Back in the day, newly qualified doctors expected to set up their Private Practices in the front room of a double fronted Victorian terrace house in an inner suburban street. In those times the tentative first steps of Private Practice would have been taken together with a secretary, possibly an emerging junior secretary from a mentor’s rooms. This trusty confidant would be wholly expected to set-up the files, phone and chairs in a particular, enduring way that that would see-out three decades of service for that doctor.
Years later, the doctor and secretary would expect to retire on the same day.
Sure in the mid-twentieth century the symbiosis of doctor and secretary was as essential to the delivery of specialist medical care as training 80 hour weeks and vying for golfing invitations with the Head of Department. One secretary for life.
While the certainty of three decades of service from a single secretary has the appeal of a certain level of security, harboring these expectations in 2017 is more likely to cause hindrance and financial loss than any real benefit.
The Modern Practice
The modern practice of medicine and surgery does not require a commitment of 30 years from a single secretary in the style of the 1965. Nowadays the best practices will be operated by staff who are motivated to learn, evolve and develop in their Medical Administration roles. Necessarily this means that staff will expect to be managed, mentored, educated and, most shockingly for doctors, mobile.
“The worst thing that could happen to my practice would be if my secretary told me they’d be leaving in one week” SENIOR PHYSICIAN
I often ask doctors if they would prefer to work with a secretary who will sit in the same, often windowless office for thirty years performing the same tasks, or to work with a series of motivated people who are able to innovate, evolve, update and maintain the energy of their practice over its lifespan.
The reality is that the modern medical administration workforce is mobile and expects training and mentoring. Harnessing this enthusiasm can be a big bonus to any work place. Indeed practice systems evolve so quickly that training and role-management is an essential part of operating any medical practice. Every doctor entering private practice should expect to employ staff who will require or demand training. Doctors should also expect their administration staff will probably leave for another role within two or three years.
Rather than seeing this as a negative it should be treated as an opportunity to ensure practice systems are implemented that are resilient, flexible and that single points of failure are minimised. Recruitment of staff should be viewed on a continuum, and as a necessary part of the evolution of a modern practice. Contingencies must be in place. Recruitment, replacement and training of staff needs to budgeted for financially and time available for on-boarding and training.
“I increased the pay rate to $85,000 per year because I relied entirely on this Secretary to run ALL of my practice operations and finances. It was only eight months later she started looking for a new role elsewhere as Senior Practice Manager.” SPECIALIST
How to employ modern medical administration staff:
1. Choose People With Nous.
nous: practical intelligence, common sense
Recruitment will be on of the most difficult jobs a doctor can do. Through the strange mediums of advertising, interviewing and reference checking a feint outline of a candidate’s suitability can be measured, but it may take six months to get to know someone’s true abilities.
Look for candidates with some experience or interest in health, demonstrated competency with software applications, proven multitasking capabilities and excellent communications skills. We look for candidates with temperament and calmness under pressure. If possible test applicants on-site, or consider using a recruitment company to sift through the candidates, though the cost for this can be very high.
2. Have Systems.
Create a work environment where systems are established, documented and reviewed regularly. This includes access to procedure manuals, training information and management oversight. Do not expect to sit a new employee in a desk and have them do their work. Time for guidance and instruction needs to be factored in. Our experience is that it takes at least six weeks of supervision to have staff at a level where they should be expected to competently take on the work of a medical administration role for a new employer.
3. Provide Management.
An employee un-managed is an employee underused.
Never accept that if there are no complaints that jobs are being done correctly. As the employer, doctors should provide managerial oversight and guidance, setting goals, targets and skills acquisition plans. Formal professional development reviews would be expected by the best candidates, and so should be part of the remit of employers of medical administrators. This should take the form of at least annual reviews of the role, planning for development opportunities and identification of training courses and key performance indicators. Promotion should be discussed, where possible, in the context of attaining skills that are required to reach the next level of responsibility.
The modern practice can make use of multiple resources that reduce the reliability on single employees and in many cases remove the burden of HR or employment altogether. Since few doctors have any experience in operating small business or employing staff ,outsourcing can take the ‘curve’ out of learning.
- A 21st century approach to staffing a medical practice is to completely outsource the management, recruitment, employment, systems and HR infrastructure to a Medical Practice Management (MPM) company. A doctor can design their team using staff from a MPM provider, without ever having to arrange payroll, perform recruitment or worry about leave cover. Staff supplied by someone else. Working as a dedicated team solely for the doctor, in this model staff including part of a Practice Manager, Business Development Manager, Front Desk Staff and Bookkeeper can be provided for less than the cost of a single secretary. Hoxton MPM provides these services and capabilities to over 120 specialists and GPs across Australia. By relying on established and proven infrastructure there is no need for any single practice to ‘re-invent the wheel’ or meet the high up-front costs of entering private practice.
- Virtual reception services can complement part time front desk staff, by efficiently providing telephone answering, messaging and patient management capabilities off site. At a cost proportional to the work, this model effectively outsources the burden of recruitment and service delivery to a third party, whose role is to work closely with your onsite team.
- Outsourced medical billing reduces the administration burden of your on-site staff to concentrate on customer service. For the cost of only 3% of receipted billings the costs are less than the employment and real estate costs of your own staff.
- Outsourced transcription and dictation ensures permanent capabilities by specialised staff to produce and send your letters. Although the usual pay per volume model can make these service quite costly, the peace of mind and certainty substantially reduced stress on busy front desk staff. Voice recognition software can take the human typist out of the equation all together.
Finally, in some scenarios selecting great people does come down to luck. Be sure to be clear about what you need and expect from someone when interviewing them, and if things aren’t working out be sure to either correct the situation early with effective management or end the employment during the probation phase.
Associate Professor David Williams MBBS PhD FRACP GAICD
Managing Director of Hoxton Medical Practice Management.