Episode 134: Employees Have Lifecycles Too

Speaker 1:

You are listening to Your Practice Made Perfect, support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.

Renee Tidwell:

Hey, everyone. Welcome back to Your Practice Made Perfect. My name's Renee Tidwell. I'm going to be your host for today's episode. Today we're going to talk about the lifecycle of an employee, along with some common HR questions. We get quite a few questions regarding employees, things like how they're hired, to employee orientation, and even how to handle employee resignations. Here to walk us through the conversation is going to be SVMIC's own Steve Dickens. Welcome back, Steve.

Steve Dickens:

Thank you.

Renee Tidwell:

We always love having you. Before we get into our discussion today, why don't you start by just telling us a little bit about yourself?

Steve Dickens:

Well, sure. Well, I've been in healthcare for almost 30 years now, which really seems amazing. I started on the hospital and physician-owned medical practice side of things, and spent about 15 years working with groups in a variety of capacities. While I was doing that, I also was very involved with home care back during those days. But for the last 15 years I've been here at SVMIC, working in risk management and medical practice services, where I'm now the vice president of the department and have worked with lots of groups across our territory and across the country during that time. Have been very active in the Medical Group Management Association as well.

Renee Tidwell:

It sounds like you've got a lot of interesting experience. Let's just jump right on in. I know we all see a lot in the news, especially the last couple of years, a lot of information about the labor market, personnel, the Great Resignation, silent resignations, lots about hiring, losing people. How do you retain people? It just feels never-ending. It seems like it's been going on for a while. Can you give us some insight on how that's affected medical practices specifically?

Steve Dickens:

Well, sure. You commented that I've probably seen a few interesting things. Definitely, probably, when I think about the stories from my career, almost all of them that stick with you are the HR-related ones. There are some things you just can't make up. But the last few years have been like nothing that we've ever really seen in the course of my career. What we've seen coming out of the COVID pandemic, if we can even say that, has really affected practices pretty dramatically. In the beginning, when everyone was concerned and afraid of being exposed to COVID, we saw facilities were shutting down procedures and doing only those things were absolutely necessary. It really affected every aspect of healthcare, and in particular, physician offices. Patients were afraid to go in. If they didn't have to, they didn't. This created a cascade effect in that it impacted the revenue stream of the physician. Obviously, they had no money coming in. They had had no work for their employees, and they simply weren't able to support their staff full-time. That left the staff with the option of either being laid off or having to find other employment.

Many of the lower-paid employees in a practice realized that they were able to make more money drawing unemployment because of all the COVID subsidies the federal government had put onto the state. So suddenly you had people like, "Wow, this is pretty great here." Of course, that did not last forever. As we saw, practices were able to access some of the federal relief funds and were beginning to have patients who were coming back in. We obviously, in all of this, created a need for patients who had delayed care longer than they should have. They were hoping to bring their employees back. But what we found was that a lot of those people did not come back.

Renee Tidwell:

Right. They'd found something else.

Steve Dickens:

You're absolutely right. A lot of them found other jobs. Some of them, depending on the state that they were in and their situation, might have still been drawing unemployment. We saw an increase in retirements. We saw suddenly this new influx of people who were going to be an entrepreneur and start their own business. But a lot of people also realized that when they gave up the expensive commuting and childcare and simply what it costs to make sure you're dressed and fed when you work outside the home-

Renee Tidwell:

The cost to work.

Steve Dickens:

Yeah. There is a cost to work. People don't think about that, but they realize that the offset for the stress and the effort of all of that, versus what they were doing now, that they wanted to stay home. In many cases, these were the people who maybe were the lower-wage earner in their family, so they were living off of what their spouse was making. So we had a group of people who didn't want to come back to work. But as the economy was opening back up, people needed to hire back all of these people that they had laid off. Well, we had a smaller pool of people, which drove up competition, which drove up the prices, the wages these people were able to command, which sounds great for an employee, until you think about what it does to the rest of us.

Out in the industry, we've seen companies simply just raise their prices to offset this. Well, that's great in theory, but again, we're seeing that play out across our economy now. But you can't do that in a medical practice. Doctors don't just get to decide, "Oh, this is what I'm going to charge today for this." Their prices are set by the insurance companies. You add onto the fact that they have no real capacity or ability to change what they're charging on top of the administrative burdens, on top of the fact that they are paying more for their supplies. We are still facing proposed cuts from the federal government for the Medicare program. They just simply aren't able to compete right now. So it really is a very different dynamic.

Renee Tidwell:

It feels like it's that way across the board, but adding that layer in about their prices being set, that money has to come from somewhere.

Steve Dickens:

It does. You're right. Any money that a practice spends comes out of what is paid to the physician and the practitioners for their professional services. It's not a bottomless pot of money. In order to pay their employees more, physicians have to make less.

Renee Tidwell:

Right. Well, it sounds like you've got this hiring process, training, education. It sounds like there's this life cycle of having an employee. Can you talk about that a little bit?

Steve Dickens:

Well, absolutely. There is a traditional cycle for an employee. When we say "the life cycle of an employee," what we're really referring to is the arc of their employment, the time that they are with someone. Some people will have many life cycles of employment with them. The day of seeing someone go to work in an organization and stay there for their entire career seems to be something of the past.

Renee Tidwell:

Right. I think we're seeing that across the board. Can you talk a little bit about where does that cycle start?

Steve Dickens:

Yeah. A lot of people believe that the cycle starts when the employee reports for work. It really starts much sooner than that. That is especially true right now because of the competition that we are seeing to attract and retain employees. The cycle in a medical practice begins when the group decides, "We need another body."

Renee Tidwell:

What they need.

Steve Dickens:

Yeah. "We need someone else." So it begins with this idea of, "What is the position? What is the job description? How are we going to recruit for that?" Practices have really got to think about the recruiting strategy in a new light now. With the advent of social media and so many people having access to online resources, it's not as easy as putting an ad in the newspaper anymore.

Renee Tidwell:

Nope.

Steve Dickens:

If you do, it's an online newspaper at that.

Renee Tidwell:

Okay. Steve, once a practice is decided that they have a need, they have a need for a position, whether they've tried to rearrange some other workflow processes, whatever the case is, talk us through the rest of the cycle. They've decided they want someone. Now what? Now what happens?

Steve Dickens:

Okay. Well, again, as I said, it starts with the recruiting aspect of the process. That means creating an accurate job description, something that hopefully would be attractive to would-be employees, and then figuring out how you're going to get that announced.

Renee Tidwell:

Right. How are you going to market it, right?

Steve Dickens:

Yeah. How are you going to market it? Are you going to use a recruiting firm, which can be very expensive and is out of the reach of most medical practices, at least for their regular staff. Are you going to go to online options, whether it's LinkedIn or Indeed? Your local Medical Group Management Association is a wonderful resource a lot of times. But once you figure out how you're going to get the word out, we've seen a lot of groups who have been very successful with putting some type of program in place for their current employees, that if they refer a new employee who sticks, who makes it, they get some sort of bonus for that. It creates a vested interest there.

Once we've done that, then we're going to move into the interview process. I cannot emphasize enough how important it is that groups be very responsive and timely in interviewing. Remember, the employees, or the would-be employees, the candidates, are really in control right now. As you look at it, it's their market. They're probably talking to a lot of different people if they're looking for a job, so you want to make sure that you look at those resumes quickly, that you follow up quickly with a phone interview, with a virtual interview, if this is somebody you like, that you get them in quickly for an in-person interview, and then be ready to make that offer. We are hearing horror stories from practices that are going through this process and hiring them, and people just ghost them. You just thought that was a dating thing. But you really have to look at this in that aspect some as well, too. It is a dating. It is a courting of something. Make those offers. Get them in quickly.

Then you move into the orientation and training phase. We forget a lot of times, no matter how long someone may have worked professionally as an adult, anytime we start a new job, there are those questions we don't know. Do people eat lunch together? Do most people eat out? Do I bring my lunch? Where am I supposed to park? What am I supposed to dress? Do we have a dress code here? All of those types of things. Encourage groups to be prepared for that and be thinking ahead of what that employee needs. What type of professional ongoing education or staff development are you going to have for them? Things are changing. You want them to stay current in their job. You want to be talking to them, making sure that they understand any procedures they're helping with, or any changes to billing or coding.

Then, really, as you move toward we've got them here, we've got them trained, we've got them ready, you got to make sure you keep them. That's where it all comes down to culture and engaging them. Hopefully, if you've created a culture where they feel a part of something, that they feel like they're contributing, they feel like they're being valued, they're being adequately compensated, I mean, let's be honest here.

Renee Tidwell:

That's a big thing right now. It's so competitive.

Steve Dickens:

It is. You've got to pay people what they're worth. The market really is driving that. Most people are feeling the impact of rising gas prices, inflation, all these other things. But you absolutely want to make sure at this point that you're doing what it is that you need to do to keep them.

Renee Tidwell:

I feel like I'm hearing a lot of communication being key here, from communicating with the prospective employee in a timely manner, to making sure you're giving them information when they get there to feel comfortable, to keeping them engaged, a lot of that is just keeping the lines of communication open, it feels like, too.

Steve Dickens:

Yeah. When I look at the work that we do, communication is one of the most valuable qualities. It's one of the most important skills. We talk about low health literacy patients who don't understand what they're supposed to do. That really is all about communicating with them in terms that means something to them. The same is true with your employees. In a medical practice, you are employing people from all sorts of backgrounds, all sorts of educational levels. We all are somewhat in tune at some level to what we see in the news, to what's going on. People want to know what that means for where they work. They want to know what it means for them.

Renee Tidwell:

What do you feel like is the most crucial or overlooked aspect in this cycle?

Steve Dickens:

I believe there are two significantly overlooked aspects. The first is the recruitment phase, thinking about what it is that you want, what it is that you need. You want to create the image that this is a good place to work, this is a fun place to work, that the people who work here are happy. Again, you've got to be able to get them across the front door to even have any hope of them being there. The second overlooked phase that is just equally as important is the retention phase. Once you get them there, you've got to keep them. There are estimates out there, the Medical Group Management Association does one. They estimate that it would cost you about 150% to 200% of an employee's salary to replace them.

Renee Tidwell:

That's a lot.

Steve Dickens:

It is a lot. It's about the recruitment cost, the downtime that, when you don't have someone, are you bringing in temporary staff? We've seen the explosion in temporary nursing right now. Are you having to pay the new people more than you paid them, or are you having to pay overtime to cover that?

Renee Tidwell:

You're still having to train a temporary worker, which is taking time away from someone else.

Steve Dickens:

You're absolutely right, and they're not at the same capacity. This phase is really about that professional development and education you're providing to them, and the communication, which is the key aspect of culture. There are definitely people out there who will leave you for a quarter or 50 cents an hour. They're looking to make all they can. I get it. At the same time, there are a lot of people that are looking for somewhere where they can be happy. A happy employee is a lot less likely to leave you for a dollar or a dollar and a half an hour when they stop and really think about, "Is it worth it to me?"

Renee Tidwell:

What's that trade-off? Yeah.

Steve Dickens:

Yeah. To give up what I know I have for what it is that I might or might not get. Again, once you get them, it really becomes about keeping them.

Renee Tidwell:

I feel like everyone is so busy right now. I know physicians and practice executives are no different, especially going back to where we started, everything that they're trying to do to keep their practices afloat and care for their patients. It sounds like, and you just hit on it, that recruiting is so important. Human Resources can be very time consuming, especially on top of everything else that they're doing. What advice do you have to help them manage that process?

Steve Dickens:

Well, when you look at it as a process, you begin to realize that there are key steps that you have to hit for every employee. While no two employees are the same, you do want to standardize the process. If you build that checklist for yourself of, "This is what I need to be doing, this is how we're going to work through this, good recruitment, good retention, orientation, training, this is what these things look like," it makes it a lot easier for you to not miss something and not let something fall through the cracks. You have to listen to your employees. No one knows their job better than the people doing it. You don't go ask the people at the front desk how the physician wants his or her exam room set up.

Renee Tidwell:

Right. Sure.

Steve Dickens:

So talk to your employees. I think you will find that if you've created the right environment for them, which is about paying attention to culture, they'll give you a lot of great feedback. They'll be able to help you with that. Develop relationships. When I say "develop relationships," I don't mean that you have to be best friends with all of your employees. That brings its own set of problems and challenges as well, too.

Renee Tidwell:

Yes, it does. Yes, it does.

Steve Dickens:

We've all been burned and learned that lesson. But you do want to know something about them. You do want to know their names. Know something about their family. Know what's important to them.

Renee Tidwell:

Well, everything you've just said helps people feel valued, too, which leads to you're learning more to hopefully help recruit. But also, it helps keep your current employees, it feels like, at least.

Steve Dickens:

Yeah, you're absolutely right.

Renee Tidwell:

Well, I feel like I'm hearing you talk a lot about some challenges, though, as well, especially where we started at, with just the cost right now of everything and where we are since the pandemic. Talk a little bit more, maybe, about what you're seeing. What advice do you have for groups that are struggling with this whole process?

Steve Dickens:

The groups that are struggling are the groups that don't have a good process. Those are the groups that really haven't built the framework for their employees. They're reacting to a crisis instead of thinking, "What is it we need to do? How do we need to respond?" They're letting the challenges of the day catch up with them. In terms of practical advice, look at everything. Put everything on the table. Look at the processes within the organization. It always just amazes me, the things that we do in a medical office, simply because we've always done it that way. This goes back to talking to your employees. What are their frustrations?

Bring together a multidisciplinary team and say, "We're going to look at the flow of our office, from the phone call when they call to make an appointment, all the way through the time that we see them and we get the claim out the door. What are the redundancies we can eliminate?" If you can get rid of some of that stuff, that will not only alleviate staffing frustration, which is a good thing, it also saves time. It makes you more efficient. It perhaps might lessen some of the burden you need for staff there. Everyone in the group ought to be working to the maximum of their scope of practice. There are a lot of other duties that the front desk can take on, that the medical assistants and nurses can take on. What can you get off them so that physicians can see it? Figure out ways to be more efficient with the telephone, this back-and-forth phone tag stuff takes time.

Renee Tidwell:

What kind of resources can SVMIC offered to our policyholders?

Steve Dickens:

Well, the folks in our medical practice services department, we've got a great group of people who've worked in healthcare for a number of years. One of the new things that we've developed this year, as I talk about standardizing the HR process, the life cycle, is we've put together an HR toolkit. It walks you through the life cycle of an employee, beginning with thinking about recruitment, going through what does it look like to onboard them? What does it look like, professional development? Sometimes it's not always a good match. There's information in our toolkit about how you do a performance improvement plan, because again, you need to figure out, is this an employee who can't do the job or an employee who won't do the job? If it's because they won't, is it because they don't understand it? So some resources there. Ultimately, if you ever have to cross that bridge, there's a termination checklist in there because that's one of the things that can easily be overlooked.

The HR toolkit, I'm sure we're going to link to it from the podcast today, really encourage everyone to download it. You can use it as-is, as a complete tool, or just pick the pieces and parts that work for you. The folks in our NPS department, we have two people who are certified as HR specialists. They are available to answer your HR questions. We are always-

Renee Tidwell:

That's great.

Steve Dickens:

... happy to do that, tell you what we think, outline options that we believe are available to you, and let you choose your own path there. If you do have concerns about your operations, are you being as efficient as possible? Are there opportunities on the revenue side that you're missing? We do operational assessments. We do revenue cycle assessments. We even can talk to you about your culture, about strategic planning. If you're looking for education for your staff, we've got a lot of webinars that are available on demand online. Of course, we can set up virtual meetings or perhaps even schedule something as a live presentation for your staff, that helps them either with their relationships with one another or building better relationships with patients.

Renee Tidwell:

It sounds like all of that would help physicians and practices save some time because it takes a lot of education experience to know a lot of that stuff. A lot of times I feel like we're so focused on everything else that it's hard to have time to focus on that. It sounds like that's a great starting point for our practices.

Steve Dickens:

Well, it is. I think that's a good point. We've gotten so caught up the last few years in this idea of patient experience that we forget, if we have a positive employee experience, that's probably going to translate to a positive patient experience as well.

Renee Tidwell:

That's true. This has all been super helpful. It's obvious how passionate you and SVMIC are about helping out the physicians as much as possible. Before we wrap up, though, is there anything else you want to talk about? I know we're going to link all of these resources in the show notes for today, but is there anything else you want to share?

Steve Dickens:

Thank you. Yes. Thank you for having me here today. I know HR can be overwhelming. Most practice executives would very likely tell you it takes the biggest bulk of their time. It's what they deal with during the daytime, and then they do the real job when everybody else is gone. But let me encourage everyone to break it down into manageable pieces. Do not let problems fester. When you see someone who's not doing what they need to be doing, or you get wind of something, the best thing to do is to be assertive and deal with it then, as opposed to let it grow into something else. Even if you think no one else is noticing, somebody else is.

Renee Tidwell:

Right.

Steve Dickens:

Talk with your staff on a regular basis, just to keep them apprised of what's going on. Ask them what they think can be done to improve operations. They have a vested interest in this as well, also. Get to know who they are. Find out what makes a difference for them professionally. What makes them tick? We've learned during all of this, too, that people value different benefits. It's not all always about the money. As you think about recruitment, you want your practice to look like an appealing place to work and get care, but you also want employees to believe that. You want them to spread the word as well, too. They are your best advertisement. You may not be able to give everybody everything that it is that they want, but at least, if you know where they are, what motivates them, and what you're dealing with, you can manage the expectations realistically and honestly.

Renee Tidwell:

Absolutely. That's great advice. Thank you so much for being here with us today. As we come to a close, just as a reminder, we will link all of the resources in the show notes for today. Thank you so much for listening.

Speaker 1:

Thank you for listening to this episode of Your Practice Made Perfect. Listen to more episodes, subscribe to the podcast, and find show notes at svmic.com/podcast. The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice as specific legal requirements may vary from state to state and change over time. All names in the case have been changed to protect privacy.