How to solve staffing challenges by hiring temps

A column about keeping your practice in good health

By Victoria Stagg Elliottis a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted May 31, 2010.

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Temporary personnel can keep your office running while your receptionist is on maternity leave, your nurse is having hip surgery, your medical assistant goes on a Caribbean cruise, or one of your billers quits. But they also can be useful if you need some extra help and aren't sure you can afford to hire a permanent staffer.

Hiring temps can help maintain staff morale when the number of permanent staffers dwindles or the workload increases. This also can be a means of testing out a worker before hiring. And if things don't work out, it can be easier to show a temp the door, especially if the worker is brought in through an outside company.

"If we get someone through an agency and if there is any kind of difficulty, whether it is coming in late or not showing up, we can call the agency," said Eileen Szanyi, director of operations at Finger Lakes Medical Associates in Geneva, N.Y. The multispecialty group of 22 physicians has a staff of 120, but brings in temporary workers during the year, either directly or through an agency.

Using temps, either for longer-term needs over several weeks or months, or as a stopgap before hiring someone permanently, is becoming a fairly common practice.

The temporary staffing industry has been one of the few consistent employment growth areas, adding 26,000 jobs in April, according to the Bureau of Labor Statistics. It's unclear how many temps work in health care.

Some experts suspect more medical practices are using temporary workers because they are hesitant to hire permanent staffers while the economy is still on unsteady footing and the outcome of health system reform is unclear. Also playing a factor: whether a Medicare pay freeze will be made permanent or whether doctors face further threats of large pay cuts.

Once the decision is made

Practice managers and experts suggest following several steps to make the process of bringing in temps and possibly transitioning them to permanent staff run as smoothly as possible.

If a staffing agency is used, the first step is to identify one that is familiar with the medical field. Most large national staffing firms have health care divisions, and some will be able to provide both administrative and clinical workers.

"Be prepared by finding a qualified provider. It's better to be ready for when you need staff," said Bob Livonius, CEO of Medfinders, a nationwide health care staffing firm, headquartered in Arlington, Texas.

Agencies say most practices find them through an Internet search, although many firms exhibit at medical conferences. Word-of-mouth recommendations also come into play.

Agencies that provide clinical staffing services can be certified by the Joint Commission. While agencies are not required to seek this certification, having it may indicate quality.

When considering an agency, experts recommend asking about the services they provide and how candidates are assessed. What kind of background check is carried out? Are references called? How are skills measured? If the staffer, such as a nurse, needs to be licensed, how is this verified? Does the agency require drug testing of candidates?

Experts also suggest trying to predict when temporary personnel are most likely to be needed. Most agencies can accommodate Sunday-night requests for someone to come in on Monday morning, but calling a week or more in advance increases the chance of booking someone who most closely matches the practice's requirements.

"The sooner you get in contact, the better," said Connie Gray, vice president and practice leader for health care at Kelly Services in Detroit. "That gives a medical practice the greatest opportunity to have the most qualified staff available."

In addition, planning ahead gives physician offices the opportunity to review several resumes and even ask to interview several candidates before a job is booked. If a temp works particularly well, they may be requested for future planned absences.

Temporary staffing agencies do not generally charge a fee to set up an account or provide initial contact with candidates. Rather, they charge a premium over the hourly rate actually paid for the employee. This should cover workers' comp, unemployment insurance and other benefits that will be provided by the agency. The fee also should include liability insurance for clinical staff.

The actual cost may be negotiable.

"Ask!" said Dixie Nicholson, staffing manager at Provisional Services Inc. in Spokane, Wash. "Some managers ask if this if the best we can do. They don't know if they are going to be able to afford that. Maybe we can come to a compromise."

Agencies usually charge a fee if a temp they provide is hired as a permanent staffer. Contracts should be read closely to ensure permanent hiring is allowed and to determine any restrictions on how soon a temporary staffer can become permanent.

Hiring managers at medical practices caution that the hourly rate paid a temp through an agency should not be more than is usually paid for the job, particularly if there is a chance the person will be offered a permanent position.

"If someone has worked for three months and you would like to hire them but the pay is less, they generally are not happy about that," said Szanyi.

Some medical practices hire temporary personnel directly, without going through an agency. This involves more work in hiring and managing that staffer, but can be effective for some situations.

For example, Finger Lakes Medical Associates brings in several college students over school vacations for special projects and to cover permanent staffers who have requested time off. The students are usually found through community contacts and tend to return for several years until they complete their schooling.

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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