI, uses a different method for winnowing job candidates. He places a blind help-wanted ad in a newspaper with a brief job description and a telephone number that rings directly to a voice mail service or answering machine. The applicant is instructed to leave a message telling why she qualifies for the job.

Sharp says, "You can tell lots by someone's tone, degree of friendliness, how they handle themselves in a one-sided conversation, how much self-confidence they have, and so forth."

Once you've discarded the candidates with unimpressive messages, you can follow up with the others by phone and request their resumes. "It's incredible what a good screening tool those recorded messages are," Sharp says. "I've hired at least four or five good people that way."

What to look for, what to ignore

Once you're ready to conduct interviews, it's important to know exactly what qualities to look for. According to Judy Bee, these qualities vary considerably among nonclinical positions. The mistake doctors often make, she notes, is trying to find a single employee who embodies all the ideal qualities and skills needed for every office position.

For instance, "it's critical that a front-office employee be able to do several things at once with a smile," she says. But, in the back office, social skills are less important than up-to-date coding knowledge and accounting acumen.

So, if you're hiring a receptionist, the most important quality to look for is the ability to multitask. After all, a receptionist must often juggle phone calls, book appointments, and chat with patients simultaneously. A friendly disposition in the receptionist (who usually has more contact with patients than you do) is very important, as well.

But for back-office positions such as billing clerk and bookkeeper, size up a candidate's skills by having your office manager administer a coding quiz. And count it a plus, Bee says, if a back-office candidate says she likes to give complete attention to the task at hand and prefers to work alone.

Surprisingly, computer skills aren't as important as you might think for nonclinical staff. Most practice management experts maintain that although basic computer literacy is crucial, advanced computer skills aren't an indication of how well an employee will do. "So many different software packages are used by different medical offices, the new employee will almost always have to learn a brand-new program regardless of her skills," Bee explains.

Moreover, technology is changing so rapidly that many computer skills quickly become obsolete. Says consultant Sherry Yingling of Sherwood Institute in Warrenton, VA, which develops programs for continuing physician education: "Most people who've had some work experience have had the opportunity to use computer applications, so I'd stress the ability to adapt to new technology."

Roy Huntsman of Medical & Dental Management in Gainesville, FL, places even less importance on computer experience, stating that a good mental attitude is far more important. When hiring office staff, he says, technical skills beyond typing and the ability to learn how to operate a simple program are often unnecessary.

Before you hire, do your homework

Before you make a final decision, do a background check on the person you want to hire. How detailed to make your check depends partly on the position, partly on personal preference. If the new employee will be handling money or confidential patient information, it's a good idea to check for criminal convictions; for a less sensitive job, checking references will usually be sufficient.

Neurologist Marc Nuwer of Los Angeles, who favors full background checks, notes that over the years, his practice "has excluded some felons." Another doctor once came across the name of one of her employees when reading the police report in the local paper. Now she always checks criminal records.

On the other hand, consultant James A. Kimble of Gilmore, Jasion & Mahler, in Toledo, feels it's more important to contact as many previous employers and personal references as possible. "Ask the employer if he would hire the employee back," he recommends.

When it comes to personal references, be prepared to delve deeper. Since a personal reference is unlikely to come right out and say something negative, you'll have to ask specific questions about qualities and characteristics to probe for the candidate's weaknesses.

Once the employee is on board, don't scrimp on wages and benefits

Now that you've hired the perfect employee (you hope), the challenge is to retain her. Often, it's money that lures staff away. According to Judy Bee, you have to offer wages that are competitive not only with other doctors' offices, but with other businesses. (See "What selected nonclinical staffers are earning by the hour" to see what medical practices nationwide pay for nonclinical employees.) "You're competing with all employers within a reasonable driving distance from your practice," says Bee.

Generous benefits are also essential if you want to keep your employees. Pension plans, health coverage, and dental insurance are most important, according to Mary Carol Parker, human resources manager and consultant at Clayton L. Scroggins Associates in Cincinnati.

Don't forget flexible hours as a good incentive for employees to stay onboard, she adds. Although front-office staff (for the most part) must be present during patient hours, she says you can be more flexible with business office staffers, who don't necessarily have to keep the same hours as the doctor.

Job sharing is one way to create more flexibility. Says Carol Gilchrist, a nurse and medical office manager in Chelmsford, MA: "One of the things we recently did to fill a position with less than desirable hours (2 to 5:30 pm, 2 to 7 pm, and Saturdays from 8 am to noon), was to find two mothers of patients in our pediatric practice who together agreed to fill those spots. They work out their schedules and let us know who is working which days. This has turned out very well for us and for them."

Just as important as flexible hours are days off. A reasonable amount of leave will not only keep employees content and loyal to your practice, but also combat burnout and increase productivity. New England internist Jeffrey Kagan recommends 10 sick days, eight paid holidays, and five to 15 days of vacation (depending on years of employment).

Others prefer to provide a set number of days off to be used at the discretion of the employee. Says Baltimore office manager Deanna Perzan: "I like the concept of lumping all time off in one category. For example, 21 days' total leave can be used as vacation, personal time, or sick time. Employees will use less sick time because they don't feel they have to use it up under a 'use it or lose it' rule." Incentives for longevity also go a long way. Bee advises linking vacation time, benefits, and bonuses with number of years of employment.

The office environment can help keep employees

According to consultant Michael Brown, nonclinical employees account for 90 percent of the turnover in medical practices. A main reason they choose to leave, he says, is dissatisfaction with the doctor or the office environment.

So try to foster a team environment and keep office morale high. Clinical employees receive constant feedback from the doctor, Bee says, so it's important to remember to express praise and gratitude to nonclinical employees, as well.

Doctors, too, maintain that teamwork is a big part of what makes for a good working environment. Parker notes that this is often achieved when the doctor puts together a mission statement for the practice. "When employees can read the practice's mission and see other staff and doctors demonstrate its principles, they better understand their roles. The employees will then live by this statement, building teamwork and a sense of purpose."

Internist Catherine R. Landers of Skokie, IL, finds it's effective to have monthly staff meetings over lunch, where everyone participates in problem solving and idea sharing. Celebrating birthdays in the office and including one another in family occasions, she says, have made her office staff not only a team but also a circle of friends.

One surgeon says that his secret is making sure the lines of communication are open both ways. His golden rule—"You can talk to me about anything and everything"—has helped him foster an office environment built on mutual respect and trust.

The consensus: Show your appreciation for their hard work, listen to the things they have to say, and make them your friends, and they'll be loyal to you and your practice.

The author, a student at Trinity College in Hartford, CT, researched and wrote this article as an intern with Medical Economics.

What selected nonclinical staffers are earning by the hour

 

Talia Krohn. Practice Pointers: Hiring--and keeping--good clerical staff. Medical Economics 2002;1:51.