By Maithily Nandedkar, MD, May 01, 2012
Owning a small medical practice often means that you are not only the physician but also the business administrator. But being solo does not mean you have to operate solo. Still, no matter how good your office manager is, he or she implements practices that are set by you. While larger practices can often afford a human resources department, small offices should rely on established best practices to help protect the practice. Everything begins with the hiring process.
Your human resources are your employees and you need to manage them. The first established best practice should be a clearly defined policy and procedure manual that delineates employee job descriptions and expectations. Provide it to your new hires in a timely manner, which is usually within the first 90 days of the probationary hiring period. Whomever you hire you may need to fire so the best defense is a good offense.
Rules for termination
My state, Virginia, is an “employment-at-will” state, but that does not mean it is a “termination-at-will” state. Make sure everyone hired knows the rules for “just-cause termination.” Do not assume common sense. Document that you have provided the rules to all employees by having them sign for receipt of this specific document. You do not want to have a wrongful discharge case against you because then you will surely need more than an HR department. Document everything: timely reviews, late arrivals, reasonable warnings, and all trainings.
Before you fire an employee, be aware of your state’s unemployment commission rules and regulations. Upon termination, the employee may apply for unemployment benefits. Most commission deputies will ask you, the employer, for documentation as to the reason for termination. If there was a violation of specific company policy that you can point to in your policy and procedure manual, then the employee is usually not eligible for unemployment benefits. Unemployment benefits are paid out by unemployment insurance policies that vary from state to state. In general, an employee is eligible for benefits if he or she becomes unemployed “through no fault of their own.” The U.S. Department of Labor website delineates the federal rules that govern state law: www.dol.gov/dol/topic/unemployment-insurance/.
As an employer, you pay for unemployment insurance to your state. (Only three states, Alaska, New Jersey, and Pennsylvania, require an employee contribution.) Usually, how much you pay depends on how many years you have been in business and how many former employees are collecting benefits. If a former employee can successfully claim eligibility for unemployment benefits, then your unemployment tax rate may go up. It is in your financial interest to know the rules and avoid needless hires and fires.
Workman’s compensation insurance is comparable to unemployment insurance — the more you use it, the more costly it becomes. Regardless of the state in which you practice, most workman’s compensation programs are “no fault” meaning the employee is covered no matter who is to blame for the injury.[pagebreak]
Performance issues and EAPs
What if a superb employee suddenly becomes unreliable? In a large corporation, a trip to the HR department would likely reveal the source of the problem and if it is personal, would be referred to an employee assistance program (EAP). EAPs were established in the 1970s to help workers cope with temporary but major personal issues that affect their job performance. Two good examples are death of a loved one or divorce. An outstanding employee can suddenly become a poor performer temporarily but improve dramatically when given the right assistance through an EAP. While most small businesses cannot afford to hire a personal counselor for employees, an EAP can offer an avenue for assistance when a temporary but real menace threatens your practice.
I learned about EAPs when one of my employees was being stalked by a former boyfriend. I was afraid not only of workplace violence but also for her personal safety. I called a local battered women’s shelter; staff there informed me about EAPs and said that I likely already paid for EAP services under the health care plan provided to my employees. Sure enough, as a small employer, we had an EAP through our health care provider. The employee in question was eligible for a pre-paid number of counseling sessions to assist her. A government document, available online at www.dol.gov/odep/documents/employeeassistance.pdf, gives an overview of these programs. The international Employee Assistance Professionals Association is located in Arlington, Va. You can learn more about it at www.eap-association.org.
Once you have an EAP, you must follow the Americans with Disabilities Act guidelines for privacy. This means that the employee should be able to freely discuss anything with the counselor with no repercussions regarding employability. Confidentiality is critical. Although employers are paying for the counseling, they have no right to any information obtained though the counseling sessions. The key concept here is that all employees have a right to privacy in order to maximize the effectiveness of the counseling and, ultimately, improve job performance by having a separate place to discuss personal strife.
The final offensive strategy is to have an attorney to help you as needed. When I started my practice, I used the Human Resource Kit for Dummies as my “go-to” manual for everything HR. Then, I checked online and for final confirmation, I asked my attorney. I had the attorney review my policies and procedures to ensure federal and state compliance. Although your policies and procedures will be specific to your practice, they still need to be legally compliant. Over the last few years, the Academy has put together an excellent guide to writing a policy and procedure manual. All HR begins and ends with this manual. (See sidebar, "Manuals can help dermatologists handle HR concerns," for more information.)
Being your own HR department can be scary sometimes as we physicians signed up for science and healing, not hiring and firing. However, we need to recognize that many of us are also business owners subject to employment law that was designed to not only protect us but also our employees.