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Reimbursement and Practice Management

Staffing – How to Hire

Hiring is a constant in a medical practice. There is no doubt that recruiting an employee will be on your agenda sometime soon, if it isn’t at the top of the list today.

This article will provide information on some important things to consider when hiring employees to complete your practice team.

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Hiring is a constant in a medical practice. According to the Medical Group Management Association, the current employee turnover rate for surgical practices is 33%, 25%, and 30% for reception, nursing, and billing/collections staff, respectively. Although the rate varies by position, there is no doubt that recruiting an employee will be on your agenda sometime soon, if it isn't at the top of the list today. Consider these steps to ensure that your practice performs staff hiring effectively and efficiently.

Determine Fit, Not Just Function. Historically, practices have hired based on two criteria: (1) Have you worked in our specialty before? and (2) Are you already trained in our information systems (e.g., practice management and electronic health record)? If not, then the candidate is typically discarded from consideration with the notion that we are, of course, so unique, that no one could possibly work here without experience in both areas. While every practice is different, this attitude limits the pool of candidates, sometimes so much that the only option is rehiring the employees who were let go last year! It would be ideal to have a new employee walk in at full productivity from day one. Instead of specialty and system expertise, therefore, look for loyal, hard-working team players who are service-oriented. Remember, you can train someone to assist you in a procedure, but you can’t teach them how to smile.

Know Where to Look. Job postings in the newspaper are no longer an effective option; getting the word out about your new position takes hard work and a bit of ingenuity. Use posting boards and listservs based at local community colleges, universities, and training schools; try professional networking sites such as; and benefit from healthcare-focused job sites like In addition to posting positions, it pays to be on the lookout. This may include current employees who have a friend or colleague seeking a new position (consider paying a small "finder's fee" if their recommendation ends up as a hire), or associates you bump into at a retailer who impress you with their skills. For positions requiring technical skills, develop a relationship with an educational institution to serve as an externship site.

Invest. Hiring is a key part of your human resources strategy, yet this area is challenging because humans are, well, human. You may find yourself in the position of an extreme drought of qualified candidates, followed by a rash of great ones. Consider introducing a little flexibility in your hiring practices. If you encounter two out-of-this-world medical assistants (MAs), for example, but only have one MA position open, hire both, cross-training them on needed front-office duties. While this isn't always possible, making a small advance related to hiring "excess' staff, if expectations are set appropriately, may be the best investment you can make.

Recognize Appropriate Payment. Candidates won’t pursue your open positions if they don't feel the payment is fair. Glean market data about salaries — for free — from websites like Because wages fluctuate, double check this information every six to 12 months to ensure that you’re not only able to hire the best, but also retain the best. As you well know, wages are only a portion of the investment you make into an employee. Yet, most of your staff focus only on that element of their compensation. Why? That's what employers post about the position — "$14.50 per hour," for example. Sometimes the term, "plus benefits" is added, but it's fairly nebulous. Create a spreadsheet with all employee benefits listed, with a description and the associated costs. Sum the "actual" hourly wage at the bottom, and provide a professional-looking compensation statement to all candidates. This will certainly boost interest in your practice, and may even sway the best candidates to join you.

Start Retaining from Day One. Extending an offer of employment may be routine for your practice, but it's a life-altering opportunity for candidates. Avoid leaving voicemails or texting, rather call or meet with the individual to make the offer. Use positive terms like "welcome," "team," and "opportunity" during your discussion, providing the candidate with a strong impression about your culture. On the first day, create a written agenda for the day or week with a "thank you for joining our family" message at the top. Have the employee's nametag ready, avoiding the label stuck on top of an old employee's tag scenario, and provide the uniform (or be prepared to take the measurements to order it). You want the employee to feel engaged with your practice from the very moment they start. For a special touch, consider sending flowers to their house with a message of welcome.

Hiring employees for your practice is never a one-time occurrence. The more prepared you are when it comes time to hire, the more likely you are to find the best candidate for your next open position.

Tip 1: Host a Working Interview

Once you decide on your ideal candidate, invite them to come for a final "working" interview. Typically scheduled for four hours, if not the entire business day, this opportunity allows you and your team to see the candidate in action. Engage your team in the decision — an action that will surely boost their morale — by asking them for their opinion. Further, the working interview also gives the candidate a better understanding of your practice, often preventing that "this is not the job that I expected" departure after just a few days post-employment. Payment for such a working interview may depend on state law, so please check with an attorney familiar with employment regulations in your area.

Tip 2: Cover the Basics

Retention challenges often stem from a lack of training. From your receptionists to your head nurse, provide orientation and basic training on all of the management information systems that you use. This includes the practice management, the electronic health record, and the telecommunications systems. Having a working knowledge of all three not only helps new employees in their roles, but it also ensures they can comfortably serve as team members. Although each individual is tasked with a specific job, it is this opportunity to work together as a team that will ensure a successful practice.

Tip 3: Hold Departure Interviews

Losing an employee is never ideal, since it leaves a gap in your practice's operations. However, understanding why that employee is departing can provide valuable insight. Ask for 15 minutes; sit down with the employee on his or her final days of employment, and have a frank discussion about the employee's decision to leave the practice. You may not agree with the reasoning, and often the issue comes down to money. However, with nothing to lose, this final meeting can increase your awareness about potential opportunities to improve your practice to ensure that it is a desirable place to work. Remember that it's crucial to be non-judgmental and listen with an open mind, rather than using this forum to argue at this stage. Consult with an attorney about the protocols for exit interviews; if there are any contentious issues related to the employee's departure, consider seeking the advice of your lawyer as to whether to even hold such a meeting.

Tip 4: Engage a School

Educational institutions involved in educating medical assistants, phlebotomists, radiology technologists, and many other skill-based positions incorporate a requirement for external training. Engage in a partnership with an institution — or more than one — to accommodate their externships. This has a two-fold benefit: your practice gains valuable labor at little to no cost, while providing you the opportunity to view first-hand the skills, experience, and work ethic associated with potential candidates. In other words, you get access to the best and the brightest before they go on to the labor market. If you find the relationship draining — the students take more time and investment than any benefit to your practice — discontinue the association with the institution.

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