Running a successful medical practice today requires not only clinical excellence and a considerable amount of business acumen, it also requires some skill in managing people effectively. Through my many years of HR consulting and management in healthcare, I have worked with an abundance of excellent clinicians, both physicians and non-physician providers alike. And, as comfortable as many of them are in their clinical roles, and maybe even as business-minded entrepreneurs, they often feel somewhat uncomfortable and awkward when it comes to handling the basic employee relations cases and other HR-related issues that arise in every practice. So, I thought I might offer you what I see as the “HR Top 7 List for Physician Practices,” the most common challenges, potential pitfalls, and easy-to-miss opportunities that many others don’t consider. We are going to touch on:
- Top HR Challenge
- Top HR Principle in Action
- Most Important HR Form to Get Right
- Top HR Proactive Activity
- Best HR Investment of Time
- Top HR Blind Spots
1. Top HR Challenge: Hiring (and Keeping) Good Employees
I hear this over and over again from physicians, and it is a mission-critical issue. No physician can do it all. The best physicians sustain their excellence by having an excellent staff to support them. And the pain of employee turnover is real. Not only does turnover impact general morale, it also directly affects patient flow, provider productivity, and revenue streams. According to a recent MGMA study, annual employee turnover rates for overall medical practices were at 40% for front office, and at 33% for clinical and business office. (Per the 2023 MGMA DataDive Practice Operations Report.) Think about that for just a second. That would mean losing 2 out of 5 front staff each year, 1 out of 3 Medical Assistants, and having to retrain the new ones in the methods and protocols that you prefer.
No physician can do it all. The best physicians sustain their excellence by having an excellent staff to support them.
Keep Your Good People
The key may well be to keep your good people happy. And that doesn’t have to mean more money. Of course, you will want to be competitive with the compensation and benefits you offer your staff, but you don’t have to lead the market when it comes to pay. For you to provide a supportive and positive work environment (with occasional displays of appreciation and encouragement) will mean just as much.
By the way, if the annual employee turnover at your practice is considerably under the 33% to 40% range, then pat yourself on the back, and continue doing whatever it is that you are doing!
2. Top HR Principle in Action: Fair and Uniform Treatment of Employees
This one may sound easy, but it may not always be that way in day-to-day practice. We are all human beings, and it’s easy to connect with some people more than others. And, while there is nothing wrong with that as a concept, it can become problematic if you display overt favoritism and inequitable treatment. This is especially true as it relates to your stated policies, the benefits you offer, and the administering of disciplinary actions.
An Example of Inequitable Treatment
Case in point: What if you had two Medical Assistants on your staff, and one of them works circles around the other and has been with you for years. Now, what if they both have been tardy on 4 different days within a given month, and you enact a disciplinary action on the Medical Assistant who is the lower performer, but you don’t want to upset the better performer, so you choose to not write her up. This could easily lead your lower performer to feel that they are not being treated fairly, which in turn could lead to them feeling they are being discriminated against, which is not a good dynamic for any practice.
So what should you do? You would certainly want to reward excellent performance along the way (even with just words of appreciation), and you would also need to address performance issues calmly, professionally, and uniformly when they occur, no matter who needs to be addressed.
3. Most Important HR Form to Get Right: The Employment Eligibility Verification Form (I-9)
This form was created as part of the Immigration Reform and Control Act of 1986, and really took center stage after 9/11. Even to this day, the federal government maintains very specific requirements in completing and maintaining this form that exceed just about any other HR or employment form there is. I-9 forms need to be completed by a representative of the practice who will sign (under penalty of perjury) that they have personally witnessed very specific forms of ID from all new hires. Further, this process must be completed within 72 hours of hire, or you are not in compliance with the law.
What If a New Hire Doesn’t Have Proper ID?
If a new hire does not have acceptable forms of ID, they should not be allowed to work until they obtain and provide the correct documents. And the U.S. government still prefers for this particular form (the I-9) to be maintained in hard copy, rather than digitally only. I can’t think of another HR-related form where that is still the case. You just don’t mess with the I-9!
4. Top HR Proactive Activity: Documentation
We all know how important medical records are as a component of good patient care. Documentation is key. Well, the same concept applies when it comes to handling difficult HR situations with your staff. Good coaching is an integral part of improving the skills and outcomes of your staff members. When you (or your office manager) have a serious conversation with one of your employees about their performance, or when there is some kind of disciplinary action, make sure that the basics of the conversation are recorded. Document the date, people involved, situation to be improved with measurable specifics, and so on. And then set a follow-up date, and document it. This kind of information will help you in the future if faced with an unemployment claim or (worse) a court case involving a disgruntled employee with a wrongful termination claim.
Something else that is important and related to documentation? Have every member of your staff sign an Acknowledgment of Receipt of your Employee Handbook, which hopefully outlines various policies and expectations you have of your staff.
5. Best HR Investment of Your Time: (Occasional) Positive Reinforcement of Your Employees
This one harkens back to the Top HR Challenge, keeping good employees. As a medical provider, your words carry a magnified impact to your staff, both the kind words and the words of admonishment. When you occasionally pat one of your employees on the back, it is very meaningful to almost any one of them. That is, it would be meaningful to the type of employee you want to keep. A few years ago, I worked with a physician who was highly respected by his entire staff, but he was a quiet man who did not verbalize or display much appreciation. He planned to throw an elaborate and expensive holiday party for his staff, and asked me if I thought that was the best way for him to share his appreciation with his staff. I told him it was a wonderful idea, but that if he made it a habit to occasionally praise employees when they really performed well at their jobs, at the time (or just after) he witnessed them perform their jobs well, that doing so would be invaluable to employee engagement. It was not a natural thing for him to do, but we discussed a mini-action plan to make it workable for him. He later reported to me that he tried it out and was surprised at how enthusiastically received his words of encouragement were. (Full disclosure: I think he eventually had his big party anyway, and may have delegated the positive reinforcement to his Office Manager. But hey, at least he gave it a shot initially and was happy with the results!)
6 & 7. Top HR Blind Spots: Updating Your Employee Handbook and Employment Law Posters
Employee Handbooks are not set in stone. They should be viewed as fluid documents that need to be updated and revised periodically. Sometimes they need to be updated due to changes in employment laws (whether at the federal or state level). Sometimes they need to be changed because you revised your benefit offerings or added an internal policy. And sometimes they should just be refreshed to keep up with the times. It’s a good idea to have your Employee Handbook reviewed every two years or so, to make changes as needed, to communicate those revisions out to employees, and to document that the revisions have been shared with staff. (See Top HR Proactive Activity: Documentation above!)
Are Labor Law Posters Important?
And what about those employment law posters you probably have posted in the employee break room or kitchen? They serve an important purpose in the world of HR compliance in terms of protecting you from problems with the Department of Labor. But only if they have the required information that is currently mandatory, and not from 5 years ago. You may want to ask your Office Manager when the last time was those posters had been reviewed or replaced.
Now What?
If even a few of these Top 7 issues resonated with you, it may be time to have the HR processes and level of HR compliance at your practice reviewed by an HR professional. At DoctorsManagement, our HR team specializes in working with physician practices to:
- Reduce employee turnover
- Improve staff engagement and productivity, and
- Maximize your HR compliance
Call us at 1-800-635-4040 to find out more, or email me directly at [email protected]. And we can make the “HR Top 7 List” a reality for you and your practice!
About the Author
Tom White is an HR consultant with DoctorsManagement, LLC, where he helps physician practices strengthen their human resources processes, reduce turnover, and maintain HR compliance. He can be reached at [email protected].
