As songwriter Henry Kaiser put it, “Problems are only opportunities in work clothes.” I can attest to this truth of this statement. As a podiatric medical assistant and consultant, I frequently lecture at meetings and speak to doctors and assistants all over the country. My mission is to help create a better work dynamic between doctors and assistants. With this in mind, let us consider some common questions that come up at meetings.
Q: I am not having any luck training my staff. I tell them how things should be done and I still end up doing them myself because they are not catching on. I simply do not have the time and patience to repeat things over and over again. What is the solution?
A: First, training someone does not require luck and second, merely telling staff is not a substitute for teaching staff. Training involves demonstrating what you are trying to teach, clarifying the importance of it, encouraging questions, repeating information to make sure your staff understands, providing hands on trial time and finally allowing your staff to go solo with this new activity. By following through with this approach, you can significantly enhance a successful outcome.
Also keep in mind that cutting back on training time does not speed up productivity. This actually does just the opposite. By not training someone properly right from the start, you risk the possibility that employees will do things the way they think they should be done. As a result, you can wind up with less than adequate service (from the handling of equipment to the handling of your patients). This only contributes to higher costs in the end. At that point, you have to stop, undo the mistake and start all over again, wasting even more of the time you said you never had in the first place.
Make the necessary time to train even if it means rescheduling an occasional hour of patients to do so. When explaining various techniques, do not assume the staff or new employees know what you mean. Spell things out for them and insist they take notes for future reference. Ask them to shadow you for a week or two to learn your specific protocols, what kinds of questions your patients ask, how you respond to those questions, what instruments you reach for, what products your recommend, etc. Utilize the skills and experience of your key assistant (if one is available) along with (not in place of) your time and schedule regular in-house training sessions. This approach is not only key for new employees, but also worthwhile in brushing up an established employee’s technique as well.
Also remember that praise goes a long way. Given that most employees do 90 percent of their duties right, how difficult would it be for you to praise them for something different every single day? Praising good behavior encourages repeat good behavior so keep those compliments coming.
Q: For the first 10 years of practice, I gave my staff person a $1 per hour raise, but now I feel I have reached a plateau in what I can afford to pay her. If I continue this pattern, I will eventually go broke, but if I don’t, she will think I do not appreciate her. What is the “going rate” average salary for a podiatric medical assistant and is there a salary “cap” for what an assistant should be earning?
A: You have created an automatic expectation by basing raises on years worked instead of performance. Essentially, you have “locked” yourself into that repeated annual increase. While one should take loyalty and commitment into account, they should not be the only criteria on which you base raises. You need to start attaching purpose to these raises and the sooner the better.
Unfortunately, because there is an undefined scope of practice among podiatric medical assistants (due to varying skill sets), it is impossible to determine an average “going rate” salary. Unlike the medical or dental assistant who graduates with a list of learned skills and qualifications, and along with them a recommended wage expectation, podiatric medical assistants must struggle without either. They have no recognizable starting ground. Unless podiatric medical assistants can adopt a more standardized job description, it is nearly impossible to create viable benchmark statistics or compare one salary to another. Therefore, salaries and raises can only be a direct reflection of individual duties and performance.
The annual employee performance review is the best tool for measuring work performance and creating the necessary time to discuss praiseworthy accomplishments as well as problem areas. Be honest and give your employee a clear sense of how he or she is doing. Discuss aspects of his or her job performance that need improvement. If the employee has serious performance issues, discuss those issues and clearly outline your expectations for improvement. Whether the employee needs additional training is another issue to discuss during the review. Of course, there will also be discussion about a possible increase in salary.
As far as salary caps, I think this discussion should take place with the employee during the hiring process. If there is a “cap” in the future, he or she should be aware of this. Perhaps you might offer an agreed upon alternative benefit that might offset a monetary increase. For instance, one may offer participation in an incentive-type bonus system, whereby the amount of an employee’s financial reward is directly driven by his or her own motivation. This can be mutually beneficial.
Another substitute for monetary incentive might be flexibility of hours, another week’s vacation, health insurance, birthdays off, tickets to a play or dinner or even a paid weekend away. There are all types of incentive-based programs to consider but it does require you knowing a little bit about each employee needs and their personalities to know what would best suit them. Involve them in the discussion for best results.
Q: Lately I have noticed one member of my staff is despondent and uncooperative. As a result, her performance is plummeting and I am concerned that her attitude may start to affect the other employees and, more importantly, the care that my patients are receiving. What should I do?
A: The expression “one bad apple can spoil the whole bunch” is true, especially when one person has a great deal of influence over the others. One should first try to resolve any conflicts. Make a genuine attempt to communicate with this individual to determine exactly what is troubling him or her. Perhaps it is a personal issue outside of the office that you have little to no control over.
On the other hand, maybe it is as simple as altering the employee’s job description. In this case, your direct input could result in a mutually beneficial solution. Try asking the following questions:
• “What do you personally enjoy the most about your job?”
• “If you had the ability to do so, what one thing about your job would you change that would make it better?”
• “How would you suggest we make that change happen?”
• “What would you say we could do together to make this office run more efficiently and create a better team?”
If you have tried to work with this individual but are unsuccessful in altering the outcome, then you need to start analyzing whether or not your practice is a good fit for this employee.
Recognize the importance of matching certain jobs to personalities. If people enjoy what they are doing, they will do it well but this works in the reverse as well.
Q: I have one assistant who is always on her cell phone. I have told her I do not approve. She will let up for a while but she eventually falls back into her old habits. What are my options in dealing with her insubordination?
A: When you have a written office policy in place that has been distributed to each employee, it should be clear which behaviors are acceptable and unacceptable in your office. If your employees occasionally use their cell phones to connect with a family member during a time that is not disrupting office flow, perhaps you may allow some leeway by establishing reasonable rules for acceptable cell phone use. However, if a particular employee is always on the phone and it interferes with his or her job, then “abuse of cell phone privilege” should be a focus of your policy. Either way, one should make employees aware of the sanctions for non-compliance. If productivity continues to be affected, then you should reconsider these incidences of use as being a cause for reprimand or perhaps dismissal.
If you have not yet developed an employee manual for your practice, it is never too late. Identify what policies you want to create, review them with (and ask for input from) your staff to make sure they appreciate the importance of each one. Ask if they have any questions and then require them to sign off on it as an indication that they understand and will adhere to the contents. Finally, give them a copy for their reference and provide them with any updates as they develop.
Once you have initiated certain policies, it is important to enforce them in a consistent manner. Otherwise, the policies will not be taken seriously.
Q: I was so excited to implement an electronic scheduler in our office, but when it finally arrived, my staff made no effort to learn how to use it. Much to my dismay, they are still using an appointment book. How can I convince them this will be better?
A: Accepting new ideas is never easy. In fact, depending on how new ideas are presented, staff can easily interpret them as more work. The human response is to resist change if the pain of moving from Point A is greater than the pleasure of arriving at Point B. How will they know it is painful if they don’t try? It is a good question but the reasons for reluctance could be different for everyone. Maybe they see it as moving out of their comfort zone or that it requires more time and energy than they feel they have to give.
Whatever the case, one should take a teaching approach with new ideas. If you have no idea how this new system works, how do you expect others to buy into it? Talk up the benefits for the staff. Explain how implementing an electronic scheduler will make it easier for them to manage appointment times. If possible, it is wise to get other people (who already use the system) involved. When new employees or existing staff hear testimonials from fellow staff, they are more likely to be convinced of the new idea’s value.
Letting employees feel like they are part of the change also goes a long way toward implementing the change. Once they become familiar with it, they will become more comfortable with it and before long, the new way will be the norm.
Ms. Homisak is a licensed podiatric radiology technologist and has been a podiatric medical assistant for 33 years. She is a team partner and practice management consultant with Secrets of Success (SOS) Healthcare Management Solutions, LLC. Ms. Homisak is also a member of the Board of Trustees of the American Academy of Podiatric Practice Management. She has lectured nationally and internationally to both doctors and assistants on motivational and management-related staff issues, and has published numerous articles on associated topics.