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Take your staff from good to great


Important as it is to find the right people, keeping them happy and productive is key to a successful practice.

Key Points

Los Angeles FP Steven D. Kamajian returned from a recent visit to the Mayo Clinic in Rochester, MN, with a new appreciation for the importance of hiring the right personnel. "The kindness and niceness of the nonmedical staff struck me as one of the keys to Mayo's success," says Kamajian. "If I could import that kind of Midwestern caring into urban America, I could change the very tone of my practice."

Finding patient-friendly, compassionate people isn't the only staffing challenge facing physicians today. Doctors also report problems retaining good employees, making sure people work up to their potential, and adapting to changes in staffing demands brought on by pay-for-performance and other incentive programs. In these days of stagnating reimbursements and rising overhead, doctors also struggle with identifying the right staffing number and mix for their practices. "It's crucial to get the right staff doing the right things," says Deborah Walker Keegan," president of Medical Practice Dimensions, a consulting firm, and co-author of Rightsizing: Appropriate Staffing for Your Medical Practice (MGMA, 2003).

We talked to consultants like Keegan, along with physicians in private practice, to find out how you can meet today's top staffing challenges.

Whatever the era, the pool of qualified non-medical personnel never seems large enough to meet the unique demands of private medical practice. But doctors these days are up against some especially high staffing hurdles-competition for the best people from other service-oriented industries, worker demand for more flexible work arrangements, the expectation among better educated front-office workers of higher salaries and better benefit packages, and so forth. Even in a down economy, well-qualified employees often make such demands, consultants say.

To compete successfully, they add, doctors need to become smarter recruiters. Among other things, that means doing your homework before you start recruiting, says Kenneth T. Hertz, a senior consultant with the Medical Group Management Association, headquartered in Denver. It's imperative to develop a clear job description, including a detailed list of responsibilities and qualifications. As elementary as this seems, not every practice takes this initial step, Hertz says. And that can lead to confusion down the road. Your recruitment ad should echo the major points outlined in the job description.

You can use a variety of media-print, broadcast, and online-to reach prospective employees. What works best in one market, of course, may not work as well in another. Assuming you aren't using a search agency, tailor your campaign to your locale. If you have a practice website, post an ad there. Also consider alternative approaches-posting notices in nearby schools, enlisting the help of current employees and rewarding those who bring in someone you hire, attracting good employees from other practices, and finding recruits in daily life.

This last technique can be especially effective, says Jeff Denning, a consultant in La Jolla, CA. "I'm always alert to people who work in Starbucks, retail shops, restaurants, and banks," he says. "When you see someone who seems smart, likeable, good with the public, and capable of multitasking, hand her your business card and say, 'If you're interested in a different type of career, I have plans for you.' "

Once you've identified a pool of qualified candidates, the screening or interviewing process should be as structured as possible. Hertz recommends developing a series of standard behavioral questions-questions designed to probe how candidates would react in a variety of situations. By having all applicants respond to the same questions, screeners can more easily compare their answers. In larger groups where new hires will interact with multiple departments and employees, Hertz recommends assembling an interviewing team, comprising, say, the practice manager, the department supervisor, a department member, and someone else who would have regular contact with the new hire. Practices without a systematic approach to recruiting-either because they don't know what they're looking for or don't know how to find it-are forced to rely on gut reaction. "A person may dress nicely and look good, but that's no yardstick for measuring his or her ability to perform," Hertz says.

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Jennifer N. Lee, MD, FAAFP