Employees: Where Do You Start?

Every practice owner has to decide at some point if and when they want to add staff to their practice.  Just as practice models vary between clinicians, so does the utilization of staff.

You likely have dozens of questions on topics such as:

  • When is it time to add staff?
  • How do I know that I’m financially ready to do so?
  • How do I find the correct staff?
  • What taxes do I need to pay?
  • What if they don’t work out and I need to let them go?
  • What should I be worried about?
  • Does staff increase my liability?

I’m sure these are just the start of your questions about having staff.

But where do you start?

First of all, stop and consider why do you even want staff. What will you have them do? Will they make your life easier, or will they add a level of complexity you don’t really want in your practice?

You could at this point, apply the SWOT analysis (Strengths, Weaknesses, Opportunities & Threats) to this question. For example:

SWOT Employees


But how do you know if you really need another staff member?

Determine the need:

What is the role and responsibilities you’d hire for?  But also determine if you can perhaps improve a process, eliminate work that is not needed or somehow redistribute the workload?

What do you really want or need this person to do?

Once you identify the role and responsibilities, you’ll want to term exactly what you want them to do. In other words, what is the job description, what policies and procedures do you have in place for this job?  Do you have in place everything that person will need to be successful in your practice?

About those finances…

This is perhaps one of the major concerns employers have, especially when hiring their first employee. You’ll want to take a good look at your overhead. In most organizations, the cost of staffing is the most expensive item in their budget.  

When you hire someone for say $15.00/hour, you need to be aware, that is only the first part of the salary. You’ll have to include employment taxes, medicare and social security taxes, unemployment taxes, workers compensation, liability insurance, payroll cost, benefits and more.

Who would be ideal?

What kind of person do you want?

What kind of personality or work ethic will compliment you and any other staff? Do you prefer to work with someone who frequently smiles and laughs? Or do you prefer someone who is more serious and professional in their personality and behavior?

What kind of education and training do you want them to have? Regardless if you are hiring another NP, a clinical assistant or a receptionist, you’ll need to determine what education, training, licensing, and/or credentialing they will have.

Both large and smaller employers will use different tools and test to determine if the potential candidate is a good fit for the company. You may be familiar with Meyers-Briggs, and the books Strength Finders and Unique Abilities.

And what don’t you want?

There are several laws pertaining to employment which prohibit you from discrimination. https://www.eeoc.gov/laws/statutes/.  It’s advisable that you check not only what the federal laws say, but also your own state law which may have added other categories of people.

While you cannot discriminate, you’ll certainly have your own preferences for employees you hire. For example, we let people know that we are a “Smoke & Drug-Free” place of employment.  When I worked for a Hospice that specialized in people with AIDS, it was important I hired nursing staff or vendor services who did not show any signs of intolerance to your patient population.

Hopefully ,this stimulates your thoughts about employees – specifically if you want/need employees, the pros, and cons of having employees and the financial obligations that go with hiring staff.

We’ve written about staff in the past, here are a few you might be interested in:

Your Turn!

Share you questions and thoughts below.

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  1. Is it legal to own a clinic as an NP living in NY without a collaborative an Internist on site?

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