Some organizations will use the terms essential and non-essential workers as a way to distinguish between who needs to be on site in the event of an emergency, and who does not. I do understand the purpose of this distinction, however, it’s very important that businesses not give the impression that some employees are more important or valuable than others. (more…)
During the holiday season we are reminded to give thanks and extend our best wishes to family, friends, and colleagues. It’s a time to step back and reflect upon the accomplishments achieved in collaboration with your team, and feel a sense of gratitude for what you have.
Do you take the time to acknowledge the contributions of others? Do you have a full appreciation for the importance of giving praise?
Many years ago I had an eye opening meeting with an engineering director named Pete. The purpose of the meeting was to update Pete on the progress of my work with several members of his team. I facilitated a process improvement initiative that ended up saving the company over one hundred thousand dollars. In spite of this outcome, the group had very low morale. One day I stopped one of our meetings and asked the team why they were so upset. They said “Pete doesn’t value us.” I asked “Why do you feel this way?” Their response was “He never shows appreciation for our work.” I shared this story with Pete in an attempt to provide him with a valuable insight. His response was “I don’t need to tell them how much I value them, they are engineers and should know how well they are doing.” I said “Pete, everyone wants to be appreciated. It’s not based on one’s position or degree. You need to express to your team how much you value them.”
To this day, I can still see Pete struggling to understand the importance of giving thanks.
The following are a few suggestions for leaders regarding expressing thanks:
Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers. Private practices are almost exclusively for-profit. Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments.
Hospitals can be for-profit, not-for-profit or government-owned. For-profit hospitals make up less than 20% of the total hospitals in the United States.
Private practice owners take a salary draw, split any receipts after all expenses are paid, and generally distribute receipts monthly or quarterly. This leaves very little at year end to be taxed through the corporation.
Hospitals that employ physicians typically guarantee a salary and offer an incentive plan where the physicians earn more for seeing more patients and/or being more productive based on work Relative Value Units (wRVUs). Hospitals may or may not use a practice expense and revenue model to measure the margin.
Benefits of Managing a Private Practice
You get to do everything, so if you like or want to learn about HR, marketing, finance, IT, contract negotiation, revenue cycle management, facility management, and lots of other stuff, you’ll get to do it in a private practice.
You are the top position in the practice, so you get to put your imprint on the practice. You can often be more creative.
Physicians can be very laid-back and practices can maintain a more relaxed, family-like atmosphere.
Decision-making can be straightforward and swift, so you can help your practice to be nimble in response to news events, trends and new ideas. If your practice decides to become a concierge practice or stop or start taking a particular payer, so be it!
You may find it easier to get a foot in the door and start your management career in a private practice as physicians don’t always hire managers using traditional means. A recommendation from another manager, a consultant or a physician may be enough to get you started.
Drawbacks of Managing a Private Practice
You report to the physicians who may not have business expertise and may fight you on your well-founded recommendations.
There is no internal career path – you’re at the top in the practice.
Physicians will make less money every time a new non-revenue generating position is added or any time equipment needs to be replaced – expect them to be generally slow to respond to capital expenditure needs, especially if they cannot see that any new revenue will come from the expense.
When physicians “eat what they kill”, taking home the dollars they personally earn less their expenses, they can be pitted against each other and have conflicting priorities.
Your practice could be purchased by a hospital and you could find yourself out of a job, or your job radically changed.
Benefits of Managing a Hospital-Owned Practice
You report to a management professional who should understand the business and be supportive of your well-founded recommendations.
You will receive support from other hospital departments: the Human Resources department will screen, orient and provide benefit support to your staff; the Information Systems department will provide and maintain your practice management system, EMR system and other hardware and software; and the Accounting department will pay the bills and write the payroll.
You may be able to climb the career ladder and manage multiple practices, or become the Vice President of Physician Practices, or the COO, CFO or CEO of the hospital.
You will get to interact with managers of other departments and broaden your hospital knowledge and understanding of the care continuum.
You can learn a lot from the process of preparing for and living through a JCAHO (a.k.a. “The Joint Commission”) visit.
Drawbacks of Managing a Hospital-Owned Practice
Hospitals use different terminology for charges, adjustments and receipts and work on the accrual system instead of the cash system, which most private practices use. It takes time to understand and distinguishes the terminology and process differences.
The entire system will be in a tizzy on a regular basis getting ready for a JCAHO (a.k.a. “The Joint Commission”) visit.
You can expect to have much less autonomy in a hospital system and there may be more red tape involved in getting even simple requests filled.
Hospital administration may find it difficult to relate to the perspective of the hourly staff and it could be frustrating to balance the needs of the staff and the needs of the organization.
Because the hospital is the big-dollar earner, the needs of the clinics may be second, third or fourth down the line in importance.
What do you see as the benefits or drawbacks of your private practice or hospital practice job?
Ever wondered if you are doing things right, or doing the right things when you hire a new employee? Then this series is for you! Human Resource Consultant Susan Hayes will cover the hiring paperwork including posting the job, the job application, the job offer letter, the I-9 form, the W-4, and the personnel file.
Image by Getty Images via @daylife
Once you have made the decision…
…to fill a new or existing position you will post/advertise the job internally and externally. Larger employers usually post open jobs on a bulletin board that is located where current employees, as well as the public, have access. When there are several hundred employees, possibly in several locations it is hard to get the word out that a job is open. However, smaller employers rarely need to post an available job because the grapevine works very well and word of mouth will spread the news before you have a chance to announce it.
What difference does it make if you post a job?
The main reason you post a job whether you have 10 employees or 200 employees is to be sure you are not inadvertently discriminating against any class of people. A hiring can be defended only if the job was posted and anyone with skills, knowledge and/or background to do the job had a chance to apply. If the job is not posted, there could be a question as to why certain people did not know. Were only males told that the job was open so a female would not get hired?
I’ve had to defend hirings in areas of race, gender, age and disability. If there is no proof that the job was made available for anyone with skills, knowledge and/or background, and there is no documentation of the decision process, you might find it hard to defend why you hired an applicant. Job postings and advertisements should be kept for a minimum of one year in order to be compliant with the Americans with Disabilities Act (ADA), Age Discrimination in Employment Act (ADEA), and Fair Labor Standards Act (FLSA).
What’s the best way to advertise a position?
Depending on the job and your community, you may advertise your position in different ways. Some practices give referral fees to employees who refer people who are hired. Some programs give 1/2 of the referral fee when the new employee passes the 90-day mark and the other half when the new employee reaches one year. Craigslist is one of the most popular places to advertise positions. Depending on the position you may also want to consider:
Employment Security Commission
Comm unity Colleges – post jobs and also ask teachers for recommendations
Local or state medical manager groups or listservs
Specialty job boards or publications (nurses, technologists, mid-level providers)
Social media such as Twitter, LinkedIn and Facebook
How should you describe a position in an advertisement?
My favorite way to give potential applicants as much information as possible so they can decide if they are a fit for the job is to place a small ad on craigslist.com, the newspaper or other media directing applicants to call a job line at your practice. You can assign a voice mail box as the job line and instruct those interested to call and listen to a description of the requirements for the job, the responsibilities of the job and the benefits of the job. Asking applicants to then email or mail a resume or complete an online application will ensure that your applicant can follow directions!
Why do I need to use an application?
While there is no law that states a potential employee has to complete an application, if you are an employer that is covered by the Fair Labor Standards Act (FLSA) there is certain information that you must collect.
Who is covered by FLSA?
Any private employer with two employees or more that engages in interstate commerce activities and has an annual business volume of at least $500,000 is covered by FLSA. Also covered are hospitals, educational institutions and state and federal public employers. Individual employees who are engaged in interstate commerce activities even if their employer does not gross $500,000 a year would be covered also.Interstate commerce is the buying and selling of products and services across state borders.
The application is a quick way to get the information in the beginning of the process and have it together in one place if the applicant is hired. The application also helps you to compare information between applicants that has been standardized. Some resumes are crafted to hide shortcomings and those shortcomings will easily appear when an application is completed.
Some people do not have resumes and the application is an easy way to have information about an applicant’s educational and work background in one place with a signature to verify the information. It can also provide legal information to refer to in the future. For instance, if an employee puts on an application that he/she can work any day of the week and then when asked to work on Sunday, claims that he/she cannot, you can go to the application and find the claim in writing.
Most applications no longer require a full social security number. Because the application may pass through many hands, this is one way to protect the applicant’s number from inadvertent exposure.
Many employers require even top level position candidates to fill out an application so they have documentation of experience and education. Applicants will need to provide details and dates of past employment and education, as well as detailed information on licenses, credentials and certifications. If the application is completed online, this application information may automatically download to a human resources program, saving the employer time and money.
It’s important for the job application to be complete and accurate. The information that you will independently verify is: Name, Address, City, State, Zip Code, Phone Number, Eligibility to Work in US, Felony convictions, and if under age, working paper certificate.
Applications should be kept in a confidential place for one year in order to be in compliance with ADA, Rehabilitation Act, and Title VII of the Civil Rights Act. However ADEA requires that applications for those over 40 years of age must be kept for two years. The dilemma is: how do you know the age of the applicant if you cannot ask it on the application? The answer = keep all applications for two years to be safe.
ABOUT THE AUTHOR: Susan Hayes’ undergraduate degree in Psychology from NC Wesleyan College prepared her to weigh objectivity with compassion. Her Masters in Public Health from The University of North Carolina at Chapel Hill and her background in benefits administration have given her a comprehensive understanding of the complexities and scrutiny imposed on businesses, particularly healthcare businesses. Twenty years as a human resource specialist in the healthcare field means that Ms. Hayes is well-positioned to help a healthcare entity of any size find solutions for human resource issues. She can be contacted atSusan Hayes, MPH, Hayes Consulting, 910-284-1627,firstname.lastname@example.org.