Seven Secrets To Successful Hiring

What is more nerve wracking than hiring people to staff your practice? Tightrope walking might qualify but more often than not, there is a net below to catch you if you take a wrong step. Jumping out of an airplane also comes to mind but you would usually have a parachute that should keep you from really hurting yourself. Indeed, hiring can be more intimidating or worrisome than either of those things partly because there are no safety measures that keep you from danger after you have brought a person on board. A new employee is live, in person, on your phones, in front of your patients, behind your counter, at your computers and in your waiting rooms. You must use all the safety mechanisms at your disposal before you hire and there is the rub. Unless you received a crystal ball along with that DPM degree, there is no way to know for certain whether a new staffer will contribute to the richness of your office culture or cause it to curdle. You and your office manager need to do all the homework up front in order to have the best chance at improving your office operations with the introduction of a new employee to your staff. What follows are pertinent common sense practices that you and your team can and should employ to find the best people possible, bring them into your operation and retain them for the long haul. They are common initiatives used and endorsed by some of the most knowledgeable practice management experts in podiatry. They have lived, hired and learned, and they want to help you make your practice the best it can be. 1. Know What You Need Before you write your first “help wanted” ad, read a résumé or conduct an interview with a potential applicant, you must know and understand the staffing needs of your practice. The first step is to stop and look around your practice and at your current staff. “If you are aware that your current employees are working too hard, it is probably time to think about adding staff,” notes Lynn Homisak, PRT, a team partner and practice management consultant with SOS Healthcare Management Solutions, LLC (www.soshms.com). “If they are supposed to be working on a new project but keep missing opportunities because they do not have the time, that is another indicator. Basically, when you have effectively used the talents of all your employees and things still are not getting done in a timely manner, you should start thinking about adding staff.” Hal Ornstein, DPM, the Chairman of the American Academy of Podiatric Practice Management, adds that these scenarios might be indicative of a process (and not a people) problem that you should assess and address before beginning to look for new staff. “It is not always a good idea to just throw people at the situation,” he notes. Dr. Ornstein suggests looking at every system and process before hiring new people, and examining what each employee is doing and what he or she should be doing. “It is not just saying, ‘Oh, we are busy, we need more people.’ It is taking a critical look,” he says. The doctor and office manager should share the burden of determining a course of action, according to Jonathan Moore, DPM, a Trustee of the American Academy of Podiatric Practice Management. “The office manager is really the anchor to the ship,” he remarks. “If you want to go about the business of building your practice, you want someone you can trust in the role of office manager. He or she should have experience in managing a practice, particularly the front office—the receptionist, the billing people and those positions. The office manager can certainly be an enormous help when you are determining what you need in the way of new staff.” It also helps to know how much revenue your practice is bringing in so you can determine the appropriate level of expenditure for staff salaries and benefits. John Guiliana, DPM, says the majority of podiatric practices operate most efficiently when the staff payroll, including taxes and benefits, is a ratio of 22 to 25 percent of the practice’s annual collections. Dr. Moore, whose Somerset, Ky. practice maintains a 17 percent ratio, agrees with Dr. Guiliana. However, he also notes that the location of a practice is a key factor in determining the appropriate percentage. “That percentage is going to depend on where you are geographically,” he says. “We are in southern Kentucky, which is a rural environment. We have 11 staff and we pay higher than any other physicians here in the area. However, there is a lower wage here because of our location.” 2. Emphasize Intelligent Recruiting Once you have considered your staff needs, processes and what your practice can afford, you need to find and attract the best and brightest talent available. Recruiting these people can be quite a challenge. Granted, there are many ways to go about it. One may want to broadcast the opening to the widest possible audience or simply talk to a specific person you want in the job. Not surprisingly, everyone has his or her favorite way to recruit. “Word of mouth is the best recruiting method,” insists Dr. Ornstein. “Ask around. People forget to do something as simple as asking others. Ask your patients. They are a great resource. If there are medical technology schools around, ask them. The hospital is a good recruiting place. Ask around there.” Dr. Moore again notes the role geography plays in such a key function as recruitment. “In our area, you are going to find more challenges when you are looking for people with the experience and education we typically look for,” he says. As Dr. Ornstein explains, a practice can put ads in the paper or contact other medical offices to find out if anyone has left. He says his practice recruited its office manager from another medical practice out of state. They were able to reach out to the office manager through a contact that Dr. Ornstein’s nurse practitioner had. “We did our homework to find someone with the most experience,” he continues. “It is tough to find that experience around here.” Dr. Guiliana says experience is fine but, particularly when it comes to office staff, you should take other intangibles into consideration. “My first assessment of people typically has to do with their attitude,” offers Dr. Guiliana, a Trustee of the American Academy of Podiatric Practice Management. “For front office staff, I suggest recruiting and hiring based on attitude and not necessarily experience in a medical or podiatric practice. You can always teach them practice matters and procedures. You cannot teach them attitude.” Dr. Ornstein wholeheartedly agrees. “You can train skills but not customer service,” he explains. “The best people for front office staff are the people who work in grocery stores, waiters or waitresses. Anybody who is outstanding in the service business will likely be outstanding with your patients. If you get great service at a restaurant, give the waitress your business card and tell her, ‘If you are ever looking for a job, give me a call.” Another recruiting must-have is a solid, specific job description. Do not be afraid of putting too much detail in your description of a position. You will regret it down the line if you go light on the details. “The candidate absolutely must know what the job entails,” insists Dr. Guiliana. As he notes, the job description covers the position’s inherent duties as well as specifics on compensation, room for growth and the practice’s expectations. “You cannot gauge whether a person meets your expectations if the person doesn’t know what those expectations are,” says Dr. Guiliana. 3. Conduct A Good Interview Interviewing candidates who make it through the initial vetting process gives you and your staff the opportunity to gauge how well the person would fit into your practice. Naturally, to get the best glimpse of that potential outcome, you should avoid taking a “vanilla” approach, according to Dr. Ornstein. “A good interview is one in which you get people to think out of the box,” he says. Whereas an average interviewer might ask the candidate to “tell me about yourself,” Dr. Ornstein will ask, “Who was your worst boss and why?” or “What was your best job and why?” He says such questions make candidates think and will reveal a lot about them. Dr. Ornstein also suggests role-playing, such as asking a candidate what to do when patients complain about waiting a half-hour in the office. “A good candidate will be able to logically think through role-playing questions and scenarios,” agrees Dr. Guiliana. “Sometimes, there is no right or wrong answer to those kinds of questions but you are just looking to see how the person might react if he or she is in that position. Good candidates are also not afraid to ask questions. The best candidates come prepared with questions for me.” Preparation is also a key factor on the interviewer’s side of the desk, according to Homisak, a member of the Board of Trustees of the American Academy of Podiatric Practice Management. She suggests having a list of questions to guide the hiring process and keep you aligned with what you want to know. Otherwise, the conversation could veer off track. As Homisak says, a list of questions keeps the interviews consistent so you can judge all the candidates equally. Homisak also advocates including others in your office in any interview process. “It is highly beneficial for the key staff person who will be working with the candidate to participate in the interview. A second opinion or perspective will help make a better hiring decision,” notes Homisak. “Also, if there is a personality clash, it is better to find out sooner than later. If you want people to work well together, involve them and allow the team building process to begin.” Dr. Ornstein likes to take such a scenario one step further, saying he leaves the candidates in the reception area to see how they interact with other people. “That gives you your best impression of how they will interact with patients if they are hired,” he says. Of course, dress and attire can reveal a bit about how well the candidate will fit in. First impressions really do count for a lot. However, some new hires might still surprise you. Dr. Moore recalls hiring a woman in her mid-20s who had an impressive interview. However, when she arrived for her first day of work, she had “a stud in her nose,” notes Dr. Moore. “I had to tell her that was not appropriate,” explains Dr. Moore. “Our patients are older folks and they really do not understand nose rings.” 4. Ensure Due Diligence Dr. Moore hesitates to do background checks for every person he considers hiring. He chalks it up to the area in which he practices as well as the people who help him recruit his staff. “We have run background checks but we don’t do that routinely for every person,” he notes. “We are in a smaller community and the people who work for me are people who have very good reputations in that community.” In a small town such as the one that Dr. Moore practices in, he says there is a small network and when he is searching for a new employee, he asks his staff for recommendations. He says the last few people he hired are people whom his staff recommended, people his staff either knew or heard were outstanding. Dr. Ornstein, who practices in New Jersey, takes a different approach. He says background checks, which cost $30 to $35, are “so important” to his practice. “It is due diligence. It is a legal and common sense issue,” he insists. “What if I hire someone who is a thief, who steals my employees’ pocketbooks or my patients’ pocketbooks? People would get angry with me if I did not check up on that before I hired that person. I feel liable if I bring someone like that into my practice without thoroughly checking him or her first.” 5. Pay Staff Appropriately One of the most difficult issues to address when hiring is what to pay your new employee. There are many dynamics to consider, not the least of which is what other practices are paying for similar services in similar positions. “There is no standardized scope of practice for podiatry assistants,” notes Homisak. “Without a base description of the role, their duties can vary from state to state and thereby, office to office.” As Homisak explains, one assistant with extensive internal training and education as well as hands-on patient care experience would deserve a salary commensurate with such a level of responsibility. However, she says another podiatry assistant, whose duties are limited to cleaning and preparing treatment rooms and ancillary tasks like filing and restocking drawers, should expect to earn a lesser wage. Dr. Ornstein suggests asking potential staff what they expect, perhaps having that question on the application. He says that will provide guidance for hiring. “The message here is to not have a steadfast, cut and dry standard salary,” notes Dr. Ornstein. “(However), my overall rule of thumb is pay them more than they are worth. You need to pay for quality.” However, Homisak notes candidates with less experience should expect to be paid a lower wage to start with until they prove they are capable of handling the tasks for which you hired them. If you feel they are working out well, reassess their pay during their first review, suggests Homisak. If the prospective employee does have experience working in a podiatry practice, it might be reasonable to ask what he or she is currently being paid. Homisak suggests starting the employee at the pay level and bumping up the pay if he or she has earned it by the time of the performance evaluation. Potential hires and those doing the hiring should also consider the worth of a solid benefits package. “Medical offices cannot compare to the very large companies in terms of salaries or wages,” points out Homisak. “Accordingly, it is important to make sure candidates know the value of any benefits offered to them.” Staff should consider the benefit package in their overall compensation. For instance, health insurance, defined benefit or defined contribution plans as well as sick and/or personal days can all offset a dollar wage amount, according to Homisak. 6. Don't Forget About Training Most practices encourage a new hire probationary period of at least 90 days. This period allows the staff to get to know the new person and this period gives the new employee the opportunity to prove his or her value to the practice while performing real duties in the office with real patients. This is also a period of training. It is important to share knowledge and teach the new employee key aspects involved with the operation of the practice. However, Dr. Moore cautions DPMs and office managers about overwhelming the new staffer during this period. He learned this when he hired a new nurse for his office. “There are two other doctors here and a nurse practitioner and we all work at different paces,” he says. “I work at a furious pace. I have a pretty complicated system that my nurses and I work with. I have made the mistake of bringing in a new nurse and having her train with me. That is not a good idea. We have overwhelmed people that way and it can be frustrating for everyone.” Dr. Moore has remedied that situation in his practice by having new hires train with the practice’s nurse practitioner, who primarily handles routine care. “The new person can learn the system at a less crazy pace and find out as well how each doctor in the practice works,” he says. “We get them started without making them feel overwhelmed. We don’t want to throw people into the fire.” 7. Take The Long-Term View Dr. Moore also likes to let his staff know up front that he wants them there for the long term. “Any time we interview someone, I tell him or her, ‘If you are the person we hire, you are family.’ We encourage a family-type environment here,” says Dr. Moore. “It can get chaotic but we treat our employees well.” That treatment includes a good salary and benefits packages, which aid in retention, but it also includes opportunities for professional growth. “We encourage everyone on our staff to learn and be self-learners,” notes Dr. Moore. “You are going to be able to teach them a certain amount but they are going to have to take what you teach them and do a little bit of work on their own in order to grow and improve.” To limit turnover, Dr. Ornstein encourages and maintains an open door policy with all staff. “I let them know communication is key,” he says. “It is a relationship like marriage or friendship. I am here any time any of them have an issue they want to discuss with me. They have my home phone number and my cell phone number. I am available to them anytime, anywhere.” Dr. Ornstein also believes in management in motion—walking around the office to check up on his staff. “I try to not be in my own little world,” he explains. “I want and need to know what is happening. Doctors need to approach the staff every so often and ask, ‘How are things going?’ Interaction is key. Make them feel like they are not bothering you and that you are actually interested in them.” Ultimately, whether you call it a staff or a family, there are indeed a variety of intangible factors to consider when bringing together the people who make your practice tick. “It is not about the job itself,” sums up Dr. Guiliana. “You have a culture here, a collective personality. The person you bring in should fit in and must fit in. He or she should be the piece that makes your practice complete.” How To Reduce The Likelihood Of Turnover You can hire the best possible people to work at your practice but the battle is only half won if you cannot retain them. Lynn Homisak, PRT, has some thoughts on the matter of minimizing staff turnover. • Take the time to develop an orientation program. It welcomes the new hire, reduces anxiety, brings him or her up to speed and helps create positive job attitudes. • Introduce job candidates to staff before hiring them. • Clearly define your expectations up front. This prevents unpleasant surprises after you have hired the job applicant. • Do not make promises you can not keep. • Show a genuine interest in the job applicant. • Be respectful and courteous. Try to be someone you would like to work for. Everyone wants to work for a good boss. Mr. Smith is a freelance writer who lives in Cleona, Pa.