Starting & Running a Private Practice

Hiring Staff

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Your practice manager is your most important, and your first hire.  They are going to be the one to handle or oversee everything, including human resources and staffing issues, payments, relationships with vendors, hiring and firing, and marketing.  It is critical to find someone with the right skill set to do this and someone that you get along with well, as you’ll be working with them quite closely.  Important qualities will include:

• Experienced (ideally 3-5 years).  Especially if this is your first time starting a practice, you want someone with substantial previous medical practice management experience.  They need to anticipate the problems you don’t know to anticipate, and be able to draw upon prior experience to deal with them quickly. 

  • Vet them carefully and check references.  Ask what tasks they took care of in previous roles.

• Strong people skills, compassion, flexibility, and adaptability.  The practice manager needs to get along well not only with you and the other physicians, but with your staff, your vendors, and your patients.  They should have a personality that is approachable and be well-spoken and mature enough to control emotions in difficult situations.  You do not want your practice manager to be the reason you lose staff or contracts.  

• Organized and detail oriented. The right person is going to need to multi-task and will be overseeing lots of small details.  In order to make sure the ball doesn’t get dropped on marketing, payments, billing and coding, and other critical day to day functions.

• Has authority but also has the ability to delegate.  The ideal practice manager will be adept at empowering the rest of the staff to take ownership of projects or tasks.  As the practice grows, it will be harder and harder to keep an eye on everything.

• Negotiating skills.  The practice manager will be dealing with vendors, staff, and patients and all the complaints and concerns they have.  They should be able to politely but firmly enforce rules or procedures when necessary.

Once you’ve figured out your practice manager, you’ll move on to the other hires.  You’ll have to decide exactly how much staff that you need.  Start as lean as possible.  Remember people can have multiple roles, and this is actually beneficial so that they can cover each other if someone is out sick or on vacation.  As you scale, their roles will become more specialized.  

At a minimum, you will likely need a front desk staff member/scheduler and a medical assistant.  At the beginning when things are slower, they can also help you with things like social media, scribing, or cleaning up between patients.  Depending on your specialty you may need some specialized staff like an ultrasound or x-ray tech, a nurse, or a phlebotomist.  You will need to make the decision about whether to keep billing in house or outsource to a billing company. Be intentional about your decision with billing, as this is what will keep the lights on, so if you decide to keep it in house, make sure your staff can keep up with timely submission of claims as well as follow up of denials. 

Also know there are various ways to outsource some of this if you want to stay lean. You may be able to outsource some staff through a hospital, MSO, or billing company, or share resources with another small practice.  You could use virtual employees through a company like Edge Health.

Now to the hiring process.  You’ll first have to look at how many hours each person will be working and decide whether it makes sense to have them as hourly employees or salaried employees.  Typically, office staff and MAs are usually paid hourly, while other medical practitioners and the practice manager are salaried.  Research what other practices are paying for these positions in your area but looking on job sites and postings, or asking around.  Then decide salary rates and what kinds of benefits you’d like to offer.  Is there a bonus structure?  Are you going to have retirement plans?  Is there paid time off, and if so, how much?  Is there an ability to work from home some days?  What will a typical day look like and what will the exact responsibilities for each position be?  Prospective employees will ask these questions, and you want to instill confidence that you know what you’re doing and that you’ll be a good employer.  At the same time, they should know they’re helping launch a new practice and they will be expected to be a team player and get their hands in the weeds.

You can advertise the jobs via local job boards, community resources, word of mouth through friends and family, or in advertising for your upcoming practice.  Cast your net far and wide, but be specific about the job description to avoid spending time on leads that won’t work.

Have a contract ready to be signed so that when you meet the right people, you can take action quickly.  Many hourly employees are looking for immediate availability and will not wait weeks for a contract like we are used to with physician job searches.  Make sure the contracts or onboarding process include confidentiality agreements and non-disparagement clauses.

You will also have to have some basic human resources like an employee handbook that delineates staff roles and personal policies.  Things that should be included in your employee handbook include medical office policies such as work hours, attendance at office meetings, break policies, PTO, benefits, how payroll is handled, how performance will be assessed, and how disciplinary issues will be handled.  These should all be compiled and given to the new employees during the hiring and orientation procedure.  

You will also need some additional compliance materials that will offer you protection as an employer.  Have a method for storing personnel files.  Make sure everything is in compliance with ADA, Federal Equal Employment Opportunity (EEO) Laws, Age Discrimination Act of 1967, Fair Labor Standards Act, Equal Pay Act, and FMLA.  Training should include modules on all of these things as well as training for things like practice protocols, disaster response, cultural sensitivity, and harassment training. 

Lastly, your employees will need a way to get paid.  You can either do this through your accountant or use a payroll service like Gusto. or Quickbooks Payroll (PSG members receive 30% off Quickbooks Payroll products for 6 months using our affiliate link).

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