Consistency key in giving staff time off

A column about keeping your practice in good health

By Mike Norbutcovered practice management issues during 2002-06. Posted Jan. 26, 2004.

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Now that the holiday blitz is over, your office has probably regained some sense of normalcy. Staff members have returned from vacations, schedules are back on track and people are getting back into their professional grooves.

Sounds like a good time to start thinking about time off again.

As physicians become wrapped up again in clinical work, issues such as time off for office staff members can easily be pushed to the back burner. But if they're not handled well, those seemingly innocuous requests can damage both the practice's fiscal health and office morale.

The key to balancing the needs of staff with the health of your practice is to be prepared for the events before they occur, health care consultants said. Whether it's a policy manual that spells out how and when employees can take vacation, or a general protocol for handling work when a staff member is ill, it's better to anticipate problems than to hope they never happen.

"It's hard to apply hard-and-fast rules to every situation," said Rick White, CEO of MedaPhase Inc., a consulting firm in San Antonio. "You have to know your office staff, know their morale."

While other professional offices usually have enough employees to cover for absent colleagues, some physician practices do not share that luxury. Limited numbers of employees can make each request for time off a debate about who deserves it, who will cover the work and how the practice will cope.

One way to make sure that work in the office will continue is to require advance notice for time off and cross-train employees so they can cover for a co-worker if pressed into service.

Something consultants don't suggest, however, is making decisions without following a handbook and arbitrarily weighing each request.

There are exceptions, of course. A physician in a smaller office might feel a sense of loyalty to long-time employees, but inconsistency in decision-making can cause strife between co-workers, consultants said. It's important to show compassion in the event of an illness or a family emergency, but playing favorites in deciding vacation time can cause bad feelings, they said.

"There's a real temptation by people to base decisions on what type of employee they are," White said. "But you should use caution because you may be asked to produce criteria to prove the definition of a 'good employee.' "

Many smaller offices rely on temporary employees when a staff member is absent, said William Nearhoff, vice president of consulting for D-MED Corp., a Plano, Texas-based consulting firm. But cross-training is still advisable for small offices because if an office worker is out and a temporary employee is needed, a practice can fill the more responsible jobs with current staff, he said.

"You can go to the temp agency for the least important job," Nearhoff said. "Or, some practices have a former employee who's still willing to come in and help."

Or, a spouse is sometimes pressed into service. Many doctors, if they don't have their husbands or wives working for them already, keep them as a backup in case a staff member calls in sick or has an emergency.

Darius Peikari, MD, an internist in Plano, Texas, has one employee in his fledgling practice. He either uses temporary employees to cover for that employee during absences, or he asks his wife or a family friend to help out in a pinch.

"With a temp service, you usually have to give a week's notice," Dr. Peikari said. "If I take off, the office will usually be closed, but I don't count that against [the employee's] vacation."

Stephen Tharp, MD, an internist in Frankfort, Ind., and a past president of the Indiana State Medical Assn., operates in a hospital-owned practice with three employees. If a staff member is out, the practice usually can borrow from another clinic or hospital department, but an unfamiliar employee can certainly interrupt office flow, he said.

"When you're lean, you don't cross-train as much, and that can have significant effects from time to time," Dr. Tharp said.

Leaner can be effective, however, if a practice considers investing in other options, consultants said.

An electronic medical record system, for example, can reduce office staff, and some offices outsource their billing and human resources duties to another company, said Bob Erra, president of Management Science Associates in Kansas City, Mo., a division of Clark Consulting.

These conveniences might be expensive, but they will help physicians get back to their patients, Erra said.

"Smaller groups should be looking at paperless solutions," he said. "And they have to think, do they really have the expertise to understand all of the regulatory issues involved with employment?"

Mike Norbut covered practice management issues during 2002-06.

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