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BackTable / VI / Article
OBL & ASC Business: Personnel & Staffing
Zachary Schmitz • Updated Jan 30, 2024 • 45 hits
Choosing the right staff can make or break a new OBL or ASC venture. Teri Yates, CEO of Accountable Physicians Advisors, covers three common personnel problems that most of her private practice clients face: (1) choosing the right financial administrator, (2) staffing the right team, and (3) employee retention. Teri also shares her advice on the importance of hiring administrators with relevant healthcare backgrounds and her experience in working through issues related to troublesome doctors and staff.
This article features transcripts for the BackTable Podcast. We’ve provided the highlight reel here, and you can listen to the full podcast below.
The BackTable Brief
• Medical practices often approach consultants for issues beyond billing, such as "people problems," including concerns about an administrator's exclusive control over financial processes such as payroll and banking.
• Many practices, including medium-sized ones, cannot afford a CFO and thus manage finances themselves. This administrative structure raises questions about who should have access to sensitive financial information.
• Hiring administrators with relevant healthcare experience helps to avoid common hiring mistakes, such as onboarding unqualified family members or friends, possibly leading to inefficient practice management.
• A common issue in practices is dealing with physicians who avoid holding people accountable due to fear of not being able to replace staff or the negative impacts of confrontation. The main problem in a practice could be the doctors themselves, displaying either hostility or an aversion to confronting staff issues.
• Yates emphasizes the importance of leadership training and developing a positive culture to improve staff morale and retention. Handling difficult situations, like parting ways with long-term employees detrimental to the practice, requires objective assessment and may be made easier with support from consultants.
Table of Contents
(1) Choosing The Right Personnel to Handle Finances, Staffing & Retention
(2) Dealing With Troublesome Doctors & Staff
Choosing The Right Personnel to Handle Finances, Staffing & Retention
Personnel problems can cause significant challenges at an independent practice. The wrong team may delay startup times, increase costs, and negatively impact the quality of patient care that your practice provides. Choosing proper financial administrators, hiring integral staff, and retaining employees can help alleviate administrative headaches that arise from having the wrong personnel.
When it comes to staffing physicians, typically the best hires for an independent practice are doctors with an authoritative list of referrers. In regards to retaining staff, practices that emphasize how personnel feel about fellow doctors and their managers may have improved morale, leading to greater employee retention.
[Dr. Aaron Fritts]
The ones that are seeking out your advice or your services that already are in a practice, what are some of the major things other than billing that you see most commonly presenting to you that you need to kind of fix or help them fix?
[Teri Yates]
Well, they come to us many times because of billing, that's obviously one, but they also come to us a lot because they've got people problems. Either they're concerned about their administrator and they feel paralyzed because they don't know what to do about this person. He is the only one who knows how to process the payroll, has the logins for their bank accounts and they're really worried about that, or staffing and retention, right? That's a huge problem in healthcare right now. If they're seeing that they are repetitively having people quit or they can't recruit them in the first place, sometimes they'll come to us to say, "What's going on in my business that is making this an undesirable place to work?" Then the third thing is, is they come to us when they just want to grow. "How do we increase our referrals and build more revenue in the practice?"
[Dr. Aaron Fritts]
To touch on the finance stuff, one thing that I know a lot of practices can't afford to do, even medium-sized practices, is a lot of them can't afford to have like a CFO and so they're managing their own finances. It might be something that they're advising you guys on, but one question is, who should be privy to the finances, because you don't want-- practice manager might be privy to it, but you don't want a lot of people because, like you said, like with staff turnover and everything, that can be problematic. When you're advising on the financial side, who do you say should be in the room for those discussions?
[Teri Yates]
Yes, that's a great question. This is a touchy subject for physicians because a lot of them want to be very private about the financial side of their business, which is understandable. Also, you have to be careful who you share that information with because it's got to be someone that has maturity to understand both the revenue and the expense side of things. For my leaning, is more transparency than less, because I think if you want your management team, anybody who's at a managerial level, if you want them to understand what decisions need to be made, if you want them to push on the right things in the business, they need to understand why. It's not easy, but I encourage more transparency rather than less.
[Dr. Aaron Fritts]
Yes, and I imagine your approach, you would have to be going in there and assessing maybe who has those capabilities in the practice, right? You're probably talking to the practice manager, the head nurse, the head tech, that even maybe some MAs who are-- what's that assessment like? How are you assessing, especially for somebody who has people problems, people problems are really challenging, right? It's because a lot of us docs are like risk averse. We don't want to upset people. How do you help handle that?
[Teri Yates]
You know, there's a lot to unpack in what you just said. Starting at the beginning, when you're trying to evaluate how much information to share with what members of the team, remember it's not an all or nothing proposition. I strongly promote data-driven decision-making at every level in the practice.
That means there has to be different kinds of data shared with people throughout the practice. Everybody needs to know what's my number that matters. Is it the number of patients that I get scheduled every day or how long it takes me to get those patients scheduled? Is it my cancellation and no-show rate? Is it my throughput in terms of procedure room turnover? Everybody has numbers that should be transparent to them that really say this is what success looks like. You have to evaluate the people, but then decide exactly what information on a role-by-role basis to share and have a forum to discuss those things regularly. Now, the other part of what you said is, well, how do you solve people problems? Well, a big part of my personal consulting practice, because I have nine other consultants, so we all have areas that we love especially. I really like digging into the culture and leadership training, so I like to help develop those managers to have them be the best they can be for the practice, but the whole tenor of how people feel about their jobs comes down to how do they feel about the doctors and how do they feel about their managers? That's where I can push and provide coaching and training to improve the morale in an organization, which ultimately leads to better retention of staff.
…I should also say, another really big potential mistake physicians make is hiring someone who's not qualified to be the administrator. It's very common to see a trusted family member that may not have experience in this type of business or a friend who has good business acumen that doesn't understand healthcare. That is often a big factor.
[Dr. Aaron Fritts]
A pitfall, yes. Yes, seen that happen as well.
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Dealing With Troublesome Doctors & Staff
Doctors and staff members can hinder a practice’s performance by mistreating patients, being unable to effectively perform in their role, or being resistant to change and correction. Occasionally a practice’s leading physician will feel that confronting an employee is a hurdle due to fear of retribution from the employee. Teri encourages her clients to build the necessary courage to confront challenging doctors and let go of ineffective staff. As an example, Teri once worked with a practice that had to go through the painful process of laying off an administrator who had served the practice for 46 years. In addition to courageously approaching troublesome staff, doctors may benefit from working with an external consultant to find interpersonal issues within their practice that would otherwise go unnoticed.
[Dr. Aaron Fritts]
What happens when, I'm sure this hasn't probably happened to you, Teri, but what happens when the problem is the doctor themselves? Maybe you didn't realize that until you were already in contract with that group, or maybe it's a multi-physician group and it's just one or two of the docs.
[Teri Yates]
It's frequently that problem, right? It depends on what the nature of the problem is. It's very difficult for me to help someone who is a hostile individual. There's just some physicians that they're going to be throwing things in the office. They're going to be yelling at people. There's only so much I can do with someone that has a personality type like that. The more common problem is that the physicians are afraid to hold people accountable, and so they may stall. It may be because they're afraid they won't be able to replace that individual.
Like I said, it may be that they're afraid of the ramifications or the harm that person can create. You have to have the moral courage to say, "This is how we treat each other here. This is how we do things here," and then use that to determine whether people are measuring up or not. If there are people that don't fit with your values, you have to be willing to remove them for the good of the entire team.
[Dr. Aaron Fritts]
Then you're going to maybe the physician leadership and inviting them that, "Hey, look, this is not a problem that maybe somebody's got to talk to him and it may not be-- it might be the physician leader is the best person, right?"
[Teri Yates]
It's tough. Most of my doctors see me as kind of their personal business coach. Some of those are really hard, agonizing decisions. I mean, we just started working with a practice that has been around for, I don't know, 60 or 70 years through many generations of partners. I just had to help that practice understand that their administrator who had been their employee for 46 years was their biggest problem. Having to part ways with someone that you've had a four and a half decade relationship with, that's emotionally very difficult. Having me put it in objective terms and provide support through that process empowered the physicians to do what needed to be done, even though it was really hard.
[Dr. Aaron Fritts]
Yes, and it's good from the physician side to have somebody, I think, like yourself, who can draw from experience to say, "Look, this is my advice to you." It's not coming from another physician. It's not coming from somebody within the group. It's an outside voice who sees what's going on and can give some objective advice. I imagine that's super helpful.
[Teri Yates]
There's something very empowering about not being an employee when you have to do that, right? If I have to tell people, this is a kind of a weird way to put it, but I have to tell people on a regular basis that their baby is ugly. That's hard to do, but it's easier to do if you know that if they dislike hearing that and they don't want to stick with you after you've said it, life will go on. I'll just work with other people. It's no problem.
[Dr. Aaron Fritts]
Yes, but their problems won't go away. Their baby's still going to be ugly.
[Teri Yates]
Correct. Listen, I don't usually get fired for telling somebody that. I don't think I ever have. I have frequently have had people not listen to me the first three or four times I tell them that, but we joke, we shrug internally and say, well, we bill by the hour, so if I have to do it four times.
[Dr. Aaron Fritts]
Yes. No, it's hard to take. It's hard to take, especially when some people put a lot of work into it. The other thing I want to touch on is operational efficiency, room turnover, patient satisfaction, all those kinds of things. They seem like a no-brainer to help the bottom line. Where do you typically start when you're thinking about this and where this seems to be an issue for an existing practice?
[Teri Yates]
I think the hardest thing about being the doctor or the administrator is that things that you see every day, you can't see anymore. The exercise in many cases is to start and pretend like you're seeing things for the first time. I will say, look at a small number of patients and do an end-to-end analysis of what happens to that patient through their journey in your practice. Follow what happens when they were scheduling and talk to the people involved in it. Look at the registration process and how the medical assistant rooms the patient. Look at if a procedure is indicated, what the process is to get the prior authorization and follow them through their journey through your OBL and on procedure day.
The thing about it is there are probably 20 stupid or wasteful things that are going to happen along the way on that journey that your staff already know about, complain about or frustrated about, but either they don't feel empowered to tell someone in leadership about it or they don't think there's any alternatives, so they think it's a waste of time to bring it up, or they are telling leadership and someone that they're telling this to isn't prepared to make those changes.
Podcast Contributors
Teri Yates
Teri Yates is the CEO of Accountable Physician Advisors.
Dr. Aaron Fritts
Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.
Cite This Podcast
BackTable, LLC (Producer). (2023, September 18). Ep. 366 – Navigating OBL & ASC Business: Pitfalls to Avoid [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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