By Maithily Nandedkar, MD, January 03, 2011
While I can’t claim to be a master at practice management, so far I have been notably successful at one major aspect: minimizing staff turnover. Hiring, the first step in the process, is the focus of this column. As this is my first practice management column, I have a disclaimer. I have never taken a practice management or business class; the advice herein is a conglomeration of lessons learned over time. I am not embarrassed to say my first practice consultant was the Human Resources Kit for Dummies. I graduated to the pink Academy publication Starting and Marketing a Dermatology Practice, which is more dermatology-specific.
Help from the IRS?
Today the IRS is one of my go-to resources. Like most of us, you probably have a love/hate relationship with the Internal Revenue Service. However, if you are the simultaneous owner and manager of a practice, I think you will fall head over heels with at least one aspect of the IRS — its website. It’s chock full of information and has become my “go-to consultant.”
When you start a practice you are not only a physician but also an employer and the CEO of a corporation. Corporations must comply with government regulations. Putting the assortment of practice management requirements in order is not as easy as W-2, W-4, and W-9. But it can be as easy as www.irs.gov. Click on “businesses” and the site offers you a simple-to-navigate resource: the “A to Z index for business,” part of the Small Business and Self-Employed Tax Center. Information and guidance on everything from starting a business, to operating one, and finally closing one is available. The site is very clear regarding requirements, including those that must be followed when hiring an employee.
While the IRS provides the legal compliance information you need when hiring a new employee, it doesn’t dictate how to manage people. Managing people is about managing expectations — and that starts when they are hired.
You need a policy and procedure manual to clarify expectations. No matter how small your practice, you need to clearly state what you anticipate each employee will do for you by creating job descriptions. Once you have them, you can hire.
I tell my staff, “Here are my needsmeet them.” Your “needs” translated are their employment requirements. Even the best staff cannot help you if they are not told what you want. Hence, the job description clearly defines their duties and your expectations. Making a job description that is clear is basic write exactly what you want each staff in their respective positions to do. Who do you want to answer phones versus assist you with biopsies? Analyze the tasks you want the employee to do now with an eye to growth potential in the future. The Academy has templates available for you in its Dermatology Employment Manual. Start with those and modify them to fit your specific needs. Every job description must be up to date with reasonable overlaps. For example, you should not ask the receptionist to clean surgical instruments, but you can expect a medical assistant to answer the phones. No matter how good the fit, you cannot abuse your position as boss by asking staff to run personal errands for you or babysit your children. [pagebreak]
I give a printed job description to all applicants to see if they can meet the requirements. Applicants who start negotiating job description aren’t hired. Remember, these are your needs. You need to find someone who can meet the required qualifications — turnover is costly.
Your staff represents you; take the time to find someone who fits your style and personality. I look for someone with a good work ethic, computer skills, and interpersonal skills. I cannot teach those. I know I can teach technical skills such as creating surgical trays, drawing up triamcinolone, dressing wounds, or ordering supplies.
To fully protect yourself from potential employee discrimination suits, which can be filed with the Equal Employment Opportunity Commission (EEOC), make sure you clearly state that you are an equal opportunity employer. Written job qualifications will help you to defend any hiring decision.
But the paperwork doesn’t stop there: Fast forward to the hire. The person is fabulous! You commend yourself on the great find, but is the person eligible to work in the United States? You cannot ask if the person is a U.S. citizen nor can you ask the person’s country of origin, but you can ask if the prospective employee is authorized to work in the United States. Upon hire, the employee must fill out the I-9, which verifies that he/she is legally authorized to work in the United States. You are responsible for its timely completion. You must review, photocopy, and verify documents such as a passport or Social Security card. However, you are not allowed to specify which document you will accept as this is considered discrimination. File it with the employment information to be available for U.S. government inspection. (Because you keep the forms, there is no filing fee.)
In order to pay the employee as well as provide the year end W-2 form that covers all of the payroll information, you will need the employee’s Social Security number along with the federal W-4 form to determine tax withholding.
The cold truth of hiring is that you can get into hot water if you don’t follow the proper procedures or are perceived as discriminatory. Make sure you follow the IRS and EEOC guidelines to make the right hire work for you.