How to hire a employee for your solo medical practice

Finding good employees is a difficult part of your job as a medical practice owner, but is absolutely vital to your success. I strongly believe in the statement hire slow, but let someone go fast. I’ve done this even if it meant running the office myself (although now I have a temp agency that can get a fill in with short notice).

Some of you are lucky enough to have a spouse, other family member, or friend work for your practice. I know of many docs whose first employee and now office manager is their spouse. But make sure they are qualified enough to do the job. I know of one fellow non- ophthalmologist who shut down his practice partly because his spouse was the office manager!

I don’t claim to be an expert as the first person I hired never showed up so I had to scramble to find a replacement before opening. Fortunately I had time. One other colleague I know had their hire not show up on opening day. Several years later they’re complaining that their practice is too busy.

It’s best to advertise before you open doors, wait for about two weeks for resumes to be sent in, and then continually pull them until you find five or six good people to interview. One of my colleagues interviewed fifty people over the phone and then ten in person before she made her hire. It was worth her time as five years later her employee is still with her practice.

In theory you could answer the phones yourself for the first few weeks, but having someone to answer phones while you’re running errands both in and out of the office, or on phone conferences learning how to use your practice management system or EHR, will save you a ton of time and stress.

Most folks in our google group started out with one employee. You definitely need a front desk person, but you don’t need a tech immediately if you’re starting from scratch. Unless you expect to have a ton of patients following you from your old job. The decision when to hire a tech is a personal one. Five years in for me and seven for Ho Sun, we both still don’t have one. I still walk my patients back to the exam room myself.

But you’d be surprised at how well Ho Sun and I do in terms of what we take home.

It has been said that for a employee ophthalmologist you need to be seeing about fifteen patients per day to justify a tech (Ho Sun sees way more than this but still manages to do it without one) but with the responsibilities of an owner it could be less. And if you are doing cosmetic procedures or lots of premium lenses you will need more employees.

We are both advocates of starting out small. If you get busy quick and find that you’re in the office after 5, go ahead and hire more people. But if you have a staff of six when you’re seeing eight patients a day, there will be a lot of sitting around. And once you get busier, your staff who are used to taking it easy might complain when they actually have to work.

Advertise on Craigslist or indeed. Craigslist costs about $35, Indeed is free and has a iPhone app to help you keep organized. You can use the sites to look at competitors postings to find out approximately how much the going rate is for your area for your position. I like to slightly overpay for an excellent candidate. I started my first employee at $10 but with bonuses and SEP IRA match wound up paying her equivalent of $15, after she left my second employee $15 to $18. My current employee gets slightly more.

Here’s a copy of my ad:

I found that advertising for front desk manager rather than front desk receptionist cut down on the number but increased quality of respondents.

Some folks say a good way to find someone is a student externship for medical assisting school. I’ve actually received letters from local community college ophthalmic tech training class asking me to be a site. But my practice is too small. Larger practices than mine can use this as a trial. The primary care docs downstairs form me say it’s a great way to trial and hire good employees.

My personal opinion is that if you have one employee it should be someone that’s experienced and good. Others hire someone who just started working and train them. This worked for my first employee but she left for personal reasons. I won’t consider someone who hasn’t worked for same job at least 2-3 years. Shows stability. Some docs hire college students part time or on summer break. While they are usually intelligent and hardworking, I’ve found that it be better to find someone that wants to work in your office for a long time, for stability reasons.

Always save all resumes submitted to your office. Ask the same questions of all interviewees and write down the responses on a separate paper, not the CV. Save everything from the interviews.

Do not discuss family, kids, religion, race, politics, or age. It is OK to ask if you’re able to lift 20 pounds if you do so for all applicants.

Be very picky on who you interview and hire. This person is the face of your practice. The wrong hire can turn off patients and slow the growth of your practice. The more they can do for you, the more stress and time it will save you.

Here are some of my questions:

Tell me about yourself

What are your strengths/ weaknessss

Describe your duties and tasks in your last job (I use this when I phone references to verify they don’t exaggerate what they did)

What do you like/ not like about previous jobs

Describe situations where you had to perform detail oriented tasks

Describe situations where you’ve had to multitask

Tell me about a previous situation where you had a disagreement with coworker or boss and how you handled it

What do you hope to be doing in 10 years

Why do you feel you would be the best candidate for this position

Ask specifically about whether they have had experience in all of job duties described in ad above (it’s ok if they don’t for every single task, but they should for most of the tasks)

Because I need the hire to verify insurance as well as collect patient responsibilities at the time of service, I also ask:

What is the difference between PPO and HMO

What is a narrow network plan

What is difference between Medicare advantage and traditional Medicare

Name some health insurance plans

Name the AHCCCS plans (AZ Medicaid)

Do you have experience phoning patients to collect monies owed?

Do you have experience phoning insurance companies to verify eligibility and benefits, and follow up on claims?

Are you comfortable collecting patient financial responsibilities at the time of service, and explaining to them reason behind amount owed?

For a tech I would also ask questions such as:

What type of visual field machine did you use? When do you get a 10-2 visual field?

What are names of some eye drops used to treat glaucoma?

Explain to me what a cataract is, and how it is treated (if they worked at a retina practice, use macular degeneration instead)

I also test cognitive skills. Everyone takes a online typing test. If they type at less than 30-35 WPM they are not eligible for hire. You could have them enter medications into your EHR sample patient. For a tech job, I would definitely test to see if they knew how to do the things they told you they could during the interview, have them use the lensometer to read glasses, do a refraction, take a OCT (if machine same brand as what they know).

The most important thing to do is phone references. Even more importantly, phone people they don’t list as references, such their manager where they worked before to verify position and dates worked. You’d be surprised at how many candidates are untruthful about their dates worked or their position and duties. If they want to talk more about the candidate that’s fine. If you get silence read through the lines. If you get the statement “my attorneys have advised me not to comment about this applicant” that definitely says something.

You should run a background check (post to follow). Consider looking at your local court dockets in small claims, justice and superior or searching your county recorder’s website for more information. This can be sometimes difficult to do if they have a common name, or if they give you a different version of their legal name. You can try to find them on social media but are not allowed to ask for passwords or to ask someone to login to their account.

Always make clear employment is at will. You will also need an employment handbook (more on that later).

Ho Sun’s first hire (who worked for him five years before she retired) was much easier. Here’s what he had to say:

Currently, I will be hiring only one person to work the front desk.  I don’t plan to hire a technician, manager, biller, scribe, or anyone else at this point.  First off, I can’t afford to hire extra help, and second, I have absolutely no volume to justify any more staff.  Based on my projected expenses, each additional staff member would probably add an extra 20% to my overhead.   I’ll probably have a good amount of free time to perform nonclinical duties, and I’m prepared to work into late evenings and Sundays.
Originally, I was planning on putting up classified ads on Monster, Craigslist, local Korean newspapers (online and print), etc.  I ended up not needing to use any of them.  Instead, I actually ended up hiring someone through the introduction of one of the Korean-American advertisers.  I’m going to refrain from any further details regarding who I hired because I don’t want to reveal someone else’s personal information online.  Nevertheless, I’m excited about the person I hired, especially because this person speaks both English and Korean fluently.

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