With a little help from your staff

Doctors' staff struggles; more nurse practitioners; and how you can recruit and retain workers

There's no shame in asking for help. That seems to be the consensus among Canadian physicians, according to your responses to NRM's 2006 Practice Management Survey. Nearly all of you — 91% — told us you have the aid of a receptionist and over half of you employ support staff to help with tasks like filing. In addition, nearly three-quarters of you benefit from the help of a nurse and, in a significant increase from previous years, over 25% have the aid of a nurse practitioner (NP).

NPs ON THE RISE
In what appears to be a new trend in Canadian healthcare, more than a quarter of you are now working with NPs, a significant increase from NRM's 2005 survey. It is fitting that 2006 is the year for that number to have jumped so much: this year also saw NPs become officially accepted in all of the Canadian provinces; in February PEI was the last to get on board.

The number of qualified NPs across the country is also rising fast. The Canadian Institute for Health Information reported that in 2005 (the last year for which statistics are available), there were over 1,000 licensed NPs in Canada, up 40% from 2003.

HELP WANTED
Despite the large number of support staff and nurses helping you run your practice, many doctors still have trouble recruiting and retaining high-quality employees.

Some family physicians in Alberta are closing their doors because staff turnover has become such a problem, according to Dr Diana Turner, a GP in a Calgary group clinic. "We bring people in and train them for desk jobs, and then once they get the clerical skills and become marketable, off they go," she laments. Dr Turner and her colleagues have discovered that Calgary's booming economy is leaving many small businesses — like small- to mid-sized clinics — behind. The fast-growing commercial, travel, information technology, and particularly the oil and gas industries are more attractive to secretaries and support staff. "They can all pay $5 more an hour than we can," says Dr Turner. "We can't compete." Her practice recently hired a part-time clerical worker to supplement their full-time staff of three, which includes a receptionist, a filing clerk, and a nurse. The new employee's salary comes directly out of Dr Turner's and her colleagues' income, but they felt it was worth dipping into their own earnings to try to compensate for their staffing woes.

Dr Kosta Milankov, who works in a group practice in Oshawa, Ontario, says you should aim for one and a half receptionists per doctor in your clinic. He agrees with Dr Turner that the root of the issue is money: "Retention comes down to how well you are willing to pay."

Other doctors have managed to find rather unusual solutions to their staffing problems, like one Ottawa GP who found help close to home. Mid-way through renovations on new offices, his partner of several years decided to quit general practice. Staffing his suddenly solo practice was a nightmare, but once he hired his wife as an administrator — "She's a godsend," he says — everything started to work itself out nicely.

RECRUIT THE BEST
Slightly over 2% of you listed staffing as your primary concern about your practice in last year's NRM survey, but that number jumped up to 8.5% this year, a fourfold increase in just one year, which may indicate the increasing difficulty of recruiting and retaining good staff. According to the survey data, this increase in doctors' concern about staffing applies particularly to GPs and less so to specialists.

To get the best staff possible, you have to cast your net wide when recruiting. Put out the word to everyone you know that you're looking for someone — though don't let yourself get guilted into hiring someone's sister even if she's not qualified. Advertise in your local paper or on any number of internet classifieds sites (some of the most popular ones are Monster.ca, Yahoo! HotJobs and craigslist.org), but keep in mind that the more you advertise, the more applications you'll have to go through.

And, suggests Dr Milankov, don't hesitate to give your applicants brief tests to determine their ability in various tasks like filing. Doing so may save you from having to correct their mistakes in the future, he says.

RETAIN YOUR STARS
Hold onto your good employees, and hold tight. Retaining nurses and clerical staff can be a challenge in a competitive field when other hospitals, clinics, and even other countries are trying to lure them away with benefits packages and higher wages. In order to keep your employees from jumping ship, try offering them regular raises if you can afford it, and other extra benefits like extra vacation days, incentives or bonuses. Your investment may pay dividends over the long run by saving you both money and time.

You can plan ahead for staff retention during the initial hiring process. As you look through CVs and conduct interviews with applicants, consider whether he or she is the kind of person who will remain with your practice for a long time: does he have a history of short-term employment, or perhaps instead she is a young parent looking to settle down? Keeping those questions in mind is a good way to make sure you find someone you can rely on for years to come.