Lawyers PI Program
“Building a PI Practice”


 From the Desk of:


“Win With Your Staff”


I am sure this is what goes on in your office every day: Your staff arrives early to clean up their work space, having eaten breakfast earlier at home to be prepared for the patients. They turn off their cell phones, so they can focus on each and every patient that walks in the door. With each patient that arrives, they only talk about the patient’s issues and not theirs, and every patient makes 1 month’s worth of appointments along with happily pre-paying all future co-insurances and cash fees. The entire office is vacuumed twice per day, so that not a shred of paper can be seen on the floor, and they are sensitive to the air conditioning and heat, adjusting the thermostat often to minimize expenses. There is never a newspaper, magazine or crossword puzzle with them in the office. They also never gossip with other staff members about non-office topics, so they can focus solely on the practice.


How did I do? Staff like this actually exists all around the country and it is up to you to create the work environment that will foster a work ethic as I just described…but it’s a 2-way street, as the staff will act and react to your leadership. Do not ask them to do something you are not willing to do. It’s not do what I say, it’s a “show me by example” scenario that will create whatever you want.


With having an office and often multiple offices for 25 years, managing staff was the most confusing part of practice for me initially (that confusion lasted over 10 years). You need to be their teacher, psychologist, sympathetic ear, patient parent, and friend...oh, I forgot…the boss...and usually all at the same time. At least that is what I used to think. In the beginning of practice, I was honestly afraid of my staff. They ran me in circles and I was too busy trying to be their friend to get them to function as they should, and my business suffered. I was horrible at it. After all, there were no “boss” courses in my chiropractic education and I was learning on the job. I remember the first staff member I had to fire, as she was horrific. I wrung my hands for days and I couldn’t sleep; I was so upset. It was so bad that to this day, I have no recollection of what transpired. I only remember it wasn’t pretty!


Here are some of the basics about your staff; they can either make or break your practice and your business. They can make your life easier or harder, and the number one rule is that if you have the right person, treat them very well. If you have the wrong person, treat them very well also, but replace them until you get the right person. Sound easy? It isn’t!


I always took my job as an employer to be critical for the livelihood of my staff…because it is. Your staff has to live on the money they earn from your office, so respect their job as if it is their lifeline to food and shelter. With that being said, you also have to do what’s best for your office.


I also learned that I never had to fire 1 staff member, and I have had to release 100’s of staff members out of the 1000’s I’ve employed through the years. They fire themselves. By the time I have to release them, they have been warned verbally numerous times in numerous ways. There has never been an instance that I can recall, when a staff member was surprised. Angry…yes…surprised…no! I also urge you to render a written warning to the offending staff member and have them sign it. This will prevent any legal repercussions in the future.


The biggest problem with failed staff is the lack of training and that is all up to you. You must train your staff and it is best to have a written manual for them to follow. I urge everyone to read the E-Myth Revisited, by Michael Gerber. It is the best book on business I have ever read and it changed my business life. It will show you how to create procedural manuals and how to get the staff to engage in functioning successfully.


Once your staff is trained, you have to be careful of one pitfall: working for your staff. When I started private practice in 1981, my mentor shared with me that I needed to run my entire office myself until I saw 100 patients per week. After I met that goal, I could hire staff. In the beginning it was torturous! I had to adjust the patients, answer the phones, fill out insurance forms, give report of findings, correspond to insurance companies, market the practice, etc. I was the proverbial “one arm paperhanger!” A strange thing happened, as I closed in on 100 patients per week (it took 6 weeks). I felt I no longer needed a staff, I could do it on my own. That is when I knew I needed a staff.


When I hired my staff I was in a position to train them and know their job better than they did. Over the last 25 years, from that initial experience, I was able to relate to and help my staff with their tasks, as I was already in their shoes. I was also never afraid of losing staff, as I knew their job and could train anyone to replace a lost staff member. This allowed me to have my staff work for me vs. me working for my staff and living in fear of losing anyone. With that said, I never wanted to lose any staff member and there were many staff members who knew more then I, but I never lost sight of the fact that I was in control because of my knowledge base.


I also strongly urge each of you to inspect your staff’s workspace. Remember, it is your office and your desk and your computers and your chairs and your staplers, etc… After hours, go to their desks and look in the draws. You will find pencils and pens, unopened ketchup and mustard packets, plastic knives and forks and menus for take out. You will then find magazines and ½ done crossword puzzles. If it’s the insurance department that you are in, you might even find old HCFA’s and account receivable reports not worked on!


This is what we have found in 80-90% of the offices I have consulted with. The doctor was always amazed to find work shoved in the back of a drawer that equated to $1000’s lost because accounts were not worked on, for whatever the reason. Also, understand that many EOB’s have a time restriction for taking action and you will forfeit the right to recoup your money because the insurance inquiry has not been responded to timely. With that being said, when I spoke with most of you initially about this program, I offered to consult on the phone. I claimed that I was not smarter than you, only that I had made more mistakes than you and had to fix them. Here is the biggest one of all…(By the way, I was beyond stupid, perhaps the stupidest practitioner in the country, and you will understand why in a moment!)


A staff member that had been in my employ for 17 years and held almost every position in my office, was managing my insurance department at the time. As a note, I employed between 20 and 25 staff members at any given time, for many years. This was my most trusted staff member and I treated her like family. She had her own private office, earned a very good salary, had a benefit package that included generous vacation time, a 401K, health insurance, sick time and could come and go as she pleased, because I valued her so very much. One day she was out sick and I needed to find a document from her department. I looked all over her office unsuccessfully. As I was leaving the room, I noticed milk crates under her desk and took a peek to see if the documents I needed were there. I felt guilty that I was violating her private office, but needed the documents, nonetheless. What I found mortified me. I found EOB’s and insurance inquiries dating back YEARS that had gone unanswered. Not $1000’s or $10,000’s, but $100,000’s (plural) on un-acted upon claims and requests for information. In other words, I treated all of those patients for nothing and then paid her to process all of those claims for nothing and then paid other staff members to process the paperwork, including postage, for nothing, paid for insurance claim forms for nothing, etc, only to be beyond the statute of limitations for taking action to ensure payment. And…I was liable for every patient I cared for, had to pay for supplies, electricity, front desk staff time, bathroom supplies, water cooler supplies, office cleaning from the mess those patients made, turned away other patients to care for those patients…for nothing! I think you get the level of frustration I experienced. It was a very expensive education.


When I tell you to look and be vigilant about your business, it’s because I wasn’t. I chose to abdicate the responsibility vs. delegate the tasks with someone I trusted. There can be no trust with your livelihood. You can trust that they will do the job and then report to you what they have done. Do not make the same mistakes I did, no matter how much you think the staff member is doing a good job. You need a series of checks and balances to ensure the work is being done in a timely manner. Unfortunately, I probably win the game of business stupidity! Don’t make my mistake; it’s not a popularity contest.


RULE #1: You should be friendly with your staff, not friends.


My current rule when I start consulting with an office, is first I look in every desk and every nook and cranny in MY OFFICE and MY DESK that I allow them to sit at. I then inform the staff that I will be checking periodically to see what’s going on. No secrets and no surprises.


As a note: Do not be obnoxious in telling your staff what you will be doing, just do it and then after the fact, let them know what you found, what you expect in the future and inform them what you will be doing in the spirit of checks and balances.


The other part is the expectations that the staff has of you. What is the company’s policies regarding sick days, vacation days, insurance, leave of absence, dress code, etc? Every major company has an employment manual that outlines the policies of the company. Do you?


Every time an issue arose with my staff, I called the NY State Department of Labor and each time the answer usually was, “There is no law, but it should be outlined in your written office policy.” Upon further inquiry, it was explained that there was a regulation requiring every office that employs staff to have a written policy, so that each member was treated equally. After inquiring in many states, it appears that this is consistent with most states. Please check with your state’s labor laws. By not having an office policy, I was exposed to any number of labor violations. Thankfully, I had never needed one, up to that point. So…we hired a lawyer at $300 per hour and 10 hours later we had an office policy for our practice. As a result of having the written office policy, I was able to circumvent many incidents that otherwise could have been very problematic, or led to legal issues. Basically, it created clarification that showed equality and fairness for all of our employees. Since there were no grey areas, these policies gave the staff direction and the office functioned at a more efficient level with less stress. You need to create an office policy.Should you not have one, you can go to “Forms and Templates” on the Web site and get a template to customize to your office.


More than money (not true…equally important), your staff needs encouragement. A perfect example is my daughters’ elementary school principal…He would walk the halls of the school with a pen and pad, then call to his office individual students and call their parents. He would tell the parent that he caught their child being good and was giving them a citation for being a “Good Citizen of the Elementary School.” Needless to say, this principal was the most popular principal this school had ever seen. He created a paradigm shift in the entire student population from what can I get away with, to what do I need to do to be caught doing something good! You should create that same environment in your office. Look for positive things your staff does and let them know it. Buy them ice cream, or a card to say thank you.


During the holiday’s, for 25 years, I made it a point to hand write a note to each staff member thanking them for all the good they brought to the office. Not a word or two, but whole pages of respect and gratitude. Every year, the feedback I received was the sentiment meant more than the money. It created a better and more productive working environment through love and appreciation.


Your staff is critical to the success of your practice. Pay close attention and lead by example.