Flex appeal: It's all in the planning

Flexible scheduling, job sharing and other creative solutions can help medical practices recruit and retain quality employees -- even for the smallest of practices. But don't let flexibility become chaos.

By Carolina Procter — Posted Aug. 13, 2007

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

At a two-physician internal medicine practice in New Bedford, Mass., one of the office's most experienced, talented lab assistants struggled to juggle family and work.

She was having to spend more time in the morning readying her four children -- all younger than 12 -- for school. That posed a problem at work, where her shift begins at 6:30 a.m. She was frazzled, and her employers noticed.

"It was a difficult time," said Nauka Patel, who is the practice's office manager. "We saw she was overwhelmed."

Though the lab assistant hadn't hinted that she might look for work, or decide to just quit, Patel and the physicians wanted to make sure she didn't think of leaving. So they did something many small practices believe they can't do -- create flexible schedules for staff.

Experts say job sharing, flexible scheduling and other creative human resources solutions help practices keep quality employees happy, which in turn translates to profitability. There are guidelines to follow, but overall, offering such perks helps recruit and retain experienced employees whose personal lives aren't conducive to the traditional work day.

"I don't see any reason why somebody should be miserable at work," said Kirk Moore, MD, a solo plastic surgeon in Salt Lake City.

Dr. Moore allows his three-person staff -- an office manager, patient coordinator and receptionist -- to set their own hours and work from home when necessary. When he moved his practice from Idaho to Utah 18 months ago, he decided that since he doesn't like being tied to a desk, he wouldn't ask his staff to work that way, either.

In turn, the policy has allowed him to retain employees who otherwise might have quit because of scheduling conflicts. His patient coordinator, for example, is in her mid-40s and is earning her master's degree in accounting. She has office calls forwarded to her cell phone when she's not at work.

"They're full-time employees, but what I tell them is, 'This is the job that needs to get done, and if you can do it here or at home or on your cell phone, it's up to you.' I give them the freedom to determine that," Dr. Moore said.

That freedom is worth it to avoid rehiring, he said. "It takes at least five times as much money to hire and train somebody as it does to try to keep the same employee. If you have a lot of turnover, there's a lot of [interruption] in your office. If you find somebody that is valuable to you, then absolutely you're much more likely to allow them more flexibility."

Accommodate the qualified worker

The Pew Research Center recently released a survey that found 79% of working mothers with children younger than 18 would rather work part time.

In the medical field, that demographic often produces a qualified crop of employees, said Gray Tuttle, a principal in the health care division of The Rehmann Group, a medical practice consulting firm in Lansing, Mich. So it's smart to pay attention to their needs, he said.

"There are a lot of moms who would make wonderful additions to the work force but want to be home when their kids leave for and arrive from school," he said. "The biggest thing is to get well-qualified people. Working moms who are [well-qualified], working three to four hours a day, four to five days a week, can certainly elevate the talent level of the staff."

The same goes for older employees near retirement, Tuttle said. "Valuable older employees may not prefer full-time work in later years, and might just leave the practice to find something better suited to them."

At the Massachusetts practice where Patel works, the mom-of-four lab assistant was offered an alternative: The practice would hire a part-time lab assistant to cover her shift from 6:30 a.m. to 9 a.m. She would start later, at 9 a.m., and leave later, at 5 p.m.

She accepted, and the new scenario started two months ago. The practice estimates that it will cost $3,000 annually for the extra part-timer, but paying that is better than trying to find someone else with equal experience and ability, Patel said.

"She's very good at what she does, and it's worth it for us to see that she's at peace when she comes to work," Patel said.

The practice then expanded its flexible scheduling to the rest of the staff. Being flexible has allowed the practice to retain not only the lab assistant but also two experienced members of the billing staff who have grandchildren they care for during the day. These employees often do their work after the office closes at night.

"We feel that every time you replace an employee, it does cost you something," Patel said. "The flexibility is a tremendous asset."

It's an asset for employees, too. From their perspective, any lack of pay caused by flexing is often a tolerable alternative to working a more traditional -- and less convenient -- schedule somewhere else.

"It's either time or money. It's hard to have both in the work world," he said.

But sometimes an employee can get pretty close to having both.

"If it's a flex position that's less than full time, then employers are often inclined to pay slightly higher rates, because they don't have the additional cost of fringe benefits and things like that," Tuttle said.

Set guidelines

Flexible work solutions are tempting operational procedures for small medical practices because the owners see them as perks to give employees, said Billie Blair, PhD, president of Leading and Learning Inc., a management consulting firm in the Los Angeles area.

But being flexible costs money, so practices should make sure employee production fills the gap, she said.

"It's certainly very popular with employees but should not be entered into unless the employee is also willing to give something extra in return," she said. "Extract an agreement that has the employee accepting additional responsibilities in exchange."

Dr. Blair also recommends generating a compact with employees that spells out the terms of the alternative schedule or responsibility. This is especially important in the medical field, she said.

"If not managed well, what flexible scheduling usually achieves is a disorganized atmosphere where the physicians never quite know when the employees are appearing, how long they are staying, where they are going and who is taking their place," she said. "This is particularly unfortunate when helping people get well is central to the tenets of the practice."

Employers also should avoid using too many part-time employees, said Tuttle, the Michigan consultant.

"I've seen practices try to get cheap and work with a full staff of part-timers to avoid providing medical benefits and retirement contributions," he said. "You lose the continuity in terms of patient issues -- for example, not being able to close on an issue that occurs in the morning until the next day. Part-timers work well when they're used to complement a stable of full-time employees."

Tuttle said this applies mostly to staff members who work directly with patients. A full staff of part-time receptionists, billing clerks and other administrative personnel is OK, he said.

Know the law

Generally speaking, employing several part-time employees or independent contractors gives a practice a "direct economic benefit," Tuttle said. Individuals who work less than 1,000 hours a year (an average of 20 hours a week or less) usually don't have to receive medical insurance, retirement contributions and other benefits, he said.

While that helps the pocketbook, it also requires close attention to the law, said Deborah England, an employment law attorney in San Francisco.

Each state has a different law when it comes to pay and benefits for part-time employees and independent contractors. And each state has a different definition of what constitutes part-time employment, independent contracting and the like.

"Learn the law of your state or get a lawyer who can tell you," England said.

For example, some states say independent contractors are eligible for the Family Medical Leave Act if their services are used enough by the employer.

England also says to make sure flexible scheduling and similar perks are offered to all employees, not just those who need them for personal reasons. "Be sure to treat everyone equally," she said, "otherwise it will create a potential minefield for the employer."

For Patel, the office manager in Massachusetts, the legal hurdles and expert guidelines are not deterrents; giving quality employees the work place flexibility they need outweighs anything else. "If you can keep a good employee for a prolonged time, then it's always good," she said. "It always benefits."

Back to top


3 common scheduling alternatives

Flexible scheduling

Definition: Employees work nonstandard hours, with a split shift or later or earlier starting times.
Advantage: Employees can accommodate personal needs; qualified workers can be retained.
Disadvantage: Employer may have trouble tracking who is working when; employees might equate this perk with not having to work as hard.

Job sharing

Definition: Two or more employees split one full-time job.
Advantage: Employers can retain qualified employees unable to work full-time.
Disadvantage: Too many part-time employees can break continuity.

Independent contractors

Definition: Individuals who are not employed by the office and instead provide services independently.
Advantage: Employers save money by not having to provide health insurance, retirement contributions and other benefits.
Disadvantage: Employer must pay close attention to state and federal laws covering the use of independent contractors. In some state laws, these individuals qualify for certain benefits after working a set number of hours.

Back to top

Flexibility extends to clinical staff, too

Flexible scheduling and job sharing aren't exclusive to administrative staff; many practices use these solutions with clinical staff as well. Experts say offering these perks to physicians, nurses and other medical personnel can boost morale in the office, save a practice money and help with recruitment.

"It empowers those who want to stay home with their families," said Jody Talbert, vice president of Martin, Fletcher, a Irving, Texas-based health care search firm. "It enables them to balance their careers and families."

But there are guidelines to follow when offering these solutions. The first pertains to continuity of care.

"Let's say you set up three physicians to job share. You want to make sure they're team players. If [one physician is] taking care of a patient and it's [his or her] day off, and there are labs to be ordered, someone's got to pick up the ball. It can't be left undone," Talbert said. "And if I have 10 days off coming up, I need to make sure there's a very high level of communication with the person I'm sharing the job with."

A practice also should pay attention to how flexible work schedules will affect employees who aren't on such schedules. This is especially relevant among nurses and medical assistants, Talbert said.

"Is there a negative reaction from the full-time employee toward the part-time employee?" he said. "If there's only 20 hours a week worth of work it makes sense, but if you have another full-time equivalent doing most of the work, there's a possibility of decrease in morale."

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn