Hiring Staff – Where to Begin

As entrepreneurs, many chiropractors assume several roles, especially in the early years of building their practices. However, as the practice grows, many doctors find they can no longer be the office manager, bookkeeper, appointment scheduler, and treat patients at the same time. Following are some tips to start the hiring process.

Assess Your Situation

If you're contemplating adding staff, ask yourself:

What are my business needs?
What hours are you open, and when are you busiest? How many patients do you see? Is your business growing slowly or rapidly?

What tasks need to be completed to make my practice more profitable?
Do you need someone to schedule and greet patients, answer the telephone, or complete your billing and claims processing?

Who Should I Hire First?

Now that you've analyzed your needs, you may be wondering: Who should I hire first? In all probability, the first position you'll need is the front desk assistant who will act as the receptionist and the appointment scheduler for the office. The next person you'll want to consider hiring is someone to handle insurance and third-party billing.

From there, you can begin adding clinical staff (i.e., clinical assistants and associates) if that is appropriate for your practice. As your patient count and your practice grows, so will your need for clinical and office positions.

Should I Hire a Part-time or Full-time Employee?

Some doctors prefer to have someone on staff full time, either to meet the needs of their practice or because they like the continuity for their patients. However, because of today's changing workforce, many workers want good jobs that offer flexible or part-time hours. This can be a good opportunity for you and your practice.

Part-time employment, either in the mornings or afternoons, makes it easier for you to recruit a student because you can work around class schedules. Another potential applicant pool is stay-at-home parents with school-aged children. If you open your office at 9 a.m., for example, your employee could drop off his or her children at school, work a half-day and be back home by the time the children return. The flexible work environment often can help you find and keep a staff of quality employees.

Of course, there are potential drawbacks of flexible work arrangements. For example, if you have two employees who are job sharing, you'll need to conduct more performance evaluations and maintain additional personnel records than you would with one full-time employee. Plus, arranging staff meetings so that everyone can attend can become tricky.

But, most doctors find that with a little planning, the benefits of offering a flexible schedule outweigh the drawbacks.

Should I Use a Temporary Agency?

If you’re thinking of hiring staff from a temporary agency, there are several things to keep in mind. With a temporary agency, you'll typically pay more per hour for someone who, most likely, won't have a chiropractic background. Even if you hire a temporary employee with a medical background, you'll often find someone who is heavily ingrained in the medical model. Sometimes people with this background don't transition well into a more alternative or complementary model. For example, they may tell patients to go out-patient or take antibiotics – things they shouldn't be saying. For these reasons, temporary agencies should be used only if absolutely necessary.

Should I Hire a Relative?

Hiring a member of the family, typically a spouse, works well for many chiropractors. It can be a good way to get the practice off the ground. But, before you pursue this arrangement, you'll want to consider:

• The financial benefits of employing your spouse, such as tax deductions for business expenses and childcare and the ability to have both spouses receiving employee benefits.
• The need to validate your spouse's employment – treating him or her in the same way you treat the rest of your employees. This includes having the correct records on your spouse and following the proper personnel procedures.
• The impact your spouse's employment will have on the professionalism of the office.
• Your spouse's compatibility with the job.
• How the arrangement will affect your personal relationship with your spouse.
• The consequences if the arrangement doesn't work out.

 What Compensation Should I Offer?

Compensation ranges vary widely according to responsibility level and geography. A trained chiropractic assistant who is also acting as your front-office supervisor would command a higher wage than an untrained college student who does little more than answer the phone while you perform the bookkeeping and billing responsibilities.

Carefully define just what you expect, then check with your local association to help you determine a reasonable starting point for wages. Keep in mind the old adage: "If you pay peanuts, you'll get monkeys." At the same time, guard against the desire to overpay.

Another factor to consider is an employee's status as exempt or nonexempt. Exempt employees receive a salary representative of payment in full of services rendered – including all required or voluntary extra hours worked. Nonexempt employees will be compensated for actual hours worked and hourly credits earned, such as paid time off. They will be eligible for premium overtime pay. Non-exempt employees will not be paid for time not worked unless they are being compensated for benefit days, such as vacation time or sick leave.

The Fair Labor Standards Act (FLSA) governs the status of exempt versus nonexempt employees based on their job duties. For more information, see the "Wages" section of the Department of Labor web site at www.dol.gov.

What About Benefits?

The most common benefits are: health insurance, life insurance, vacation, holidays and sick leave. If you don't have a benefits package, you must state that during the interview, or prior to making an employment offer.

A growing number of offices are adding 401(k) plans to their benefit packages to provide an additional benefit and increase employee retention and loyalty for long-term employees. It may be more affordable than you think! Contact your insurance consultant or your state association for a list of companies that specialize in employee benefits.

In a small office, you can't afford to have people on long vacations. Usually the rule of thumb is if the employee works six months, he or she is entitled to a week of vacation. Over time, this may increase up to two weeks. Usually employees are not allowed to take two weeks in a row, since it's hard to have somebody out for two weeks if you only have one employee. Part-time, hourly employees generally don't receive many other benefits.

Sick leave benefits are always an issue for full-time employees. One option is to provide your employees with "benefit days," in which a total pool of days are available for your employees to use as they wish – whether it be for vacation, sick leave, or for personal time.